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Katy Cat, the newest member of the Midwife Diaries team is curled up hedgehog style on our yellow throw covered mattress. We're between sofas right now as we've just moved. Katy Cat's not thinking much. Cats don't consciously think nearly as often as humans.

I think there's good midwifery knowledge to be learned from them. Please bear with me here,  it might look like I'm straying into harp playing dolphins territory. But there's science involved and if you've ever wanted to hone your intuition, you'll find this post fascinating. (more…)

When I came across the whole ‘live in the moment’ philosophy, probably first in the 'Little Book of Buddhism ', I thought, well that must be lovely. You know, for artists and musicians and people like that. But you try 'staying present' when you have 20 lives in your hands, all off which need attention right now.

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The MBRRACE report is incredible. Confidential Enquiries have reduced maternal deaths from 90/100,000 to 10/100,000 since the 1950s, which is a huge achievement.

MBRRACE is also put together by prestigious, multidisciplinary teams.

So it might seem strange that I'm putting up a post finding fault with it.

But midwives have a duty to assess recommendations as part as advocacy for women. It’s why midwifery degrees cover how to critique guidelines and research.

It can feel really frightening going against the grain. But midwives time and again have changed practice for the better. (Click here for Mary Cronk's wonderful account of refusing to do routine episiotomies).

There are 2 main questionable areas of the MBRRACE report I've noticed so far:

1. The Flu Vaccine Recommendation:

Pregnant women are more at risk of getting flu, and of complications.

MBRRACE states: 'Increasing immunisation rates in pregnancy against seasonal influenza must remain a public health priority'.

This sounds like very good advice.

But we don't know for sure how effective the vaccine is.

Sara Wickham, in particular, has mentioned on her wonderful blog that there isn't evidence to say all the flu-related maternal deaths were preventable. This is because a recent Cochrane report found protection from the vaccine was only mild; there was ‘no appreciable effect on hospital admissions or working days lost.’

MBRRACE argues the deaths were preventable, as it would have been better for these women to at least try the vaccine.

There are some specialists that argue the Cochrane data was too ‘finely cut’ to show any overall message, and quote trials which show the vaccine is very effective.

It seems there’s a lack of information from the research.

The best approach may be to tell women the vaccine is recommended by a high-quality report/specialists, but that evidence doesn’t show clearly how effective the it is.

2. The 'Think Sepsis' Obs Recommendation

Like with flu, pregnant women are more at risk of sepsis. We think this is because their immune system is a bit suppressed during pregnancy, so the baby doesn't get treated like an invader.

MBRRACE says ‘Think Sepsis’ at an early stage when presented with an unwell pregnant or recently pregnant woman, take all appropriate observations and act on them.’

But this is controversial just because it’s sometimes very hard to tell when a woman is unwell.

We might screen women needlessly…and then end up with false positives.

Sepsis comes with lots of different symptoms. Women can have the typical ones like a fever, shivering (rigors) or nausea and vomiting.

But they can also have headaches, painful urination, and light-headedness.

Should we do a set of obs on every woman who has any those symptoms?

We’d end up doing obs for pretty much everyone, as headaches can be caused by crying babies, passing urine can be painful because of stitches, and light-headedness can be caused by tiredness.

Doing obs on every woman means eventually we'll get a dodgy result. So we'll end up sending at least some healthy women into hospital for a check….and we medicalise, which can do more harm than good.

I'm totally biased, but wouldn't a better conclusion be: midwives and others need more time and more continuity with women?

It’s a lot easier to tell if someone’s sick if you're not meeting them for the first time.

It could be argued that a one midwife, one woman system of care would help prevent a lot of these flu/sepsis deaths. Better communication between professionals and women, and continuity of care would help nearly every case.

Currently, this is hard to achieve as time = money.

For now, we just have to try our best to give a balanced opinion about the flu, and Think Sepsis.

Heavy stuff! But important.

See part one: Before Their Time
See part two: 5 Lessons I Learnt

Brr! I'm snuggled by the heater typing! I hope you're somewhere warm and cosy while you're reading all about MBRRACE.

I'd love for you to be able to read the whole MBRRACE  report start to finish now, as it's essential knowledge for every midwife....

But as we all know, just because something is essential, it doesn't mean you have time to do it this second! As a midwife, family time, sleeping and eating can be hard enough to fit in. (more…)

I've been looking for a spare window to read the new Saving Mothers’ Lives report since it was released in December (2016). This week I finally got a chance to finish it, fuelled by many cups of tea and slices of toast. It’s a fascinating and moving piece of work.

I want to tell you about this kind of report in general, because they're important and make me proud of maternity care in the UK. They look in detail at the care of every mother that died.

I think that's amazing.

The reports are published every three years and have been running since the 1950s – the longest enquiry into maternal deaths in the world. (more…)

There’s something important I have to tell you before you read this post: I’m a bit scared of writing it, and the possible reception of it. But I think it’s a post that needs to be written.

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I was curious...

I work with some wonderful midwives to be. They work incredibly hard well before they get to a midwifery course, and they love the volunteer work and study they're completing.

I wanted to hear why they thought midwifery was so important. Some of them juggle kids, study, paid work and volunteering, and I wanted to know what drives someone towards midwifery. So I set up a competition on Facebook, asking them 'why are midwives important?'. (more…)

We all know lots about obesity, but we don’t learn much about anorexia in midwifery training.

Midwives are busy people. The work is a privilege, but that doesn’t stop the fact we have mighty workloads on challenging shift patterns, caring for difficult demographics, and all while documenting clinical chaos in legalese! Sometimes it can feel like we're drowning in information, and we have limited time to spend learning about the conditions that crop up infrequently. (more…)