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Is 37 weeks a full term pregnancy?

Is 37 weeks a full term pregnancy?

I run a big midwifery Facebook group and one of the questions coming up a lot recently is:

‘Is 37 weeks pregnant actually term?’

Follow up questions include:

Is a Mum allowed to use a birth centre if she’s exactly 37 weeks pregnant? What about if she’s one day before that?

Does a baby at 36+6 need extra observations and heel prick blood glucose levels doing? What about if the heel pricks stresses them out and interferes with breastfeeding? Could we just pretend they’re 37 weeks since it’s so close?

How important is this concept of 'term' anyway?

I can easily get stuck on this kind of question. This is my typical thought process:

1. SAFETY! Safety first, I have a responsibility to offer the safest care I can, and who am I to question guidelines, I’m just one fairly junior midwife

2. Lots of excellent midwives I know are fans of cut off points, so there must be good evidence for this

3. But when I look up the evidence or read researcher’s blogs words like ‘low quality’ and ‘weak’ start to pop up...are we making decisions based on culture again?

4. Conversations about due dates, induction of labour, and whether babies born at 37 weeks are more at risk are HARD!

I bet you’ve come across similar problems?

You might know about Dr Sara Wickham, I have a burning desire to lock myself in my room and binge read her blog fairly often. She’s a researcher and independent midwife.

She and other researchers have a lot to say on the topic of due dates and the concept of being 'term'.

For instance, the 280 days of pregnancy we use to estimate the ideal length of pregnancy appears to come from something called Naegele’s rule, which we started using in the 1800s. There’s not much new evidence to back it up.

(Naegele was a German Obstetrician or a ‘dirty old man who names things after himself’ to quote one of my old midwifery lecturers, smashing the patriarchy one physiology lecture at a time...).

Only 4% of babies will arrive on their due date. Also, there’s evidence to suggest that dating scans are only as accurate as last period dates. They're not as precise as we sometimes like to think.

Also, what about genetics, ethnicity and even nutrition? Wouldn’t it be weird if these things had no impact on a woman’s ideal length of pregnancy?

All in all, due dates are questionable.

The other thing is, we’re not really sure what starts labour. It’s a synchronised swim of hormones and physiology. It's not a factory process which notices a finished baby and then ships it at the correct date.

How do we know if a woman’s gone into labour for the correct physiological reasons or if something else has started it? We don’t often have clear answers. One baby could be completely ready at 37 weeks and another might be displaying breathing problems associated with prematurity.

We also don’t know why! Is it because women have varying length pregnancies or because we have due dates wrong?!

What we come back to is:

What even is a full term pregnancy?

I’ve come across some evidence from the American College of Obstetricians and Gynaecologists which suggests that the idea of ‘term’ simply looks at the evidence on how babies get on when they’re born. On average, at 40 weeks, babies have least respiratory and other problems, though anything from 37-40 weeks looks pretty good too.

But newer evidence suggests babies born between 39-41 weeks do ever so slightly better. This means in the USA, 37-38 weeks is now considered ‘early term’.

But these studies aren’t perfect, the concept of a due date is just our best educated guess.

So is 37 weeks actually term?

If we going to go along with the concept of a term pregnancy, most  guidelines, including those from the UK, say yes. America has recently renamed 37-38 weeks ‘early term’.

But as with all these things, it’s a line in the sand based on all available evidence.

Mother Nature didn’t leave us with a rule book saying ‘pregnancies will end between 37 and 42 weeks and if this doesn’t happen medical science will need to intervene’. It’s all just on a scale.

Having good observational midwifery skills and knowing the things that babies need like breastfeeding, skin to skin, rooming in with Mum, etc., are all good ways of supporting a baby who may or may not be a little early.

I’ll be making it my mission to to get to know every Mum and baby as an individual (as far as possible in busy practice!), as this is the best way of picking up on issues.

Now I’d love to hear from you:

Have you had experience with babies born around 37 weeks? Any stories you can share to teach us?

Is questioning the evidence and not having absolute answers about due dates outside your comfort zone? If so, what’s one action you can take to better communicate evidence to women?

Hope you found this as interesting to read as I did to write!

All my best, Ellie xx

p.s. Comments welcome, please put in as much detail as possible. You never know, what you add might prompt the breakthrough that another student or midwife needs to support a woman 🙂

April 11, 2019 4

Confused by the New NMC Education Standards? I explain via Video Blog :)

If someone asked you what the new NMC education standards mean for midwives training in 2019 and beyond, would you know how to answer?

Or would you think ‘I should know this, I care!’

Maybe you’ve had a look at the new Nursing and Midwifery Council guidelines on education and gone ‘ack, complicated, what?’

When you see 19 separate guidelines on practice supervision in corporate speak on the NMC website, it’s easy to get demoralised.

But it’s actually pretty straightforward.

In this post I’ll set out what you need to know in easy terms and with some of my informed opinions sprinkled in, ‘cos it’s my blog : )

You can also watch the video if that's easier.

In 2017, the NMC ran a consultation on education standards that midwives could add their opinions to. There have been panels and independent evaluation groups at the NMC looking at changing and improving education for midwifery since then.

The NMC have said several times that new education standards for midwives are needed because the world is changing, women’s lives are different and midwives have a more demanding role and skill set than ever before. Events like those at Morecambe Bay will likely have been a reason for the new standards too.

These standards will be rolled out from winter 2019.

The changes that stood out to me are as follows:

Care simulation hours will no longer be capped. Unis will be able to have their students spend more time in skills labs if this is what they feel is best. Students tend to value these sessions, so as long as simulated practice doesn’t outweigh real practice, this sounds like a good thing to me.

