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Ellie Durant
Hi, I'm Ellie and my goal is to help you become a fantastic midwife. I qualified as a midwife in the UK and have worked in both the UK and New Zealand. Now I'm a midwifery writer and support giver.

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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 1

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?

If you’re reading this and you relate you’re likely an empathetic, gifted student or midwife and we’re lucky to have you in the profession.

But 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

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

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

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