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

What is the RCM going to do about the fact that Maternity Matters has not been met and only another 20 days till end of 2009 when its meant to be met? One to one care in labour? Bloody joke!

Just another vote for improving post natal care on the ward (I had my babies at Bolton Royal Infirmary)

I had two c- sections, both times I was still immobile when the night staff came on duty.

Both times there was one midwife and one auxillary nurse caring for between 16 and 25 women. The staff were exhausted and very grumpy. Asking them to pass you a crying hungry baby whose cot had been pushed out of reach was apparently an imposition. I was left in dirty bedding and nightclothes for over 12 hours.... and I remember crying when my DH and family left in the evenings. Those of us who had been there for more than a couple of days would end up helping the night staff out, pressing buzzers and holding babies for the other mums.

But, on the otherhand.

• midwives in theatre were brilliant
• midwives pre-natally were brilliant
• midwives on the ward had to deal with some extremely stroppy and unreasonable mums "but why can't we smoke in here?" "I don't want to bath IT, can't you do it?" etc etc...

Most of the MWs I saw were lovely lovely lovely, and pretty pro-birth.

I moved house at 36 weeks:

• The new CMW couldn't fit me in for a routine appt for four weeks i.e. after the due date!

• The senior MW who came to my house was a cat-bum-faced Can't-Do sort of person - just reeled off that reasons why I might not get my home birth (staff shortages, dontcha know), that I couldn't have a water birth unless experienced staff were available, that I couldn't have a third stage in water, etc. She made me feel scared for the first time in my whole pregnancy, although mostly I was terrified she would have to attend the birth!

• The two who were at the birth were fantastic - both sort of middle-aged and experienced, but one was particularly excellent and confident. She noticed that although I was past explaining myself, I was probably in transition and not able to get out of the birth pool, walk upstairs to empty my bladder and lie back for an exam! and that although I wasn't pushing, it was because my body was doing all the pushing by itself. The other was a bit more nervous and unsure of what was going on, so thank goodness for her.

I would definitely like to have an Independent MW or at least a doula next time, for continuity of care and to know that by the time the birth comes I will definitely have someone with me who understands me.

My sister had her first baby in hospital in August. She breastfed her within the first hour at 7am (does that allow them to tick a box?) and was then ignored in the ward until 6pm.She and baby slept all day. She was offered no pain relief until 9am the next day. She got herself discharged and went home. on day 2 the CMW arrived and INSISTED the baby needed formula and advised my sister to use a nipple shield( thus cutting down the contact between baby and breast completely). The day after, I arrived just as the CMW was hosing formula into baby,while hubby stood panicking and poor sister, exposed and humiliated sat there trying to express milk to prove she had some.

"Some women just don't have any milk" quote.

She was given no advise about breastfeeding what-so-ever. Thankfully with the help of the NCT and me stepping in as maternity nurse for a couple of days she is still breastfeeding and baby is thriving.

So,staffing levels in hospitals need to be increased so that new mums get the support they need both for themselves and with feeding.
There needs to be a calm and consistent approach to helping with early feeds. The "breastfeeding friendly hospital" title requires a lot more than a few tatty posters.

I also think that there needs to be a realisation that breastfed babies will lose more weight, milk doesn't come in properly for a few days and no midwife should be advocating indiscriminate use of formula before trying ways to improve breastfeeding.

P.S. I had two of my three at home, wonderful care,fantastic staff,but I know my sisters experience is not uncommon where she lives.

I would say Thank You, Thank You, Thank You, to the fantastic MW at LGI in Leeds who helped me achieve my VBA2C and who was as hands off as she could possibly be and who helped me get out of my t-shirt when DS2 was being delivered via forceps in order that I could have immediate skin to skin and who convinced the theatre staff to dim the lights and have music playing to help me achieve the birth I wanted, even if it did end up in theatre. She then fought my corner regarding my DS's low blood sugar four hours after his birth. Paeds were urging me to give formula or at the very best express, even though he had been in skin to skin with me and feeding well and they couldn't tell us what a normal blood sugar level in a healthy term infant should be, only that his was too low. MW got them to agree to recheck in a few hours and then again a few hours later. She also fought my corner regarding BFing and taking anti-depressants when the paed was telling me I couldn't BF and take ADs at the same time and listened to me howling about failing to have a natural delivery and made me see that I had achieved 90% of my natural delivery which after 2 CS's is no mean feat. She also stayed on after her shift to see us safely delivered to the transitinal care ward where we were put because of DS's low blood sugar and my anaemia.

