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

I've had great support from the community midwives in Brighton who've always supported me to have a home birth and shown respect for my decisions.

They have also been very sensitive and caring during a time when when there was uncertainty about whether i would have a termination. They were brilliant and nonjudgmental.

I think there are issues with regards to 'what type of care service' they are providing. It's near on impossible to see one midwife throughout your pregnancy if you wanted to - illness, holidays etc need cover. As i knew i wanted a homebirth i knew there was no way I'd know who was on duty that day/evening so it didn't matter to me, but if I'd had more complicated issues during my pregnancies or during labour i would have liked to have the midwife I'd established a relationship with look after me.

YY to calm and caring please. One of the MWs I saw ante-natally acted like she was scared to touch me, just on bump-measurement and BP taking. I want a MW to look like she's happy to roll-up her sleeves and get stuck in James Herriot-style

I had a doula for my second birth. She didn't do anything much at all on the day, but because she was booked, because I had built up a relationship I went into the birth in the first place, unafraid, confident, positive etc and I believe it was THAT that led me to have a fantastic outcome.

Before that I was so terrified because whilst I could accept that how the birth goes is unknown, I could not also deal with the other unknown things like:

Would the midwife take me seriously if I said I was in pain? Would she withold a requested epidural due to staff shortages (like with no.1), would she send me home? Would she 'allow' me to birth in my chosen position? Would she 'let' me use the pool, and would she 'let' me when I wanted to? Would she refrain from directecd pushing as written in my birth plan etc etc etc.

Whilst midwifery is a job for you and you will see many, many women have babies, sometimes several on one shift, for the women having the baby, it might be their only time, it will almost certainly be one of a handful of times that they give birth.

Be kind, be supportive, be knowledgeable and don't assume that just because you've seen a zillion births, you know everything about how this woman feels about hers. Or, even if you do, don't let her know you do!

Don't set "mother and baby both alive" as your target standard of care - as a baseline, it's fine, but don't have it as your aspiration!

And do learn about breastfeeding and how to support women to do it. It's important, you know - especially if the birth's gone a bit off-piste. A good breastfeeding experience after a bad birth heals a lot of wounds. Don't add insult to injury by effing up the breastfeeding for the woman too.

Both times my Community Midwives were brilliant - emphathetic (sp!) after mc at 12w, ensured I got early scans with both DS1 and 2, consistent, sensible advice - bracing when necessary!

Birth with DS1 ended more 'managed' than I would have wanted, not least because of the second midwife I had. Biggest quality she lacked? - empathy! I am sure that she was utterly clinically professional & I realise that it is just another birth for them, but, when my legs were up in stirrups, a paediatrican had been called for and she was telling me that I was not pushing hard enough, that the babies heart was dropping and had to come out now, she didnt have to follow it up with "What are you crying for?"

Birth with DS2 was magic. In midwife unit, there because my community midwife had given me the confidence to go for it. Consistent CARE, with the midwife (there from start to finish) telling me that they (the midwifes) didnt deliver babies - they helped their ladies to do that! A big, big difference. I was a person not a hospital no. Oh Yes, and she also worked out when she needed to be bracing not sympathetic!

So, for me its consistency, empathy and a "people centered approach"

It's quite simple really, just tell women the truth.

One of my MWs (who were all fantastic up until then!) from the bank of 6 I saw both ante and post natal tried to tell me that the reason for my DDs erbs palsy was because of how she had been lying in me, when it had been put in my notes and those sent to the physio that it was due to a shoulder dystocia made worse by the Dr using a ventouse to speed up the birth as she was in distress. I understand that some people are in that mindset where they want to sue at such things and that she was probably protecting the staff, but I understood that if they hadn't gotten my DD out quickly, she might not have made it at all and for that I was extremely grateful. I did not need a MW making me feel as if I'd damaged my baby 4 days post natal. As if I wasn't weepy enough at that point!

We are intelligent people and should be treated as such.

Incompetent psychopaths.

Generally.

Ante-natal try be more empathic and listen to your clients. losing notes,too many agency staff,and generally not being able to genuinely offer individualised care is common place

Post-natal.a 15min visit doesnt always suffice and many mums wont speak up in that time to tell you. we know your caseloads are horrendous and paperwork overwhelm you

i suggest enhanced training ante natal and post natal about working with vulnerable mums with psychiatric issues.you have 2 clients mum and baby.

liaise with HV collegues so yuo dont contradict each other advice

Our local ones are top. The one thing I would say to them is a big thank you. I love the way they are so obviously on our side.

The ones that don't know about hyperemesis need to be told about it, though. The mw I had before I moved to this area gave the usual advice about ginger and said it was important to have a sense of humour about it . The information I got about it, which turned out to be absolutely crucial, all came from the internet.

