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
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.
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.
*(details have been changed to preserve anonymity)
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:
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!
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 update.
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 great.’
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.
A good friend of mine had put up one of those ‘copy and paste this onto your status if you care’ posts on Facebook. It was on mental illness, something I feel passionate about. But I didn’t repost. And then I felt bad about it.*
Does anyone else have problems like this?
My reasons for not sharing these posts range from not having time to consider them properly, to having an overwhelming number of these posts on my feed, to knowing another friend who’s experiencing the issue right now and not wanting them to think my status is because of them.
Also, even if the topic is really important, I don’t like being pushed into action. I’d much rather learn something and share in my own time.
I don't want to let people down, though. I really care about these issues and I'm devastated that people I know are suffering from a lack of support.
But my other concern with this kind of post is that they often contain subtle messages of shame. You know the kind of thing - ‘if you’ve read this far you’re better than most’ or ‘if you’re a true friend you’ll...’.
I suspect for every person who reposts, there are many more who scroll past uncomfortably, just because of the wording.
Even when a subject is as important as miscarriage, infant death or mental illness, I don’t think using shame as a teaching/communication tool is a good idea.
Shame might change our behaviour in the short-term but it doesn’t do anything for the issue. It doesn’t offer the individuals going through it any true empathy or help. It doesn't give us meaningful tools for discussion.
These ‘copy and paste’ posts evolved for technical reasons. They’re a powerful way of spreading a message as there's no deleting the ‘parent’ and all the shares in one go: when a post is being copied and pasted, you can't stop it travelling. The original post can’t be traced by Facebook and I’ve read the format is associated with scams.
You can see why people want to use this type of post for taboo topics. They get shared. It’s so much easier to paste something about mental illness than it is to come up with your own comment.
I guess this is the definition of a taboo topic: it’s hard to talk about. And then marketing techniques designed to take advantage slip into the cracks.
I have a suggestion.
These days if I see a ‘copy and paste’ post on a subject I care about, instead of reposting, I leave a comment.
‘I care about this and I don’t always get my approach right. I found x (book, film, documentary etc.) very helpful in understanding. I wish we could talk about it more and I’ll commit to trying to be brave and asking people how they’re doing when the issue comes up. I'll try and hold a space for them to tell their story and understand. All my best to you and yours, Ellie x’
Adding to the conversation lets people know you care. If I was suffering from postnatal depression, for example, and saw a comment like this written by someone I loved, as opposed to a viral repost, I'd feel much more cared for and understood.
It takes more time and more courage but this approach feels right to me.
A further suggestion.
If you're feeling really brave and you want to start a conversation about something taboo, can I propose you make some art?
Draw something and upload it, write a poem, write a song, make an area of your garden into a shrine and show us.
Make us understand your experience. This is so much more powerful than anything copied.
It's braver because it's a part of you that you're putting out there.
I know this won’t be for everyone but if you’re considering it, know that it doesn’t matter how ‘good’ your art is.
In my experience, people on social media today wandering through adverts of jeans (filled by unattainable sized bottoms) and angry fake news stories are desperate for truth.
They’ll recognise the freshness, authenticity and reality of your work many Facebook miles away.
Just to clarify, I’m not having a go at anyone who’s put together these kind of posts or those who’ve copy and pasted them. I know how hard it is to get heard. There are good people out there using this strategy too. It's just I think we can do better?
And, I suspect there's also an argument to be made that I've overthought all this and I should get off Facebook and go and do some writing of my next novel!
But I'd love to hear from you. What are your thoughts? Leave me a comment letting me know!'
*(I do have full permission to write this post by the way).
Sometimes you come across a blog with a new and authentic voice which shows you what life is like for someone else. 'Mama Unexpected' is one of these rare finds.
Hana Young's blog is founded on writing about being a single parent to her disabled daughter. It describes a vibrant, challenging, loving life with Tilly, who has Guanidinoacetate Methyltransferase Deficiency or GAMT, a metabolic disorder which affects the nervous system and muscles.
