Baby loss awareness week 2022: My story.

There is no “normal” journey to motherhood. Granted, there are those who decide to have a baby, have unprotected sex, get pregnant straight away, have healthy pregnancies, healthy birth experiences, but even in those seemingly perfect circumstances, there is almost always more to the story. For many many women, myself included, the road to motherhood is a long and complicated one.

One in every four pregnancies ends in miscarriage. For me, two out of my three pregnancies ended in miscarriage. In March 2020 I was 10 weeks pregnant with our first baby when I started to bleed. Despite every bone in my body begging for everything to be ok, it wasn’t to be. I was told I’d experienced a missed miscarriage.

I’ve never known emotional pain like it. I felt like a complete failure. For a long time afterwards my heart ached with grief. I resented my body for giving me false hope. I felt deceived. Our baby only made it to six weeks, but my body continued to hold on for a further four before showing me any sign that anything was wrong. It then refused to let go. I refused to let go.

I needed medical management to end the miscarrying process. Although emotionally the pain was unbearable, I didn’t experience much physical pain during this process. I did however bleed, torrentially. I turned up at A&E with blood soaking entirely through my bottom half and through to the seats I was sat on. Not ideal in a waiting room full of people. The measly sanitary towel I had on was good for nothing. Having been quickly assessed I stayed overnight. A scan in the morning revealed that I still hadn’t passed everything. I can’t remember returning home. I bled for a while on and off and a week or so later was told everything was gone.

Following this experience I honestly thought I was broken to the idea of pregnancy for good, but, slowly I returned to work, I returned to “normal” and my desire to be a mother continued to burn overwhelmingly. Once my body had recovered, we continued to “try”.

In December of 2020 I was pregnant again, but I immediately started to bleed within hours of my positive test. I spent the weeks leading up to Christmas going for blood tests and scans. I continued to show levels of pregnancy hormone in my blood at an increasing level, but with no viable pregnancy to see. An MRI ruled out complications, for which cancer was something they wished to rule out. I didn’t think I’d feel relieved to have a failing pregnancy at any stage during this process, but in that moment, I was glad that it was nothing more.

I found myself wishing and willing for the end to happen quicker this time. For the pregnancy to be over as quickly as possible. All that time spent hoping for it. It’s such a very sad place to be in. The pain this time was unbearable and came all at once. Having experienced labour, I can now say that the pain was the same. This was my body working on its own to end the pregnancy which it did, and we grieved once more for another lost baby. 

In June 2021 I had my third positive pregnancy test. This time, I hardly wanted to believe that I was pregnant. I went into self preservation mode. I was offered an early scan which I accepted but I delayed for as long as I could stand it.

For some, for me, scans are not a lovely, exciting experience. All I had known from attending a scan was heartbreak to this point, so although I longed to see a healthy baby, It took every bit of strength I had to actually walk through those doors and look at the screen. At seven weeks they found a viable pregnancy. Some LONG weeks later, we had the routine viability scan and my heart leapt when the sonographer told us that everything was good. At the 20 week anatomy scan again, we held our breath until we heard that our baby was healthy from head to toe. 

Feeling him move was the turning point for me. He of course took his time. He waited until he was 24 weeks big to really start giving me reassuring nudges, and I finally gave myself permission to enjoy my pregnancy. For those first 24 weeks I had lived in no man’s land. We didn’t officially “announce” our pregnancy. We didn’t have a “gender reveal”. Even when it came to going in to have Sonny, my mind drew a blank when imagining walking out of the doors with a baby in our arms, but we did it. We made it. For that, I know we are incredibly blessed.

He’s currently asleep on me a whole 8 months old and I can hardly still believe we made it here. To me, he feels like a miracle. A fighter against all odds. The most precious gift. I feel overwhelmed by love and primal protectiveness over this little person that I dreamed of for so long. I may have only been a mother for 8 months in some ways, but to me, I’ve been a mother since that very first positive pregnancy test. 

Mine is just one drop in an endless ocean of experiences, many of them kept unsaid. This baby loss awareness week, remember to be kind. Be sensitive. You never know what people may be going through or what they may have been through to get to where they are. 

The curious incident of the Midwife in the cupboard.

