So how’s it going?!

It’s been a huge challenge and a massive change from what I'm used to doing. And obviously, I didn't make it easy for myself, I moved from Band 6 to Band 7 and I also moved trusts, which was just ridiculous, really, in hindsight, but I think I've taken it in my stride as much as I can. And yeah, I just love it. I love it so much, it's the best thing that I've ever done.

Brilliant. Do you think certain things would have been similarly hard if you were doing the bereavement role in your original trust?

I think the hard bit was just the transition; as a rotational Band 6 midwife, you know roughly what you're going to get, you turn up to the ward, you get given your assignment. And at the end of the day, you should have done all of your jobs, and then you hand it over to someone else. And now I turn up and I might not have a patient. And then it's up to me to think about what to do in terms of the big picture, implementing the National Bereavement Care Pathway, for example. It’s more abstract work, and I have a responsibility for my calendar in a way that I’ve never really had before. That was an adjustment, as well as being more involved in things like big team meetings with management, talking about changing the processes in the hospital. And being the person that people ask questions of. These are challenges that I hadn't thought were going to be the difficult part. I thought bereavement care would be the most challenging thing. Being more involved in processes and policies has been the biggest change for me.

What does your week look like?

Hinchingbrooke is quite a small hospital, I only do 22 hours, as 3 eight hours shifts a week. I turn up around eight, but it's flexible. Typically, I won't be doing clinical care for patients, that’s not supposed to be the role. But I will be heavily involved in their clinical care especially if we’re strapped for midwives. In the morning I will usually get in touch with any clients who are postnatal. I have a work mobile and they take that contact number home with them. I tend to get in touch first thing and ask if they would like a phone call or a visit that day. 

I do home visits which are not something that bereavement midwives do in every trust. And I think that has been a lovely part of the role because it allows you to liaise with the community teams, so you can take care of clients’ postnatal needs. It's like a mini continuity of care model. It's not 100% that way, but it lets the clients have follow-up at home with somebody who really knows what they're doing. And I’m usually in the privileged position of having met their baby as well, which a lot of clients find comforting.

I'll organise home visits throughout my day, and if there is an intrauterine death that’s diagnosed, or a lady who's been going through the antenatal screening process who gets some bad news, I will go down to the Day Assessment Unit. I’ll work alongside the consultant and sometimes the screening specialist midwife and I will have a discussion about what their options are. We'll counsel them for medical management or surgical management, termination for medical reasons if that's what they want to do, or I’ll just talk to them about what to expect if they decide to carry on the pregnancy. They might end up going down the palliative care route. And those can be quite challenging discussions, but I think it's nice that they have the opportunity to meet me beforehand, and for me to be able to answer their questions before they are admitted to deliver their baby. 

We will also tell them about the investigations that we offer, blood tests, placental histology, cytogenetics and post mortem. I talked to them about how to organise funeral arrangements, we’re able to offer every baby over 12 weeks a hospital funeral here. Not every trust is able to offer that. Sometimes I get to attend funerals as well, it’s an honour to be invited along. I also attend clinic for follow up around the 8-week mark to discuss investigation results and implications for future pregnancies, how their plan of care might look in future. And some ladies who are pregnant again after a loss will get in touch with me for support in a subsequent pregnancy as well. So my role follows them through for a long time. And so I'm providing that care for them, attending some of their early scans. Being in a small trust means I’m in the privileged position of providing a personal service. And to be honest, following people through and attending funerals means I find closure for myself in a way and I’m able to say goodbye to these babies myself. You don’t get to do that as a clinical midwife so much, you don’t get to see how the family grieve and their life after the bereavement, so I’m privileged. 

Another part of my role is in panel review, any intrauterine death or infant loss over 20 weeks is addressed via a panel review, where a consultant obstetrician, the risk team and external reviewers meet to see if we missed anything. And we also address any questions that the parents have about their care, we essentially go through with a fine toothcomb and see there is anything missed, if anything could have been better. And so that's also quite a large part of my job. And to be honest, because I'm only part-time I feel like half of what I do is preparing for these review panels and presenting the information that we find. If we found that we've missed something, then obviously, it's about disseminating that information back down to the other staff and coming up with actions to make sure that it doesn't happen again. It means you need to have a good working knowledge of the policies and procedures for every part of care.

