What makes a good midwife?

[Crazycupcake]

Based on your experiences (good and not so good), what skills and personal qualities do you think midwives should have? You have the chance to influence the training of future midwives by sharing your thoughts. I work at Bournemouth Uni and want to hear about mums' and mums-to-be, experiences/thoughts about midwives. N.B. Please don't post any info that would identify individual midwives. Thanks

To me the single most important thing is a midwife who knows her own limitations when faced with a medical emergency or a problem in labour. My midwife did this during mine, and before I knew it the room was filled with drs and it wasn't until a couple of days later I even found out what had happened in terms of me and DS getting into trouble - she was so calm, it never occurred to me to get too worried at the time plus I had had gas

When I was in the earlier stages of pregnancy I thought she was a bit dismissive and disengaged, but when it really mattered - the end of pregnancy, labour and post-natal care - she was fab. I think in retrospect that's where she focuses her energy, not on women earlier in pregnancy.

I had no hesitation about using her again in my current pregnancy.

The midwife, when giving birth to dd1 was lovely. She was calm and friendly. She came to see me in the post-natal ward just to see how we were doing. The mid-wife with dd2 was nice enough but not as friendly as the first (she Both were very competent but the first one stands out in my memory (14+) years ago.

What I miss the most, is midwives who know me at least a little bit.

I had my first baby in Canada, where I went to a midwives practise (there were about 4 of them I think), saw them however often it was, but the receptionist greeted me by name after a few times, the midwives the same.

Here in the UK I've seen various midwives, consultants etc and none of them know me past what's on my notes (which some barely even read). The community midwife I've seen twice, but she wouldn't know who I was unless I told her.

In Canada I felt in control, I felt that I was being looked after and cared for (despite fewer tests/appointments), I felt that they would catch if something was going wrong (which they did). The doctors/nurses/midwives involved in my birth all gave me that same confidence - they also treated me as an adult, always told me the risks and options so I could make an informed choice.

In the UK I feel like I need to keep on top of everything, research everything they say/try to prescribe me etc. because I just don't have the confidence that they know my circumstances and they just seem to be box ticking a sheet in my notes. When it comes to birth, things just don't feel joined up, I feel that no-one will know what's going on unless I tell them, and it doesn't matter what one set of people say, because another set will say something else. Risks and options are not well explained (shoving a pamphlet at me with no real information in it doesn't count), and that they seem to think they can do what they want to me without giving me any choices.

I don't know what you can do about training that in. I do think that being a couple of minutes late for an appointment so you can read my notes is better than bringing me in on time, but reading them in front of me. It gives me more confidence that you are professional and prepared.

A good midwife needs to be kind, patient and knowledgeable.

They need to listen properly and not be dismissive.

Pregnancy is scary whether it's your 1st time or 10th time. Most mums to be and new mums want to be reassured by someone with a smile not a frown

Brains
I'm sorry, but drippy dim MWs trying unthinkingly to follow the rules without understanding them are truly dreadful.

We expect this from Health Visitors, but MWs must be better.

Treating women as people not patients, understanding some of us can understand the heart monitoring machine and the blood pressure readings, we will google the blood test and scan results and yes we will scare ourselves.

We need someone who can talk to us on our level, this goes for consultants too.

Oddly Britain has been sending women to university for a good few years now. My 80+ year old DF has an a degree.

Of course the answer to this is have a HB, the MWs they allow free range in the community to do that are absolutely lovely.

chunky i'd agree with you about the having to be in control bit.

my community midwife is nice, if a little abrupt at times. but i've only seen her twice so far and she was v quick to make sure i was referred back to endocrinology early on.

the two midwives at the hospital have been vastly different. one was nice enough but failed to give me all the info that i needed about triple testing etc and i had to ring her back. she also seemed to assume that i knew about tests but this is my first baby! the second one asked me about birth plans at the 20 week appt and was surprised that i hadnt made up my mind! i honestly thought i'd longer to wait before making all those decisions

my main thought would be that i'd like midwives to remember that pregnancy - whether for baby no 1 or 5 - is an exciting and nervous time for mothers. i dont want them to be falsely over excited for me (they dont know me!) but a little enthusiasm wouldnt go amiss. i know they are used to dealing with hospital procedures all the time but i'm not.

Adjusting their handling of clients according to client's wishes and personality - no one size fits all.
I am a scientist (vet) so need all information, facts and figures, no bullshit, no platitudes. Hate phrases like 'baby is being a bit naughty isn't he' - during labour when heart rate falling. Would prefer 'babies is bradycardic and I am getting the doctor now as this is a concern' - IYKWIM.
A lot of my distress in 1st labour was to do with hiding information.

