What do you wish midwives did better?

[AlmostNewlyQualified]

I'm a student midwife, almost qualified, only have a few weeks left on my course. I am very excited to start my job but also super nervous, as I don't want to let any parents down. I am determined to do my absolute best to look after pregnant women and give them the best birth experience I can. I have a lot of passion for midwifery and will take a couple months off before starting my job as the course has been so intense and I need a break to re-charge my batteries.

I've been watching youtube videos of difficult births to find out what the mothers felt had gone wrong and it's often that the midwives were not believing them and not respecting their wishes. I promised myself I will never be this way, that I will always respect what women tell me, advocate for them and remind them that they have a choice in what happens to them in labour. I've been given feedback that I'm always kind, caring and and calm, and I pretty much do whatever the woman needs me to - if possible!

I was wondering if anyone has any thoughts and feeling on what they felt their midwife should've done better - or maybe you had an amazing midwife and you can share why she was so amazing?
thank you.

Congratulations OP. I am in the same boat. I finished on the 1st August and start my preceptorship in October.

It sounds like you are doing a fabulous job already!

The midwives in my first birth were ok but one I really didn’t like was very judgy, telling me off for wanting the monitoring with the clip on baby’s head because I didn’t want to stay lying on the bed.

Second were amazing, I was at home and one was super experienced, about to retire, and felt like this sage old granny that knew everything, was ultra calm, and made me feel so safe. The other was young, perhaps training, and telling me all the time how I was doing so well, I was ‘one of these women who were made to give birth’ (lol). She told me after it was her first HB and she seemed genuinely in awe, she made me feel like a goddess!! Also they respected everything I wanted, gave us privacy when baby was first out, tidied up, made me toast etc - they were the goddesses.

Congratulations, I'd say your on the right path just asking this question.
Communication is obviously a big one.
Advocating, I had a brilliant midwife when I had my twins, I said I didn't want lots of doctors/on lookers in the room (only when needed) as i foundtwin pregnancies attracted onlookers. She physically removed the doctor from the room after he'd done his bit!
Trauma care - after my first I was told just to get on with it, I was lucky to be alive. I should have been referred for counselling at the time. I actually think any one who's ended up on itu should be refered (even if it's just a one off checking assessment).

I had a wonderful student midwife during my induction. I progressed very quickly and was in desperate need of pain relief. She spoke up for me against the senior midwifes 'better' judgement. I am forever grateful for her that she advocated for me as her patient. It's really important to support your patients and speak up for them when they are not able to.

Postnatal pain relief!! Most women won’t know they have to ask for pain relief. Ask them, are you in pain, would you like pain relief every.single.time!

Absolutely biggest issue is the night shift.

The constant loud chatting with colleagues, across bays, up and down corridors.
The constant door slamming.

I realise that to the midwives it’s just another work shift but to the new mums it’s a precious intimate time and they need a little consideration to at least have some rest and maybe even a little sleep!

A generation ago maternity wards were quiet, restful places - even with a two hour “quiet time” after lunch before visiting. Now it’s a free for all, noisy and stressful place.

Believe you. With both mine I went in and was almost fully dilated. In my second the midwife took ages to check me and tried to send us home despite me saying I had a really fast first birth and my DH saying this is exactly what happened last time. I have quite a high pain threshold so obviously didn't seem ' in pain ' as much as she wanted. She couldn't believe it when she eventually checked me and I was ready to go.

I've had two children and my first midwife I wasn't impressed with and the second (for my second) was amazing.

First off, I'd had multiple miscarriages before both of my successful pregnancies and that caused me to be very anxious about everything going ok for the births. I felt the first midwife wasn't very empathetic about my anxiety and would get annoyed if I asked (too many!) questions. Also, she used my anxiety against me when I said I wanted an epidural. I was having a back to back labour and had managed 10 hours of contractions, puking so much I had to be put in a drip. But when I begged for an epidural she told me it would delay things and there were lots of risks and was that what I really wanted given I was already so anxious.