How did you cope with learning everything you needed to?

I share my office with the labour board manager so it's very easy for me to just ask her a question. But starting at the new trust, really the first couple of months, I just had to sit down and read everything. And a lot of the things, you know, are very much the same nationwide. But there was a lot of self-teaching.

In doing these interviews I’ve found that every specialist midwife says, I very quickly taught myself how to do an audit, I very quickly taught myself the stats behind whatever I needed. I think we assume there's some magical thing that happens when you're a Band 7 where you're given the keys to knowledge. But it’s just being proactive and getting experience.

Yeah, there's no magic to it. It's just experience. I think it's exactly the same as when you're newly qualified, I thought I was supposed to suddenly have an enormous amount of confidence and knowledge within the weeks of gaining my pin, and you know, you don’t have to figure it out all at once. I think the other thing is that it's not just me doing that review process, it's a big collaborative effort. So if I sit down and think well actually I’m not sure which leaflets we hand out at 16 weeks because I haven’t done that for ages, it’s knowing I can ask the lead community midwife. It’s supposed to be a pooled knowledge base. So it’s a big learning curve but with good support.

Do you have any advice for student midwives in their first bereavement situation? And any advice for all of us, in terms of bereavement, or vicarious trauma?

My biggest bit of advice is to be open about how you're feeling, and to seek clinical supervision or support or therapy as soon as possible. I personally experienced vicarious trauma when I was a newly qualified midwife. About four months into being nearly qualified, I was involved in a really horrific incident to do with a fresh stillbirth and I did not at the time seek support in any of the ways I would now advise. And it really affected my practice. It was a really long time before I was capable of looking after anyone who was even slightly looking like the same kind of case without feeling my hands start to sweat.. At the time the biggest source of support for me was actually the bereavement specialist midwife at that trust, who honestly is like my personal hero. If I was going to do things differently, and I've had to do things differently since because of this role, it’s that I seek support from management and I’m really open, I say straight away when something has really rattled me. I've sought help through occupational health. I've got myself into counselling, you know, we have to take care of ourselves and be open about it and try not to be ashamed about being shaken by things.

Yeah. The biggest surprise for me during these interviews is how so many of midwives have a counsellor.

Absolutely. When I’m talking to other professionals about this kind of thing the word mindfulness comes up. I’m not sure when this became so mainstream, there are like 1000 apps about it. But looking at the kind of hobbies and things that I do, and the kind of outlets that I seek in my life, I think mindfulness is part of a lot of them. I do things like running where I can just turn my brain off, journaling, writing, and crochet because you just have to count stitches, and you can't think about anything else. The things that I do at home to try and soothe myself are all very much about mindfulness.

And it’s also important to find somebody that you can talk to. For anyone in healthcare, it’s difficult because you can't really go into detail about what happened during your day to those you love, because of confidentiality. But also, especially with bereavement, sometimes people just don’t want to hear about it, it’s a really bleak thing to be talking about over and over. Sometimes counselling is the only way that you can really find somebody to talk to without overburdening them.

Do you have any advice for students or midwives thinking about taking a specialist bereavement role one day?

Probably like a lot of people, in my second year of being a student midwife, I had a bereavement case for the first time and I just instantly knew that it was the most rewarding thing that I'd ever done. It felt like such a privilege to be able to support somebody through something like that. And I think for anyone who's wanting to go down that route, it's a career that’s based on personality and passion. As long as you're getting yourself that experience, then that's the biggest thing that you can do. So put yourself down for working in the bereavement suite or shadow the bereavement specialist midwife if you can or maybe go down to bereavement services and see you know how they do things down there. You can also go along to panel review meetings. I never had a chance to do that before I started the role and I kind of wish that I had. They are useful for student midwives to go to anyway because they go into detail about the policy and procedure.

In terms of students, not every bereaved family is going to feel comfortable having a student in the room with them, but you can still help out with some of the things like memory making, doing hand and footprints, and gaining your confidence in handling babies, which I think is something that a lot of people feel quite nervous about. And familiarizing yourself with the paperwork is vital. It’s something that many midwives struggle with, newly qualified and experienced alike. The biggest stress that I have in my role is going through paperwork that's not been quite filled out properly. And I completely understand how it happens. But if you can familiarise yourself with it before you have to use it, then that's going to make things a lot smoother. Another thing that I did as a newly qualified midwife was I attended a lot of the SANDS (Stillbirth and Neonatal Death Charity) conferences which was extremely helpful. 

