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A Simple Summary of MBRRACE – and some thoughts on the maternal mortality stats linked to race

I'm sitting here with my purple mug of long cold tea, trying to get into words what the National Perinatal Epidemiology Unit (NPEU) is and how MBRRACE works.

I've noticed a few students worry that they don't understand, and I've struggled to find a post explaining, so here's my take. If you read towards the end, you'll also find a summary of the 2019 findings and my comments on something quite hard to talk about, which is race and how it impacts maternal mortality.

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Everyone's talking about MBRRACE right now because of the report published in Dec 2019. It was actually blocked from being published for a while, as the government did their general election period 'purdah' thing - the idea was to stop the report influencing votes given that no party would have had time to change manifestos based on the findings, but it's questionable whether this repression was ethical.

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MBRRACE is the bit of the NPEU that do Confidential Enquiries; it stands for 'Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries'. Since the UK started to run Confidential Enquiries into Maternal Death in 1952, the maternal mortality rate has dropped from 90/100,000 to 10/100,000.

That's a lot of Mums who got to see their kids grow up, thanks to lessons learned.

The MBRRACE-UK team is based at Oxford and Leicester Universities. It's made up of midwives, obstetricians, anaesthetists, pathologists and others and they receive every set of notes for every mother who died so they can share lessons with maternity care providers. This is what the Confidential Enquiry process is.

The 'Saving Lives, Improving Mothers’ Care' report is out annually, but as (thankfully) only 200ish women die from maternity causes each year, MBRRACE has to wait for three years to get enough data to assess.

This means MBRRACE publishes on different topics each year.

This is the bit students find confusing, it's kind of like one of those magic tricks with the three cups and the ball but the reports go like this:

2014 (covers deaths from 2009-2012): Topic cycle A which covers sepsis, haemorrhage, amniotic fluid embolism and more

2015 (covers deaths from 2011-2013): Topic cycle B which covers psychiatric causes, thrombosis, homicide and more

2016: (covers deaths from 2012-2014): Topic cycle C which covers deaths from cardiac causes, deaths from pre-eclampsia, and more

2017: (covers deaths from 2013-2015): Back to Topic Cycle A again, i.e. sepsis, haemorrhage, amniotic fluid embolism and more

And then the cycle continues.

It's like if a TV show covered the whole week's news but did it in three different themed episodes spaced out across 7 days.

There'd be a bit of a delay while the episode got made, but every day and every topic would eventually get covered.

The 'Saving Mothers Lives' reports give details about the death rate as a whole, particular lessons learned from expert opinion, and also 'maternity morbidity' themes are chosen and addressed.

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This year it was breast cancer, which is fascinating, lots on chemotherapy and how to breastfeed around the treatment, it can't just be me who has limited information on the topic.

On to the actual findings. I might need coffee. Or wine...

The main learning points were about clinicians getting better at multi-professional teamwork and liaison, and that the maternal mortality rate has stayed about the same, which is not great because, in 29% of mortality cases, care could have been improved.

The leading cause of death is still cardiac disease so we all have to be on the look out for high resps, sinus tachycardia and breathlessness, and other signs that are not normal in pregnancy, and we need to ask for help from specialists fast.

There's lots on pre-eclampsia, particularly on taking aspirin throughout pregnancy if you're in a high-risk group. This is a new recommendation.

And then there's there are the stats around mortality and race.

If you're an Asian mother, you have a 3x increased risk of dying during childbearing; if you're black you have a 5x increased risk.

These risks are not linked to being from deprived areas (though that in itself is another issue).

I'm reading a lot of Reni Eddo-Lodge and Roxane Gay and reflecting on this inequality and I think this quote summarises things well.

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“When I talk about white privilege, I don’t mean that white people have it easy, that they’ve never struggled, or that they’ve never lived in poverty. But white privilege is the fact that if you’re white, your race will almost certainly positively impact your life’s trajectory in some way. And you probably won’t even notice it.”

- Reni Eddo-Lodge, Why I’m No Longer Talking to White People About Race

And I'm also thinking about some of the online events regarding race and midwifery that happened last year.

You might not have heard but a particular midwife was found to be trolling black women (amongst others), saying things like 'she brings every argument back to race'. The mainstream media reported on the online abuse but didn't really mention racism.

In our cultural climate, it can feel we should ignore it, these attacks were linked to Instagram communities where the currency is beautiful bowls of porridge and fruit, handbags and holidays.

Saying that social media doesn't matter, there are bigger things to worry about, is seductive.

But social media is where we talk and reflect, and this is how racism plays out, in a country where black women have a five fold increased risk of dying as they have their babies.

For what it's worth, I think the comments towards black women are part of the culture and we all have the roots of that behaviour inside us because that's the water we're swimming in.

But when that kind of racism happens, we have to notice what's going on. We can and have to talk about it and strive to do better.

This is what I'm trying, anyway. I hope this helps with understanding what the reports are about, and how we can help.

I'd love to hear your thoughts on all this.

Leave me a comment, what's your key takeaway from MBRRACE 2019?

I'd recommend a hot cup of tea to help the learning!

Much Love, Ellie xxx

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January 19, 2020 0

The Secret Community For Midwives In The Making Reading List

I first became obsessed with midwifery when I was a teenager, and I found out Waterstones had midwifery books. And I could ‘browse’ them for free.

I'd turn up most weekends in the bookshop cafe, order the cheapest coffee on the menu and then take Mayes or Myles Midwifery from the shelf, remove my bookmark, and start where I'd left off. I made notes.
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November 19, 2019 17

Should We Apply #MeToo to Birth – Webinar with Milli Hill

Here's my debate with birth activist Milli Hill about whether #MeToo should apply to birth.

It's up now! You can stop asking me for the replay! 😉

Thanks for all the questions, there were some brave ones.

