Please tell us your thoughts on midwives for an upcoming meeting with the RCM

[policywonk]

MNHQ is meeting up with representatives from the Royal College of Midwives in the near future, and to help us get a sense of the issues that concern you most, we'd love it if you could post your thoughts here.

Basically, we want to know: what one thing would you say to your midwife about the care that you received (or are receiving)?

Ta x

Perhaps they start out kind but then go a bit mentally derranged with their pressures.

Because the service is so awful, they get a lot of abuse. I mean, if I had a c/s then I would be abusive to anyone who said that my dh couldn't stay with me overnight, because I KNOW that my painkillers will not be delivered on time and that my baby will be left to scream without me being able to get to it and given the choice between the two I'd rather kick up a stink and be a pita.

My cousin is a mw and she says she often gets kicked by labouring women too.

I saw quite a few midwives, but that wasn't a problem for me as they were all kind and professional.

Midwives during the birth in a MLU were fantastic, and the immediate post-natal care in the MLU was wonderful. It made what could have been an awful experience really positive and memorable

But if I'm totally honest, I do resent the fact that those who opt for a home birth have a midwife with them all the time, and those who choose the MLU end up labouring alone for much of their labour. No wonder HBs end up with fewer interventions!

I got myself into a right state, and ended up quite out of it on pethidine. Actually, it was totally fine, but I know it might not have been.

But this is probably more of a policy point than something the RCM can influence.

Something has gone wrong with a system which lets anyone, let alone midwives (of all jobs) become deranged by the pressure of their job.

If people are not trained or supported properly it's a poor show. But if you don't have the correct disposition to start with, it's not going to be help. No-one makes anyone be a midwife. As I said bebfore IMO it is a vocation - i.e. only do it if you really want to.

They need to remember that whilst the birth is one of many for them it is extraordinary for you- really once in a lifetime for this baby, this birth and respect the sacred nature of that.

Midwives also need to know that gentle birth is possible, they should be made to watch videos of normal calm gentle births (eg Birth as We know it, Birth Day, HypnoBirthing) to see that it is possible. They should be the guardians of the birth watching for signs of something not going as it should and helping the mother have confidence in her body unless there are indications otherwise. Midwives should not undermine confidence by believing that birth always is violent and in need of them doing something just because they are there.

18 years ago my sister was seen by the same group of midwives consistently throughout her pregnancy with one main person who she saw most frequently, when labour started one of the midwives came to her and accompanied them to hospital, she did see her main midwife just after the baby was born and had the follow ups with her

for me I only saw 1 twice and on the first occasion I saw her her welcome was 'what are you doing here? you are supposed to go to the other clinic' during labour/ birth it was again a few different midwives, then for after care another one
there were some good some bad some in between
but it felt like sailing in rough seas with no idea where I was going
no reassurance no time to answer questions no continuity

sorry I realise I did not really answer your question will have a think

meant to say saw a few and only one of them twice

most of the MWs i have had with both DS and DD were wonderful BUT

in hospital i was told by 2 MWs, DD's latch was fine when it wasn't and ended up with bleeding, blistered nipples

another i saw postnatally with DD was bloody awful (advised top ups when DD was 10 days old and other naff advice)

i rarely saw the same MW twice and both times in labour i had a MW i had never met before

both times, they were utterly AMAZING which is hugely lucky though

Lesley Angel you were an utter star and got me through a very quick and intense labour (i will never forget her name)

I'd also like to ask why homebirth was not mroe supported.

I wanted a homebirth but given I got through 4 stand up tanks of gas and air I was concerned that I would run out. The midwife said she'd only be bringing 20 mins worth and if I sucked too hard on it it would be used up within 10 minutes.

When I questioned this she said that homebirths were for people who wanted a natural birth without pain relief so they don't provide much.

I'd also like mws to be more honest when they talk about pain relief. Unless you are asking for an epdiral there is no such thing, only tools to supposedly help you cope.

Why lie?

Another vote for seeing the same midwife more than once.