Tilly has irreparable brain damage which means dangerous seizures and profound learning difficulties.
Hanna also has a little boy called Arlo and is a student midwife and hypnobirthing teacher. Hana is one of my heroes and I've chosen a few recent entries for you to get stuck in to.
21st August 2018
Tilly is away at the moment in Holland so I just have Arlo at home.
Good grief life is so much easier.
There’s no one to pin down to give meds. No nappies to change.
I eat my breakfast with both hands with no one to spoon feed theirs.
No thinking about whether my child is thirsty or hungry, he can just tell me so.
No very early wake ups.
No one to pull my hair or scratch my arms and face relentlessly.
No giant pushchair to think about.
No screaming in the back of the car.
No Mr Tumble.
No knobby stares from knobby members of the public.
We can go to the park and I can sit and watch, safe in the knowledge he won’t attack another child or attempt to kill himself.
We can pop places. Just in and out. It’s amazing. We can do whatever we want whenever we want. Just go and do it. No need to assess or plan. Just go with the flow.
And I hate it.
I miss my girl so very much that even writing this is making me well up. I miss how much she needs me, I feel lost not having to think at 100mph anticipating her every volatile move. I miss the ferocity with which she throws herself at me for a cuddle. I miss her so so much.
I didn’t think I was cut out to be a carer. I didn’t think being a mother to a disabled child was part of my identity, it was just the situation I was in. But I am a carer and a mother. Caring for my disabled child is a part of me and I didn’t realise how much I would miss it and how empty I would feel not having her with me. I’ve spent five and a half years with her by my side and it’s like missing an arm being without her.
It’s only been five days. I miss my best girl
28th August 2018
So today went well.
So well I ate a whole tub of Ben and Jerrys.
This morning a social worker came round to assess whether or not my children needed to be put under a child protection order.
I realised this about five minutes into the appointment, when I realised the social worker wasn’t from the disabilities team. That the team had decided Tilly didn’t meet their criteria (she does) without meeting her and sent a child protection social worker instead to make sure my children aren’t at risk. I had to answer questions about my relationship with my estranged husband, my childhood and what type of mother I am. I said tired if you’re wondering. All to check my children weren’t at risk in my care.
Turns out they aren’t, the social worker was embarrassed the disabilities team had passed us on without ever meeting Tilly and called me superwoman.
Can’t say I could appreciate the compliment after having nightmares the night before that they’d say no and tell me she wasn’t disabled enough for them.
If my children had been placed under a protection order today, if I had been having a bad day and broken down in front of the social worker, I would struggle to ever find a job as a midwife in the future.
An appointment that was meant to discuss direct payments for a carer or respite care for Tilly turned into that. This is the fun and games that come with raising a disabled child.
Fucking hell how is it only Tuesday?
Woman on the edge.
2nd September 2018
Sometimes it can feel like a bit too much having a disabled child. Some times I can’t make it into a funny story.
This evening whilst I was cleaning up dog poo Tilly stripped off naked and pooed on the landing, covering every single step and the floor at the bottom in poo before smearing it all over herself.
I shed a silent tear showering her off and scrubbing every single step. The carpet is ruined.
I shouldn’t have to scrub my almost six year olds adult sized shit off of the floor. I shouldn’t have to wrestle her to change her nappies or even keep them on. I shouldn’t have to desperately try to find pyjamas options she can’t get out of or else I’ll find her naked and wet (if I’m lucky) in the morning. I shouldn’t have to throw away outfits after the first wear because she’s completely destroyed them by chewing them instead of the stupid chew toys I have to tie to her.
Sometimes it’s absolute shite and sometimes it makes me really sad.
3rd September 2018
Player One Ready. Her bags are packed, her clothes are labelled, her meds are sorted. My biggest girl is back off to school. Back to the same class. Her first year was difficult, she lost her able to communicate, she ended the year much more violent and volatile despite the hard work of
her brilliant teachers. No amount of brilliant teaching could battle against the epilepsy raging through her body. This year will be different however because this year she has been on treatment for her metabolic now for six months. She is no longer ruled by seizures. She’s now able to learn and retain skills. She is changing every single day. I can’t wait to see what this school year will give her.