The NMC will also be adopting prescribing guidelines from the Royal Pharmaceutical Society, which sounds fine. Midwives have stringent rules around prescribing anyway since unlike nurses, they can prescribe pretty much from qualification, so I can’t imagine this will be too different. Interestingly nurses will also be able to prescribe as soon as they’re qualified too when previously they had to wait three years to apply.

But the most important change for me is that clinical mentors will no longer be a thing.

In the past, student midwives has ‘personal tutors’ doing the academic side of things and ‘sign off mentors’ who they had to work with 40% of the time in clinical practice.

Under the new standards instead of these there will now be:

Academic Assessors

and

Practice Assessors

These two staff members will collaborate on how students are doing and together recommend that students should progress to the next stage of the course (or not) .

This is an interesting change because students don’t have to work with one key mentor as much.

Instead they can work with ‘Practice Supervisors’ who can be any staff member regulated by the NMC. ‘Practice Supervisors’ might be newly qualified midwives, paediatric nurses, basically anyone with good skills to teach students. The new standards mean anyone regulated can muck in with teaching.

Practice Assessors will collate feedback from Practice Supervisors.

It’s my conjecture that students will get to work with more people and there will be more flexibility about teaching in placements. The same standards or higher will apply and unis and placements will be able to organise themselves as they see fit.

This might mean more student midwives can be trained, which is what the government wants and the country needs.

It also might mean nothing changes in some places. Students will continue to primarily work with sign off mentors just under the new name of ‘practice assessors’.

I’m very capable of criticising the NMC when necessary (see my series of posts from when Independent Midwives weren’t allowed to practice), but for me, in terms of the new education standards, it looks like there’s potential for students to get an amazing level of education.

Of course, this is all up to universities and trusts.

It also means as a newly qualified midwife you may end up having a student with you much sooner.

This could be a problem, we don’t want the blind leading the blind. But the newly qualified midwives I’ve met are up to date with the research and have a ‘third eye’ of hyper vigilance in terms of accountability and asking for help. They may also get how to teach students midwifery skills since they’ve had recent experience of being students themselves.

The only issue is continuity. With ‘Better Births’ being implemented around the country to achieve continuity for women, with all the benefits and satisfaction that seeing one midwife provides, I can understand why many are wary of taking continuity of mentorship away from students.

But I think there’s always been a need for students to find their own mentors to help nurture them through their career.

The midwives who formed me most didn’t necessarily mentor me, I was won over watching their practice or reading their books or online comments. I made contact at conferences or found out about their work through groups like the Association of Radical Midwives.

Often it was all to do with the emotional wellbeing of women and how they made them feel, though of course epic clinical skills are vital to underpin this.

It’s also this group of informal mentors that I learnt midwifery intuition from : )

Under the new NMC education guidelines, it might be even more important to seek this kind of mentorship out for yourself.

Once you’ve read this through, I’d love to hear from you. Leave me a comment letting me know:

1. How do you think the new NMC education standards will impact you?
2. Do you have a midwifery role model? How did you meet them or learn from them – how would you suggest a student or newly qualified midwife find such a person?

April 4, 2019 2

My Granny Inspired My Time Management Skills As A Midwife

My Granny Inspired My Time Management Skills As A Midwife

Everything’s happened at once this week. My Granny died and though she'd been lost to dementia for a long time, and it was expected, it’s still knocked us sideways.

I also have a family friend who’s passed away unexpectedly, age 52, so I’ll have two funerals to attend next week.

Both my Granny and my family friend wouldn’t want me to ease up on my midwifery support business and writing so I’m trying to keep the plates spinning while doing family stuff. And it’s an unexpectedly beautiful February with canopy blue skies and cold air. Enjoying this is vital.

Aspiring, student and qualified midwives are often overwhelmed. When you’re midwifery inclined you’ll have a caregiving role in your community and family. You'll typically do a lot of carrying everyone down the path.

I have no idea what’s going on for you at the moment but I know you have inner strength and I also know it can feel hard to get that out into the world just because of the sheer volume of life admin!

My granny was a tenacious person. She ran a small business selling floor tiles while bringing up two kids and an endless stream of rescue dogs. Her time management skills were second to none. To be honest, I was quite scared of her when I was little, she had strict rules, and her dogs could be a bit bitey (!) but as I grew up I had respect and love for her.

My life is jam-packed right now.

I bet yours is too.

I remember my Granny tackling things bravely, straight to the point.

Here are my time management strategies based on her example.

This will show you how an old-school, overly busy, incredible woman organised her life and got all the important tasks done, while still enjoying her kids and dogs:

  1. Sit down for twenty minutes and make a big list of everything you need to get done. This should include midwifery training, any revalidation work due, but also stuff like needing to do the washing, birthday cards, bills to pay, doctors appointments etc. The aim is to get everything out of your head down on paper. Once it’s on paper it will stop chasing your thoughts around and you’ll be able to tackle things one at a time.
  2. Cross out any tasks that don’t need to be done (coffee with that person you secretly find really annoying? If there’s not a good reason, remember you’ve only got one life, seize the carp and politely decline) - and cross out tasks you think you ‘should’ do but aren’t actually that keen on!
  3. Crucial: ask for help. Where can you delegate or pull in a favour? Remember how good it feels to know you're helping, it may be there are people in your life who are just waiting for you to ask.
  4. Put the tasks into categories. Those that need doing today, tomorrow, and this week. Those that need doing next week. Those that need doing next month. And those that can be left until beyond that. Then plan out the next two weeks using your diary, write out all the tasks. Add all appointments and shifts to your calendar. You now have a plan and even if you don’t manage to carry it all off, you’ll have a much clearer idea of what needs doing and the essentials will get sorted early.
  5. Schedule in at least one thing a week that you just WANT to do. It might be escapism with a book or TV series. Or a beauty session. My granny would have taken the dogs out for a three hour romp in the country somewhere.
  6. Always have tea and snacks on hand for all of this planning. My granny liked Earl Grey and brazil nuts (and secretly, biscuits).