Being responsive to the mother and really listening, taking seriously (and acting on) what she says - concerns, worries etc.

Being an advocate for the mother when necessary.

A caring approach - that 'human touch'. Cannot underestimate how far that goes.

Continuity of care as far as possible.

These are very personal to me. I had a very bad experience of MW 'care' with my first pregnancy, labour and birth.

During my pregnancy, I had: my excruciating SPD and associated depression brushed off as 'part of pregnancy, unfortunately'; a sweep literally forced on me; and I never saw the same MW more than once.

During the labour and birth I was treated like a piece of meet. Midwives did not even introduce themsleves, smile, talk to me or explain what they were doing when they woke me up in the night for an internal examination or to take bloods (during a long induction). A midwife gave my baby formula without consulting me straight after birth and discouraged me from attempting to breastfeed as it 'wasnt working' ...about 6 hours after an emergency c-section.

In the four days I was kept in afterwards, I saw a different MW every time the shift changed. Not one of them was polite or friendly. Not one of them took my concerns seriously (what shall I do with my baby when I need to use the toilet and have a drip attached and am a new, nervous mum? I need my anti-d injection, its been nearly 72 hours! I need some BF support! etc - all ignored, fobbed off or treated with impatience and even contempt).

My second birth was different. Consultant-led, but the MWs I came in to contact with were fabulous. I felt they cared, they were professionals and they were passionate about their roles.

I was admitted for an emergency section when I became ill at 37 weeks and the same MW stayed with me, advocated on my behalf to the Consultant (who was dithering about whether I needed an emergency section...I remember her saying 'this woman has reduced foetal movements and is in distress, Mr X. I really think you need to reconsider.' Excellent! :-) She came to see me the following day as I was about to go in to theatre to wish me luck. The MW in theatre was like an angel. Smiling, warm, held my hand and was so supportive of my BF issues afterwards. The after care was completely different, even within a (different) very very busy London hospital. Every MW was caring and tried to be as attentive as possible, given their busy schedule, and there didnt seem to be such a chaotic rota system - fewer agency staff, saw the same two or three MWs over 3 days. I felt listened to and valued.

I think a midwife has to be a people person and have a sympathetic ear. Of course pregnancy and childbirth becomes part of everyday routine for midwives but it's certainly not for their patients and I've encountered a few who are quite dismissive- though on the whole, the midwife team I had were fantastic, especially as reassuring me. Without naming individuals, I'm sure from where you teach that you've taught some of the midwives I had during my last pregnancy and labour

But on top of being calm, reassuring and kind, I think a midwife must know when to be a bit firm. Like during labour! Sometimes (like at the pushing stage) a midwife is going to have to tell the lady what to do and be insistent (perhaps not the right word, but I can't think of it right now) if the lady hasn't listened, isn't pushing for long enough etc etc

My best friend is a midwife. She's constantly getting chocolates and gifts from parents so I'd guess she's quite a good midwife.
How I know her, I'd say her best qualities for her job are that she's very hands on, very steady (I can't imagine her ever freaking out about anything), kind and understanding.

I'd love to have a midwife like her when I give birth.

Wow everyone! I'm amazed at just how many of you are messaging on this. Thank you for taking the time to respond - your comments, experiences and suggestions are so valuable. Some of your stories are difficult to read, so thanks for writing them. I know that when I feed this back to the midwifery team on your behalf, they will be extremely pleased. It is SO important to have the views of real women informing the training of future midwives - so thank you, and keep sending more comments/ideas

I think there needs to be an acknowledgment of the different skills needed for different aspects of midwifery. The process of bringing a human into the developed world is so complicated, you need a mw with excellent organisation skills to get you through booking in etc. So the lovely but scatty MW is a nightmare when you're wading through the treacle of forms and trying to work out what the hell you're supposed to do next. (Perhaps each PCT could produce a no-nonsense flow chart of what do do when, so the MWs don't have to remember - particularly useful if you're on the boundary of three PCTs and your MWs can't remember what the rules are for each!!)

Taking time to listen to each and every pg woman's concerns - no fobbing off with "its just part of pregnancy", because to that woman, it isn't "just" anything.

During labour - giving the parents all the information they want at the level they want. YY to the "baby's being a bit naughty" type remark - I'd find that intensely patronising, but appreciate that there are women out there who would struggle to understand what "baby is bradycardic" means. Surely identifying a lay-person's capacity to understand medical terminology/understanding is an essential skill to being any HCP.

