Your views on MCAs at birth?

[cherrycherry16]

Hello lovely MNers!

I was just wondering how ladies who've given birth (or are set to give birth soon) feel about having a maternity care assistant present at their delivery? I've never thought it was that strange; I've been an MCA for several years and have been in on deliveries and helped with antenatal and postnatal care since I began (and I absolutely adore it btw!)
But I'll soon be starting my midwifery degree at uni and it has prompted lots of friends to say how they've always been amazed at how much responsibility and input I have already as an MCA with no training at all. Lots and lots of people have piped up with this view, and I do have to take umbridge as its really not true! I'm up to date with all my training including resuscitation and emergency procedures, and I've got lots of experience of mothers and their families who tell me they've felt really well supported by me. I had no idea so many people's minds boggled that I'd be let loose on a labour ward. MCAs aren't a band of uneducated oafs, I promise!

How do you all feel about it, or has it never been something you've really thought about?

I don't think I had an MCA at DD's birth but I had a midwifery student. As far as I was concerned the entire world could've been in there, I was unreasonably proud of the fact that something alive and cute was coming out of my vagina (also very high on gas and air).

Having someone with even basic training, and experience - and more importantly, someone else there to reassure and support - would make me even happier, I think :)

Thank you Moomin! I can say you definitely weren't unreasonable in your pride, you've done an amazing beautiful thing and should be absolutely bursting with it!

Aww :)

I think the unreasonable part is the fact that when the senior nurse (the sister? I think?) came in to see how it was going, she asked if she was alright to come in and I shouted something along the lines of 'Yep, it's a free for all, everyone can come in!'

I first heard of an MCA on the postnatal ward after DC2 was born. They were helping out with things like changing sheets, requests that new mothers had (eg wanting info on feeding, or pain relief). Tbh I had no idea until I read your post that they are actually present at births and learn medical skills like resuscitation However I wouldn't have had an issue if an MCA was present at one of my births, as long as someone had said, "This is X, she is an MCA, she's training" etc. I had plenty of midwifery students throughout pregnancies and childbirths.

I think that is probably a large part of the problem - people hear about MWs and student MWs all of the time, but not MCAs so much (ime), so people draw the conclusion that MCAs are general assistants rather than medically trained staff. I think it would help if expectant mothers were given a bit more information about MCAs and with time I think more and more people would be aware that they are skilled staff in the ante/postnatal world rather than just assistants that happen to be in ante/postnatal departments.

If I'm honest, I'd rather have two qualified midwives (as is normal for most areas) and no-one else. I don't see the need for a 'free for all' in the room and prefer to have the room as private and quiet as possible. I know that the plan is for a consultant to be outside the room during 2nd stage when I'm induced on Wednesday as I've had a previous shoulder dystocia. That wasn't at my request but I appreciate the thought and don't want lots of bodies watching me. And with the utmost respect for you and your experience, in my particular case I think it is preferable to have two qualified midwives who can spot signs of a potential shoulder dystocia before it actually happens. I say all of this as someone who was a highly experienced HCA and regularly the only 'nurse' in theatre because I was signed off as competent - but only when appropriate.

No. I don't want anyone in the room when I am giving birth unless they are directly involved in my care and therefore could only be of benefit to me. The fewer the better. My preference would complete silence and only DH and I there. Having said that, if I changed my mind OP, what could you do for me? (genuine not goady question).