I'd also like to say a big Thank You to the post-natal night MW at St Jame's in Leeds who helped me get BFing off to a roaring start with DD and who kept checking in on me to make sure we were doing OK (I was in a side room due to having had a section and the day staff pretty much ignored us) and admonishing me for not calling her to help with getting DD out of the cot and latched on well.

On the downside; I would like to say a small BOO to my CMW who assumed I would be booking in for another section and who told me that I would "never be allowed" to attempt a natural delivery. I felt that she kind of washed her hands of me at that point (my booking appointment!) and felt that she wasn't as supportive of me with that pregnancy as she had been when I had my DD 18 months previously...

...and a big BOO to the nursery nurse on the transitional care ward who, when watching me struggle to get DS2 latched on, asked me if I wanted a bottle of formula

I'd say to my midwife: you were so amazing and I know made birth something very special for us and

I am sorry that you could not continue to do such a fantastic job within the NHS and therefore left.

I would like to know, as well, why some midwives are tolerated, whose manner and lack of caring and dogged mistrust of the birth process affects the future mental health (and sometimes physical health) of so many women. Who is letting this happen?

Since someone else has named their midwife, can I say to the RCM, go and find Maisie the HV at Falcon Road surgery in Battersea. I know she's an HV but your members could learn SO MUCH from her. I would never have managed to b/f ds without her practical and emotional support.

In our area we are supposed to have our own Community Midwife, which I did have for my first two births. But on my third, my midwife went off sick and so then I was nobody's. I would actually have preferred to have no personal midwife than nominally have one who wasn't there because all the other midwives who I had to see instead treated me as an imposition.

If the locum midwife's weekly clinic was full, I had to beg someone to come out and do a home visit. At which point I was told off for not having arranged my appointment early enough (which is illogical because someone has to miss out unless people are making unnecessary appointments).

All of this would have been inconvenient but not awful except that I have had a fairly rough time obstetrically. My first baby was stillborn at full term. Because of this, my midwife has always said that they will come out any time as an extra to reassure me if I need it. Additionally DC3 had an unrelated congenital condition that could have killed him in utero (thankfully he is fine) so I was mega stressed. I never actually asked for any extra appointments (well I did towards the end, I left a message on the MWs central answerphone in tears but no-one called back) but even the routine stuff, because it was all a bit unusual I was tutted at and told off for.

All of this ramble is the background to two points:

1. There needs to be backup when providing a personal service, because if your midwife is on long term sick for the duration of antenatal care then my experience was there was no scope at all for getting my personal needs and concerns addressed.

2. Please can midwives actually read the notes just a little before leaping in? My notes had three separate high risk pregnancy alert stickers on, and the little butterfly they put on in our area to signify a previous loss, but no-one looked at the notes before telling me off for asking for basic antenatal care. I assume this was down to carelessness rather than a deliberate lack of tact but it was very hurtful. And PLEASE check for a butterfly before chattily asking how many children I have (or worse checking the parity, not noticing the "SB" and merrily asking where the other two are)

I would also like to thank all bar one of the MWs who looked after me during pg, birth and post-birth of DS. Especially the lovely lady who was also a lactation expert who came to my house to check how I was getting on with bf'ing DS and who expedited the referral to the paediatrician to get his tongue tie snipped.

The one I wasn't keen on couldn't even tell if my waters had gone. I told her they had, the loo had been full of blood and there had been an almighty splosh, but that wasn't good enough for her - nor could she tell after feeling around. SO I said "is it bulging?" (the membrane) - she said No; so I said "well it was before so if it isn't now, I'd say the membrane's gone, wouldn't you?"

What else - well, I had a luckily lovely experience overall but many of my friends haven't and I would therefore borrow from their experiences.