When you walk in on your first day of Midwife school you feel on top of the absolute world! “I am bright, I am breezy, I AM AWESOME!” Although three days of pampering and prep in a bid to impress your new friends was an utter waste of time because it’s Manchester, and it’s torrential, and your umbrella whipped itself inside out 0.3 seconds after stepping off the bus and you got off the bus what feels like 100 stops too early because you can’t just ask Lady Google to get you to the university, she wants impossible specifics, and you spent so long packing pretty highlighters that you forgot to bring a standard pen so had to detour to another country to buy one, BUT! you can’t help but feel like you’re having the best of best days because all of your dreams are actually coming true!

Your smiley Midwife lecturer welcomes you all with warm, cosy, mother hen arms and you all bunch together in your baby midwife nest waiting with baited breath to hear about the amazing life we’re all about to embark on. And she says something along the lines of:

“Write yourself a letter tonight telling yourself why you want to be a Midwife and what motivates you to be here today, because it might take one week, one month, one year, or ten years, but there will be a time when you feel like you want to walk away.”

Gormless pale faces quickly replace the bright and breezy ones. But only for a moment, as she quickly moves on to detail all of the wonderful amazing things we’ll come across and learn about in our journey to become the Midwives we’ve always wanted to be.

Of course we decide to forget about her slightly jarring first piece of advise, preferring to live in the rosey land of denial. “This is my dream! I will love it forever and ever and ever.” So of course, I never wrote that letter. Looking back now, I really wish I had. Because here I am, googling “how to make my cute cat rich and famous”, almost certain that I’m ready to walk away from it all.

I don’t think anything, or anyone could have prepared me for what it can feel like to be a Midwife sometimes. Having spoken to a number of my fab Midwife friends about how I feel, it’s become clear that I’m not alone, which has been both reassuring to me and saddening. I’m going to write quite frankly and openly about my recent experience, (omitting any details that might get me into trouble of course), in the hope that it sheds some light on a subject I wish I had a better awareness and understanding of before I found myself here, so here goes.

Over the last few months I’ve been involved in the care of more high risk women. This happened to correlate with my step up from a band five to a band six so was somewhat expected. With most higher risk cases I have come across similar before and manage it based on both policy and experience, happily within my comfort zone, however, I’ve had a few particularly unique cases and emergency scenarios arrive on my Midwife doorstep of late, all within quick succession and all of which have prompted what we call “incidents”.

For the non- healthcare professionals amongst us, I’m talking about what happens after a high risk event occurs. In maternity this corresponds with a mum, or baby having required emergency action and attention to ensure their wellbeing. When an event such as this occurs, an “incident” is inputted shortly following, detailing the event itself and the action taken as a result of it. This highlights to a specialist team within the unit that the event has occurred. They look at the notes detailing the event and gather information to assess whether or not it could have been prevented, and whether or not it was managed appropriately. (That’s a very brief description). This is standard practice. Pregnancy and birth comes with it’s risks and we know that. We learn to recognise the “normal” and act when we suspect something is falling outside of the “norm”, early on.

We’re also prepped and ready for when the toe dipped outside of the normal escalates into an emergency requiring urgent action and we practice the management of such over and over again until we can manage them with our eyes closed. I was prepared for the emergency events, but I don’t think I was prepared for what happens afterwards.

Following an event you go over what happened in your head and talk it through with others involved. I go through my actions meticulously to make sure I made the right decisions at the right time. More often than not, outcomes are positive, but knowing that things may not have been is enough to give you a couple of sleepless nights going over and over and over what you did and questioning whether or not you could have done anything differently. The next day, and subsequent days you ask colleagues how the family are getting on and call whoever you have to to make sure mum/ baby are well. Your hopes are confirmed. With that, and the reassurance from your colleagues that all was done correctly, you finally start to believe it yourself and attempt to move forward, grateful for the additional experience under your belt, and confident that should such an event occur again, you would do the right thing again. You try to put it to the back of your mind.

You’re then invited to an incident review. During an incident review everyone involved in the case is invited to come together to go through the notes and decide whether action was appropriate and whether there’s anything we can learn from the event in hindsight. I attended two incident reviews in May and have just been invited to another. I was nervous in both reviews that I’ve been to. Being sat there as everyone reads through the care you have given and actions you’ve taken is daunting, but on the whole I came out feeling glad that I’d gone. I had the support of my managers also in attendance and hopes that I’d done the right thing we’re confirmed. Learning points to carry forward were highlighted and valuable, and so I went away again, trying to put it to the back of my mind.