This process will save you time and effort getting everything done. You’ll then have more headspace to be with the women you’re caring for and you’ll be able to enjoy the people around you. Being organised with a calendar might sound basic but this is all the successful, caring people I know to do this or something like it.

The opportunities to enjoy life can slip through your fingers if you lose them all to just tasks. Midwifery time management on wards is so difficult, you won't have time to write lists, but the same structure should apply. Do the most important things, delegate and ask for help if possible. Try and do at least one thing a shift which you really enjoy.

The picture at the top of this post is my Granny getting married in 1948. She’s 18 years old. She died aged 89 still married to my Grandad. She was a woman who handled a lot and her life wasn’t easy.

But she loved the time she had with her family and pets and we will always remember her as a woman of strength, tenacity and a wicked sense of fun. She knew how to prioritise.

Hope this helps you as much as me,

Much Love, Ellie x

P.S. I’d love to hear a) what lessons have you learnt from your older family members that apply to midwifery and b) how do you manage your time?

Leave a comment letting me know!

February 21, 2019 6

Bullying in Teams: How to Survive It and Thrive – A book by Chartered Psychologist Aryanne Oade

Bullying in Teams: How to Survive It and Thrive – A book by Chartered Psychologist Aryanne Oade


Have you ever worked incredibly hard, only to find yourself being criticised and dominated? Especially in midwifery, where all you want to do is get it right for women and families, this can be hugely damaging to your confidence and your practice.

If you’re a kind and empathetic person it can be hard to identify that what you’re going through is bullying and that you need to do something about it.

Enter Aryanne Oade’s ‘Bullying in Teams’. I’ve written about Aryanne Oade before, she’s a chartered psychologist who specialises in challenging workplace dynamics. I came across her on a recommendation of an NHS midwife friend of mine.

Bullying is a toxic, dangerous phenomenon in midwifery.

Research and reports (The Francis Report, The Kirkup Report) show that care is compromised and morbidity and mortality can occur when the culture is bad enough. Every student and midwife needs to know how to stand up for themselves and their workplace.

I know many of us go into midwifery wanting to believe that all professionals will be kind towards everyone.


The problem is when you believe everyone in the midwifery is lovely, you bend yourself into pretzel shapes to keep this belief intact – even if they’re being unkind. When they’re having a bad day, or when they have methods of coping with the work that adversely impacts other staff members, you find yourself making excuses:

‘They’re reacting to the pressure of the service.’

‘I must have a personality that they don’t gel with.’

‘They’re lovely to the women, they probably just don’t have the head space for me.’

You might find yourself thinking things like this even when a midwife colleague has just said something like:

‘Some people pick things up quicker than others – don’t they (your name)?’

Charming. And not constructive.

Without getting into my personal life too much, I’ll just let you know that it was unacceptable for me or my siblings to get too angry or advocate for ourselves while growing up in our family.

If there was someone bullying us my parents would always ask ‘and what did you do? What’s your part in this?’

This isn’t a bad thing, I owe my parents a lot and I don’t think it’s a coincidence that my mother and both my siblings are in caring professions.

My parents were doing the best job they could to keep three wild kids under control and we probably needed reminders to think of others.

But in the adult world, if empathy is the only tool in your toolbox, you’re going to struggle.

There are patterns of behaviour that prelude bullying and in midwifery practice, they’re just as important to pick up on as clinical signs of pre-eclampsia or APH.

The information in ‘Bullying in Teams’ is vital. In practical style with lots of examples you’ll learn how to:

  • Protect yourself from being affected by poor culture
  • Restore your dignity
  • Understand that bullies are adept at exploiting any room for manoeuvre you may inadvertently give them through using unassertive behaviour. You can learn to protect yourself and the book will show you how to do this, through acquiring both mental and behavioural skills
  • Identify patterns of behaviour that lead to bullying and how to respectfully challenge them, for you and others
  • Recognise undermining behaviour
  • How to use phrases and body language that will establish your reputation as a student or midwife who deserves respect
  • How to encourage those around you to support you and challenge bullying
  • Restore your self-confidence

A ‘standing up for yourself’ toolkit is vital and you have a very good chance of turning poor culture away from you and your practice.

And as a sensitive, excellent student or midwife you have every right to get your voice heard. In fact, we need you to lead.

But if you’re anything like me, the thought of even needing such a toolkit is difficult to accept.

In practice, I aspire to be a midwife Gandhi. I rage against the idea any midwife could be unkind, I’m committed to seeing the best in everyone.

In reality Gandhi was actually lawyer and was amazing at standing up for himself and others.

One of the hardest lessons I’ve learnt in my life is this:

You can empathise even while recognising someone is behaving badly.

 You can know that a person attempting to bully you is a good human being at heart and they’re doing the best they can.

But at the same time, you have to realise that not everyone experiencing distress reacts in the same way as you.

There are many who are desperate and though they come across as tough, they’ll do anything to save themselves, including bully and power grab.

Empathy is wonderful but there have to be boundaries. Without boundaries, you lose yourself as a person and a midwife and you let other people decide your path.

You might also be thinking ‘but constructive feedback is important, shouldn’t I be listening to everything and working out what might be helpful?’

Yes, absolutely. But there’s a big difference between constructive feedback and someone trying to take you down. You know the difference in your gut. Trust it.