Not to detract from the seriousness but Milli is hysterical - love the story about talking about birth rights on a train, Milli reports it 'was like that Peter Kay stand up about garlic bread.'

People just didn't get the concept. Birth? And rights? We don't need that in the UK, do we?

Answers to this question and much more can be found in Milli's new book, 'Give Birth Like A Feminist', out 22nd August.

Leave me a comment - I bet you have an opinion! Should We Apply #MeToo to Birth?

Thanks to Milli Hill and to you for listening. Much love and respect to birth workers leading the way x

August 17, 2019 3

Concerned about bullying in midwifery?

Yeah, me too. That's why I've got a chat with a mw researcher looking at 'civility' coming up. 'Civility' is just a research term for being nice and kind and polite.

I'll make a magic link where you can attend the video chat and ask any questions. Deidre Munro is a total lovely.

This will be in 'Wholehearted Midwives'. If you sign up to this chat you get access to the forum for a month too. It's £4.99/month, get a refund if it's not for you (within 10 days).

Or drop me a message as you sign up and I'll email you to remind you to cancel after the month if you like.

CLICK HERE AND 'BECOME A PATRON' TO SIGN UP

Se you Monday at 6pm!

NB. This event is now over. Here's what we found out:

'What's very clear is that civility saves lives.

But otherwise, the concept is fluid. Civility doesn't have one definition and changes depending on culture and current events.

Individuals have different takes too, what's incivility or bullying to one ?is just someone having a whinge to others.

This means it's impossible to write a guideline specifying how you s??hould behave in practice? and actually, that'd be awful. Monitoring stuff like? ?micro?expressions and voice decibel level?? ?Creepy.??

?Our researcher ?also ?mentioned something I've come to realise ?and that the ?evidence shows:

?People being uncivil often ?have something horrific going on in their personal life - or they've been bullied themselves.

On one level I'm reassured by ?this because it's easier to know that people aren't ?mean, they're in pain.

But on another, when you're standing up for yourself, it's easier to think you're in the right and they're just a bully.

The main take away for me is that we're all making it up as we go along and this bullying or ?'?incivility?'? thing ?is a multidimensional mess of misunderstandings?.?

I have so many questions.

?Is it possible to ?develop? a 'toolkit' to deal with difficult behaviour?? While still respecting the colleague in mind? (Our midwifery researcher mentioned the SBAR tool for communicating)?.??

How do we suggest ?a toolkit? without implying it's ?every staff member's? responsibility to deal with ?incivility?, i.e. the whole resilience debacle?

How do we respectfully help those who are behaving badly?

What gives me the right to class behaviour as bullying?

?Should we be writing about this online or ?should we leave it until we have more evidence??

Memory's a funny thing. ?Now I'm writing this I realise these are all questions that were raised in the conference on midwifery culture I ran in 2017.

It's great we're thinking about all this in the research and it's too important of a topic to ignore until we have all the facts.

?It's fantastic that? practice appears? to be changing. ?I?f we look at? the Caring for you Campaign, the mention of staff culture in ?Better Birth and ?really ?the last 50 years of changes in? NHS there's a lot to be hopeful about.

I'll going to keep? writing about ?bullying and civility? because it's too important to worry about getting it wrong.

But I'll be more careful to press the fact that ever?y NHS staff member??, even if they're causing pain, is doing the best they can.'

June 27, 2019 0

Getting your place as a student midwife in 2020

"Invite this one for interview asap!" - your admissions tutor after reading your statement.

Get step by step instructions on writing your statement and 'Ask Me Anything' sessions so you won't get stuck.

We're in a private Facebook group, you can get help at any time.

'I now recognise I have many strengths... I would definitely recommend this group to anyone who is struggling to get started or needs help with the structure/flow of their writing.' - Gemma Davies

Join now so you can steadily write your statement and be confident about it by the beginning of August.

Reserve your spot below, scroll down and 'add to cart':

Deadline for Midwifery Personal Statement Writing Group 1st July - £9.99

UCAS opens 4th September

**This group is now full**

If you try the group and feel it's not for you you'll get a full refund.

(This isn't for people wanting one to one coaching. This is for mutual support, great if you're staring at a blank page, are having problems writing with confidence, or struggling with structure. )

Testimonials from the first group:

'The weekly prompts helped massively as it broke the process up into manageable chunks' - Lucy Jo Bradford

'I found it very helpful at keeping me on track. Prompts were really useful, loved the Ask Me Anything sessions. I have a draft written that I'm pretty confident about!' - Keeley White

For more info or to book, see above or email me on ellie@midwifediaries.com

p.s.

I'm 99.9% sure I won't be running one of these again this year due to other projects. So if you'd like to do it, now's your chance!

June 26, 2019 2

This thing that almost happened to me

This is a story of me being a prat.

A few years ago, I left midwifery to work on my blog and books. But actually, I left because of night shift.

When I was practising in New Zealand, I was also training for a half marathon, writing a novel, running my business and doing conversion exams. I was getting up at 5 to get a start on it all before a 7am shift and working in the evening too.

How could there be anything wrong? I was nuts for midwifery and life.

I thought I just had a regular aversion to nights (like many).

But on runs of nights.... I’d fantasise about whether I could get my bike hit by a car on the way in.

Huh.

And between you and me, it did get a bit more stupid than that but don't tell my Mum, okay?

On days, my mental health was great. On nights...well.

I'm not sure I could have explained any of this, I wasn't good at thinking about it at the time.

I didn't think I could be very helpful to midwifery as a non night shift midwife.

So instead I gave in my notice, published two midwifery books, and founded a 24,000 strong midwifery community.

A bit of an overreaction.

What I needed was for someone to ask me how I was doing and to point out I was being a total lunatic idiot.