To put it mildly, I think getting more midwives or other professionals who have a background like Hana's into the profession is a good idea. It's the bootcamp of getting things done and standing up for people's rights and Hana appears to be made of oxytocin and titanium. I have no doubt that Hana will be a huge asset to midwifery and a voice for those who are vulnerable (she's currently campaigning to get GAMT on newborn blood screening tests).
And the nice thing about Hanna's Facebook blog is that she always makes me feel capable of changing the world too!
What are your thoughts?
Hana and I would love you to see you take action....get over to her Facebook page and click 'like' and you'll get her stories popping up in your feed. If you see something on there that you think the world needs to know about, please share it.
1. Have you got a friend or family member who's a carer or who has a disability? Anything you wish the general public knew?
2. If you're a student or qualified midwife, have you cared for a client who has a disability, or who's a carer? Is there anything we can learn from you?
Today's post is chock-full of goodness on one midwifery topic: pinards in emergencies!
You know those moments in life when you find you’ve forgotten something critical? Passport. Housekeys. Drove to the vet and took all the correct paperwork and your purse only to find on arrival you haven't actually put the dog in the car 😛
There’s that sinking feeling and then maybe you laugh a bit as you start to put together a plan to correct the mistake.
But imagine you do that as a midwife and suddenly there are two people’s lives on the line.
Midwifery is full of safeguards and checks and it’s crucial to be diligent and careful. But mistakes can happen.
That’s why I wanted to publish this anonymous write in from a midwife who found themselves in a very sticky position (read on).
In those moments of hellish limbo, you need to keep your head and find a safe solution. The worst thing you can do is panic.
This midwife found their way through using an ancient practice that's underrated in the UK.
Of course, I’m talking about being able to auscultate a fetal heart using a pinard!
If you don’t know what pinards are, they’re a type of stethoscope used to listen to the fetal heart. They're low-tech and old-fashioned, a bit like a horn crossed with an egg cup, see here:
(loving the hat!)
It takes time to learn how to use a pinard. Electronic sonicaids, like the one below, pick up the fetal heart much easier and the sound is amplified.
But once you have the skill, pinards are more reliable and accurate. Not to mention more satisfying.
You can hear different tones and it’s easier to distinguish between a fetal heart and maternal blood vessels. You don’t need batteries (a crucial consideration in some parts of the world).
And because you have to be skilled in placing a pinard to pick up a fetal heart, you can also confirm your palpation and work out the position of the baby.
They’re so important that I wanted them to be a motif in my novel. Chloe the student midwife inherits a pinard from her Mum and is determined to use it at every opportunity.
This is the midwife’s email…
‘So I have a midwife birth story for you all.
In the early hours of this morning I was called to attend one of my ladies who had gone into labour. I set out on the 45 minute journey from my house to hers.
On my arrival I took one look at her and could see she was in established labour. So I began to get my birth kit sorted. I opened my kit bag to realise to my horror that I didn’t have my sonic aid or pinards.
At that moment I had realised I had left them by accident at one of our MLUs the day before when doing an antenatal check. This birth centre was approx 1.5hr drive from her home. I must of completely forgotten to pick them up when I left the unit.
I wanted the ground to open up and swallow me up. She was having good FM and I could clearly see these as she was naked and dancing through her labour in a very mammalian way.
So I called a colleague to come and bring me some kit, however she was an hour’s drive away herself so I had to improvise in the mean time, as I could see the labour was advancing quite quickly for a first time Mum.
I asked for a toilet roll tube. Luckily they had one! I used it just like a pinard and it worked wonders! It also gave her birth partners a good laugh but I definitely could hear a good fetal heart.
My lovely colleague arrived an hour later with a pinards and sonicaid.
