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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The perplexity of choosing snacks which aren’t going to add to the methane problem.
And it has to be tasty because snack time is the best bit of the shift, or at least a close second to pool births.
We know that people who do shifts, especially nights, are more at risk of all kinds of metabolic problems. Everything from extra gas because your tummy’s working odd hours, to obesity and type 2 diabetes to ulcers*. Thanks, vocational career!
But the evidence suggests some of this risk is because of quality of diet and we actually have control over this bit.
There will be times where everything on shift is conspiring to get you to make unhealthy food choices.
But if you’re like me, junk makes you feel worse, especially if it’s part of a pattern of eating badly. As a long distance runner, I can feel what a few weeks of sugar does to my body and it’s not pretty.
Shifts can also make it harder to make healthy food at home. If you’ve have three 12 hour nights, seen six babies born, been there for a cat one section and now don’t have the energy to meet up with mates as planned, it’s easy to stay on the sofa, order a takeout and make sure they put in some of those soft bake cookies too.
We all know that midwifery is way more demanding and important than running, so, let’s fuel right.
Obviously everyone is different and these specific suggestions won’t work for everyone. But take what works and adapt, and if you find something helpful, awesome!
(These are for those times when you have to grab something while doing your notes).
My other busy midwife health hack is to keep fresh sauerkraut in my fridge at home. Please give it another chance if you’ve tried it and hated it, the raw food company sauerkraut is absolutely delicious, like a raw, mild crunchy cabbage salad.
The ingredients are just salt and cabbage but it's full of healthy bacteria. There’s limited research out there but it’s been a health food for about 2000 years that to me this is basically a longitudinal research study.
I add this to the side of pretty much every meal, though I wouldn’t take it to work, way too stinky. And my boyfriend loves Kimchi but we won’t go there just now...
Over time, your gut health should get better and it’ll help with bloating on night shifts.
I’m not saying I don’t fall off the wagon from time to time (god, I discovered sesame snaps about a month ago, sometimes you can’t help it) but a healthy diet is important.
I mean, everything in midwifery is important but the health of the workforce is the foundation on which care runs. If you don’t take your health seriously, all the midwifery skills you build up over a career can disappear because your main tool – your body – can’t do it.
Delicious and healthy food that you prepare for yourself = good care for the women.
THANK YOU for doing shift work or being there for women across the weird hours needed.
I’d love to hear from you:
Leave me a comment below and don’t forget to share this with anyone midwifery related who might find it helpful.
All my best, Ellie x
P.S. Something important I need to tell you: I have huge problems doing nights. This isn’t something I’m ready to talk about on my blog. As the writer Elizabeth Gilbert once wrote ‘this is a story I’m living right now rather than one I’m telling’ so I hope you understand if I don’t go into more detail. But I didn’t feel right not telling you any of this either, considering I'm recommending some ideas. These really are the foods I used for nights and it did help but it turned out I had bigger concerns.
If you’re suffering because of nights, go and see your GP x
** (Gan et al 2014, this is from the Occupational & Environmental Medicine Journal, a branch of the British Medical Journal) + (Lowden et al 2010, Scandinavian Journal of Work, Environment & Health)
**Obviously be careful around anyone with nut allergies
I run a big midwifery Facebook group and one of the questions coming up a lot recently is:
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.
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:
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.
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 🙂
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?
"Tell them to have chocolate raisins first. Get a relationship with them -- then you can talk spinach."
Finding the courage to speak up about something isn’t easy. Today’s post is from Rosie Brown, mum of five, who's expecting number six. She's an aspiring midwife and her open letter to women and midwives is about having a large family and some of the comments she’s received from medical professionals.
'Dear Ladies and Gents,
Would you take a moment to listen? I promise you will be a blessing to others like me.
I'm an aspiring midwife and now I guess I am a 'Grand Multigravida' too.
I've had something on my weighing on my heart for a while and it's been stirred by the opening scenes of One Born Every Minute series 11.
