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Community (Corona Reflections: Day 7)

Community (Corona Reflections: Day 7)

This is a post that started as an email to my list. It's from a series of reflections I wrote as coronavirus ramped up. If you enjoy it, perhaps subscribe here.

 

I've spent the last two weeks having more meaningful conversations than I've had in the last two years.

Turns out my upbringing was much more British than I thought. Growing up, I never felt particularly distant from my friends and family, but our boundaries were in place. We never talked about death or love, way too heavy for everyday.

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April 6, 2020 0

Storm (Corona Reflections: Day 6)

Storm (Corona Reflections: Day 6)

This is a post that started as an email to my list. It's from a series of reflections I wrote as coronavirus ramped up. If you enjoy it, perhaps subscribe here.

 

When I was a staff midwife in New Zealand, the small coastal town I worked in would be hit by 'weather bombs'. These swept in off the sea, whipping tree ferns and scaring the sheep. I was 24, in a new country and something of an outdoorsy nutter, so I found being out in these exciting.

On one wild afternoon, I cycled home from the hospital, battling headwinds, then pushed by tailwinds. I had something to do.

I was soaked to the bone, but I didn't even shower, just towelled off and changed my clothes.

I wanted to do something. I read through my first midwifery blog post for the tenth time, pulled my guts together and hit publish.

It sounds like I'm making it up but there was a shift. My brain gave me an auditory metaphor, the raindrops on the roof as individual readers finding my writing.

I knew it wasn't that great and I had a long way to go, but I also knew this was going to work.

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April 6, 2020 0

Worth (Corona Reflections: Day 5)

Worth (Corona Reflections: Day 5)

This is a post that started as an email to my list. It's from a series of reflections I wrote as coronavirus ramped up. If you enjoy it, perhaps subscribe here.

I'm going to be vulnerable walking onto a ward. I'll try my best and I think if I'm paying attention it'll all come back but it's going to be awkward and hard.

At the same time, I'm talking to a lot of registered staff who are working and not one of them knows what's to come or feels prepared.

All I can do is turn up with what I have. A willingness to help goes a long way.

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April 6, 2020 0

The Big Bang Theory (Corona Reflections: Day 4)

The Big Bang Theory (Corona Reflections: Day 4)

This is a post that started as an email to my list. It's from a series of reflections I wrote as coronavirus ramped up. If you enjoy it, perhaps subscribe here.

I started writing this email as a light-hearted recommendation to watch The Big Bang Theory. I've been enjoying it for about 3 weeks now and it's simple, a re-hashing of sitcom old ground, like Friends but with a group of PhDs who self identify as nerds.

If you don't know the show, the focus is on Sheldon, a theoretical physicist who isn't socially aware enough to know he's being taken care of by his mates.

Obviously, I was addicted from the first episode because my partner and his crew are software engineers. The jokes transfer to our social circle. Sort of.

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April 6, 2020 0

Anger (Corona Reflections: Day 3)

Anger (Corona Reflections: Day 3)

This is a post that started as an email to my list. It's from a series of reflections I wrote as coronavirus ramped up. If you enjoy it, perhaps subscribe here.

 

I was annoyed to hear my local triathlon club are still doing their usual long run session, albeit at a 2m spacing. Afterwards they hang out in their cars and chat through the windows. I'm tempted to ask - can they not just stay at home?

But I breathe, pause and remember that when I'm scared it's easy to cling on to self-righteous anger as a way of making myself feel better.

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April 6, 2020 0

Advice and Strategy for Aspiring Midwives Facing a Remote Interview (phone/skype)

I know how unfair this must feel. Please have a look at this video to stay on your game as an aspiring midwife.

Thanks for wanting to join the profession, you can see how crucial you are.

My advice is:

  1. Be as calm as possible, especially right now admissions tutors will be looking for student midwives who can be creative, empathetic and resilient

     

  2. Focus on what can be done

     

  3. Revise standard interview questions; look around here on midwifediaries.com, Better Births, MBRRACE, the Imperial College London COVID-19 modelling document and see this video (an interview you can 'attend' at home)

     

  4. Revise MMI style questions - in my course there is a format for working through unknown questions which is essentially: common sense, MW/non-MW point of view, wider social and ethical implications, and who's most vulnerable - this is not just for MMIs but for all questions and situations - also see this blog post

     

  5. Put your attention on your interviewer like a light shining on them as opposed to your nerves
I'm sending all my best! You're so brilliant, thanks for being here and wanting to be a midwife! xxx

March 20, 2020 0

On Coronavirus

On Coronavirus

It's really frustrating me that I'm not in practice right now. I want to be making a difference.

Coronavirus is obviously a wild card that the NHS didn't need and the situation will get worse before it gets better.

I'm no expert and I'd advise everyone to listen to scientists and medical professionals, and your Trust, for the latest information and official recommendations.