Brilliant. Any advice for Band 7 interviews?

I was definitely panicking about my interview for this post. But I actually didn't find it different to my interview when I was newly qualified, it felt very similar. A lot of the questions covered similar ground, you know, how do you cope with stress and that kind of thing. 

The most useful preparation I did was in making sure I was really familiar with the job role and what it entailed at that particular trust, and linking that to things that were going on in policy and governance. I made sure I was really up to date with the MBBRACE report, and the Saving Babies Lives care bundle, those had both just come out. They asked me about my midwifery experience, and I think all of that plus knowing about the panel review process was a good idea. 

And for this role, I think it was such a personality thing, the fact that I'm passionate about bereavement care. I made sure that I talked about my experiences and my deep passion for it. And I think honestly, that was probably the thing that's interesting, more than anything else. I felt like I didn’t do so well on the question about the Ockenden report, there are definitely things I look back on now but I think the fact that I was so passionate came across more than anything. I went in saying, I see that you do things this way and offer certain things to your clients. I also discussed the fact that I’ve only ever worked at tertiary units, and how that has affected my practice in terms of time management and being calm under pressure. I also talked about my experiences with different cultures and my knowledge of different cultural bereavement and grieving processes.

Do you have any advice for students and their first experience of bereavement care? Or for all of us undertaking bereavement care, come to that.

I mean, looking after bereaved families, I could talk about that for about five hours! But basic advice would be to listen to everybody who comes in because grief is really personal. Try to give the woman some power back over the situation by working with her to make a birth plan that makes her feel most comfortable. And use the baby’s name at every opportunity. Because for most women, they're going to have a limited number of times that they see that baby's name written down, or hear their baby's name said aloud, and they crave it. Don’t shy away from talking about their baby. And while you shouldn’t be blunt, don't sugarcoat things. I think a lot of people like to dance around the issue of what has happened, and it can cause confusion. So just talk about the conditions that the babies have.

If you have diagnosed an intrauterine death, you shouldn’t shy away from saying your baby has died. And then give them the time to process that, and understand that grief doesn't go away, you just make room for it. I think people are scared about saying the wrong thing or not being able to say anything to make it right. And that woman's not expecting you to say something to make it right, because nothing can. And you're not going to say anything that's going to make it worse unless you say something ridiculous. So just talk to her and let her say what she wants to say. A lot of my job is just listening and letting people talk about the way that things have affected them. 

Also, find something to say that is beautiful about that kid. You know, they've always got beautiful feet. We do foot casts, sometimes at being able to send somebody home with a plaster cast of their baby's foot which has every line on the bottom and the toenails in beautiful detail is just something that a lot of people really appreciate.

Anything you’ve learnt that you think could be useful in other trusts?

Yes: journaling. We started giving journals to all of the women and their partners who go home and I've never had so much positive feedback about something so simple. If we give out journals to these women, they pour their hearts into them. I've had so many people say I didn't want to write in it and then I sat down and I've written about 50 pages and I've been writing for about four hours. So if there's anyone out there who's a bereavement midwife and they haven't started giving out journals, I’d highly suggest it. It started in our trust because we were lucky enough that a family I looked after donated 56 journals because one of them worked in publishing. So we had this big stack of hardback journals and I made them into little parcels with a pen. And a little note on the front saying that they had been donated by another bereaved family and that they could be used for writing down things that people were struggling with or for writing letters to their baby, writing their memories down, whatever they wanted. And the uptake has been incredible. 

I'm also part of the bereavement midwives forum, which is basically a mass email chain across the entire country with pretty much every one of us, there are 250 bereavement midwives in it. This group has prompted a House of Commons debate. Jane Scott, who is a really prominent bereavement midwife in London actually went and brought our concerns to Parliament, as many of us feel we should have inbuilt supervision in our role, like counsellors get. The fact that it went from just us discussing it to Jane saying well, something needs to happen, we should ask for clinical supervision a standard, is a great example of political action in midwifery.