There's a lady expecting her 6th baby and the midwife says something along the lines of "haven't you worked out what's causing it?"
Future and current midwives. We might laugh it off and make a funny come back like we don't care, but do you know how exhausting this is?
Every day, every week when we are out with our children, here is what we encounter, from complete strangers.
"Don't you know what causes that?"
"Don't you own a TV?"
"Aren't you a glutton for punishment."
"Wow, how old are you?"
"Do they all have the same dad ?"
"Don't you know what birth control is?"
"Are you done?'
And then to have your midwife or health care assistant do the same when you are vulnerable can be overwhelming.
We sit on a ward listening to midwives go to other couples with 1 or 2, even 3 kids, and there are sweet and reassuring comments.
And then it's our turn.
For whatever reason, parents with big families don't get reassured.
Last week I was in A&E and a health care assistant was taking me for a test, and do you know how relieved I was when he said "Oh how lovely! Your house must be full of fun! Did you always want a big family?"
Us proud mums will probably answer willingly all the above as we chat about our kids, but this question was the correct one to ask.
Personally, we are Byzantine Catholic and my husband is training to be a priest and yes we did always want a big family, and I'm happy to tell you that. But 'Are you done?'.... that's an immediate judgement and I suddenly feel like as you check my cervix I have to justify my entire life, my religion and my sanity.
Please take a moment when encountering a big family to think about your words.
Just because this is our 6th or 10th baby, doesn't mean we aren't every bit as delighted and excited as if it was our first baby. Whether you agree or not, we come for support. Not to be shamed.
Thank you for listening if you made it this far :)'
I personally don’t believe any midwife will mean to be unkind but in our society, we tend to comment on mothers and their choices. Especially if there’s something unusual about them.
Seeing things from a woman’s point of view amidst busy practice and the rocky terrain of trying to keep humour and connection front and center is hard.
I think Rosie’s post contains valuable insight. Especially about the healthcare assistant with the kind and thoughtful comment, this is a great example of being with woman, understanding what it must be like to lead her life and talking with her accordingly.
As Rosie says, thanks so much for reading this!
And thanks to Rosie for writing it, it's brave and how gorgeous is her family?!
Do you have anything to add – have you cared for a woman with a big family? How did you talk about it? Or are you from a big family, is there anything else we should know?
Leave a comment below.
Much love xx
This is one of those. Especially if you're white.
Reni Eddo-Lodge is a journalist and author who wrote the book 'Why I’m No Longer Talking to White People About Race'.
Her work focuses on racism and feminism. I think it's the exhaustion in her tone that gets me.
It's a hard one. If you're white, you might be thinking 'well I'm not racist'.
I believe you. But we live in a society that's got racism baked into it. Not our fault. Still our responsibility.
Reverse racism hits the news sometimes. White people being at a disadvantage because people from a black or ethnic minority group are discriminating against them.
The problem is that reverse racism doesn't happen in a way that takes meaningful power away from white people.
White people might find themselves in a single situation - say working for an ethnic minority family who pass them over for a promotion in favour of someone from their own background - but that white person will have more many opportunities over the course of their lifetime based on their ethnicity.
Ethnic minority groups literally do not have enough people in positions of power to even begin to level the playing field.
I think it's so important for midwives and students to be aware of the tension and inequality that black and ethnic minority people face.
It's just that there's a huge bias that black and ethnic minority people have to fight against all the time. You can't really fight against sexism without understanding racism. You miss so much of the picture.
The problem is to understand race as a white person, you need to put your own way of seeing the world on hold. This is pretty much impossible. The only way to do it is to think of a time when you've been so frustrated that someone couldn't see the inequality in a situation.
For instance, many women will have had a conversation with someone who doesn't see the point of International Women's Day as there's no International Men's Day.
I've been in a situation where I've been frustrated to tears trying to get a guy to understand why International Women's Day is important.