In the example at the start of this blog, where the midwife said ‘some people pick things up quicker than others – don’t they?’ a good response might be something like ‘you seem to be implying I’m not a good midwife or learner. What exactly do you mean by that?’

This would have alerted the midwife in question that her colleague’s good standing and ability to learn wasn’t up for debate.

We have record numbers of newly qualified midwives leaving the profession. And one RCM report found 43% of midwives and student midwives have been bullied (NB: there are study limitations)

There’s only so much self-doubt that is actionable and helpful so you need to draw your own lines around your self-belief and keep them there.

To me, this is just as important as knowing what to do during a PPH. Women’s safety depends on it.

Aryanne’s books are like nothing else on the market; I have no idea why this isn’t a mainstream topic? Why are there not guides to behaviour in Myles and Mayes midwifery?

Possibly it’s just a hard skill that few are prepared to teach professionally.

The RCM ‘Caring For You’ Campaign and the government report ‘The National Maternity Review’ are drawing attention to the importance of workplace culture in achieving satisfying, safe care for women. The way we think about these skills is changing.

I believe both Aryanne’s books, ‘Free Yourself from Workplace Bullying’ and ‘Bullying in Teams’ should be on every student and midwife’s reading list.

Now I’d love to hear from you:

  • Have you read any of Aryanne’s work? What did you think?
  • Do you already have a ‘standing up for yourself’ toolkit? Any tips?
  • Have you developed any of these skills and is there anything you can share?

Leave a comment below. I hope this helps and I’m sending so much love and respect,

Ellie x

February 6, 2019 1

“Tell me, what is it you plan to do with your one wild and precious life?”

“Tell me, what is it you plan to do with your one wild and precious life?”

I got to talk to a lovely trans male midwife this week. He’s called Nathan and I’ll try and get his whole blog post up soon.

The most important thing I learnt from Nathan was this:

He and every other trans sibling he’s asked believe that motherhood and womanhood are what midwifery are made of.

I don’t know if you’ve heard but there are some debates that ‘woman’ and ‘mother’ are too gendered and shouldn’t be automatically used in midwifery?

Nathan believes that all midwives and other healthcare professionals should be aware that you can’t tell someone’s gender by looking at them, and be open to asking questions about pronouns, especially if there are cues like more androgynous clothing.

But motherhood is too important a word to take out of childbearing. It's just we need to ask people what they need from us with sensitivity.

Nathan stance on this argument goes with my gut, but I’d love to hear your thoughts.

There’s a fantastic blog from Shawn Walker (RM, PhD) here that covers the concept: Can “mothering” be gender-neutral?

In other news, I’ll be going to Mary Cronk’s funeral tomorrow. I didn’t know Mary but I think she’s extraordinary. The daughter of a unionist, she campaigned for women’s rights in maternity care, became a breech birth expert and was amazing at handling complex politics.

You can see more about Mary and some important fundraising in her honour here.

If you have a few seconds this week please think of her and her family. Also the fundraising is for the Association of Radical Midwives, if you can add anything, she'd so appreciate this.

It’s a strange coincidence that as I was putting this blog together I found out another Mary, one of my favourite poets, Mary Oliver has died today. I'm quoting her in the title of this blog:

“Tell me, what is it you plan to do with your one wild and precious life?”

May we be as brave, clever and funny as both Marys, and as open and wise as Nathan.

Much Love,

Ellie x

January 17, 2019 0

Christmas Midwifery

Christmas Midwifery

Thank you if you're working Christmas. We're all impressed and comforted by the people who keep caring for us. There's sacrifice involved and we don't underestimate it.

Some students and midwives shared their thoughts on Christmas time with me and I thought you might want to see. I asked them how they coped and this is what they said (picnic in the lounge anyone? 😉 )

'I practice smiling, telling myself I am empowering my women and their families! I’m an enhanced midwife so my clientele includes safeguarding/MH/teenagers/asylum seekers/learning disabilities/domestic abuse/substance misuse.
And let’s not forget alcohol and cake/chocolates haha! Merry Xmas x'

'By reading! Getting lost in an evocative novel in another time and place. Releasing and processing emotion and memories that way! Kate, student midwife.'

'I’m going to drink lots of gin! On a more serious note, I’m going to cherish every precious moment I get with my beautiful babies. I’ve taken the pressure off everyone this year by saying we aren’t making a traditional Christmas dinner as we all spend so much time stressing about it and then precious time on Christmas Day is spent in a kitchen cooking. Instead we are having a picnic on the lounge floor with the children and I’ll be soaking up every second (whilst in my PJs with an all important gin)! '

' - How to "keep afloat" during the Christmas season? Spend the Christmas season nourishing your body with good food, thoughtful conversations and reflect on the year. What was my midwifery highlight? What was my personal life highlight? And look closely at the balance between our midwifery lives and our personal lives. It needs to be balanced! I believe the happiest, most productive midwives have many passions besides midwifery to keep them refreshed in their midwifery roles. But sometimes it can be very easy to have that balance 'out of whack'. Spend the Christmas period planning for the next year and 're-balancing' where necessary. Sometimes filling up our own cup doesn't mean we're selfish, because we need a full cup to give to others. And empty cup has nothing to offer. 
Have a beautiful Christmas, Meg.' 