That put me off for a few more hours but in the end I just couldn't take it and begged again and she gave in. I regret so much not being given the epidural sooner. I think it would have helped me conserve energy and helped me at the pushing stage (needed an episiotomy and forceps in the end).

Second time around the midwife was so much more supportive of both my anxiety and my choice to have an epidural. In fact after I had it, she told me I'd done the right thing because of how intense my contractions were. I felt so supported and validated. Made all the difference. I had such a relaxed labour and was able to push and be fully present for the birth.

Also, the first midwife basically treated my husband like an unwanted guest. She had no patience with him. The second midwife was great, keeping him in the loop and involved and also very direct and specific about telling him ways he could help and support me. Which he needed and I appreciated!

So yeah, for me, being supportive of my pain relief choices and understanding of my anxiety made a huge difference. Also, being inclusive of my husband too, it made me more relaxed knowing he was more relaxed.

I think the fact you've made this post in the first place, tells me you're going to make an excellent midwife. Going into it wanting to do the best thing by the women you help. I'm sure you'll be the 'amazing midwife' that others describe in the future. Best of luck!!

Communication. Tell me what is happening and listen to me. Don't treat me like an idiot. Explain to me what is happening and what the options are. And speak to me, not a birth partner/DH.

Either train up as a proper tongue tie assessor or don't pretend you know what you're doing. Refer to a proper lactation consultant. The amount of people I know who were told by a midwife there was no tie when there was and it caused significant issues is staggering. Why try and bluff your way through, just admit you don't know!

Hands down this. Also, consistent intervention when visitors are inconsiderate about noise.

Congratulations op! It sounds like you are going to be a lovely midwife :)
For me having my 2 dc, there was a lot of inconsistency. Some of the midwives were lovely and I have so much gratitude for them.
There were a couple of midwives that were rude and seemed almost resentful of their patients. Also a lot of the older midwives don't listen to mums and what they are saying, they think they know best. Of course midwives are the professionals but please listen to mums and what their bodies are telling them. For example being told repeatedly you aren't in labour and being denied pain relief... then the baby is crowning and low and behold you were in labour. Lots went wrong in my second pregnancy and I was offered a 'debrief', not sure exactly what its called, but its pointless when its over.

I also had a miscarriage in 2014, was in pain and gushing blood and the midwife shouted at me nastily because i got lost looking for the bathroom and walked into an (empty) side room. I will never forget that.

I work in the nhs so I know how much pressure the clinical staff are under so I do get it. But you will be dealing with women going through sometimes the hardest thing they will ever go through and I think kindness and patience goes a long way ❤
Congratulations again you sound lovely :)

midwives were not believing them

This.

Also judging, lots of midwives are judgemental to women when they're at their most vulnerable whether they see it or not.

I don't know what goes wrong to be honest, I don't believe all of these midwives are horrible people who don't care about women, but hardly anyone has a decent experience.

Also just to add after I had my daughter I was being wheeled in a chair onto the postnatal ward and I went past the nurses station and the three midwives there clapped and said congratulations. That was brilliant I felt wonderful :)

Accept that you will not be liked nor please every mother.

And the job is safe healthy baby, safe healthy mum. It’s not about pleasing or being liked.

Some mums will gel with you, some will hate you, you’ll have provided exactly the same care. The important thing is knowing you’ve provided safe healthy care.

Congratulations OP!

agree with the comments about advocating for patients, in my case only the senior midwife who came in when the alarm was pressed advocated for me but it was already too late. No one listened to how I felt or what I wanted before then.

Patience too is also important, I felt like I was an inconvenience at hospital. Agree with PP, it’s another shift and another patient to clinical staff but a smile and a kind bedside manner goes a long way when it’s a really intense and scary time.

I hope you don’t lose that optimism and determination from your post, you sound like you want the best for your patients and it’s nice to hear.

