During my third year of student placement I was fortunate enough to spend some time on our specialised ward which focuses on pregnancy loss, early pregnancy care and miscarriage management.
Initially I was extremely apprehensive to begin this placement. Honestly I was scared.
But what of?
Not the babies
Not the families
Not the situations and dealing with difficult moments

But my emotions.
Was I strong enough to look after people when some of the worst experiences have happened to them?
My belief was kind of baseless as I realised very quickly - no matter if you are a member of staff or a member of the family, you are never alone and always supported.

I attended a SANDS training day a month prior to the placement and we re-watched 'A deafening silence' - a fantastic learning resource surrounding communication during the period of pregnancy loss and still birth.

I am using both of these terms 'pregnancy loss' and 'stillbirth' as technically they have different legal and medical meanings.

Early Fetal Demise / Early Pregnancy Loss
Spontaneous loss of products of conception prior to 12 weeks gestation.

Miscarriage
Defined as spontaneous loss of products of conception before 23 weeks and 6 days of gestation.

Stillbirth
Death of a fetus after 24 week of gestation


Many find it difficult to discuss loss using terms such as demise so it is important to be sensitive when discussing with parents and families. However it is important that information is given clearly and no doubt is passed along. Phrases such as 'There is no heartbeat. Your baby has died' is often used.

The NICE Guidelines on Ectopic Pregnancy and Miscarriage (2012) suggest that women in Scotland should have access to an early pregnancy assessment unit (EPAU). This was where my placement took place. My trust's hospital is lucky to have this ward as many staff shortages and cut back sometimes threaten wards like these to close. Unfortunately then mothers undergoing miscarriage or loss then have to experience this in wards with mothers and their live babies - and non specialised care.

A number of my duties included; answering telephone calls, booking early scans, taking beta hCG blood samples, discussing management of miscarriage with families, supporting women during discussion of management of miscarriage, supporting women undergoing medical or surgical management of miscarriage and 'delivering' mothers undergoing termination of pregnancy for fetal abnormality (Many of these were non compatible with life if carried to term, or had passed away due to events such as early rupture of membranes).
I also was involved, and utterly honoured to be involved in, making memories for stillbirth babies.

Our ward used SIMBA boxes (pictures below) and although the idea of making memories, taking photographs and spending time with their babies was sometimes abnormal to families, they really appreciated the amount of time and effort we took to ensure their baby was treasured that day and for many days, years to come.

Photo from: https://www.simbacharity.org.uk/what-we-do/

One story which comes back to me as I write this is a fathers story of seeing a beautiful yellow butterfly in the ward outside the families room. We often used butterflies to symbolise stillborn babies. He knew, and their daughter also knew that this was their daughter/sister visiting them, although she had passed on. I cried a lot on this placement. I was never made to feel bad for this.

I was supported the entire time by the amazing team of midwives and healthcare support workers who worked tirelessly and emotionally all day for these families.

Below I have made a little infographic for student midwives. Please share!!




Ruth x
@Ruth_NQM - new twitter handle!

'We're going to get the doctor to give you a hand'
'Baby doesn't like when you do that'
'Its best if baby comes out sooner'

How often are we told that one of the key roles of the midwife is communication, and yet how often are we experiencing old outdated phrases from medical staff and colleagues, repeated merely in learnt behaviour, to women and families?

As a first year student I found it difficult to find my 'voice' when caring for mothers and families, often repeating what I had heard from other midwives and medical staff - often patronising and unclear.

We are constantly taught that to communicate well we should avoid technical and medical jargon, but I question whether this is really helping mothers in regaining the control they often desire during childbirth.

After developing my Midwifery style three years I have become more focused on creating a positive birth environment including keeping women informed during the journey. This is more commonly experienced when caring for women in labour ward, and interventions are required.

Often I find myself using my advocating role to explain procedures and medical staff plans to the woman and her birth partner.
This has developed from my experiences of really being 'with-woman' and experiencing the look that they often get when procedures or intervention are discussed and they physically glance to myself as the midwife, not for guidance but more for explanation.

Many times I have found myself looking at the woman and partner explaining 'this means the doctor is suggesting a forceps delivery' when they are faced with the comment 'we will give baby a hand to be delivered'. The consent is often ignored and I find myself being the one to put the control back into the woman's hands by explaining why this is suggested and if she wishes for this to happen. Often this takes a matter of seconds but is often followed by a thank you or understanding nod which relaxes the woman and removes some negative energy surrounding the impending intervention.

Language can build trust, which is key in providing women centred care and I find talking with the women I am caring for, discussing their wishes and wants for birth, along sometimes with discussions surrounding potential interventions (for example, the potential need for neonatal resuscitation if meconium is present in liquor) creates a bond, and can promote calm well informed birthing experience.

Many families I have cared for state they 'didn't know what was going on' in previous traumatic deliveries and as this is my area of interest I always ensure I spent time discussing their worries or concerns and answering any small or large question they have. Even non verbal body language such as a smile during a contraction, a nod of the head when they reach for the gas and air. I believe good communication can prevent birth trauma occurring again.

I will constantly be reminded of this from an experience at the beginning of this year where continuity meant I had spent two days caring for a woman undergoing induction of labour. Our communications surrounded the reasoning for this (reduced fetal movements), her concerns, her previous births meant that when her membranes ruptured in the induction ward and she felt the spontaneous urge to push, merely eye contact allowed her to calm and be transferred to a labour room. Each contraction she made direct eye contact with me, a direct form of non verbal communication, a show of trust built on a developing relationship.
Afterwards she stated she looked at me because if I was calm she knew everything was going to be okay.