I used it just like a pinard and it worked wonders! It also gave her birth partners a good laugh but I definitely could hear a good fetal heart.
The labour and birth progressed without any intervention or vaginal examinations to a home waterbirth and a physiological 3rd stage with an intact cord until after placenta birthed. Intact perineum.
So if any of you homebirth midwives do find yourself without something to listen to an FH with, then use a loo roll tube - works wonders!’
The key thing to note about this story is the midwife in question has to be skilled with a pinard to be able to find a substitute.
I’ve heard really experienced midwives can sometimes find and listen to a baby’s heartbeat just using their ear to a woman’s abdomen! Amazing!
I know how difficult it is to find the time to learn how to use a pinard, as sonicaids are quicker. But be brave and start asking women and mentors.
There are some brilliant learning resources on how to use a pinard over on Sara Wickham’s blog:
You never know how useful this skill could be one day. And during the zombie apocalypse, or maybe just if you forget your bag, don't forget the toilet roll trick.
Have you ever been in this position? Or have you used anything else as a pinard? I've heard of wine glasses but would love to know your story, leave a comment 🙂
Please do share this post with anyone who might find it useful as well.
Much Love, Ellie x
P.S. Goes without saying but please don't use a pinard or homemade pinard as reassurance that your baby's okay. Even if you have midwifery training, it's important to get medical advice if you're worried about movements or anything else.
I have a particular acquaintance who's an amazing business woman. She’s clever and beautiful and leads her family and community in ways I have so much respect for.
Every so often, though, she brings up something that just knocks me sideways.
Like employing a psychic to analyse what her dog’s thinking.
Younger Ellie was a harsh critic with no time for anyone’s beliefs if they weren’t evidence based. When I was sixteen I was proudly reading Richard Dawkins and similar authors and loudly criticising everything.
I’ve now grown up a bit and understand a) I don’t know everything, no matter how many books I read b) being friends with people who think differently is a healthy, stretching experience.
But still – when it comes to pet psychics, the evil judgemental bit of me is thinking, oh, god, really? And then I muse on the fact that she enjoys it, it'll probably help with her dog's behaviour as they're spending time together and getting advice, it's not my place to judge...
It’s okay, I have a jokey relationship with this person and some of the things I do make her think I’m mad so we’re even.
Recently she’s started to go for vaginal steams, otherwise known as yoni steams. She feels they are making her periods lighter.
Based on this, I reflected on how midwives might discuss such a practice with clients, and learnt about my own prejudices and how best to cope with them.
If you haven’t come across vaginal steams, they’re a type of alternative medicine, or spa treatment, which involves sitting or squatting over steaming water infused with herbs. It’s claimed they’re good for reproductive organ diseases or issues, including fertility, but there doesn’t seem to be any evidence to back up these claims.
Some midwives I know like the idea as a nurturing activity for women and feel it's a historic practice that celebrates femininity.
Other professionals like gynaecologist Virginia Beckett, from RCOG and via the BBC, suggests the treatment is unlikely to be beneficial.
What is a midwife’s responsibility here?
Factors to consider:
· It's likely vaginal steaming will produce a placebo effect for some women.
· Placebos are very powerful
· But they work best when you’re not aware you’re getting a placebo
· Midwives have a responsibility to give evidence based information as per the NMC Code
· But they also have to respect client choice and there are cultural and spiritual needs to think about
My friend is completely genuine in feeling this treatment is helping her.
There is no formal evidence to show vaginal steams don’t work – but if we trust physiology we know that dilute herbs in steam absorbed by the vagina are unlikely to help with heavy periods.
If my friend was your midwifery client, what would you do?
We have to be careful about validating treatments that aren’t evidence-based, but we also have to maintain good relationships.
After all, a good midwife/mother relationship is responsible for the amazing outcomes of continuous midwifery care.
It might be more simple to say ‘do whatever you feel is best’ but I’m not sure midwives can get off the hook that easily either.