Thank you for doing this and asking the important question. My main thing is listen to the mum in labour. When my eldest was born 19 year ago I was really struggling with labour. Midwives kept telling me to push harder but I was pushing with all my strength and still no baby. I kept saying something was wrong but they just said try harder. Ended up with an emergency C-section as he was stuck and his oxygen levels were dropping. So please please listen and advocate for the mums X good luck x

Be open to bottle feeding
yes I know it’s best for baby and I did give it my all - stayed in hospital 4 nights trying to get the hang of it with lots of midwives grabbing my tits every hour trying to help but he just couldn’t latch on. in the end the paediatrician told me in no uncertain terms that as my baby was born small and losing weight rapidly I was risking his health… the midwife eventually gave me a bottle but made me feel such a failure😢

Also on a lighter note I had a student midwife in with me for the birth, she was lovely and the day after came to say hello and excitedly tell me I was her first forceps delivery, it did make me laugh😂

I'd agree about bottle feeding. My baby was born a bit early and struggled to gain weight. We did get there eventually but the early days every shift change seemed to bring a midwife with a different view on how to hold him. One would say up a bit, the next would say down a bit. It felt they were all contradicting each other. Once I was referred to the lactation consultant it was all much better because there was a co-ordinated approach.

Sorry, I should have added, I think there was too much expectation about breastfeeding.

Treat women like human beings. Be respectful, listen. Don’t dismiss first time mums- I nearly lost my baby because the midwives didn’t believe me. I was left all night because “you can’t be in that much pain, you’re only 1cm”. With vague threats to wait and see how much worse it got. The pain was because my placenta was detaching, not contractions.

learn about breastfeeding. Don’t just go with “having trouble? Here have formula”

I think just remember that although this is maybe the third birth you've seen today, it is a rare and momentous day in the mother's life and a unique one in the baby's. Some of my midwives made me feel stupid for not knowing what was going on. I feel the very fact you have started this thread means you won't forget that though.

Communication is key, even if it's not a nice conversation. I had a great midwives both times, 2 different systems on 2 different continents. The second time I agreed for a student midwife to join us and it was her first "catch", she wrote me a note of thanks for letting her and that she hoped everyone was like me (was a simple birth, perfect for a first)

Listen to, and believe, women, and the data! I was on an antenatal ward waiting for induction dyte to late onset htpertension (39+6) but went into labour naturally. At 6pm I was 2cm at my one and only exam. My contraction timer was showing established labour by 8pm but because i was managing well with the pain the midwife didn't believe I was any further along, despite being monitored every hour and the machine showing strong regular contractions. I was begging for an exam but kept being dismissed and sent on walks.

The midwife actually said 'you are too coherent to be in established Labour, only call me when your waters break' ... newsflash, my waters never broke! The pain was really really bad at 1.30am, I went to the loo, got an overwhelming urge to push, decided I wasnt having my baby alone in a toilet, so waddled back to my bed, husband rang the call bell, TEN MINUTES later he went to find someone. They came back telling me I was still nowhere near, it hadn't been long enough, lifted me onto the bed from being crouched on the floor, and they could see the head! Made me get in a wheelchair to take me to a labour room that i was in for 5 mins before my daughter was born (partially en caul, waters broke as she came out). I was pushing for...twenty mins maybe, 15 of them alone (apart from husband) and terrified.

Incredibly lucky to have had no issues with me or baby. High BP is a flag for precipitous labour and I should have been monitored and listened to but as a first time mum who dealt well with pain I was totally ignored.

I had a debrief with a specialist midwife a few months after which really helped me work through my feelings. Best of luck to you, my delivery midwives were absolute angels who made up for the shocking labour x

Definitely after care. I had a long labour resulting in an episiotomy and kiwi delivery and afterwards we were just left to get on with things. Been allowed to drive home whilst still in pain from a difficult birth, 48 hours of no sleep and with a newborn seems crazy.

I then had two home visits from them to check how I was doing but they failed to pick up on the fact that my stitches were infected despite me asking for them to be checked and explaining that I was still in a lot of pain. I was told I needed to start walking around more to promote recovery. I didn't get any help until I ended up in hospital a week later. I should have complained really but wasn't well enough to think about that at the time.

I also dealt with a cancer diagnosis shortly after and the nurses throughout that have been amazing. Listening to me and doing what they can to make me feel more comfortable. Such a contrast to the midwives who jut seemed to expect me to get on with things.