All the posts Ellie's written since 2012.

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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

Epidurals

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.

(more…)

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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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

The Fourth Trimester of Pregnancy

The Fourth Trimester of Pregnancy

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

The fourth trimester theory can help with that.

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

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

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

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

May 2, 2019 0

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

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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