I found the team dealing with my antenatal care lovely, altho saw a different one each time.

When i came into hospital and stayed in (before getting sent home again the next day, when really i shouldnt have left with the pain i was in) I had seven different MWs tho they were all nice they all had different advice, one told me they would break my waters in the hour and then she left and another MW came on and told me that no, they wouldnt be doing that! so was very upset by being told a different thing each time and having to re-tell me life story to each one, surely they had my notes?

However Kathryn, who managed to deliver both my children (three and a half years between them) was absolutely amazing and did a superb job.

Depressing reading, this thread. Thing is the RCM will know all this already. I hope they hear the hurt though. It isn't their fault on the whole. All the good experiences I have had with midwives have on the whole been with women who are calm, competent and warm who had a strong sense of vocation and seemed to really understand the sensitivity of their role.

But the RCM already know what impact underfunding and undersupply of staff is having - they make this point all the time. I'm sure they wish to provide continuity of care because this would give them a much better working relationship with women.

It is the NHS management and the govt who need to act.

I suppose I do think the RCM could make an impact upon the culture of institutional blindness that affects any large institution and hospitals in particular. I wonder if an emotional 'supervisory' relationship much like the one therapists and social workers have to have might make a difference to care provision? Or maybe this is in place already but it doesn't work well?

Someone needs to remind people who are institutionalised what it is like for the 'customers'. My students fill in evaluations about me all the time; and I have to respond to that. I had a 'no shit sherlock' moment this week when the report about noise in hospitals came out. Normal working practices don't always suit those on the receiving end and need to be challenged and reviewed on a regular basis.

I would say: Your attitude matters SO much when you are dealing with vulnerable people and most women are vulnerable at some point pre, during or post birth. They REALLY need you to be supportive, kind and encouraging. This may sound obvious but it is, I think, not always put into practice, particularly on postnatal wards. I had my babies (twins by c section then a singleton vaginally) 10 years apart in different hospitals and found that both times the actual in-labour care from midwives ranged from adequate to really excellent. My community midwives were lovely both times too. By contrast, both times the postnatal ward was host to some noticeably piss poor practice, mostly due to a significant cohort of the midwives on shift having a terrible attitude problem. The lovely midwives really stood out there. 10 years... plus ca change!

I think it's important for midwives to focus on the fact that they and their actions will be imprinted on the memories of women they help (or hinder) for years to come. Of course, to a greater or lesser extent, to the midwife it's just a job and it must sometimes seem like the same old, same old, like any job, but to each and every pregnant or postnatal woman it is an amazing, individual, terrifying, wonderful. lifechanging event. Again, this sounds obvious but is, I suspect, all too easy to forget. But forget at your peril- at times of high adrenaline, change and stress, things stick in the memory; I can still picture the faces of the midwives who were lovely and the ones who were complete cnuts from my twins' birth all those years ago, as well as those at my daughter's much more recent entry to the world. And though I am usually a mild mannered laid back type, I do bear grudges, as well as holding fast to many wonderful memories of lovely supportive fabsters!

Disappointed with lack of continuity during first pregnancy. Saw 4 different midwives and 2 students at ante natal appointments. Measured by different people every week resulting in a growth chart that said I was getting smaller towards the end of the pregnancy resulting in late scans. My allocated midwife was rude and barely spoke to me. She made me feel as if I was an inconvenience. To be honest, I spent a lot of time trying to work out what I had done to annoy her.

Lack of knowledge regarding the antiD injection I was to receive, I was told that they didn't really know anything about it as they didn't give it very often.

I was given no information regarding the parenting classes and had to constantly ask for things including my maternity certificate.

3 Different midwives during labour - all fantastic and supportive.

A good friendly midwife is worth her weight in gold. A rude unfriendly midwife can make you feel worthless at a particularly vulnerable time.

I consider myself to be extremely fortunate to have lived in parts of Sheffield covered by a one-to-one midwife scheme.

They provided ante-natal care at my home - which when you've got a toddler already is fantastic. I saw the same midwife for most appointments, meeting the others on the team before due date. Homebirth actively encouraged. Birthing pool loaned free of charge (£40 for liner).

For DD, MW visited me twice at home when I was in labour, then came in to hospital with me, and never left my side, staying well over the end of her shift, despite having to drive to London the next morning.

DSs were both homebirths with same wonderful team, so in those cases, 2 wonderful midwives.

Yes, this personal touch means they invariably run pretty late for appointments, and occasionally have to postpone them. But it is a truly fantastic scheme and I wish it could be rolled out nationwide.

When I was in labour with BabyG I felt that something was wrong. Nothing indicated that anything was wrong, the monitors were all fine and I was progressing nicely. But I KNEW something was wrong.