It's good news that midwifery clients and babies seem to be at low risk - the RCOG Guidelines are here.

And public health scientist and infectious disease expert Michael Osterholm has been sharing a lot of his insight.

I found this interview to be very helpful in understanding transmission and remaining calm and centred.

Twitter is also a great place for information if you follow the right people and critique what you read, this list is a good place to start (thanks Tim Ferriss).

I'm thinking of everyone out in practice, especially those who like me, have elderly loved ones with asthma, high blood pressure and some funky undiagnosable sinus conditions.

And I'm also aware that every professional I've talked to about coronavirus has said 'we will get through this'.

There's a great interview on finding peace amidst the chaos of coronavirus here, lots about on acknowledging fear and letting it come through you so you can find your centre again.

Healthcare professionals will be leading with their calmness and the number one question I'm asking is 'who do I want to be in this situation?'

The likelihood is if you're on MidwifeDiaries.com, you're the kind of person that's interested in caring for others - so if you're doing this, thank you and look after yourself mentally and physically,

All my best,

Ellie x

March 13, 2020 0

Can we talk about this? (Epidurals)

Can we talk about this? (Epidurals)

This weekend I was at a party in a rented Air B and B manor house. It was a blissful spot, with enough room for 30 of us and you know what it's like when you're in a roomful of people you love and you've known most of them since school.

My lot are now all assorted doctors and dentists and are busy getting engaged and getting pregnant, not in that order. We wanted to meet up before everything changes and as always when I go to this kind of thing, the discussion got midwifery themed pretty quickly.

It started with considering old fashioned baby names life Audrey, Dorothy and Tessa.

Then on a windy beach walk, we talked about waterbirth.

And in the hot tub, where some of the pregnant people did join us, because it was the same temp as a bath, and we figured it couldn't be more of an infection risk than having sex (right?) we were discussing pain relief in labour, especially epidurals.

The conversation was prompted by a Guardian article that's making the rounds on Facebook right now. It does acknowledge that a lack of staff, or very fast labours can be reasons that a woman doesn't get an epidural, but overall it focuses midwives denying epidurals to women because it makes for a less natural birth.

So as we sat in the drizzly garden with the jets on, the chat got controversial. Denying anyone pain relief if they need it is a horrific thing indeed.

If you've read the Guardian article, you'll know there are loads of online comments ranging from I'm a midwife and I've never seen a woman denied an epidural all the way to this happens all the time.

It's a personal discussion to many.

On one hand, as someone with a clinical background as a midwife, it's hard not to feel attacked by this article.

It tears into a midwife's role in promoting physiological childbearing, ending "(we need to) eradicate the last remaining pockets of any outdated ideological support of so-called “normal births".

When in actual fact, we know from Better Births and many other sources that women feel denied all kinds of things, including their right to pursue a natural approach to childbearing.

Women are just not listened to as much as they'd like in general.

But then I can't help thinking about that David Foster Wallace short story about fish. Two younger fish are swimming along and an old fish comes over and says 'Hey, how's the water?' and the younger fish reply 'What do you mean?'

Most people can't see the water. Maybe what I'd see as a hard conversation about pain relief someone else would see as outright denial and part of a cult-like culture.

On reflection, I have heard midwives saying that an epidural isn't possible. But the times I can think of are often at the end of labour where an epidural might not have time to take effect, rather than denying a woman a choice to promote normal birth. Or during early induction when an anaesthetist might find it hard to get an epidural working because, to quote one of my anaesthetist friends you have to have pain to have it taken away.

As we walked back up the drive, across the village and towards the station to catch our train home, the results of the polled healthcare professionals were that only one agreed that sometimes midwives do promote normal birth in this way. I'm not sure if this is relevant, but the doctor was on first her obs and gynae placement, and was quick to tell me she was very new and very afraid of birth.  Hmm.

I'd like to say I came to a solid opinion on whether women are denied epidurals. But all I can say for sure is the Guardian article lacks nuance, and because of this, I'm pretty sure it will blow away and be forgotten.

But I hope women's experiences won't be. When I'm back in clinical practice in September, I want to be able to see the water. I want to be good at listening. I want women to be able to tell me their opinions and discuss what they need as easily as if we'd known each other fifteen years and were sitting in the garden in a hot tub, whether that's an epidural asap or a waterbirth at home.

I'd love to hear from you about all this.

Do you have any experience with women being denied epidurals? Or anything to add on the subject of midwifery in the media?

Leave me a comment letting me know.

 

March 5, 2020 0

A Simple Summary of MBRRACE 2019

A Simple Summary of MBRRACE 2019

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

We have to be so careful about keeping our privilege front and centre.

 

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

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

11 Responses

  1. 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??

    • 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

  2. 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.

    • 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

  3. 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.

  4. Pille

    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

      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?

  5. Miroslava

    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 🙂

  6. Alysia

    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?

  7. Keeley

    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!!!! ??????

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