Cut to three years later, I went to an ARM midwife at my local hospital and asked for her advice.

She booked me an appointment with the Head of Midwifery...and, one GP appointment and sleep researcher advice session later, turns out I'll be clinical again in 2020, sans nights.

There was a lot of ugly but happy crying.

I was this close to never coming back at all. (Thanks midwives who helped!)

Please learn from this:

We were never meant to face midwifery alone.

Enter Wholehearted Midwives:

I’ve set up Wholehearted Midwives as a private, off Facebook support group.

We’re here for you in whatever way you need us but mostly we remind members that:

Everyone has challenges, it's how you solve them that counts
You’re a strong, rocking, awesome, empathetic student/midwife
Sharing your stories and listening to other midwives is key – hearing from those who’ve got through the stage you’re at is essential

CLICK HERE TO JOIN OR FIND OUT MORE

June 13, 2019 0

Can I Count You In?

I have this idea, could I run it past you?

We’ve all been to doubt and exhaustion land.

People are leaving the profession over this.

I’d like to start a group for student and newly qualified midwives who get it, who want to do something to reset their positivity and be part of their midwifery community. I'm researching platforms and costs but I'd like it to be off Facebook and with a live component.

I want you to think about what would happen if you had unwavering support, you were listened to, knew what you were feeling was normal and often heard stories about wonderful midwifery care.

When you feel good about your abilities, you pick things up fast, and get a rep as a fantastic midwife. You have a social life because you’re not exhausted all the time. And you can drawn on supplies of confidence and self-respect even when it’s hard.

I want to call this group 'Wholehearted Midwives'.

In Wholehearted Midwives we would:

Focus on one anonymous midwifery challenge or story a week
Discuss practical and emotional tools for midwifery, showing up for each other,And
Read without judging, offering advice and help wherever we could, so none of us feel on our own.

What do you think? Leave me a comment if you'd be up for it.

As always, thanks for reading. More on this soon,

Ellie x

This project is now afloat! Click here to become a Wholehearted Midwife

May 23, 2019 0

The Maternal Journal Project, Hollie McNish, and Motherhood Poetry

I’ve just got back from the Maternal Journal project in Cambridge. Sat here in my PJs. I got soaked on the way back but it was totally worth it and I wanted to write up while I remember everything.

This was the first session in a series supporting a group of mother to keep art journals.

This project is an awesome idea because:

Cataloguing those raw, precious, early days using art is a wonderful thing – and creativity improves mood*
In the long term, creativity helps you make sense of things, leading to better mental health**
We got free lemon drizzle cake and I got to hang out with toddlers with some of the best hair I've ever seen

We started off with motherhood poetry session led by local writer Hollie McNish.

If you haven’t read Hollie McNish’s book ‘Nobody Told Me’, it's so worth your time. It’s a collection of funny, insightful and clever motherhood poetry.

I was going to get Hollie to sign my copy of 'Nobody Told Me' but it’s in bad shape, I’ve dumped a glass of water on it and dropped it in the bath, a clear sign it’s one of those books I keep going back to. As a writer, Hollie’s work reminds me to be honest and not to overthink it. As a midwife, Hollie reminds me that each woman brings an entire world to her care, not just a bump.

Hollie is a working poet and you can tell because she has a stock of ways to get herself writing.

She shared prompts with us like:

Tell me about bad advice you’ve had about motherhood
What about good advice
Tell me something about socks
Tell me something about comfort
Tell me something about your body you like

And then the women shaped their notes into poems, many of which made us cry.

So what did I get up to?

You could argue that a lot of what I was doing was running around after toddlers and making tea. One of the women even apologised and said I was overqualified to do this (why do we always apologise???). Sod that. If I’m in any way qualified to help women write I’ll grab at the chance.

As Hollie said, most of artists and writers throughout history have been men and that’s because they haven’t had little ones running around needing attention.

Women are the people holding families together (usually) so it’s a shame more women don't write. Motherhood poetry is often the most powerful work I come across.

Women have better stories to tell. The motherhood poetry we heard exhibited this, everything from the reflection that ‘having a baby is actually quite a violent thing’ to 'you unlatch and it's peaceful. I love you.'

Each woman was given a leather-bound journal to write their thoughts in. No pressure, there’s no homework and you don’t actually have to do any art at all. But you could see the women were loving fast tracking their thoughts and emotions to the surface. It’s about breaking free from perfectionism.

The project is led by midwife/artist/producer Laura Godfrey Isaacs and I couldn’t be more impressed. It reminded me a lot of when the famous obstetrician Michel Odent said we should think more about the ‘happiness’ of women – at his clinic, singing around the piano with other families was encouraged.

Wouldn’t it be great of one of the questions we asked at appointments was ‘and how’s your motherhood poetry coming along, anything you want to share with me?’

Jump at the chance if you can go and volunteer at a Maternal Journal group.

All my best,

Ellie.

P.s. Have you written any midwifery/motherhood poems you’d like to share? Leave me a comment!

I made one based on Hollie’s prompts which I’m reluctant to share because poetry is not my thing, I just do blog/novels.

But the women today were brave enough to share so here we go!

(I changed the prompts to be about midwifery because I’m not a Mum)

Things You Can’t Tell A Midwife

I’ve been told by TV that I’m prettier when I’m thinner
But when I see expanding bumps/milky boobs
I know that's not true
I’ve been told by senior obstetricians
that anyone can be nice, we’re here to save lives,
But being with women and actually hearing them
has taught me almost everything I’ll ever need to know
I’ve been told by Netflix
that you spark joy by de-cluttering your house and folding your socks
But the happiest I’ve ever been was when I was sat against the heating pipes on the floor of room 2 of St Marys Birth Centre
with a labourer in the pool
with snow falling outside
with my room at home a glorious mess

*/** Jaussi, K., Randel, A. and Dionne, S. (2007). I Am, I Think I Can, and I Do: The Role of Personal Identity, Self-Efficacy,
and Cross-Application of Experiences in Creativity at Work. Creativity Research Journal; Stuckey, H. and Nobel, J. (2010). The Connection Between Art, Healing, and Public Health: A Review of Current
Literature. American Journal of Public Health

May 9, 2019 0

The Fourth Trimester of Pregnancy Theory

Ever wish you had a way of helping women know they're normal and good enough?