Midwives sometimes work with women who are desperate for treatment to work, for instance, those having IVF.
Vaginal steams can be over £100 a treatment and some practitioners claim they can help with fertility issues. I think midwives have a responsibility to advocate for their clients in this situation, especially as this treatment could be recreated at home for pennies!
The cleanliness of facilities and dangers of hot steam on delicate bits of our anatomy might be worth discussing too. I wonder what this treatment might do to the vaginal pH, as well, could it kill off some of the healthy bacteria perhaps?
It’s also a little concerning that in some countries vaginal steams are performed as women feel they need to 'tighten' their vagina to make sex better, or because they think their vaginas are inherently dirty. I'm a little afraid that vaginal steaming might be similar to waxing or douching - it's done because vaginas are presented as needing maintenance to stay clean when really they're very good at staying clean all on their own.
If women are booking steams because they think there’s something wrong with their normal physiology, that’s an issue.
If you pick up on this kind of belief, it's might be a prime opportunity to quote Ina May Gaskin when she says ‘Even if it has not been your habit throughout your life so far, I recommend that you learn to think positively about your body.’
On balance I think that midwives can be supportive of vaginal steaming. Like any other choice, it's important to offer information. But women might feel a special connection with the practice, or simply enjoy it. If you've offered all the evidence, you've fulfilled your professional requirements.
After that, trusting women to make their own choices and being a good, kind, respectful person is the name of the game.
What do you think - have you ever had a vaginal steam? Would you?
How do you deal with differences in opinion when it comes to clients?
Leave me a comment letting me know and please do share this post with anyone considering these issues!
The image for this blog is me moderating, in a heatwave. I run The Secret Community for Midwives in the Making, the 20,000+ member Facebook group that discusses all things midwifery.
We’re having some challenges at the moment. I've needed several glasses of wine and long runs. Don't feel sorry for me - I chose this job and for the most part I love it. But I have some things to say.
Topics like breastfeeding, abortion, circumcision and vaccination frequently come up. While this is brilliant and we get to hear opinions and stories from across the planet, they’re also subjects that make us vulnerable.
Often debates turn into anger. As the group grows, this is getting more common.
I’m aware that some people can campaign for better care using anger – but I’ve never been that person. I’ve always been quick to cry when I’m angry and that’s not a very persuasive place to start debating from.
In the Secret Community, we have one main rule which is that every post and comment has to be written in an overtly kind way.
Passionate debate is fine but anger or contempt directed at someone isn’t.
The reason for this emphasis on kindness is that I’m at the helm. I didn’t think for a moment that The Secret Community would end up this big but it has, and because I’m in charge, we’re going to have to do things my way.
This means being extravagantly kind, even when you disagree with who you’re debating with. Even if what they are saying is in your opinion, unsafe or disrespectful. Contact a mod by all means and we'll follow our procedure, we sometimes get in touch with trusts or universities and we have a policy for what to do if someone's letting us know they want to hurt or kill themselves (it happens).
But don't start or engage in a fight about midwifery issues.
This rule is because, in my experience, an angry debate in an online setting doesn’t usually change anyone’s mind.
People typically have one response to anger and that’s to get angry back. Even if they agree with you in principle, if you have fighting energy they will likely have a similar response and you’ll get nowhere.
Think about it – when was the last time someone was shouting at you and you listened and changed your mind?
People don’t say ‘oh yes, you’re quite right. There is something fundamentally wrong with me as a human and mother. I’ll change that at once!’
They just think, what a horrible person for making me feel this way.
What might be better is staying calm, or if you can, using humour? Not sarcasm directed at the person but just something to get rid of the tension. It often builds bridges and then you can teach.
This is why I often start my moderation posts with something like ‘oof, G and T time for the mods!’
It helps get us back to human communication.
Notice I'm not saying 'keep your opinions to yourself'.
I'm saying be kind.
I know. It’s not perfect.
Many of you will be saying that nothing will stop you fighting for the rights of women. That if we can’t handle flashes of anger then we can’t be good midwives and censorship of any kind is wrong.