Would also have been helpful to see a midwife with some knowledge of hyperemesis (midwife in my first pregnancy told me to pull myself together and try crystallized ginger - I lost a lot of weight and was unable to keep down fluids and discovered during my second pregnancy I should have been hospitalized).

Can they please consider popular terminology too. Current terms imply that things happen by bad luck or as the fault of the woman.

'failure to progress'
'failed to bf'
'end up with c/section'
'natural birth' (should be straightforward birth)
'established labour' (there MUST be a better term for this surely'
'pre-labour' no such thing etc etc etc.
'incompetent cervix' - fgs

Good midwife - the one I had until 20 weeks pregnant, who held my hand through the Edwards scare after triple-test (why do they never tell you what '3' is beforehand?), and the one who did home-visits and really helped me get confidence in BFing and looking after DS.

Bad midwives - so many.

The one who TUTTED at me when I bled on the bathroom floor. The same one who wouldn't get me any decent pain relief so I could get some sleep when DS wasn't progressing, even though I knew I could do it if I could just get some rest - DS was back to back and I hadn't slept in 24 hours at that point. She was also the one who put in the canula for a spinal which then got infected - didn't help with trying to BF when my left wrist was agony.

And the one who - after the slash and grab under general - when I asked to help BFing looked at my nipples and said 'they're not very good are they'. And insisted on my having the blood-thinners even after I was up and about, and even though every injection left me with a bruise the size of a satsuma. And said the morning after 'don't get the dressing wet', and the morning after that 'haven't you showered yet?' And broke it to me - after DH had gone for the day - that I needed to wake every 3 hours to feed DS (what did I know?) and tutted (a theme) when I asked if I could be woken then, as I didn't have an alarm clock with me.

And after the first, lovely, midwife left my GP practice, I didn't see another one more than once until the lovely midwife who did the postnatal visits.

That was quite cathartic.

Oh, I suppose I'd better summarise...

o Continuity of care
o Listen to the mother and believe what she's telling you
o Don't be a fuckwit.

To my community midwives - you were wonderful, but I would have liked to see one or two of you at most throughout my pregnancy rather than never knowing who I was going to see next.

To the midwives at the hospital - when I came in the first time, and my very regular and painful contractions momentarily stopped, I wished that I had had the courage to insist that you checked how dialated I was, because I was a lot further on that you realised just from looking at me. It could have saved me the later delivery where I was too far along for any significant pain relief.

Please do not just look at labouring women and say 'Well, you can't be that far along, or that dialated, you should go home again' Check properly!

I typed a response but it was becoming a 10,000 word essay. I will try to summarise.

The books you read before giving birth put give you certain ideas as to the care you will receive. For me, the contrast to the care I actually received (or frankly didn't receive) both in labour and afterwards was appalling. I even bought a midwife textbook afterwards to see if the stuff I'd read was unrealistic. It wasn't; it was all in the textbook too.

All I want is for midwives to have the basic knowledge of labour, and the basic attitude of caring, described in their own entry-level textbooks. This was utterly lacking in the midwife who delivered my first child and in the post-natal ward afterwards.

That said, the midwife for my second birth was great as she read my birth plan and carried out all my requests to the letter.

The mw that checked me when I arrived should have just said to my face that she didn't believe I should be there yet, it would ahve been more honest than the look on her face. It would ahve also been nice to ahve had an acknowledgement that i was right

My midwife that delivered dd was not only looking after me and another lady but also a lady in labour with twins.

After arriving at hospital at 9cms, which had only taken 5hrs, it was then decided at just after 2.5hrs that the baby was in distress and I was then asked if I was sure that I couldn't feel the urge to push and told that a ventose would be used and if that didn't work the forceps were waiting. This resulted in a 2nd degree tear in two drections.

This was the only time i was asked about pushing, at no point was I given any other option, at no point was the position I'd already asked to deliver in allowed(and the bed changed to allow)

I believe if I had receved more 1-2-1 care I would have delivered quicker, without distress to the baby, without me thinking i have to get this baby out to avoid forceps and therefore without a tear which still bothers me almost two years later and also makes me wonder how I will deliver another baby.