The fourth trimester theory can help with that.

I have a really good friend. We’ll call her Pippa.

I was thrilled to go and help Pippa when she’d just had her baby. You know the kind of thing. Keep the fridge stocked, keep bringing her water for breastfeeding support because it drains you dry. Hold the baby when she asked. Empty the bins. Tell her she was the best mother on the planet.

I loved every second of it, when you have a midwifery background and you just get to do nice things for someone you love, it’s the best.

When I left it was November and Pippa’s baby was ten days old. She said cheerily ‘Come back at Christmas!’ (we tend to meet up at Christmas) ‘He’ll be sleeping through by then.’
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May 2, 2019 0

Debating Difficult and Emotive Midwifery Topics: 5 Strategies

Have you ever struggled with a midwifery debate, unsure whether to share your point of view or whether to leave it be?

Having run a 25,000ish member midwifery forum for ages, I’ve seen a lot of arguments. I’ve also been there for some fierce discussions in real life. And I''ve got stuff wrong (see point 4 below).

It’s important to know your take on debating because a) women depend on us advocating for them b) it's pretty easy to waste energy/get hurt.

In midwifery, it's all personal.

You also don't want to offend other staff, what you believe is lively discussion is a personal attack for someone else who's just been through something.

I definitely don't have all the answers but here's how I tend to wade in (or not...)

*This is my way of doing things. Yours might be different! Totally fine, let me know in a comment.

1. Decide Whether You Should Get Involved at All

When someone says something awful, or there's a debate already in session, check yourself before you wreck yourself.

Are you wanting to learn? Share your knowledge? Stand up for the women? Enjoy the art of debate?

Or does that quote about 'getting high on the fumes of self-righteousness' apply 😉

It’s easy to make this mistake online.

I’m passionate about the right to abortion, my novel is focussed around this.

But these days I try to understand people who have the opposite belief to me, sometimes their views are valuable in helping test mine, and people don't change their mind if you just tell them ‘you’re wrong' over and over.

2. Check Context

Sharing with an aspiring midwife that yes, women can make the choice to have an elective caesarean for no medical reason = great.

Discussing ‘This Is Going To Hurt’ especially the bit when the doctor says ‘home delivery is for pizza’ = good thing.

Getting into a debate with your a family member who's just said 'AT LEAST YOU KNOW YOU CAN GET PREGNANT' to a mutual friend having her second miscarriage...

Look, I know this isn't an empathetic thing to say. But taking it up with her then and there was a ***bag move on my part, probably more to do with me grieving than anything else.

You have to reliably stick up for what you believe in, but if you choose the wrong moment or voice, and shame people, they can’t hear you.

Use your life experience, gut instinct and what your Mum taught you about politeness to decide if this is an okay time to talk.

3. But Don’t Just Let Things Go

Midwifery topics are personal because they concern women’s decisions and the outcome for their family. We’re accountable for their well-being.

If a doctor/midwife/other person is not offering true informed consent…

...for instance saying ‘this baby can’t come out that way’ re breech

…. you can say something like ‘we both know that’s not true, should I get some information for us?’ (dive for AIMS leaflet.)

Then you can pick up the conversation later.

Notice you don’t say ‘that’s an appalling way to offer someone informed consent’.

It’s important to stay factual and have compassionate understanding, even if you really disagree. Otherwise they’ll just feel attacked.

Plus, no-one's better than anyone else: it's important for all of us to understand different points of view.

I like sociologist Brene Brown’s definition of civility for moments like this:

‘Civility is claiming and caring for one’s identity, needs and beliefs without degrading someone else’s in the process. It is about negotiating interpersonal power so everyone’s voice is heard, and nobody’s is ignored'

4. Know When to Leave

Basically, when there are threats or violence of dehumanisation, it’s time to walk away. The threat of physical violence is the first step in physical violence being committed (see 'Less Than Human', David Smith).

This can be overt, for instance if someone online threatens to beat you up (or rape you...it's lovely isn't it), block them and contact the authorities.

But it can be more subtle.

For instance, debating about termination of pregnancy is okay.

Deciding on whether the death penalty for termination of pregnancy might be an appropriate punishment, is not.

It might be you need to contact a manager or professional body about stuff like this.

We got this wrong in my midwifery forum the other day.

Trump’s government has been working on several states to try and get the death penalty for women having terminations.

We let a debate continue after a member suggested ‘a life for a life’ was an okay belief.

We were trying to be tolerant of opinions but we should have removed that comment and member immediately, there has to be a line where we protect people.

5. Be Kind

I'm actually quite good at this, I think it's one of the reasons I've managed to keep the midwifery forum going.

For instance, a recent passionate, angry response from a midwife was because she'd recently cared for a baby who'd died. Only by assuming there was more to the story and listening carefully to the midwife in question did we figure that out.

My Mum was a nurse who’s raised three kids who all went on to caring professions.

If we were involved in conflict at school her first response was ‘and what did you do? what’s your part in this?’

I’ve had to learn to stand up for myself 'manually' as an adult because anger doesn’t come naturally. This means I've been a target for bullying sometimes.

But I find it great for modding, because I always try and understand everyone’s point of view and be non-judgemental in my assumptions.

In an honest debate, think the most generous thing about whoever disagrees with you and you’ll get far more out of the process.