'I stay afloat with lots of coffee, and I finally started seeing a counselor (online). The stress of everything has been getting to me and as much as I’d love to connect with other women in person, it just hasn’t been happening. Its been a good release. It’s a hard gig trying to be a mum and a midwife. ' - Allie

' I start my midwifery degree in September! But a massive thank you to all the midwives out there who are working so so hard this Christmas, everything you do is appreciated. True superheroes.'
- Mia Gwynne - Smith 🙂

'I will be working Christmas on Delivery Suite, very happy , I really love it!! ' - Amaia

'I keep afloat by focusing on the positives and the women. It's easy to dwell on everything that's wrong with the system. And believe you me I indulge in that plenty but when it's really tough I find focusing on the tiny things you can do to hone in on individual women in a system that just doesn't, makes all the difference. A section that shouldn't have been a section… When everyone is focused on the baby, I focus on the woman, hold her hand, explain what's going on, tell her how amazing she is for having just birthed a baby etc etc. In a booking where she's been waiting for hours, listen to her, tell her she's amazing for getting this far and she's well able for what's to come. Knowing that these tiny insignificant things are night and day. Knowing that while the broken system ties your hands and restricts your practice, there are some small ways you can make a difference. Seeing your very sick women from antenatal come back to a postnatal clinic with a beautiful baby… These tiny things all keep me afloat, especially at this time of year when inductions are Christmas crackers.' - Deborah

Here's to 2019 being amazing for care and I'm hoping midwifery and the NHS in general will receive much more funding and political support.

Love to everyone, from Ellie and all the midwives/students involved in this post xxx

December 25, 2018 0

Refreshing My Learning on Midwifery Support For Asylum Seekers and Refugees

Refreshing My Learning on Midwifery Support For Asylum Seekers and Refugees

I think most of us would like to provide incredible care for anyone having to flee their country. It occurred to me that I haven’t learnt anything on this topic since I was a student and given all the events in the world right now, I was overdue for some study.

I headed over to all4maternity.com, made a cup of tea and settled into their refugee module.

Here’s what I found, both from all4maternity and from my own research which the module prompted:

Refugees are people who have been granted asylum in the UK.
Asylum seekers are those still going through the process.

In 2017 there were more than 120,000 refugees and more than 40,000 pending asylum cases in the UK.

Interestingly, it’s developing world countries that offer the most places for refugees. Turkey currently has 3.5 million refugees with Pakistan and Uganda also taking large numbers.

Reasons for this might be Turkey receiving international credit for taking refugees but there's also a culture of helping others in Islam which is prompting this care. Though obviously, Turkey shares a border with Syria so proximity is a reason too.

Being a refugee in Turkey is very different from in the UK, though. Refugees often receive only a temporary right to stay in Turkey and they may be expected to stay in camps.

I think many people in the UK believe that refugee applications are rising but actually they've been stable since around 2002.

The UK asylum process is incredibly tough, complex, and often seems unfair; for instance, in 2015 38% of appeals on asylum cases were upheld in the asylum seeker’s favour.

Imagine what it would feel like to run from your country, apply for asylum, supply all documents and evidence that may be very difficult to get and then to have your application refused on unfair grounds. You’d have to be brave to challenge this, even if you knew the decision was wrong.

It’s intensely distressing to think of a pregnant woman or a new mother going through the asylum seeker process.

Other factors that healthcare professionals need to consider include the experiences of mothers and families escaping from political or other persecution. Refugees have often walked hundred of miles, lost their homes and possessions, and seen death and violence. Mental illness, particularly PTSD will be a concern. There’s good evidence to suggest continuity of care might be a wonderful way of supporting women in these situations (imagine having to retell your story every time you see a midwife, as it’s a new person – continuity of care would avoid this and help you find coping strategies for labour and parenthood).

Malaria and tropical diseases screening and care are also factors to think through with this group of women.

If a woman presents as very unwell and she is a refugee or has spent time in a refugee camp, she is at much higher risk of these. A midwife caring for a woman being removed from the UK needs to consider if anti-malarial prophylaxis is necessary as well.

Asylum seekers do have the right to full, free NHS care but sometimes they don’t know this.

Women in the immigration system are at risk of not coming for care anyway so it’s important to get this info to them. Combine a woman reluctant to seek care with a language barrier, and perhaps inappropriate translation going on and you can see why this group is at risk. Professional translation services should always be used, there might be safeguarding or accuracy risks if friends or family members are used.

What I found extremely startling was the transition between being an asylum seeker and being a refugee. In the UK, once you’re granted refugee status, you have 28 days to start claiming benefits and find new accommodation; in practice, this is often unachievable and many refugees end up on the street.

In summary, being a refugee can be a lonely, terrifying process and midwives can offer life changing care. You can support someone at their lowest. (see the 'p.s.' below for a real example of this).

I would highly recommend subscribing to all4maternity.com and heading over to do some further learning with their refugee module. It's the online learning tool put together by the journal The Practising Midwife, perfect for aspiring, student and qualified midwives.

The references are all there too.

All4maternity has some brilliant learning on subjects as diverse as refugee women, delayed cord clamping and midwifery resilience. It’s easy to navigate and if you learn best curled up with a hot drink with your laptop, instead of at the library with lots of hefty books, you’ll love it.

Now I’d love to hear from you! Leave me a comment letting me know your experiences with women seeking asylum – or your own personal experiences?

Is this care you’d like to be involved with?

I know you might feel stretched thin at times but your contribution to women’s lives means more than you realise.

Much love and keep going x

P.S.

For a bit of inspiration on what midwives can do for asylum seekers, see this interview with Deborah Hughes – who offered a woman on her caseload asylum and helped her retrieve her baby from Africa where she was scheduled to have FGM.

Honestly, if you’re ever doubting midwives have an impact, this blog will help #faithrestored

December 5, 2018 1

What happens if a woman wants a homebirth and it’s too complicated? (UK)

What happens if a woman wants a homebirth and it’s too complicated? (UK)

This is just about the most important question in midwifery. A woman's right to choose where she gives birth says a lot about the system that's offering her maternity care.