It's back! The Channel 5 docu-series following a group of Midwives from the Highlands of Scotland undertaking rural midwifery at it's best.
This season they've introduced new group of midwives working in North East of Scotland in Peterhead - which is where I had my third year community placement!

So maybe, slightly biased review coming up. Especially as I working with some of the midwives and involved in the setting up of the renovated Midwife-Led Unit.

For that reason I'm going to do a slightly shorter review of the first three episodes with a little pros and cons list.

PRO's

• It is so great to visit each of these women's unique story and see their choices and requests being discussed in an open and honest way with the midwife
• The midwife-mother relationship remains a strong theme in the series
• Midwives praising the continuity of carer they can experience
• Showing elective c-sections as a CHOICE for women and no shaming
• Outlines the geographical issues women have in the Highlands of Scotland

I'd love to hear people's views on the how as I have had positive feedback from friends of mine who have experienced maternity care in Scotland. Also, perhaps how this show compares to One Born Every Minute?

Tweet me @ruth_stmw

Ruth x

Here's a picture of me in the Peterhead birth room, Moonlight.

I haven't blogged in a while and while putting out content about midwifery practices and recent news reports, I realised I hadn't yet finished my reflection on completing teaching antenatal classes.



After my first post on beginning antenatal classes I then had the opportunity to teach another group of prim mothers - and I jumped at the chance. Midwives are both healthcare supporters and educators. And I needed to build my confidence on the education side of things, especially as more and more opportunities approach me to do public speaking.

I really enjoyed the first set of classes as it was like reaching out into the unknown. I developed systems and trialled use of resources to engage both mothers and father. I found my tone of voice when discussing certain subjects needed changing and that my wide experiences of working in midwifery-led labour care and obstetric unit labour care helped greatly when answering women's worries about pain relief, mobility and options in childbirth, and postnatal care.

Class 2 was Labour 2 - focused around pain relief and options in labour and birth. I also found it important to discuss potential for change in birth, including touching on need for forceps or emergency c-section deliveries. We discussed birth plans and mobility in labour. Here I felt the women listened intently to the science around childbirth and it was fun to discuss the hormones which supported birth and this time the group was very vocal in asking questions.

Class 3 was Infant Feeding - I outlined at the beginning of the class about the UNICEF baby friendly initiative and that the session was focused around breastfeeding initially, but did outline to the mothers choosing formula feeding that I would discuss sterilisation and making up feeds correctly. I tried to involve both types of feeding when discussing key elements such as skin to skin, bonding, and wet/dirty nappies. Honestly I found this difficult as I am very pro breastfeeding however it was great to answer questions surrounding mothers worries about milk production and how best to care for themselves when breastfeeding. I had positive feedback from the mothers choosing formula that they didn't feel excluded.

I didn't undertake the fourth class as this was relaxation and was provided by a trained midwife. However I encouraged my group to attend as we had discussed a lot about breathing, feeling of control and I felt this would be beneficial.

Overall the feedback was positive with some expectant mothers recognising me at clinic, or working in day assessment unit and discussing classes with me. I felt it helped build trust and rapport with mothers. Especially as a third year student midwife as I felt a positive experience with a student might make then more open to having students present at their births (something I have found is still declined in our trust).

I developed a lot of skills from those classes and hope to apply then to my parent craft presentation I have at university soon.

Ruth
twitter: @ruth_stmw

During my current placement I have had the opportunity to teach a full set of antenatal classes to a group of first time mothers and their partners.
Initially I was anxious I wouldn't be accepted as a student midwife, or as a 'teacher' as this wasn't quite what I imagined as part of the midwife role, however I found from presenting at university last year that standing up in front of people is something I enjoy doing!
It was the second day of my placement when I taught my first class - solo! As a third year student we are encouraged to practice independently and my midwife mentor attended the last half an hour and was (apparently) impressed with my class.

The class was on Labour 1 - from Braxton Hicks to Calling to come into Hospital / MLU / Calling in  Homebirth team!
We had fun and did some good ice breakers and encouraged discussion - I found initially many didn't ask questions during the sessions, which was a little demoralising, but it was because they wanted to ask them separately afterwards!

I also actively encouraged the families to visit the places they were planning to give birth as I talked about the cocktail of hormones and increase of Oxycontin and Endorphin's in their own or safe environment and the benefit of the familiarity of their place of birth.

I'm planning to complete all three classes and get some feedback from the attendees at the end of the sessions to see how I've done and if I've helped them feel prepared for labour, birth, infant care and breastfeeding.

I'll keep you all updated on how they go.

Ruth
twitter: @ruth_stmw

Hygge (pronounced Hoo-ga) was all the trend last autumn/winter as people began to prepare for the cosier months and an easier, happier way of living was introduced to use by the Danes.



Hygge is defined as the practice of creating cosy and congenial environments that promote emotional wellbeing - sound familiar?

Birth environments should be cosy, congenial and promote emotional well being. So why not apply the elements of Hygge to birth, specifically homebirth.

Here's a little infographic I put together on how this could be achieved by both mothers and midwives.
Infographic for this post can now be found at http://sagefeminist.blogspot.co.uk/p/infographics-from-blogposts.html

What do you think? Could these elements help create a better birth environment or even make us remember elements which can promote natural physiology of labour.

Ruth x

twitter: @ruth_stmw