Differences of opinion are a good thing, they prove you’re not in an echo chamber. We know these are dangerous because they cause division rather than working together.

You have to be yourself. But you need to do it kindly.

And this is how I approach midwifery debate!

I’d love to hear from you, anything you’ve learnt from this you can implement?

What are your midwifery debate tips?

Lots of love xxx

April 26, 2019 3

Personal Statement School FAQs

With Personal Statement School you’ll be writing your statement to show the best of yourself and you won’t be alone – I’ll support you with every step, from identifying your transferable skills to knowing what areas of midwifery to research and write about.

Nearly 1000 aspiring midwives have gone through this course now and not one of them has asked for a refund because they thought it wasn’t helpful.

Instead, there are rave reviews and this process has helped open the door to lots of university offers!

In case you're wondering about anything, here are some questions you may have about Personal Statement School to determine if it's for you.

Isn’t this cheating?

People are really passionate about midwifery - is your support ethical, and are you not just profiting from this excitement?

I’ll do it closer to the deadline!

I want to get my work experience done before starting my statement.

I just don't have time right now.

Any tips on getting started? I don't want to sign up for something when I'm not able to get going.

I'm a practical person, not an academic or a writer. Will Personal Statement School still help?

If you don’t give actual feedback on my statement, will it actually be useful?

Isn’t this cheating?

There's less competition than ever, is this really necessary?

What’s your refund policy?

Isn't this cheating?

In a word, no. In Personal Statement School you’ll be writing your own statement.

I coach you on how to complete a successful application. We cover midwifery knowledge, professionalism and the core philosophy of midwifery, including advocacy.

I'll show you how you’ll draw on your own life to show that you understand these essential concepts.

You’ll likely feel like you’ve been drinking from a fire hose at some point during Personal Statement School. It’s hard work, but it’s worth it!

I also want you to have the techniques you need to take forward to apply for jobs when you’re qualifying.

If you feel like getting help somehow makes you a lesser applicant, fair enough.

But I’ve worked with enough excellent midwives who didn’t get a spot first time to believe that this isn’t the case.

I know many now qualified midwives who used Personal Statement School and they're amazing professionals!

My aim is to shorten the learning curve for you so you don’t have to do multiple years and cycles.

I suspect we lose excellent midwives just because their application technique isn’t quite there the first year and then they do not continue to pursue this career.

My goal is to assist as many aspiring midwives as possible, by removing the obstacle of not knowing how to complete a successful Personal Statement.

People are really passionate about midwifery - is your support ethical, and are you not just profiting from this excitement?

That's a really good question. With so much absolute rubbish being aimed at parents (£100 sterilisers presented as a 'must have' when you can just use Milton tablets?) and formula companies trying to give midwives free pens and education to advertise their milk, I can completely understand why you're sceptical about anyone making money in this field.

MidwifeDiaries, The Secret Community, conferences, services and books all took so much time and effort that I made far below minimum wage for years. I'm happy to do this, it's a vocation for me. I believe that the essential skills of good communication are vital not only to the Personal Statement process, but to midwifery in general. We want good applicants to shine and sometimes they haven't written a statement or interviewed in a long time. No shame in needing some support and practice in this area so they may follow their dreams.

I think this resistance to getting support for a midwifery career is linked to undervaluing midwifery in general.

People completely understand why you’d pay for application support to get into medicine or dentistry. They’re good, worthwhile careers, it’s an investment and you’re not expected to know it all already.

But midwifery is linked to motherhood which means we think people should ‘instinctively’ get it and if they get help applying then they’re somehow not right for it.

Of course, there are people not cut out for midwifery and part of being an advocate for this community is having those difficult conversations with applicants.

But that’s a million miles away from someone dreaming of caring for women but not knowing where to start to put that into a professional career application.

Also, in terms of my support specifically, the midwifery internet space is a pretty small community. I've been doing this since 2013 and if it was in any way unethical, you’d know about it!

Instead, I've been asked to speak at the Normal Physiological Birth Conference, the RCM conference, and lots of student conferences; I've had a novel published with a major midwifery publisher 'Pinter and Martin'; and my book 'Becoming a Student Midwife' is on University reading lists for application support.

I don't get sponsored and I’m not interested in writing or doing anything I don’t believe in.

It would have been far easier and more lucrative for me to settle into a nice community midwifery job - or any job for that matter!

But like most of us, I’ve experienced loss I had no control over and now I FOLLOW MY DREAMS no matter what. I do midwifery application support because I find it so rewarding.

You can't fake anything in a midwifery application, it's too complicated and you'd be found out immediately at the interview stage anyway.

But you can learn how to present the best of yourself to admissions tutors, and this is what I am here to help you do.

I’ll do it closer to the deadline!

Okay, but...are you waiting for ‘the right time’?

It might be that this isn’t the right time but writing a midwifery personal statement is hard and time consuming.

Even if you’re someone who brings 100% effort normally, you can stumble with this process because it’s very difficult to write about yourself.

Are you sure your brain isn’t just giving you excuses not to get started? What do you gain if you put it off? I’ve seen so many candidates leave it to the last minute because once you give in to one excuse, it’s so easy to make others, relying on the fear kicking in near the deadline – but you don’t want that nervousness to come through in your statement.

I find when candidates start and get through the first resistance it’s such a relief. And when you’ve finished your statement and read it through it’s an incredible feeling which will give you confidence.

Having a statement you’re really proud of really makes the process far more relaxing and exciting. Once you get that first draft done in a timely manner, you have loads of time to review your statement, which can be the secret ingredient to pushing it even further and getting it to stand out. Perspective is wonderful.

To encourage you to honour your goal of getting your statement done before the deadline, midwifery applicants who join Personal Statement School during April get my bonus training ‘5 current issues in midwifery to inspire you and to mention in your application’. It’ll be gone after this!