Respecting that each and every woman is different and wants to be treated differently - so what works for one may be a nightmare for others. Again, its a soft skill that may be difficult to teach but really is essential to being able to provide frontline care at such a massive stage of a family's life.

Crazycupcake - I agree different skills are needed at different stages. The midwife I praised in my post for her help postnatally I suspect would NOT be my ideal midwife for labour - she was really bossy! Which was ok when imparting useful info about winding but would have been awful during labour.

Steady, kind, understanding & adaptable. And competent. They're all good things, I reckon.

Sorry - I meant I agree with Whatwillsantabring

I have had the pleasure of working with a group of student midwives. They were a lovely, kind, caring sympathetic group. A few months after they had qualified, I observed a few and they had turned into cynical, hard faced and cruel people who couldn't wait for shifts to end.

It takes a very special person to want to become a midwife. To get on the course is difficult enough - and the training is tough. What happened to those students to make them so bitter?

It is a shame that for so many women, the midwife becomes the enemy - denying pain relief (as in my Dsis case). Ignoring birth plans. Laughing at women who can't cope. Ignoring women who refuse internal exams with the words " I'm just going to do a little check", not supporting breast feeding, passing the baby around to everyone in the room before the mother holds her baby.

There are midwives out there who make labour and birth a fantastic experience for some women. Find one - and persuade her/him to become a trainer.

Encourage students not to use disempowering language. Try not to use words such as " failure to progress", " poor maternal effort" or " if you don't push now I'll get the doctor to do a section". Consider not using words such as "can't", "let" or "allow". Please stop waving the stirrups, scissors and forceps at women to hurry them up because its 21:50 and your shift ends at 22:00.

Most of all teach your students how to communicate, how to empathise, how to have endless patience and how to treat all women in labour with respect.

With my dd my antenatal appointments where all the same midwife unless she was on holiday. She was lovely, very friendly explained everything carefully and in a way I understood.

The midwife I had during my induction was awful. I had my dm in the room and she asked her the questions instead of me ( I was 20 so not exactly a child!)
The whole way through she spoke down to me and just wasn't pleasant, I told her I needed to push - she laughed at me and told me I couldn't possibly have progressed so quick. She didn't even check.
She went for dinner and I got a lovely midwife, dd was born 14 mins later.

Aftercare was shite, in the 4 bed room I was the only one not shown how to bath my baby, I wasn't told until after going to the loo several times they needed urine samples ( I think because I had stitches?) the only person I remember from the hospital was the lovely receptionist who after seeing me upset and talking to me and realising I hadn't been told visiting times and was sat on my own, phoned my dm ( I'd forgotten my phone)

This time around my midwife is fantastic, I'm very laid back and she lets me get on with it whilst guiding me slightly but not forcefully, I've planned a home birth and I'd love her to be the midwife at the birth

I'd just add a really major one in my view - impartiality. This is just so important - not forcing views (in a friendly way or otherwise) on no epidural, natural birth, gas and air, formula feeding, mixed feeding, breast feeding, etc etc. Just the rational facts and explaining when each has there place (which they all clearly do). My midwife is just great - she is clear and concise explaining the ins and outs of the above (bar gas and air - banned in germany). The bloody midwife at my birth prep courses was stupid TBH and very 'natural'. I am currently footling breach - grinding about on a birthing ball for an hour saying 'om' is not helpful and drives my breach baby further down into my pelvis - I know this thanks to other advice - but this midwife kept trying to get me to do this - and I pointed out is it not helpful with a breach abby - and she then relented. She really should have checked upfront IMO. Basically to be honest with Mums that hopefully you get the birth and pregnancy you want, but invariably things crop up and that is quite normal for the most part.

What would be good is to go through when things might help - i.e. a woman veering towards PND who is isn't coping may be very well served by things like mixed feeding, or FF - ( you may need to try a few different teats on bottles to make it work though), perhaps someone who has a very low pain threshold would not be so traumatised after by having had an epidural - there is nothing wrong with them. Explaining what actually happens in a c-section, and why you might need one, and what the turning procedure consists of - and that is perfectly ok to say no - down to small things like what about your pubic hair - does it get shaved - who by? That you might then need a catheter after, and a nurse would change your maternity pad for you. How many internals will happen - when. Because when a womans dignity is taken from her there is no undoing this - it is how it is prepared for that affects how she sees it.

When you look at a lot of the Q's on here from women - they are often relating to things like this. I think it is the real things that affect our pregnancies, births and early days that leave a lasting impression, so yes good bed side/patient manner is key, but so is being impartial, not foisting personal opinions on women and explaining clearly what the main things that will occur and why are.

p.s. apologies for mis-spellings!!