DO NOT patronise your patients - DO NOT pat their faces and say "you don't have the look of someone in labour", send them home and have them require an ambulance to fetch them back to the hospital because they can't get out of the bath due to contractions.

Nor should you say - "come back when your contractions are less than 2 mins apart" (when they're already 2 mins apart) and only on patient's refusal to leave the building check the dilation, to discover full dilation and imminent birth!

ALL MWs should be prepared to expect the unexpected and to assume that every birth will be different. There are no "standards" - there are no "rules". And LISTEN to the patient, even if she does appear to be utterly neurotic.

They should all have some kind of empathy training too.

Please stop freaking out women in their third trimester by telling them your measurements indicate a massive baby. Most of the time women (including me) are told such things by MW sucking air through their teeth like a mechanic shaking their head telling someone "It's gonna cost you.".

The fact is that 3rd trimester sonography is only 60% accurate on size. That's a huge margin of error. I speak as someone who has worked as a medical technician. I think all MW telling women that their babies measure big on 3rd trimester measurements should be required to say that measurements are not at all reliable at that late stage.

So many women come on MN freaking out about how their baby has been measured as fanny destroyingly huge, and I think makes women worry about birth unnecessarily, and doubtless increases c-section rates.

A lot of the time, I think it's used as a way to scare women into obedience as to a suggested procedure it was for me.

I wanted a home birth, but had a high BMI. I insisted, was a perfectly healthy pregnancy so they relented, but then ladled on the pressure about DD being so big there was a danger of shoulder dystocia. This was based on fundal measurements, the most unscientific measurement ever IMO. I got sick of the harrassment so agreed to an ultrasound at 36 weeks after being scaremongered informed it might be an indication of kidney problems. Ultrasound comes back 99th centile, cue MW shaking their heads, sucking through teeth, doomsaying etc. 4 weeks later DD is born and weighs in on the 50th centile. I was a little annoyed.

Also- use large blood pressure cuffs on big women PLEASE! A misdiagnosis of pre-eclampsia due to poor measurements is utterly unacceptable, but given that I had to remind and insist on it at every goddamned appointment I imagine it happens all the time.

I had MW's try and persuade me it was unnecessary, it was bloody necessary! One time I let 'em try a small cuff on me, late in pregnancy sick of fighting my corner, and surprise surprise I had high bp. I then insisted they go get the large cuff and hey presto I was normal again. If I hadn't made a fuss that high bp reading could have seriously impacted my care, how many other high BMI women have had their pregnancy and birth unnecessarily interfered with due to this laziness?

I had the same community mw for pre natal care, and she messed up taking my bloods, then lost the results, was always late and generally didn't give me any confidence, lovely lady but did not inspire the trust I needed for my first birth, but I was unable to have anyone else because she was the only mw attached to my doctors practice and I wasn't allowed (I tried) to change practice. Post nately she did try to help me to get a good latch bfing, sadly she didn't help much, giving me advice to aim nipple at dd's chin! And she ran one of the antenatal bfing clinics.

My sil's community mw didn't return calls and actually failed to attend some appointments

Luckily my mw giving birth was fab, she listened, agreed to my birth plan, stayed on after her shift for at least an hour to see me through to the end, gave me the drugs I asked for and essentially let me take the lead and get on with it which was exactly what I needed. Another at the hospital was fantastic at showing me how to bfeed lying down when I was so knackered I was close to passing out.

I think that the community midwife could be great, but where possible women should be allowed a choice.

I want to know why the midwife I saw for all of my antenatal appointments only does homebirths? I therefore had a midwife who I had never met delivering DS2 as I had a hospital birth. I was told that they have different midwives in the hosptial to the community teams so this is the case for everyone who has a hospital birth.

I then had a succession of midwifes come to do the homevisits after I came out of hospital. I never did see 'my' midwife again and have no idea whether she knows I had a boy. I feel this is particularly sad as she looked after me really well after a second trimester loss and encouraged me to try again when I was scared.

With my first two pregnancies (in a different area) I saw a different midwife at every antenatal appointment and then had a different midwife again for the deliveries.