But the internet has some dark holes of horrible comments and threads which make most of us lose faith in humans. I’ve seen these in the context of midwifery and I’m not willing to be responsible for a community doing this, especially not one debating such important subjects.
If I and the mods stopped moderating, the community would go feral, you know it would.
In the Secret Community, if our policy of kindness means removing members, even if they’re esteemed midwives who we really respect, we have to do it.
It's 'just' a Facebook group. But everyone gets to have their own corner of the social media world and this is ours. If you'd prefer a different kind of moderation, please set up your own group for angry debates. I'd totally support it if you can find a way to get it working!
We have a truly amazing moderator team who do so much behind the scenes and I can’t let them down either.
Keep it kind, everyone, please. Online midwifery will be better for it.
Much Love and RESPECT to all x
(This post was directly inspired by Caitlin Moran, one of my feminist idols, and Reni Eddo-Lodge, who wrote ‘Why I’m No Longer Talking To White People About Race' – both are angry at injustice, both using techniques other than anger to teach and change things).
I’ve read quite a lot of pregnancy guides and I wasn’t sure there was much call for another one.
With the burst of amazing writers releasing things like ‘Birthing for Blokes’ and ‘The Positive Birth Book’ I thought it was covered.
I was completely wrong.
This particular birth book is designed for any pregnant woman who feels like a bit of iron filing caught between two magnets.
Rebecca Schiller is a doula, journalist and campaigner for women’s birth rights.
The book is snappy and balanced and talks to women like they’re intelligent. Not that other books don’t, but it prioritises making the reader feel in control.
It gets into the choices that need to be made in pregnancy and how they can impact us mentally. Overall it has a kind approach that fosters sensible self-belief and it focuses on preventing guilt.
It made me sad to recognise how crucial addressing guilt is.
But it’s a strong and unusual woman who manages to avoid feeling bad about her choices as she becomes a mother.
According to our society, ‘successful’ women are supposed to be thin, pretty and accommodating of others’ needs (study). The scope for us feeling bad is pretty big even before pregnancy.
I believe that pregnancy can hothouse shame because of the physical and personal needs that conflict with how women ‘should’ look and how they should feel about their child.
Self-care is something we talk about but it’s a hard concept to get to work in real life when we’re all so busy and focused on the people we love.
Rebecca’s book covers all the standard information needed. From screening to cord clamping to infant feeding, the facts have been collected and presented well, with resources for those who want to assess the science further.
Mental illness is addressed and it’s great to see the unspoken fear tackled – many women who suffer from depression worry about having their baby taken away and so don’t ask for help. But as Rebecca mentions, the odds of a child being removed purely because of depression are next to zero.
I won’t go into every topic mentioned but I was impressed by the breadth. The only thing missing is race – women from black and ethnic minority backgrounds experience a different story in pregnancy which ultimately puts them at higher risk. It would have been great to see this addressed in detail (I’ve become more aware of this social injustice problem in the birth world recently).
My way of telling if a pregnancy book is successful or not overall is ‘would I send this to my sister (a neuroscientist researcher) if she was pregnant again?’
I absolutely would – it’s more like a letter from a well-informed best friend than a pregnancy guide. And the vignettes included from the experiences of women help illustrate how different we all are. From those who wanted an epidural, to those who find masturbation in labour helpful.
The weird thing was, 'Your No Guilt Pregnancy Plan' was even useful for me personally. I’m not pregnant but everyone needs reassurance about trusting yourself when overwhelmed with options and choices.
I suspect that we all have these mental hurdles. It’s just that in pregnancy they’re more intense.
I enjoyed the way Rebecca presented it all as a challenge to develop self-trust, not an ordeal.
Now I’d love to hear from you.
Have you read this book? What did you think?
Do you think women face guilt in pregnancy? How do you address this as a student or midwife?
You know those books that you read and feel yourself being changed? I think it's called 'internalisation'.
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.
