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 had an incredible midwife for the births of my Dd3 and DD4 - she was very, very experienced, gave me wonderful care flouting local policies about aiming to be the midwife who attended me at my home births. Didn't push me to do anything I wasn't happy with and respected my choices.

I wasn't so lucky with DD1 and DD2 - I had a midwife who didn't like homebirths so tried to put me off them. I also met another one who said 'oh, if I'm on call when you go into labour, you won't be able to have a waterbirth - I don't do those!' and who also said that she only handed out information about bfing to women she thought would breastfeed!

So, from my own experiences, more training needs to be done so that midwives stop allowing their personal experiences and opinions colour the way they practise. They should have more debriefing time and more time to learn that they should be giving evidence-based information only and support to mothers in making the decisions that are right for them - not the decisions that the midwife thinks they should make!

In addition, they all need far, far, far more training in supporting women to breastfeed so that they don't do head ramming and don't reach for the nipple shields at the first instance.

My general experience has been of a system that is stretched to breaking point. Both the community team and hospital team were horribly busy and seemed to barely have time for me.

The main difference, however, was that the community mw tried her best to shield me from that, when I saw her she spent all the time with me I needed.

The hospital team on the post natal ward had no such finer feeling. Time and time again (after the birth of both dd1 and dd2) I was treated with impatience and contempt. When I asked about seeing a bf counsellor the mw snapped "that's for people with REAL problems", turned on her heel and walked away. Less than 24hrs post cs with dd2, still cathaterised, still bed bound, I asked for a drink of water and was refused. When I asked for help changing her nappy their response was to plonk her on my tummy and walk away.

I don't think I have ever felt so afraid and alone.

imo this isnt personal it is narrative about our subjective experiences.as painful as it must be as a midwife to read this,it is necessary

also recognition that there are many fantastic competent MW too

That abandoning a first timer in a room on her own and visiting twice in five hours because she entered the hospital at 8cm and seems to be coping well will leave her unable to enter hospitals without having a panic attack, unable to think about birth without crying and unable to think about another child for four years. The birth was 'normal' but I have never felt so frightened and alone as I did in that room. Postnatal 'care' meant being patronised and frightened all over again, rolling a woman over and sticking an injection in her bottom without telling her why surely isnt good practice.

That homebirth can repair the damage of a traumatic first birth, that a gentle birth is wholly possible. That if you show a little empathy and kindness towards a labouring woman especially when conducting a VE it makes it easier (my midwife said sorry when she hurt me, this made all the difference). That you should listen to the woman when she says she doesnt labour 'normally' and has a long latent stage before dilating very quickly because then you wouldn't frighten her after 19 hours of labour with the prospect of a transfer to hospital to get antibiotics (I gave birth 30 minutes later). And on a lighter note telling a mother of two who just triumphantly birthed her son to 'tinkle' in the shower in front of her mother will reduce everyone to astonished laughter.

Forgot to mention, for the love of god get in touch with technology. My midwife the second time around was insistent that I meet every midwife on the homebirth team. Great, except I had four missed appointments as it relied on them transferring the appointments between their paper diaries-which often got forgotten so I had to wait at home for a mw who never turned up. And to add insult to injury I never saw any of those midwives again, my named midwife had to go off shift and passed me over to two women I had never met before.

Lack of continuity during antenatal care is the biggest problem and makes women feel lost in the system. Seeing a midwife who knows you and your background/wishes, especially during labour, can be so reassuring.

Apologies, need to correct my earlier post. According to DH the MW did come back into the room just in time, I just couldn't see her!

Wouldn't want to slate someone unecessarily

I would like to say thank you to my midwife she was amazing.

However she was an independent midwife who had confidence in me and supported my choices. She treated me like a human being. I will always be grateful.

To the NHS midwives I saw pre and post natally, I'd like to say remember we are human and please respect us, our feelings and our choices.

Continual Professional Development should be mandatory and paid.

Especially in breastfeeding, homebirths including waterbirths, active births.

Each midwife should have a long term career goal outlining how she has updated her knowledge in these areas.