And you’ll be training your brain to tackle hard assignments head on, exactly what you’ll need to be successful once you are in the degree course.

I want to get my work experience done before starting my statement.

Awesome that you have work experience, midwifery is a practical profession so this counts for a lot, but I would still get your statement written early for a couple of reasons.

a) You can write about what you’re going to gain from work experience. e.g.

‘I have arranged to shadow a community midwife later this year, and from this I hope to see how midwives achieve care and compassion with a busy workload. This will also give me the opportunity to talk to midwives about the challenges and privileges, and to the women about what they want from midwifery care. I organised this as I know nothing can prepare you for midwifery apart from the job itself’.

See how writing about what you want to gain shows your amazing insight?

You'll look out for more learning opportunities on your work experience too.

You can then add a line or two of specific insight before you send it off, but you know basically what will be in your statement.

b) This will also give you some great stuff to talk about at interview.

If the placement doesn’t work out, that’s a shame but you can be totally transparent and honest about why and you’ve shown you know why it would have been a good idea. And you’ll be even keener to get started!

I just don't have time right now.

Yeah, I have huge time pressures too.

The thing is, we all get the same 24 hours in a day and it depends on what you prioritise right now.

Can you give yourself a few hours a week?

It’s all you need. Book it into your calendar, get someone else to have the kids, explain how important this is to your future. You’re modelling such amazing behaviour.

As women (if there are any guys applying, you’re likely caring people so this applies to you too) we tend to not give our dreams the time and attention they deserve.

We think we can do it with the scraps left over.

But by prioritising this task you’re taking the first step to putting the rights and needs of women at the top of your to-do list. It’s a very worthy thing.

Can I suggest you subscribe to Personal Statement School and then find a few hours a week to go and sit in the library or a cafe and work through the modules?

Even the impact this has on your mental health is worth it.

(I carved out an hour a day dedicated to writing for years. Although I did not feel like I had the time, I did it anyway, and somehow made it work. You can too!).

Any tips on getting started? I don't want to sign up for something when I'm not able to get going.

Yeah, it is really hard. Most of us applying are from the UK and therefore don't have a good relationship with compliments, and this is basically a long list of compliments to ourselves!

Also, if you're female you're probably used to 'one downmanship' or 'one down womanship' i.e. when someone says you're good at something you come up with a reason why it's a fluke or isn't true.

The blank page is something we all struggle with though.

I'd say make a start. Stop overthinking it.

If you have loads of conversations going on in your head you will talk yourself out of it. Brains want us to not take any risks and the emotional exposure of starting writing something with so much riding on it is hard.

But, being a midwife is all about courage.

This is what I do for writing: make a deal with yourself to concentrate on your writing for one hour. You have to sit there with a blank piece of paper and brainstorm all the reasons you'll make an excellent student midwife. Even things like 'I write really neatly which will be good for notes'. The rules are that you are only allowed to write or to stare out the window. No googling for ideas, no calling up your mum. Just sitting and writing or thinking about writing for one full hour.

Then plan another hour in a few days time and spend it circling the top 15 reasons you'll make a good midwife.

You can then come up with a structure (Personal Statement School can help with choosing the ideas and the structure) and you'll have a solid plan.

It doesn't have to be perfect, you just need to start.

Think of all the potential midwives who never even got their application sent off. You're not one of them! If you wait until you 'feel' ready there's a real possibility you'll still be chilling out watching Netflix when the time to send your statement comes along.

I'm a practical person, not an academic or a writer. Will Personal Statement School still help?

Well, good news. The odds are you'll write a sensible, to the point personal statement which emphasises skills like compassion.

Midwives don't need to be highly academic (though there are roles where this is extremely helpful - but there are many more roles where you need to be good with people, dilemmas, have stamina etc.)

Write about what you love doing, in midwifery terms and it'll be fine.

Personal Statement School will show you how to find your experiences and skills and structure them, while referring to the research.

Why are you doing this instead of practising midwifery?

Long story involving mild suicidal ideation and night-shift but I did this as well as midwifery for quite a while. I love clinical midwifery and will be going back to it soon. Application support is one of many ways of helping the midwifery community. Essentially, I love words, love helping people express themselves and I'm particularly fired up by supporting aspiring students and newly qualified midwives.

If you don’t give actual feedback on my statement, will it still be useful?

I don't look at your statement, this is a self directed course, and if you don't learn well in an environment where you are self-directed, this may not be the best fit for you.

However, nearly 1000 aspiring midwives have gone through Personal Statement School and not one of them has asked for a refund because they didn't find it helpful. Instead, there are rave reviews (scroll down).

If you do want one to one help, drop me a line on ellie@midwifediaries.com

There's less competition than ever, is this really necessary?

Numbers of applicants have dropped since the bursary was taken away from training student midwives, but the competition for midwifery is still very high.

Birth is an amazing part of people’s lives and many want to be part of that.

Also, being a midwife means friends and family tend to be proud of you (rightly so) and you’re a useful person to have around.

It also attracts applicants of many ages.

It’s still a course which nearly 7000 people apply for every year, and while statistics vary it’s apparent that midwifery is one of the hardest courses to enter in the UK, probably coming a close third to medicine and dentistry.

Here is a breakdown of applicants per available places in 2019:

700 applicants for 33 places Cardiff
700 applicants for 70 places CCU
800 applicants for 28 places Chester
300 applicants for 17 places Lincoln
1500 applicants for 60 places SHU
1200 applicants for 60 places Stafford
1000 applications for 18 places UWE

But please don’t let this put you off! Many of these applicants will not be successful, due to lack of qualifications, lack of understanding of what midwifery is about, and poor Personal Statements.