Did you know:
A slogan put about by the Conservative government was 'if you want a n**** as your neighbour, vote labour' - this was 1985
Children of colour get marked down in school
But when their work is assessed independently under a white British sounding name, they get the grades they deserve
Bristol was a slave port and the UK has a lot of its wealth from black slavery
Black and ethnic minority women are three times more likely to die during childbearing.
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.
I'm not saying white people don't have adversity or don't work hard. I had my first job at age 12 and I've worked ever since then. My family was often financially insecure when me and my siblings were growing up. I've faced sexism as well, in a workplace that still thought the men were more likely to be correct than the women.
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?
p.s. I don't feel wise enough to write this. But I have a platform and I'm white. Even if I get it wrong I need to be trying. Feel free to correct me and please know - if I have made mistakes or caused offence, this is due to my ignorance, not malice. I'll keep learning, I'm sorry I and others haven't noticed in a meaningful way until now and I'm LISTENING.
If you’re interested in what having your first novel published feels like…??
??I used to think that the biggest fear you could experience was in a birth room with the lives of two people in your hands. I still think that’s objectively a much bigger deal than getting a book out. So the emotion that’s possessed me over the last few weeks has confused and, at times, exasperated me. There are much bigger problems in the world (staffing crisis in the NHS, Brexit or Trump, anyone?) ??
Other writers warned me the run-up is intense but this was when back when my book hadn’t been accepted for publication yet. I wasn’t impressed. I thought: pull your socks up. When you get a book published you’re not entitled to feel anything other than ecstatic.??
Cut to three weeks before it’s out and sometimes I’m a bit of a mess.??
For a long time I couldn’t even put a name to the feelings. They're bigger than anything I’ve ever felt before, a whirling, circling, complex mass of emotions that take over without warning. The best way I can describe it is it’s like the sharp edge of falling in love. ??
I’m doing a lot of writing of book two, which is calming. I’m also doing a lot of cycling. I rode to Leicester and camped out in my bivi under the stars the other day. Being out in nature helps me remember that this is just a book and it doesn’t matter. No-one is going to lose their life based on a novel. I’ve also ridden to Norwich and back with my brother this weekend. As a social worker, he’s a talented panic absorber.??
I did some psychology in the saddle and realised a bit more of what was going on.??
I want to do right by midwives and the women who’ve experienced the events in the book – drug addiction, abortion, birth. There’s an anxiety about what people will think. ??
But there’s also joy at having got the book done at all (something I’ve wanted to do since I was little). ??
Brene Brown the sociologist talks about ‘foreboding joy’. It’s the sensation we all have when something really good is happening. Like if you’re a parent and you poke your head around the door to see your child asleep you feel such overwhelming love that you instantly think about all the awful things that could happen to them.??
It’s easy to get so caught up in foreboding joy that you forget to enjoy what’s going on. That’s dangerous because you risk never enjoying the best events of your life.??
Focusing on delight is just as important as being aware of the terrible furnace of the world, to paraphrase the poet Jack Gilbert. ??
I’ve found that focusing on gratitude often sorts my feelings out, or makes them bearable. Just being grateful that it’s done and someone liked it enough to make it into a real book. A novel that will be in someone’s hands soon.??
I also realise that when you feel that deeply about something, you’re probably on the right track.??
New Walk is out on 18th October 2018. Wish me luck.??
'I was suspended and investigated for taking a woman on my caseload home and letting her live with me and claim asylum. It’s a long and terrible story, and it was an awful 3 months whilst awaiting hearings and being threatened with NMC referral, but I won the case with the help of friends...'
Did you know I'm the middle of the final edit for my midwifery novel?
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.
It might be contradictory for a midwifery blogger, but I have concerns about the online world.
It's easy to forget how recent it all is. Imagine you're a village midwife in the 1800s, regulated by the church and unconnected to the knowledge of others. Enter MatExp the Facebook group - what would those midwives have thought of it? It's mind-blowing how far we've come.
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.(more…)