Get all the formula advertisements out of the midwifery magazines.

Infant feeding education to HCPs should never ever be in the hands of a company which manufactures formula. These courses should come from unbiased groups like UNICEF.

Increase the knowledge of breastfeeding to midwives while they are still students. Have Breastfeeding counsellors design and deliver the modules. Have student midwives attend well established breastfeeding support groups over a period of months. I'd say at least one a week for 12 weeks.

PS by breastfeeding counsellors, I mean someone who is active with one of the 4 breastfeeding charities or someone with the IBCLC certificate.

I think midwives need to get bolshy with health service managers and make it clear when the service isn't safe or staffing levels are far too low to do an adequate job, let alone a good one.

And they should get bolshy with their own CPD providers, whoever that is, and demand much more and better training on b/f. (And take some ruddy responsibility for their own training, too). Most of them haven't got a clue.

quite edam.

Sorry, just thought I'd add a telling example about safety - when I spoke to the community midwives after having ds about the scary staffing levels at St Thomas's (one midwife to seven women in active labour on the midwife-led birth unit), they said ooh, yes, Tommy's is terrible, we all talk about them being lucky they haven't managed to kill anyone yet.

Why the HELL are midwives keeping quiet about issues that serious?!

oh, i meant to say i agree with your whole heartedly!

isn't that hwat 'quite' means?

the team leader for my community midwives and I had a barney over 'if we are busy you will have to come in'

I told her there was a snowball's chance in hell that I would.

she said (summarising a long convo) that i would be depriving other women of midwives and that I would be selfish to have one for myself.

I told her it is up to midwives (and women how want home births) to demand enough midwives to go around at all times. not for me to give in and go to hospital. Noooo! Why should I go into an already overstretched (ie unsafe) labour ward and put myself in the position I was in the first time? The one that could have cost me and dd1 our lives or our permanent well-being?

It was being abandoned and ignored in hospital despite being brought to hospital under blue lights the previous evening that gave me PTSD and made me terrified of going back to one.

(and women how want home hospital births)

I would have loved the midwives during my labour to actually LISTEN to me, READ my birth plan and RESPECT my wishes. Also a debrief afterwards would be great so that you could say what you were happy or unhappy with so that lessons could be learnt about good and bad practice.

Specifically I would say to my own midwives:

If I say "Stop!" while you're doing something because it is causing me a lot of pain, please stop immediately - don't ignore me.

Don't repeatedly offer me a totally unnecessary epidural when I have clearly stated in my birth plan that this is not what I want.

To be fair, I had 4 midwives in total during my 2 labours, and 2 were excellent but 2 (1 each time) were incredibly set on doing things their own way. I felt quite bullied and considered making a complaint on the first occasion though never did.

There were simply not enough staff. It made the experience unacceptable and poorly managed.
After 26 hours in "active" labour I ended up with a emcs.

I felt that some of the staff were simply too exhausted and overworked to remember that this is a big event for everyone of the women having children.

Some kindness and patience wouldn't go amiss.

Remembering that women in pregnancy often are frightened and vulnerable. They are not trying to cause an unnecessary fuss, piss you off and aren't just some sort of waste of time.

I witnessed mw being actually cruel
and offhand to some of the mothers in my ward and displaying very different behaviour than that required from hcp... vv different than that displayed by the community midwives.

Also being unable to give any constructive advice on breastfeeding as there was no one who had experience of women with large breasts wasn't the best start.

I think if you are unable to remain level, calm and positive in your role as a mw that you should consider a different one.

My second daughter with elective c/s and private room care etc was a blissful experience in comparison and whilst that isn't what I would have wanted to say it is the truth

Oh, and if you think you want to help women breastfeed, go and find out how to do it. Don't combine bullying women while simultaneously doing your level best to undermine them so badly their baby will inevitably end up on a bottle. (The post-natal midwives at Chesterfield Royal Infirmary might want to take special note of this.)