In the UK, it’s a situation that’s recently been impacted by some changes to midwifery law. In particular the removal of supervisors of midwives.

The basic answer is: if a woman with complex needs chooses to give birth at home, even if a medical team and trust feel it’s unsafe, care must still be provided.

Unfortunately in practice it's a lot more complicated than that.

Back in 2016 if a woman with complex needs was planning a homebirth, a meeting might take place with the head of midwifery, obstetric team and a supervisor of midwives.

Or if a client was in labour and no plan had been made, there would be a supervisor of midwives to call to try and find a solution. Supervisors of midwives were on call 24/7.

These days because supervisors of midwives no longer exist, the process is different. England, Ireland, Scotland and Wales all have different approaches to supervision but it’s now employer based as opposed to midwifery profession/NMC based.

In England, ‘Professional Midwifery Advocates’ (PMAs) have now sort of replaced supervisors.

However, they don’t have legal responsibility towards midwives in the same way as supervisors did. It’s now the trust who have this responsibility. Supervisors can encourage education for midwives and good communication between midwives and clients but they no longer regulate. Some trusts offer 24/7 support from PMAs and some don’t and midwives are telling me it's a weaker style of advocacy for women.

There are also some other challenges midwives and women are facing around homebirth.

As we all know, we are thousands of midwives short in the UK. Trusts can refuse to send a homebirth midwife due to lack of staffing and this does happen. (I have heard of one trust who got fined for doing this repeatedly).

I’m also hearing from homebirth groups that sometimes paramedics are sent to provide care for labouring women in lieu of a midwife. Paramedics are amazing in emergencies. But a labouring women needs a professional able to support her normal physiology and recognise when medical expertise is needed. Paramedics haven't been trained to conduct planned homebirths.

Another alarming report I've heard from midwives is of social services being sent to visit women planning a homebirth against medical advice. This seems very unkind and unhelpful to me, unless there are true social issues that need addressing.

Finally, there may be times a midwife feels she's not the best person to attend a certain woman - for instance if a baby is on its way in the breech position.

If a woman is labouring and a midwife refuses to attend her because she’s not skilled enough for the situation, it’s unclear what the legal ramifications would be. It might end up with the NMC trying to investigate whether that’s true, though obviously that's not very helpful to the woman when she's needing a midwife there and then.

As far as I know, human rights laws mean that if a trust tried to stop a midwife from attending  a birth and any harm came to the woman or baby, the trust may have breached the ‘right to life’ (I’m quoting from Birth Rights legal charity here).

Often in practice a woman will be asked to sign to say she understands the risks and midwives are sent to support her, though any of the above situations could happen.

Essentially, any woman still has the right to birth at home. But the logistics can be complex.

Has anyone been through this recently, as a woman accessing care or as a midwife? I’d love to hear what happened to get it clear in my head. Please comment below. Much love, Ellie x

November 15, 2018 3

The One Time In Midwifery I Want You Not To Empathise (Read: ‘Free Yourself From Workplace Bullying’)

The One Time In Midwifery I Want You Not To Empathise (Read: ‘Free Yourself From Workplace Bullying’)

“I suggest you rethink that care plan,” said the co-ordinator to me, quietly, but in front of a group of doctors.

Nothing so wrong with that. But in the context of daily puts downs, blank stares and a lack of humour or respect, it forms a pattern of bullying.

To summarise Aryanne Oade, author of ‘Free Yourself From Workplace Bullying’, bullying is made up of:

  • Personal attacks which you find emotionally or professionally harmful
  • Deliberate attempts to undermine you
  • Deliberate attempts to remove power from you, especially when the bully keeps the power for themselves

At first, it can present as the staff member testing to see if you react.

If you wobble at an nonconstructive piece of criticism - ‘that’s a mistake that I’ve never seen on this ward – ever’ - it can then progress to more frequent attacks.

But even though I've read all the books and have experienced bullying a few times, it's still really hard for me to react well. 

When I face bullying behaviour, I experience mental and emotional confusion. I don’t want to think badly of anyone so my first instinct is to think I've misunderstood or I'm overreacting.

The co-ordinator I'm writing about was particularly bewildering because I’d seen her been kind to women in her care. She had amazing clinical skills as a midwife.

And yet she was horrible to me.

I assumed it was my fault, that I wasn’t up to scratch, that perhaps I was annoying. That I should be able to show her what bringing me down in front of the doctors was doing to my confidence.

Surely if I could get into her head and heart I could convince her to be kind?

With the greatest respect, this is the one situation in midwifery where I want you not to empathise.

Empathy is not going to work with someone who has chosen to use aggression in the workforce. This co-ordinator had chosen to remove my power so it's unlikely she had any interest in emotionally supporting me. I believe she already felt entitled and like she belonged at that hospital, and experienced little to no self-doubt. Me reaching out to her and explaining how I felt was unimportant to her.

This all sounds awful but the upside is, knowing how things can be will help you develop coping skills.

As a midwife you need many social skills in your toolbox. You don’t always have to be upfront and honest about your vulnerabilities with every team member and hope that they will have your best interests at heart. Sometimes clearly stating your boundaries and showing you’re not going to be bullied is the best thing you can do for the women and your workforce.

If you’re in a bullying situation, I would strongly suggest you get Aryanne Oade’s book.

You have no idea how much power you have in small moments.

Taking on someone older and more experienced can be done if you’re clever about it, stand up for yourself and remain calm.

Looking back, I had many opportunities to put things right. Once I lost my marbles and was using an obstetric wheel to work out a woman was term + 1 (doh!) and once I forgot to label something in the fridge. On both of these occasions I acquiesced to bullying behaviour because I felt I deserved to be ‘told off’.