I think having a midwife (or a team of say 3 or 4 midwives) that I could get to know would greatly enhance the level of care I perceived to receive.

Related to cece's point there seems to be a great emphasis on improving the experience for low risk women - home births and also lovely birthing suites which a high risk woman like me would be barred from using.

In my area the Spires maternity unit has opened with nice lighting, windows to the outside world, ensuites and it frankly infuriates me. All this improvement could have been provided in Delivery Suite so that any woman could have benefited from it, but instead the new resources have been lavished on low risk women to the total neglect of those with more complex obstetric needs.

I would like you to say:

The agency midwife I had for the first half of my labour was shocking. She left me alone; she asked for consent for an episitomy when I was about 3cm; after 6 hours in hospital (back to back, very painful, had been having heavy contractions for 24 hours) she broke my waters and said "congratulations, you're in labour" (I v nearly cried).

What is the RCM going to do about ensuring that agency midwives become accountable for their behaviour and that they are up to date with proper expected standards of care?

The community team I saw pre and postnatal were lovely, but sadly I rarely saw the same woman twice.

I haven't given birth yet;- I am 34 weeks pg with my first.
So far I have had pretty good support from my community midwives- sometimes at the antenatal appts they are a bit rushed, but my "usual" midwife came round to talk about the birth plan today, spent 2 hours with me and was great.

However, you can't help noticing that all is not well in midwife land here in W. Cornwall.

This area has a 17% home birth rate, which is apparently fantastic. However, in the 6 months since I've been seeing them, the community MW team has gone from being down 1 to down 2 MWs, including an actual designated MW for my doctors' surgery(hence I've seen quite a few). Apparently the post has been advertised for the whole time, but somehow has not been filled..?!?

There are also rumblings that the community MWs are going to have to work shifts in the county hospital, due to short staffing- with no more community MWs taken on.

The worries are that this will make having a home birth far far more difficult, due to lack of staff.....Yet hasn't the Government made a commitment that every woman should be able to have a home birth if she wants?

My MW alluded to all kinds of politics and skullduggery going on at management level, that she couldn't really go into, but surely central government should be pushing for a community MW recruitment drive if it wants to honour its commitments?

This should make sense- after all, low-intervention, MW-led births are much cheaper!

re: Edam: "Why the HELL are MWs keeping quite about issues that serious?"

I'd better be careful what I say here, because it was told to me definitely off the record, along with plenty of: "We're not allowed to talk about that", but:

A letter was written from our community MW teams to "management", expressing concerns about staffing levels, and about the threat of community MWs being forced to work shifts in the county hospital to cover low staffing levels...

Apparently the person who put her name to the letter, on everyone elses' behalf, has been "punished"....cue great caginess from my MW.

Words fail me.

Just skim read the rest of this thread and noticed nothing else about high BMI and the necessity for big cuffs, so I'm gonna reiterate my point to make sure I'm heard- please raise this issue with them PW, BIGGER LADIES REQUIRE BIGGER BLOOD PRESSURE CUFFS FOR ACCURATE BP READINGS.

We had a thread about this a while back where every woman with high BMI had the same experience as me, having to insist upon large cuffs, being pooh-poohed, ignored, shamed (for being fat), and mostly not even knowing that it was necessary to have a large cuff and having misdiagnosis seriously impact upon their care.

I was a midwife for many years.

Bullying and burnout are major problems in the NHS. Most of the people I trained with left midwifery after a few years. One colleague killed herself due to pressure of work, stress and bullying by management.

It seems to me that things have not improved. The only thing that exercises the minds of those who are at senior management in the NHS is saving millions of pounds. They spend thousands on management consultants, and thousands more on "cost-cutting" managers.

People with clinical skills and experience, including senior clinical staff at consultant level, are treated with total disrespect by senior management, most of whom have no clinical knowledge whatsoever..

In every area of care, the most important thing is targets and tick boxes.

IMO nothing will improve until clinical need is considered more important than saving cash. But we, as taxpayers, have to be prepared to pay for it.