Thank you for your honest responses, I complete respect your preferences. Variety is one of the many things to love about my job! Really good question Beatrice, I suppose my answer would have to be whatever you'd like me to do. Some women choose to have no one but a midwife, other times I'll be called into a room when delivery is imminent (normally when the baby's head is just visible with the mother's pushing). At those times I'll be a spare pair of hands for the midwife to write down relevant times and notes, open up equipment and have a couple of nice warm towels on standby ready to give your baby a nice welcoming rub! But most of all I'm offering words of encouragement and praise to the mother, and reassurance if it's needed. In addition to those things I'll do whatever you need; some women might need a hand to squeeze or want someone to rub their back or pass them their drink. It really is individual choice and need, whether you want to be cheered on or just for me to be quiet so you don't even know I'm there. Some women afterwards are just pleased there was someone to check in on their partners while they were concentrating on their labour too; most birth partners are fab, but could at some point do with a sick bowl, some fanning or just need to be told to lie down with their feet in the air!
If anything strays from the expected I'm there to help; the midwife might need help to help you into a different position or get me to call the emergency team. And the excellent training we all get means that the midwife just needs to state the issue, eg 'shoulder dystocia' or 'cord prolapse' and we all know our role and what we need to be doing. I fully appreciate I'm not a midwife and don't have their full skill set or knowledge by any means, but I can pull an emergency bell, help a lady into McRoberts or start chest compressions and maintain an airway as well as anyone on the team! If you're a member of staff on labour ward I think our women and their families deserve nothing less from you than that level of competency.
So really I suppose MCAs are an extra pair of the midwife's hands, guided by their instructions and with the woman's needs as the only focus. And in addition to the original post, a further question would be what would you expect of someone other than the principle midwife who is supporting you through labour? Was there a time when someone could have done more?
Thank you for the question though, genuinely good to be asked and you're not goady at all!

Where I work we have two midwives for the delivery. The MCAs don't come into the labour rooms.

Had 2 births, never heard of an mca before this thread.

And to be honest I want that second midwife there. They give the syntometrine with the birth of the anterior shoulder so I can concentrate on the delivery. An MCA can't give syntometrine.

Also worst case scenario and there's a pph and baby needs resuscitating at the same time then there's a midwife for each. Our MCAs do come on our resuscitation training I guess but inbetween annual training I don't think they practice resus skills like midwives do. I'm not sure they'd be overly confident or competent.

There were no mcas in the labour wards only on the post delivery wards. I wouldn't have minded but then again there were 12 medical professionals in the room when I gave birth do a few more wouldn't have mattered.

My only concern would be if MCAs were being used in the place of fully qualified midwives to save money.
But from a personal perspective it wouldn't bother me. I had a great student midwife in my first labour (dd was the first baby she delivered) and I really liked having someone in the room with me the whole time. I much preferred it to my second labour where I had one senior midwife who was much more cold and clinical. But I think that depends on the individual. I enjoyed hearing the midwife and trainee talk amongst themselves but others will prefer silence/privacy.

does everywhere have mca's? have to admit i have never heard of them. i am not a big fan of deskilling, if mcas are being used to reduce the number of midwives needed on a ward?

Thanks for your reply OP. With the greatest respect, I wouldn't be happy if an MCA was present during my labour. I wouldn't appreciate someone coming into the room at the end of my labour to help either. I would have no relationship with you and a stranger in the room, when I was at my most vulnerable would be very upsetting.

Good luck with becoming a MW. When you are qualified, remember to be kind.

After my birth the MCAs on the ward were amazing. They gave me lots of help with breastfeeding and as I was in hospital for a long time with an infection they always found time to come and have a chat and reassure us. They were incredibly patient with all my stupid questions and I would be more than happy for an MCA to be present at the delivery next time.

Thanks for all the responses, particularly to those who haven't even heard of MCAs before- extremely interesting to hear how different places operate. Especially having two midwives on each delivery, that's a rare treat where I work.
Just to put people's minds at rest, MCAs are in no way used as unskilled midwives. We are like the care assistants on the general wards but with different, more maternity relevant skills. Considering it's our policy to have MCAs present on te ward it's better that they are trained and able to help out with all scenarios than not. But that's got a worst case scenario where every other pair of hands is busy- I'd rather know I can step in and help than stand there like a wally until the rest of the team arrive. But we only consider a full staff quota to be a full staff of midwives plus one MCA and one senior midwife.
I completely accept that some people would not like someone they haven't met popping up at the end of their labour, I'm not sure whether I would myself! So I try and make my presence at calm and positive as I possible can.
Thank you for your honest opinions xx

I would refuse.
I wasn't given a choice about the MCA who attended a transvaginal scan with me I though she was just taking me down for a scan (I was an inpatient) I didn't know she would be present for it. And to make it worse the dr quite happily shoved the paper dress up to my chest and had me fully exposed.