But I was learning. I could respond carefully and accurately at times. I wasn’t letting my professional power be taken away nearly as much.

There’s a sense of personal accomplishment and breakthrough to be had. The ability to set professional boundaries is an essential part of midwifery.

A couple of years later I saw the co-ordinator out having coffee. By this point she’d retired. It would make a better story to say that she was like Meryl Streep in the Devil Wears Prada, swinging a handbag and an expression of disgust under her sunglasses but she was out with a group of women and a toddler, sweetly laughing, drinking tea and ordering scones.

Thinking that holding a grudge wasn’t my style, I actually went and said Hi.

She looked a bit surprised but greeted me politely. Then she praised my midwifery skills and I thanked her and left.

I honestly don’t know whether she felt guilty, had no idea she’d been bullying me or simply wanted to keep things peaceful in front of friends.

It reminded me that she was just a person after all.

But save the empathy for the women and your colleagues that value it. They’ll get more out your kindness than a bully would get from five years of you trying to scale their walls.

This all sounds very severe - but the flip side is, if you show strength to someone with bullying characteristics, in a way that's the most empathetic thing you could do. You're not stooping to their level but you are showing you understand the dynamic going on. If I'd have been a push over, I never would have had the strength to approach the co-ordinator when she'd retired. Who knows, perhaps she appreciated me standing up for myself in the long run.

Have you read Aryanne's book? Have you got strategies to deal with such situations and people?

Let me know in the comments below. And if you're in a workplace bullying situation right now, I'm sending you strength and support.

Ellie x

*(details have been changed to preserve anonymity)

November 7, 2018 1

The Most Important Writing Technique Ever – and What Happened on ‘New Walk’ Launch Night

The Most Important Writing Technique Ever – and What Happened on ‘New Walk’ Launch Night

New Walk came out six days ago. I still feel like my brain has floated out of my head, probably sometime after the launch evening and it’s somewhere above the chimney pots in London.

It’s strange and wonderful and all I can do is take regular breaks to stare out at the Autumn sunshine on the buffeting trees and let myself re-calibrate.

I’m getting not enough done right now but I don’t have a choice. (Just a quick reminder here if you’ve done anything big recently – like getting an offer to train as a student midwife, qualifying as a midwife – if my experience is anything like mine, you need recovery time from the good things as well as the bad things!)

Here’s my favourite review so far:

'Hiya Ellie,

I'm not someone who would usually message but I just want to say Congratulations on your book release. I have bought and read the whole thing already!

I have currently entered my 3rd year of training and can strongly relate to Chloe. Within my training I have had to deal with my mum suffering a brain haemorrhage, my Nan passing and I also was pregnant earlier this year and decided it was not the right time for myself or my family (although i am still not 100% i did the right thing)

I have dealt with some unsupportive staff and felt like I have been taken for granted on shifts as I was an MCA previously at the trust I work in. I feel morale on placement within the trust is very low and the new HoM's idea of help is glancing at the boards and responding to concerns with 'but you always manage!'. With all this I feel like I have 'lost my way' however this book has re-ignited my love for midwifery and reminded why I came into it in the first place - for the women, their babies and their families, so for that I just want to say a big thank you. 

Looking forward to the next read!'

Needless to say, I sobbed when I read this.

If you missed the launch check out the video below. Comedy value of me half perching on the seat, not sure there are many 4ft 11 inch authors around! I talk about the single most important writing technique I’ve come across.

(The transcript is below if you’d prefer).

Thanks so much everyone who's shared about 'New Walk', posted pictures of them reading online or reviewed on Amazon!

Ellie x

The Single Most Important Writing Technique I’ve Come Across – my Book Launch Evening Speech

“This is really surreal for me.

It's really strange! Thank you very much everybody who's come, all my friends and family and my online family, please come and say Hi later and we can chat about whatever you'd like to chat about.

The reason it's surreal is I kind of remember when I was about six going 'I'd quite like to write a book, and now I'm 30, tomorrow, and I'm kind of looking down a tunnel in time - has anyone had one of those kinds of moments?

It's a very, very strange feeling.

I want to tell you about a writing technique because I think it's going to help you hack in to some of the stories, the TV series and novels that you like the most.

This writing technique is really simple; the idea is your book should have a single theme and this theme should be inherent in every single scene. It holds the story together.

And has anyone seen 'Breaking Bad'? Really good TV series! If you haven't seen it I highly recommend it. This series taught me the most about this particular technique. There's a very mild-mannered chemistry teacher called Walt, and over the course of the series he turns into this meth cooking drug dealer gangster sort of guy.

Right at the beginning of the first episode, he's talking to his chemistry students and he says 'chemistry is the study of transformation'. He talks about growth and decay, solution and dissolution and then you realise that what he's talking about is the transformation of himself.

It goes all the way through the series, it tracks back to every single scene.

And in 'New Walk' I had this one particular concept in mind, and that concept, I had it written down actually, stuck to my computer screen on a piece of paper.

That concept was 'life is not as it should be but you still have to try'. And the reason that was the concept is being a student midwife in the NHS is really difficult. The courage you need to do the job itself is incredible, but on top of that I really haven't glossed over some of the staffing issues, the culture of the NHS, and things like that. But then you still have to try and remember that amazing things happen, even in the same shift.

And I realised that I love 'Call The Midwife', I love the series and I love the book but I wasn't sure there was anything out there describing the modern experience of being a student midwife so that's why I wanted this phrase.

And then I realised once I'd finished writing that the phrase 'life is not as it should be, you still have to try' can be described in one word.

And that word is: resilience.