Many make the mistake of thinking that if they “write from the heart” they will have a successful application. Passion is important – but your personal statement/interview must focus on the skills that are going to make you a wonderful midwife as opposed to just talking about how much you love midwifery!

This is a learnt skill! REPEAT – application writing is a learnt skill and one you can absolutely master!

For instance, have a look at the following two sentences from a statement. Both are passion filled, which one is more effective?

'Within my friendship group and at work I practice active listening, a skill which midwives need because…'

vs

'I now understand the compassion and listening skills midwives need.'

See the difference?

If you make it to interview, you'll generally have a 1 in 3 chance of getting a place.

If you get help to make sure you’re thinking within the midwifery model, and you help yourself to the right information, you have every chance of success.

What’s your refund policy?

Try Personal Statement School for the first 3 teaching videos and if it’s not for you, that’s okay. Just email me and ask for a refund and I’ll honour it. (This hasn't happened so far but no worries if it’s not for you!)*

*You are responsible for unsubscribing when you’ve finished, I want to be really up front about that and you will find instructions on the welcome email and main Personal Statement School page.

It takes IT support to process refunds and to work out when you last logged in. This means I don’t usually offer refunds if you just haven’t remembered to unsubscribe as it’s not financially viable for such a small business. Hope you understand!

If there are special circumstances, of course, email me at once and we'll sort it!

April 22, 2019 0

Too Busy to Eat Healthy Because of Midwifery? Some Suggestions, What to Eat at Night, and the Midwife Trouser Whistle Issue

Ah, what to eat at night.

The perplexity of choosing snacks which aren’t going to add to the methane problem.

And it has to be tasty because snack time is the best bit of the shift, or at least a close second to pool births.

We know that people who do shifts, especially nights, are more at risk of all kinds of metabolic problems. Everything from extra gas because your tummy’s working odd hours, to obesity and type 2 diabetes to ulcers*. Thanks, vocational career!

But the evidence suggests some of this risk is because of quality of diet and we actually have control over this bit.

There will be times where everything on shift is conspiring to get you to make unhealthy food choices.

But if you’re like me, junk makes you feel worse, especially if it’s part of a pattern of eating badly. As a long distance runner, I can feel what a few weeks of sugar does to my body and it’s not pretty.

Shifts can also make it harder to make healthy food at home. If you’ve have three 12 hour nights, seen six babies born, been there for a cat one section and now don’t have the energy to meet up with mates as planned, it’s easy to stay on the sofa, order a takeout and make sure they put in some of those soft bake cookies too.

We all know that midwifery is way more demanding and important than running, so, let’s fuel right.

Obviously everyone is different and these specific suggestions won’t work for everyone. But take what works and adapt, and if you find something helpful, awesome!

5 ideas for shift work meals you prepare the night before/have at home:

Leftovers, cook with lots of veg and you’re eating healthy the next day with no effort (pasta tomato bake, curry, stew etc.)
Baked potatoes: hear me out. Cold baked potatoes are FABULOUS. Cook them by rubbing them with a bit of olive oil and salt and bake them in the oven. Then have them cold the next day with some cream cheese from a tub and some cherry tomatoes. So easy to prepare. I used to do loads at once and freeze them
Jar of nut butter**, ryvita, and a crunchy apple
Chickpea salad. Tin of chick peas in a lunch box, add olive oil, lemon juice, seasoning, grated parmesan, garlic granules. Add rocket for something green. Tasty and healthy and done in < 2 minutes
I’m into chickpea cous cous at the moment. Chickpea couscous: just add stock, I add tinned tomatoes, herbs (dry) and garlic granules (dry) and top with some grated cheese. Better for you than wheat couscous apparently and again, very quick

5 ideas on what to eat at night:

Porridge, fill yourself up with good carbs – blueberries are supposed to be great at keeping blood sugars steady, use oat milk instead of dairy for less..y'know
Take a homemade smoothie – you can experiment with adding nut butter and coconut oil, which have good fats which will keep you full and healthy. In my experience, the fats seem to help with the gas issue too because we all know smoothies can produce nuclear weapon level sound effects
There’s nothing wrong with having a big cup of fancy coffee before a shift, it’s a treat and you are working against your body clock. Sprinkle with cinnamon, again this is supposed to keep your blood sugars level. Also...it can help you go to the loo, again good for the gas issue
Make yourself a Really Amazing Sandwich – nice seedy bread, cucumbers and spinach, tuna or another protein. Maybe not hummus on the night unless it doesn’t impact you!
Try some very dark chocolate. The magnesium will help you sleep later and the caffeine will keep you up on shift

Ideas for healthy ‘emergency rations’ to have in your bag:

(These are for those times when you have to grab something while doing your notes).

Peanut butter sachets. Nut butter is great natural fuel which doesn't have sugar in, these can be expensive but as emergency food they're my go to thing
Those fruit and nut power ball or flapjack things – or make your own (I just mash ripe bananas with a little water, coconut oil and a few whizzed up dates + the oats to form a sticky mass – in the oven in a tin @ 180 degrees for 20 minutes or so – cheap) – I would have a few of these in your uniform pocket if at all possible!
Electrolytes for your water bottle, these help prevent headaches

My other busy midwife health hack is to keep fresh sauerkraut in my fridge at home. Please give it another chance if you’ve tried it and hated it, the raw food company sauerkraut is absolutely delicious, like a raw, mild crunchy cabbage salad.

The ingredients are just salt and cabbage but it's full of healthy bacteria. There’s limited research out there but it’s been a health food for about 2000 years that to me this is basically a longitudinal research study.

I add this to the side of pretty much every meal, though I wouldn’t take it to work, way too stinky. And my boyfriend loves Kimchi but we won’t go there just now...

Over time, your gut health should get better and it’ll help with bloating on night shifts.