It's inappropriate IMO to have anyone who isn't medically trained present during procedures and delivery.

I only had one mw and she was hands-off (pool birth in a mlu) but ds needed to stay in for a bit due to rh- issues and I found the different people on the ward very confusing. There were people who weren't mws. There were paed nurses and there were non-nurse people but I have no idea what they were called and who could do what. As I had no real issues and was just waiting for blood test results it didn't matter to me but it was confusing.

I've never heard of an MCA either.
But you sound nice.
Id let you rub my back anywhere...

Good luck with your training!

I don't like the idea of replacing the 2nd midwife with a care assistant, or of having someone popping in right at the end without being introduced properly and their role explained.

I'm sorry to hear about that LittleBairn, that must have been awful. Your privacy should have been respected, I hope you felt you could voice that, if not at the time then in a complaint afterwards.

From a purely personal point of view, when I go on to labour with my own baby I would be very happy to have an MCA present, and not just because I've been one myself. I'd like it to be someone I'd previously met as I agree with the above comment that a stranger popping up when I'm naked, sweaty and vulnerable would be upsetting. I'd like to think that my body is capable and my efforts are enough to deliver my own baby, with a midwife and an MCA at the end if necessary. To me, a care assistant would be getting things ready for my delivery and helping the midwife so the midwife's focus can be on me 100%. I'm fully prepared for people to tell me that's a biased and rose-tinted view of a care assistant's role but that's how Id like my own labour to be. The thought of Drs milling around in the background would set me on edge, but again, purely personal choice. I know that people have different experiences and views on childbirth but to me it's natural and doesn't need to be a medical event. At least that's what I've got my fingers crossed for when I have my own, we'll see!

Lots of people say no to having us present and that's completely fine, and it's great that people aren't bamboozled and are happy to say what they feel. If all I can do for you is make a spot of tea and toast after the happy event then I'll do that to the best of my ability!

With all due respect you are been used as a cheap midwife replacement if you're there as the second member of staff. If the MCA role didn't exist at your unit it's unlikely they'd just have one midwife at delivery. It is usual practice at most units to have two. From a clinical governance/risk point of view not everything can be done which needs doing in a timely manner with just one person.

We used to have only one midwife, I'm talking ten years ago. Our pph rate was through the roof and we did a massive audit. The only factor we could possibly think of was the syntometrine been given a bit late as no second person. We made it policy for a second midwife and our pph rate improved dramatically.

I wouldn't have any issues with an MCA (properly introduced) as an extra pair of hands.

I'd have big issues with an MCA as a replacement for the second midwife. There are two patients in that room at delivery. It needs two midwives.

Our unit is midwife-led, on the occasions when a woman asks not to have an MCA present one midwife will deliver the baby unless we are really quiet and two midwives are available throughout the woman's labour. Lots of midwives choose not to be the sole staff member at delivery but those who don't are free to be on their own. As I say, if all I'm needed to do is help position baby on mum's chest and hand over warm towels whilst the midwife gives syntometrine, then I can manage that. I don't feel under qualified to rub down a baby. I'm happy that I have the knowledge to help in an emergency if needed, but if not I'm literally a second pair of hands. Why does someone need a degree to open a packet containing a sterile cord clamp? I'm in no way an under skilled, cheap midwife. It's not that I take offence at that, it's just I have the common sense enough to understand how our particular unit works and how my role fits in, and that's not it.

Sorry if I'm coming across as snappy, I don't mean to be.