That said, there is a huge amount of waste and incompetence in the system.

continuity of care, wasn't bothered antenatally but post natally to see the same face and get some consistent advice would have been nice.

Community midwife - fantastic throughout as she has been my midwife for two of my children and really knows me. This is just what you need especially whe there are complications.

Hospital midwife - Having given birth twice with no pain relief - have just had third and the midwife was ok but I came away feeling bad as I had an epidural and she made it clear she felt I had made the wrong decision. [angry}I am left feeling negative about a birth which was actually a great experience. As a third time mum I felt she should have respected my views. Having given birth twice before with nothing I knew my limit and am annoyed that she has made me feel I have to justify myself to everyone. A shame as it was my last and I still feel I have to explain to others why I decided to have one!!
A more supportive approach would have made my birth experience better!

Continuity would be nice.

Am pregnant with first. Have had so far 6 ante-natal appointments and have so far met 5 difference midwives. Am due to meet another new one next week.

Admitedly I did move into a different area mid-pregnancy but even so I don't feel any sense of connection with my midwife to the extent that when I was suffering from ante-natal depression I made an appointment with my doctor as I felt I had a chance of being able to see him again if I needed to unlike midwife.

individualise ny care don;t just follow the algorithm

The problem with providing indiviulised care is that you then get a huge bollocking for not following the protocols. I still give women choice and document accordingly but given up counting how many times my manager has screamed at me "you must follow protocol". Eh, actually no I don't have to. Its making me very unpopular at work.

So maybe management ought to be reminded about informed choice, etc.

Also for the person who said their m/w left as her shift ended 15 minutes before the birth of their baby and she thinks the m/w should have stayed. Sometimes I've been in this position and can't stay as I have to pick DD up from school. Sorry, I do feel awful if I leave at such a point.

It is the structure of the midwifery system that prohibits tailored care . You are in many circumstances treated as a piece of meat on a conveyor belt and not as a person with a particular set of needs.

Yes, just to second Stripey here. Acting outside prptocols is not a simple case of supporting women in their choices by being brave and gutsy. When we do that we efffectively hand over the vicarious liability insurance and protection working for an employer gives us. We are always personally liable for your care, but in this instance, should any adverse incident occur, that either you or the statutory body felt was preventable and persued with a complaint - we as the individual would be left with no legal support. The risk of job loss, registration loss, facing tribunal alone...and so on, is often considered too great a risk for a woman trying to pay the bills like everyone else. Not to mention the trauma of having something like this on your concious.

I'd also say on the end of shift thing, it isn't always possible to stay, like it isn't always possible to provide continuity. Childcare childcare childcare. My dd1 is at home today with vomiting. I would have failed to attend all the women I said I was going to [had I not been on mat leave at the mo].

In the bigger picture, the flexibility in shifts required to provide team approached midwifer is a nightmare to find childcare for.

NONE of this is womens fault, so we should not suffer by it. We need people with teeth fighting our corner for us - for women. If the RCM fight the corner for women and womens rights, everyone benefits. Cheaper more flexible childcare, no tolerance towards poor pay for long hours, no tolerance for poor life/work balance, no tolerance for hypoglycaemic staff or babies, no assumption 'they will do it because they love the job, so let's give them another 10 beds and no morning break',... the list goes on....

A blaaardy Christmas card and a fiver for Christmas might be nice. My dh works in the most miserable sector of factory working and even he gets £10 in his pay. Pah!

Am saddened by stories here. Also for your lost positive experiences. All I can say by way of [unasked] for advice, is in the cases where one individual did/said the wrong thing, but did not affect the outcome of your birthing experience, try to focus on the other brilliant positives. A shame to let one person overshadow this momentous time - although entirely right to not stand for it. You know what I mean. I will always remember the withering glance and awful attitude of someone I asked for a cuppa after my first delivery [19 hours, 4am, epidural legs, cup of tea not unreasonable?] But bugger her, there will always be miserable whatsits with a headache and a bad attitude, others were nicer and I got my intact perineum. That was My Fear.

We need the RCM to work behind the scenes telling trusts this level of interpersonal skill will not be tolerated. We, the service users, are too busy caring for our newbies. So crack on.