I’m not saying I don’t fall off the wagon from time to time (god, I discovered sesame snaps about a month ago, sometimes you can’t help it) but a healthy diet is important.

I mean, everything in midwifery is important but the health of the workforce is the foundation on which care runs. If you don’t take your health seriously, all the midwifery skills you build up over a career can disappear because your main tool – your body – can’t do it.

Delicious and healthy food that you prepare for yourself = good care for the women.

THANK YOU for doing shift work or being there for women across the weird hours needed.

I’d love to hear from you:

What are your go to recipes for eating around shifts, oncall and nights?
Have you noticed you have more energy when you’re eating right?
If you’re not currently paying too much attention to your diet and you’re feeling bad about it, forgive yourself immediately, you have a really challenging job. But what’s one thing you can do to change things?

Leave me a comment below and don’t forget to share this with anyone midwifery related who might find it helpful.

All my best, Ellie x

P.S. Something important I need to tell you: I have huge problems doing nights. This isn’t something I’m ready to talk about on my blog. As the writer Elizabeth Gilbert once wrote ‘this is a story I’m living right now rather than one I’m telling’ so I hope you understand if I don’t go into more detail. But I didn’t feel right not telling you any of this either, considering I'm recommending some ideas. These really are the foods I used for nights and it did help but it turned out I had bigger concerns.

If you’re suffering because of nights, go and see your GP x

** (Gan et al 2014, this is from the Occupational & Environmental Medicine Journal, a branch of the British Medical Journal) + (Lowden et al 2010, Scandinavian Journal of Work, Environment & Health)

**Obviously be careful around anyone with nut allergies

April 18, 2019 1

11 Responses

Katie Fox
- February 21, 2015 - 2:02 am
- Reply
Hi I’m 12 and hope to become a midwife when I am older do you have any tips or know anything I could work on now towards it??

Ellie
- February 21, 2015 - 7:52 am
- Post Author
- Reply
Hi Katie, thanks for you comment, wow you’re very focused at such a young age! I would come and subscribe to midwifediaries.com for free blog posts on midwifery which are up to date, I have fun with them too so they’re good to read! Volunteering with people is always a good thing to do to develop your transferrable skills, could you get involved via your school with any caring volunteer positions? I’d also start to read everything you can get your hands on midwifery wise, and perhaps come over to the Secret Community for Midwives in the Making on Facebook for an idea of what midwives talk about x

Alicia
- January 21, 2016 - 1:55 am
- Reply
I love your blog and am currently reading your book. Unfortunately, I am from the US so the educational path and such is much different than what you describe in the UK. Do you know of any American midwife blogs? I’ve tried searching online but most are very, very established in their careers and the things they write about are so far off from where I am in my journey to be a midwife.

Ellie
- January 22, 2016 - 6:05 pm
- Post Author
- Reply
Hi Alicia,

Great question! I don’t know many American midwife blogs sadly, though MidwifeThinking is a great Australian one, and SaraWickham.com is one of my favourite UK ones. Please do let me know if you find any good American midwife blogs, I’m always on the lookout! x

Bettina Dwyer
- October 13, 2016 - 3:36 am
- Reply
Hi Ellie,
I just wanted to share a bit of the furore that is occurring in the Queensland state of Australia. Obstetricians are moaning about the poor outcomes etc etc of midwifery led care. http://www.couriermail.com.au/news/queensland/ama-queensland-seeks-urgent-change-to-way-maternal-services-delivered-in-queensland/news-story/5fa372d6478e4cdbba9de7977df224e1
I thought we were passed all this but apparently not.
Pille
- March 23, 2017 - 9:19 pm
- Reply
Hi Ellie,
I’m a first year student midwife, and would eventually like to work as a midwife on First Nations reserves in Canada. Do you have any contacts who have trained as a midwife in the uk and moved over to Canada? Or do you yourself have any idea how the transfer would work?

Rachel Wild
- October 18, 2017 - 11:52 am
- Reply
Hi Ellie – if you particularly want to work for First Nations’ families I would first contact some of the Aboriginal health organisations or governance bodies to scope out how they would see a midwife from the UK working out. Perhaps you have First Nations/ Aboriginal heritage yourself, but if not you’d need to consider the implications of working as a outsider in communities that have a history of colonialism harming their existing birth cultures. e.g. http://www.naho.ca/midwifery/ also your immigration and work visa would be through the Canadian government but perhaps you could also ask permission of First Nation government for the area you’d like to practice in?

Miroslava
- October 29, 2017 - 2:27 pm
- Reply
Hi Ellie, i am a second year student of midwifery in Slovakia.
I would like to ask you, what’s your posture for needs of women who are in puerperium ? What is your opinion for lactation and sports activities in postpartal period?

Thanks, for answer 🙂
Alysia
- November 1, 2018 - 3:42 pm
- Reply
Hello, I have always been interested in midwifery at young age. At the moment, I am a Senior in high school and I am writing a paper on a career that I am interested in. I am required to have an interview with a midwife for research for my pages.Would you mind if I interviewed you for the role?

Ellie
- November 2, 2018 - 7:28 am
- Post Author
- Reply
Hi Alysia, please email team@midwifediaries.com and we can sort something 🙂

Keeley
- April 24, 2019 - 8:24 pm
- Reply
I’d LOVE LOVE LOVE to win a free month of your personal statement school! I’m a 33(nearly!) year young working Mum of 2, retaking 2 of my GCSE’s, training to become a breastfeeding peer supporter, and trying to save as much as I can for 3 years without a wage and shed loads of student debt, with a mortgage! I’ve got your book which I LOVE! But I am still struggling on how to even get started!!! And what experience I have that’s relevant enough to be worthy of going on my statement to stand out! I’ll be applying in Sept 19, to hopefully get a place in Sept 2020, so this would be amazing!!! Pretty pretty pretty please!!!! ??????