MyMW listened to me and got hte head MW to come in. SHE listened to me and got the registrar. He DIDN'T listen to me, so the Head MW phoned the consultant at home in hte middle of the night I ended up with an emCS and BabyG had cord around his neck 4 times, then tied in a knot and tangled all around his body! I would never have delivered him naturally, never. If they HADN'T listened, I would still have ended up with the CS, but it would have been at a much later stage of labour and a birrova bloody nightmare, frankly.

My thing would be: encourage MWs to listen to mothers intuition.

Oh - and post-natal MWs PLEASE have up to date BF info, please. I was pushed into topping up BabyG and I don't really think I should have been.

Absolutely listen to intuition.
Don't forget that woman in Mexico who did a self- c/section. There is no way in a million years a woman would do that unless she KNEW that the baby wasn't coming out V.

Which goes to show I think, that unless it is a crash situation, women should be involved in the 'decision' to go for c/section and should be encouraged to suggest if if they feel it is necessary. If more c/s decisions were truly made with the woman I bet there'd be less.

Please don't put someone who's baby is fighting for his life in Special Care in with 5 other mothers who have their babies safely next to them. It just adds to the misery and loneliness.

Or at least ask them if, when another bed becomes available, if they'd like to be moved.

In a nutshell:

1. continuity of care.
2. It may be the millionth pregnancy you've seen, but too us we are the first woman in the world to do this
3. Time. The midwives I saw were constantly in a rush to get you out the door or to get on to the next woman. I felt like I shouldn't really bother them.

I have experience of four; two community midwives and two who actually delivered my children.

My first community midwife was wonderful, open, friendly, informative, supportive, and we had a great relationship. The midwife who actually delivered DC1 was wonderful warm and supportive. DC1's pregnancy and birth was a great experience all around.

I saw my community midwife (we moved) only two or three times throughout my pregnancy with DC2, she wouldn't follow up on questions when she said she would and I usually saw someone filling in for her when I went in for appointments. No relationship.

The midwife who delivered DC2 was brusque, not overly friendly but very efficient and competent. I felt I was in very good hands through a precipitous labour. (I'll always take competency over friendliness when in labour!)

So in general, please tell them great job and thanks from all of us.

continuity of care.

a named midwife for high risk women to contact antenatally, even if it's just office hours only. My last pregnancy was high risk and I had almost no contact with a midwife until labour, just doctors that would barely look at me let alone spend the time to go through things.

when you have a child with SN any future pregnancy is going to make you extra anxious, this should not just be greeted with, well that's unlikely to happen again, end of conversation.

just want to say my postnatal care on the ward was absolutely fab when I had my last baby.

My community midwife care was good 1st time and this time (33wks) I have seen the same lovely mw every time who knew me from 1st pg (I am high risk so complicated).

I was an emergency and the delivery suite mws were all fantastic, I had severe PE. I had a mw with me always and afterwards I had the sister mw.

The post-natal ward was awful, there were too little mws and the care assistants gave opinions rather than medical advice which I didn't realise at the time. I waited 3 hours for mw to take out my epidural so I could shower etc. despite dr and physio saying "aren't you up yet" and yes I did make a fuss!

Mws need to be up on breastfeeding advice, as all the post-natal ward were concerned about was writing how many minutes I'd fed for, not how effectively. We were nearly sent back to SCBU after discharge due to weight loss but thanks to same wonderful community mw we weren't. Were sent to bf group instead.

the midwife who seen me through my pregnancy was fantastic. the midwife who helped with my delivery was not so good. she lacked the ability to listen and never took any of my wishes into consideration. she kept discouraging me on having epidural for no reason. the delivery went wrong i nearly lost my ds and have suffered p.t.s.d. since.

Antenatal care was excellent. I had the same community MW (except when she was on holiday) all through my pregnancy, and she was the one who assessed me postnatal as well.
During labour the care was good. I asked for an epidural as soon as they had finished assessing me, and they were fine with that (although they did say the pool was free. I wish I had said yes to the pool). I didn't get it in the end, but that's because my labour was progressing too quickly (it slowed down after a bit though).
The only complaints I have are that I was strapped to the monitors for the whole damn thing even though I didn't have the epidural in the end. Also, especially at the end, it felt a bit like the birth scene in Monty Python, with lots of people in the room, and me with no idea what was going on. Apparently they explained everything to DH (almost had ventouse), but I am an adult and regardless of the fact that I was a bit woozy from pethidine I think they shouldn't have deferred my care (and DSs) to DH without at least trying to ask me.
However, they were fantastic about helping me BF even though they were obviously very busy and I didn't feel like they were trying to kick me out of the door as soon as I had had the baby IYSWIM. I would happily go back there next time.