And I'm not talking about the kind of resilience that sometimes is pressed on us, you know, being masochistic and just absorbing really bad behaviour or y'know, there needs to be political change and you just put up with things.

I'm talking about the kind of resilience where you get home at the end of the day and you still like yourself. And you know you did a good job, and that's what I've tried to write a novel about.

I'll do a quick reading for you.

So in this bit of the novel there's a woman who's making a particular choice about her care and it's not necessarily in line with maybe what the medical advice would be.

And just to say, I've got really good friends who are doctors, and sometimes I think we don't celebrate the amazing things doctors do enough. I have a friend who's an anaesthetist who's here and the amount of work she's put in over the years, she has to know the atomic level of all the drugs she gives and we're sort of like 'oh, let's have an epidural, oo, pain fairy!' so this isn't me saying 'oh no I don't like doctors' it's just me wanting to explore some of the issues that I came across in practice - so here's the reading:

‘How’s Room Four, then?’ says Beth, sat at the staff base and
printing blood forms off the computer as she listens to Jo’s
update.

I know I’m smiling like a lunatic, my feet barely meeting
the floor. I’m having major déjà vu. I have a particular memory
from a birth in Alabama where I was woken in the night, picked
up under the arms and plonked down in front of the pool to
see the baby born. I’ve always wondered why Mum thought
this was something I needed to see, and whether I’d ever do
it with my own child. I never thought to ask her before she
died. Since then it’s been a bittersweet thought, a touchstone
for pride, regret, sadness and passion that I’ve come back to
thousands of times. Tonight it’s clearer than it’s ever been.
Dr Roshni appears at the end of the corridor, some notes in
one hand and a cardboard cup of tea and a KitKat in the other.
I notice she’s changed her shoes for black wellies. She must be
coming out of theatre.

‘How’s it going?’ she asks me.

‘Yeah, very good. The woman in there is amazing.’

‘Oh yes? This is the one that refused monitoring isn’t it?’
She takes a sip of her tea, flicks to the correct page in her notes
and starts writing at speed.

‘She declined being on the CTG, yes,’ says Jo, reasonably.

‘Chloe’s doing listen-ins, aren’t you Chloe? All the makings of
a great midwife already.’

I beam at her.

Dr Roshni frowns. Some of her hair has fallen from her clip
and she brushes it out of the way and asks, ‘Fetal heart okay?’
‘Beautiful, as far as intermittent auscultation goes.’

‘Does she know the implications of what she’s choosing,
though?’ says Beth, and my euphoria fades as I tune into the
worried lines around her eyes.

Dr Roshni adds, ‘I can come and speak to her, if you like.
She knows me from the clinic and knows what my opinion is.
Healthy Mum, healthy baby is what everyone wants.’

‘I don’t think a chat’s necessary, but thank you. Brenna
knows everything she needs to. She’s signed the informed
consent.’ There is the barest edge to Jo’s voice. ‘She says she’ll
get out of the pool and go on the monitor if there are any
problems, but at the moment everything looks and sounds
great.’

Dr Roshni stops writing and glances first at Jo, then at me.
I gulp at the brightness of her look, feeling a bit like a mouse
about to be swooped down on by an eagle.

‘If the patient has consented to monitoring if there is a
problem, then I would find a problem.’

She says this with such care that I feel the weight of each
syllable and my mouth falls open.

Jo nods, thoughtfully.

‘I don’t think we need your input yet, but we may at some
point. I’ll pass on your best wishes, though.’

‘Of course.’ Dr Roshni resumes writing and smiles at both
of us. ‘Keep me updated.’

‘Come on Chloe...’

As we walk along the corridor, Jo says, ‘You look shocked.’

‘I just... I don’t think I could ever be a part of that. Telling
a Mum there’s something wrong with her baby’s heart rate
when there’s not. Does that kind of thing happen?’

‘Well, from Roshni’s point of view she’s keeping the ward
and the women safe. It’s really busy and she doesn’t want
to be in a situation she doesn’t have time to manage. So it’s
not great, I agree, but keeping women and babies safe is our
role as midwives too. You’ll learn, don’t worry. You’re mainly
observing right now anyway.’

Now my excitement has fallen away I can feel I’m tired and
hungry. My limbs are heavy. I follow Jo back into the room
and smile at Bob, who’s been making tea for all of us in the
kitchen, and try and pull the atmosphere of the birth room
back around me.

Um, so that's quite a sombre scene, but there's a really happy ending there!

Just I hope you can see the privilege of being a midwife - the emotions you get from the birth room are really amazing sometimes, it's what protects you as a midwife and there are some very uplifting moments in this book as well I hope.

I just want to say as well, I haven't written this book about stuff that actually happened to me as a midwife.

These aren't women who are real or events that are real.

But I absolutely don't think people are going to believe me.

This is based on something that happened with my parents. Um, so when New Walk went up on Amazon I rang my Mum and I said 'oh it's there' and she got to look at the front cover, it was a lovely moment where she looked at the blurb.

And I said 'you know some of my writing friends have warned me that you will probably see yourself in this book and I just want you to know I haven't written about you, it was the intention, you're really not there.'

And she said 'yeah okay, that's a good warning, that's really important.' She was very serious about it.

And then she passed the phone over to my Dad and I heard her say 'Ian! I'm dead and you're a drug addict!'

So, that's that.

Yeah, I just can't tell you how happy I am that Pinter and Martin decided this novel was worth pursuing and I'm really grateful to everyone being here.

And yeah, let's get back to the wine!”

October 24, 2018 2

11 Responses

  1. Katie Fox

    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

      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. Alicia

    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

      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. Bettina Dwyer

    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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