Finally, remember that if you carry out a procedure on a woman without her consent, you are guilty of assault and might end up in court. The ante-natal midwives in Battersea might want to take note of that. Although I hope since my complaint they have changed their practice.

This is going to be long - sorry.

To the midwife in the CLU (first pregnancy) -
Thank you for saving DD1's life.

To the postnatal midwife (first pregnancy) -
Thank you for helping me during my first night with DD1. I was completely exhausted and frightened that DD1 was going to stop breathing. I know that you were in a large hospital and that the postnatal wards were full, so you must have been really busy, but you always came and helped me lift DD1 out of the crib and put her back in, so that I could breastfeed her on demand.

To the community midwife (second pregnancy) -
Thank you so much for taking my concerns about childbirth seriously. I was completely dismissed by most of the medical profession. It was lovely that you recognised how hard I worked to have a natural birth the first time, how badly I was treated by the consultant when everything went pear-shaped, and how much the resulting vaginal damage had affected my quality of life. If you hadn't offered me an elective C section and supported me, then I would never have had the courage to try for another natural birth.

To the head of the MLU (second pregnancy) -

Thank you for taking time out to talk to me and for reviewing the notes of my first labour and delivery. It was really good to know why things had gone wrong, and it gave me lots of confidence to know that you had officially "authorised" my birth plan for my second birth. I would have been much more anxious without your help.

I must have been really lucky, as I know that there are horror stories, but I have always had very caring midwives, and I am very, very grateful.

Nothing the RCM can do about it but as a newly qualified midwife I have realised that what we need is more staff, much more staff. So that we can invest the time antenatally to convince women that they can deliver their babies. More staff so that we can provide compassionate care on antenatal wards, and one to one support in labour. More staff so that we can really support breastfeeding mums, and not be constantly panicking that we have spent an hour with a mum getting feeding established and have not done any of the other 200 things we should have done that morning.
Less duplication of paperwork, the same thing 3 times on the computer and written in the notes.
More staff and better pay so that midwives can work the hours that suit them and their families, and keep the passion and enthusiasm alive they had when they qualified.

MrsTM, that's a lovely post.

Reiki, the RCM can do something about it - to be fair they have tried making the case again and again that more midwives are needed. They need to rethink their strategy, though, to get much further with this.

To the community midwives - thankyou, you listened to me and supported me.

To the delivery suite midwives who helped me through labour - thankyou you listened to me and supported me.

To the triage midwife - you did not accept that I needed strong pain relief - I felt that I had to beg for the epidural and remembering this even now brings me to tears. Listen to us - 1st rule of analgesia - pain is what the patient says it is.

I could literally CRY when I think about the lack of knowledge many midwives have when it comes to breastfeeding.
As a counsellor on the national helpline I am often stunned to hear of the inaccuracies women are told about breastfeeding and the basics of breastmilk supply.
I work alongside a (now specialist) midwife who told me how her and her colleagues used to argue about who would go to support new mums on the ward as they felt so insecure about their breastfeeding knowledge. She received just 6 hrs of training on the subject.
TODAY I met a mother of a 2 wk old who was told he should be gaining 50g a day and not being back up to birthweight at 10 days was a serious concern (he has lost 5% of birth weight and was only just under birthweight at 10 days). WHERE had this midwife received this information and WHY did she feel so confident in giving it out in such an officious tone?
Every week I meet mums of newborns who tell me the one thing that made their hospital experience difficult was that every midwife told them something different about breastfeeding and they all contradicted each other.
I appreciate it takes time and money to train people properly but parents are being given misinformation at the moment and starting life with their baby brimming with confusion and frustration. Even just one laminated sheet of A4 stuck on the wall in hospital/ clinic would help - e.g. encourage people to use the same language and phrases when it comes to attachment and positioning, acknowledge not all babies feed for the same length of time, talk about how feeding patterns change once the milk starts to become fattier and that's the way to judge 'the hindmilk' coming in - not X number of minutes.

The mother I observed feeding today had also been advised to hold her breast away from the baby's nose. COMPLETELY unnecessarily and she was risking a blocked duct with the amount of pressure she had been told to use.