I had an amazing midwife who made me feel like she genuinely cared. At one point baby's heart rate was low but although I knew it was a bit low I had no idea about the severity of the situation until afterwards when dp told me (when I was in the bathroom apparently they said they might need to do a c section). She gave me a few suggestions of positions to move into and was so calm and gentle.

When it came to pushing she was like a cheerleader, which I loved as I felt I'd established a rapport with her and she made me laugh.

She was bloody brilliant and without a doubt she is the reason I had such a great time giving birth (genuinely!!) haha

Ps there was one who was an utter cow when I was upset at being sent home again at only 2 cm dilated! Made me cry. I guess as others have said, we know you're stretched but this is a vulnerable time for us; please don't lose your bedside manner!

The main gripe re: aftercare was the complete lack/inconsistency of breastfeeding knowledge and advice. I felt that we are put under pressure to bf due to government targets but the midwives are not adequately trained to provide the support to help us to achieve success.

It's frustrating having to explain the same things to each midwife you see and them not taking you seriously because it's the first time they've seen you. If you saw the same one then at least they might flag up a concern - for example, I've mentioned at each appointment that I've been feeling anxious but because they are all hearing it for the first time I feel like no one is really listening.

I think listening is crucial as a quality for individual midwives. I was told by one midwife that to stop me from worrying I should keep working for as long as possible so that I didn't have time to worry too much. She said this without even checking what I did - which happens to be a physical job with lots of lifting. This is aggravating my sciatica but I'm self employed so have to carry on. If she'd actually listened to me she would have realised that what she was suggesting as being good for my mental health is possibly not good for my physical health. I was advised by mw to go back to work after a period of bed rest (which consultant advised) with no discussion about what the job involved.

I was very lucky to have the same community mw for all my appointments, she had such an air of calm about her and really took her time to explain things to me and made it clear all the way that I had choices. I had a homebirth and always wished it would happen on her shift as I knew she would listen and respect me as an individual. In the end I had a different mw who I had never met before but she was equally lovely. The language used was so different to my first labour - "If it's ok with you I would like to ...." , "If this hurts just tell me and I'll stop" and "how about trying this? " rather than "you have to ....", " I'm going to..." and "you're not allowed". Listening to the woman, remembering that she has the right to be treated as a person and she knows her own body makes a huge difference!

I was lucky to have The same midwife throughout, including labour. It felt safe.
I know why you guys need to put a grey cannula in, but it would be really nice if you could use a bit of lidocaine beforehand. It is extremely painful.
Also, after a c-section, the recovery is a bit hit and miss, it's a time when the blood pressure can drop dramatically, yet there are hardly any midwives in the room to properly recover. Perhaps the first half an hour after coming back from theatre could be better monitored?
Does my head in being called 'mum'. I have a name.

What I really liked was being given a wash afterwards, I was extremely grateful.
Sometimes parents are paralysed with fear at dressing a baby first time, it was nice my husband had a lovely mw showing him how it is done.
Thank you all for a fantastic job, and thank you OP for your post.

Thanks Champagnebubble for your comments. I'm hoping that most regions are asking for feedback, and not just in a tokenistic way. The NMC (Nursing & Midwifery Council) requires the design, delivery and assessment of all the programmes, include input from the 'service user' (their terminology) in order for the course to be validated. We consulted women last year in order to generate a question for the interview process for prospective students midwives. Ideally, it would be great to have 'service users' on the panels themselves, but that isn't always practically possible. So the incoming cohort for 2013/14 at Bournemouth Uni will have been asked a question based on the comments of women.
There have been comments on this discussion here about how you teach 'personal qualities' and it is a tough one, but more and more when we ask people what they want from any health/social care practitioner; they always mention those personal qualities such as 'caring, compassionate etc.' I don't think you can actually teach some of these things, but what we can do perhaps is to focus a lot more on 'communication', case studies and women actually coming in to the university to talk to students. We already do that in mental health nursing, child and adult nursing, OT, physio. .. and the students really do get a lot out of it. When the validation 'day' happens, we will have to provide evidence of listening to women and gathering their views, and demonstrating how we have taken them into account in the curriculum. I'll be writing all your comments up, identifying themes etc. Along with this marvellous 'Mumsnet' feedback, I'm also going to visit Children's centres to talk in person to parents. I love this part of my job - going out to meet different people. As well as the academic perspective, we need to have the views of the 'real' people who are on the receiving end of midwifery services - so thank again. . . . keep talking!