I'll be honest - writing my second midwifery novel isn't going well today. But instead of having a self-induced meltdown, I'm sat here writing this with a liquorice, fennel, thyme and orange peel blend tea. This has been inspired by today's interview with independent midwife Joy Horner (and replaces my 'rocket fuel' coffee that I usually have, so is a bigger deal than it might sound). It helps no end to realise there are wise women like Joy out there. I bet you'll find her just as uplifting as I do.
Joy Horner is an independent midwife from Glastonbury who offers life-changing care to women, especially those who have experienced previous birth trauma or abuse. She also specialises in attending breech birth. She's been a registered midwife for 18 years and independently practising for 12 (before that she was an occupational health nurse for many years).
Better Births is currently being implemented in the UK, with promises of much more continuity of care for childbearing women. But most still struggle to get this one to one care at the moment. Midwives like Joy have been practising this evidence-based, much loved form of care for the majority of their careers so we have a lot to learn from them.
Which book do you most often recommend to midwives and students?
It has to be Spiritual Midwifery by Ina May Gaskin. I bought it during my first pregnancy. I had completed my midwifery training but was working as a nurse at the time. I was gobsmacked. Why had I not been taught that women could give birth joyfully and without medical intervention?
My training was very medical and I was astonished to learn about women giving birth in a hippy community with no access to medical care. What was really amazing was the outcomes of these births. A less than 2% caesarean rate and very low baby mortality rates. It gave me hope that after a very medically managed first birth I could have a joyful birth, and I did!
I would recommend this book to any student or qualified midwife. It will restore your faith in normal birth and help you see pregnancy and birth as sacred events in a family's life. It may help you attend births in a truly gentle and respectful way.
If you could put a sign up on every labour ward or midwifery work place worldwide, with a big message for every member of staff, what would it say?
'Oxytocin at work. Please do not disturb!'
What is something unusual you do as a midwife – is there something you love which really helps in practice?
I'm not sure if it's odd but I try hard not to disturb women or babies during the second and third stage of labour. If we are not very careful we can cause serious problems by our interventions so I interfere as little as possible.
Many of my independent clients have suffered trauma in previous births or from abuse. They have taught me how to be a very good hands-off midwife indeed.
In the second stage I do not dictate maternal position or coach pushing. As baby emerges the woman or partner receives the baby (unless there is a clinical reason for me to be hands-on, and that's rare). If the woman is unable to lift her own baby I place it beneath her (most women are kneeling), and cover baby with warm towel. Until the mother claims her own baby I visually assess baby's APGAR. No vigorous drying or stimulating are needed if baby is full term, cord is intact and colour, heart rate (assessed by feeling the cord) and tone are good.
The mother gently explores and lifts up her baby and I stay quietly vigilant as I write my notes. Baby usually finds and attaches to the breast unassisted. The mother indicates when the placenta has separated and I may encourage her to push it out. The family ask to cut the cord (or keep it attached) usually an hour or so after the birth. The newborn examination is done in the mother's arms or beside her. The family place baby on the scales, help hold the tape measure and my stethoscope on their baby's chest. The families then decide to dress their baby.
Working this way enables families to claim the full power of their birth experiences. So important in healing previous trauma. The baby also benefits from not being separated from its mother and receiving only gentle, minimal handling from me as they adapt to their new life. Does that sound odd or just respectful?
How do you cope with the stress of being a midwife?
I have worked part time for most of my career since having children. It has enabled me to find the correct work/life balance. I have had a tremendous amount of support from the Association of Radical Midwives (ARM). Nurturing my creative side has also helped restore a sense of balance in my life.
Caffeine or not caffeine for shiftwork?
I have to admit to using caffeine for stimulation on night duty. I worked nightshifts for about 7 years when my children were small. The time around 4am was always the worst. Lots of tea helped. More tea before driving home got me home safely. The zombie feeling due to lack of sleep during the day was also alleviated by tea and the odd energy drink. Although it helped at the time it is of course not good for our health in the long term.
Can you tell us about a favourite midwifery moment you’ve had (keeping things confidential for clients involved)?
I don't think there is one single moment that outshines the others. Each birth is a miracle of course. My favourite part after seeing the parents greet their baby after a healing birth, is always other family members meeting baby for the first time. With Mother and baby resting, siblings or grandparents are invited in to meet the baby. I can recall so many births when I've felt joyous tears sting my eyes watching these happy families celebrate the birth as I fade into the background.
My non clinical favourites include talking alongside the greats of the midwifery word at various international conferences. This is a huge achievement for a shy person, and to meet and speak alongside your midwifery (S)heroes is truly a dream come true.
What is poor advice you hear being given to student or newly qualified midwives?
Become resilient. This to me means toughen up and put up with bad working conditions. Pick yourself up after a knockdown and go back for more. My advice is to be political, stand up for what you believe and support women whatever their choices. We don't need to toughen up, I've been a soft-hearted health professional for 34 years and I've managed to survive.
What do you do when you have lost your midwifery mojo, feel unfocussed or stressed by it all?
Tell your friends, colleagues or mentor. Ask for help from loved ones and care for yourself as gently as you would a young child. Surround yourself with friends and activities which lift your spirits. Join the Association of Radical Midwives (ARM). Go to their study days or their wonderful annual retreat where you'll be in good company.
Thanks so much Joy!
If you ever get the opportunity to speak to Joy, or attend a speaking event where she's a lecturer, I highly recommend it. Her work in Glastonbury for women who have chosen to give birth outside normal care (or in Yurts!) makes her one of the most intelligent, kind and meaningful midwives I know.
The photos she has of oxytocin filled, women worshipping labour environments and births are uplifting. Plus, she does pottery and loves bees, so you know she's a good'un.
I hope this interview helped you. Hearing from Joy always makes me feel better about life.
Could you leave Joy and I a comment letting us know your most important realisation from her answers?
And also, do you know of another inspirational student or midwife who you think I should interview? We all know and love some of the big names in midwifery but I’m very aware that many brilliant midwifery leaders do their work under the radar – yet these are people we could learn a huge amount from. See the quiz here.
Take care, Ellie.