The risk of FGM, pay differences, the tension women face balancing having children and a career etc. It falls on deaf ears. It's like it doesn't even exist.
This is what black and ethnic minority people are trying to tell us. There's a whole existence in parallel with ours as white people. We're blind to it.
It's not for me to tell anyone what to do but I'd encourage you to read Reni Eddo-Lodge's book, listen to her podcast, or listen to Sprogcast, the episode with Doula Mars Lord.
Listening and understanding is only fair.
But also, if like me, the best bit of midwifery or caring for others is the privilege of understanding their stories: there is so much more to learn.
So many more ways of existing in the world to get to know.
I find this exciting.
Now I'd love to hear from you.
Please comment, especially if you're from a black or minority ethnic group, especially if you think I've left anything out!
Or if you're white - do you already know this?
Much Love,
'New Walk' is burning a hole in her bag and she cannot wait to get settled in a seat and get reading again.
That person I’m writing for could be me or my sister or many of my friends.
I just want a few people to love this book. That’s what I’m after. That’s my goal.
Do you think that might be you?
Have a look at the prologue below and see.
‘A profoundly moving coming-of-age story, where midwifery, birth and the decisions life throws at us combine to shape a young woman’s life’. - Pinter and Martin, publisher
Prologue
Sunday, 5th August 2001
It’s my choice, I have a deep sense of rightness about that. I’m glad to be in a country where I can make this choice and I’m glad all the physical stuff, the pain and bleeding and everything at the end, was here at home. Despite the sadness, a bit of me is standing back and assessing the experience for anything that might be useful. I have a kind of morbid curiosity about the emotions and sensations.
This is not the kind of learning anyone would ever want to hear about, though. Even if a woman you were caring for had gone through the same thing, you could never tell her. God forbid you raised your hand in a lecture and talked about it in front of the cohort either.
It’s an hour or so before sunset and the temperature is dropping which I’m grateful for because digging is taking a bit of effort, the earth is dry and set and I’m sore. Despite everything being neglected, the garden is bright with the daisies and red asters that Mum planted. They come up year after year. The birds are talking to each other in different calls and my emotions are blowing around like the breeze.
I’m also thinking about how judgemental I can be. Even when Dad is hiding from me because he’s rolling his tenth spliff of the day and I want to wash his body warmer and feed him a healthy tea with green vegetables, or Ali is stalking around in Leicester in heels and an almost entirely theoretical miniskirt, they are surviving in their own ways.
I put my everything into this life. For years now I’ve been the passionate, responsible one, reading up on embryology in Mum’s old books, studying Spiritual Midwifery birth stories over and over until the cover came off, taking every opportunity to learn skills like blood pressure and resuscitation and how to listen. Midwifery is my distraction of choice and I’m proud of that.
But it’s also my obsession and underneath I’m not sure I’m coping. I get so angry sometimes. I got so busy lording it over my Dad and my sister that I’ve found myself here.
I lean the spade against the fence. Before I put the box into the ground I apologise out loud, standing there in my welly boots I’ve put on to dig the hole. I’m truly, deeply sorry.
I’m beginning to understand now. I’m not in control of life; no-one is. It never turns out the way you expect. You just make the best of things. This is not always a bad thing; it’s just a true thing.
It’s both the magic and the catch.
I can remember crying my eyes out in the middle of labour ward because it was just too painful. Luckily, I had an amazing manager who gave me continuity with the family in question and I was able to follow them for 3 days worth of shifts. Their little boy had been stillborn after a complicated labour.
I'm beyond excited about it of course. But in a way, I don't want to finish the work and leave this world I'm living in. My early morning writing sessions hanging out with my main character, Chloe the student midwife, are the best thing about life at the moment.
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You probably know Francesca Martinez as a comedian from Live at The Apollo but she’s also an actress and writer.
Francesca has cerebral palsy but prefers the term ‘wobbly’ as it’s far more positive than ‘cerebral palsy’ (which I read somewhere she thinks sounds like a doctor who villain). (more…)
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