Due (with DC2) today so may update later...

This time my antenatal care has been excellent. Same mw for each appointment, she has taken time to listen, knows any new literature/policy and has remembered the (minor) complications that I've had.

The thing that is worrying me most about the birth is the unpredictability of who (mw) will be with me during labour/birth, how many changes there will be, whether they will stay around or disappear to see others, what their personality will be like etc. Essentially it's the lack of continuity of care people discuss above. You are very vulnerable in labour and the mw that you have appears to have so much power over you. Last time I had one very unpleasant officious woman who refused to examine me after 36 hrs of regular contractions because I would be 'screaming if I was properly in labour'. Fortunately I was examined shortly afterward by another mw, was 7cm and gave birth shortly afterwards (that mw was there till birth and excellent). The period between seeing the two was awful because I felt so unsupported and vulnerable, started to loose my calm and all became more painful.

I would feel far more confident about labour if I knew that either (1) the mw would know me (I am a very calm person and was unlikely to be screaming) and/or (2) would have respect for and listen to me. As it is I feel that I don't know whether I will be sent home in labour, whether my wishes regarding pain relief will be respected, whether my concerns about the birth will be taken seriously etc until I get to the hospital. That inevitably ups the tension and I feel DH and I have to be ready to argue - not the best position to be in.

Also agree that postnatal provision and support for bf was terrible.

Essentially though, much of this must be about lack of resources so I'm not sure what the RCM can do except for lobbying for more.

It's a bit the luck of the draw isn't it...

My ante (and post (at home) natal MW was a nice person, but went through my history with me, and should have known from that I could do without the horror stories - like the 'you're carrying too much fluid' diagnosed on the 'tap test' (I've confirmed that this is an oldwives tale) and that as a result of this 'the baby's lungs won't have developed properly and they'll have to have an operation as soon as their born' (consultant seen following week confirmed it was just a big baby, no extra fluid...) and the 'I'm expecting to see you in with pre-eclampsia in the next few weeks, so read this leaflet and see what to expect'. Post birth she was no better and even managed to press one of the staples further in rather than remove it (then tried to rectify the problem without proper instruments etc).

In contrast, the mw during labour were lovely and supportive. And I had a reasonable level of attention on the ward given neither ds or I had any 'problems'. However, not keen on the Sister on nights who accused me of not knowing how to bf properly at 2am (that's the only thing that had gone to plan about the birth) when it was actually colic kicking in early.

To the mw on the ward for first labour who (I called at 11am) suggested I need to eat 12 raisins every hour to keep my strength up and just give you a ring at 6pm to check how things were going.

YOU WERE TALKING ABSOLUTE BOLLOXS. If I had listened to you, my daughter and I would have been put in grave danger.

Do not underestimate how laburing woman cope / not cope when all you have done is speak on the phone to them once.

I am currently pondering whether to ask my mums lovely friend (who is a midwife and a real gem) to act as a "doula" for this labour (if I can have it at home). I feel the best thing is a having a relationship with your mw. This seems to be lacking alot unfortunately.

The community midwife team was great. Reading these comments makes me realise how lucky we are to live in the country (at least I assume the instances of very overstretched teams are mainly in cities).

At the hospital, there was a lot of variation between midwives (and it took 57 hours to push DD1 out, and 44 hours for DD2, so I got through several shifts!) As a gross generalisation: you get some old witches who probably have not had children themselves, but most of the younger ones (i.e. under 55s) were fine.

Perhaps only women who have had children themselves should be allowed to become midwives. And make empathy and roleplay a part of midwife training.

YOU ARE IN A CARING PROFESSION. Greeting people and using their name and smiling and acting like you give a shit is CRUCIAL. Being busy / overstretched etc is not an excuse to be rude. If I took my exhaustion after a 12 hour shift out on a client I'd almost certainly be sacked.