And then the external review body come in. This is a new thing, and something few of us had experienced before. I attended under the impression that the questions asked would be in an aim to establish whether or not there was anything to be done that could assist me in future. By this point i was confident that my actions had been correct and that I shouldn’t be worried about the interview. I walked in slightly apprehensive of the unknown. The interviewers (two of) were welcoming and consented me, and told me that the conversation would be recorded. Self conscious me wasn’t best pleased about that but I wouldn’t have to listen to it so I went with it. The interview wasn’t what I was expecting. It started off with no real direction. I was asked to “paint a picture” of the event that occurred. I could only go off what I’d written, and had a very vague memory of the event now, in that it had occurred a good many weeks ago and I’d consciously tried to put it to the back of my mind, so I did my best. I talked through my documentation. I was asked about why I’d done what I’d done and for specifics which quite frankly, I couldn’t detail, such as, ‘where was the patient in the room at a particular time?’ and ‘what were they saying and doing?’ I felt that the questions were difficult to answer as I didn’t remember such detail, and I told them so. However, I could see how it would be easy to “remember” something that potentially wasn’t 100% accurate but felt appropriate to mention based on the questions, which worried me. I stuck to what I’d written. Comments were made about the way I had documented certain things and I left feeling deflated but with no real understanding for why I felt as I did. They had been pleasant, and told me I could ring them should I feel the need to talk through anything with them. I took the card offered to me and went home. I was tearful in the car. I sat at home and went over the interview in my head and the thing that stuck in my mind was that they’d mentioned the NMC at some point. I got myself wrapped in knots in my head, and my stomach and had to call the number I was given. On speaking to the woman she reassured me that I had nothing to worry about. I’m glad I rang, but I was frustrated that I’d been allowed to leave the room without such reassurance. If I hadn’t called, I wouldn’t have known what to think.

By this point, in my own my mind, and with my colleagues, in an internal review and in an external review I’d gone over, and over, and over and over what I’d done and whether I could have done anything differently. I have been given the impression that no, there isn’t anything I could have done. The outcomes for the family were positive I was assured which was my main concern, so in an ideal world I should pack it all away and move on. But that was just one.

I’ve been involved in a further incident since then, for which I’ve been to interval review and yesterday I received an email inviting me to yet another incident review. It’s safe to say, I’m exhausted and I’ll openly admit that I’m at the point now where I go into work and just expect something to happen to prompt another.

My experience with such consecutive incidents has flipped a switch in my brain. Where my care two months ago was wholly centred around ensuring the comfort, health and safety of the women and babies in my care, I now also carry around with me the concern for my own legal safety. Where I once had confidence in my documentation, I now spend more time making sure every detail of my care is written down, just in case I’m asked to “paint a picture” again in the future. This undoubtedly takes time away from the time I’m actually spending engaging with the people in my care, a part of the job that I love the most, and this switch definitely contributes to the decline in my job satisfaction of late.

I also feel like my trust and faith in “normal” midwifery has dwindled. When things step outside of the “norm” so consistently for a period, it’s difficult to trust and have faith when things are actually low risk. In that sense, I’ve also recognised that I’ve lost my nerve. I suddenly need a lot more reassurance and clarification from my colleagues because I worry that I’m missing something. I worry that one day they will go through an incident and find that I should have done something that I didn’t. (Colleagues: that’s why Cathy dragged me into the cupboard, haha). 

I wholly respect and understand that such incident reviews help us to develop the best, safest models of care, and highlight potential areas of improvement or highlight areas of outstanding work. I also understand that we live in a litigious society, and one where the culture of blame is inescapable, and I also understand that there is nothing I can do about that.

There is also nothing I can do to change the fact that there will always be a level of risk with pregnancy and childbirth. That is inescapable. Delivery suite is the front line for such events, so I have considered taking a step back, onto maybe the ward or community, because I know I need a break. I also know however that if I run for the hills i’ll completely lose all of the confidence it’s taken nearly 3 years to build, and it’s already taken a big hit. I know I need to stick with it where I can and rebuild what I’ve lost before it vanishes entirely. 

It’s not easy sometimes. It’s bloody hard. The last two months have taught me that. Thank goodness for the endlessly supportive, patient colleagues of mine. I’d have long gone without you all! A hug and a cry in the cupboard is the best medicine sometimes!

And to my madly devoted family and friends, I’m sorry for all the moaning I’ve done. I offload never expecting answers or solutions, despite your best efforts to give them. I just vent. That’s my coping mechanism! Along with this, and I will forever appreciate the unwavering faith in me you hold. 

I’m hoping that in time I’ll bounce back tougher and more bad ass than ever, and when I get there, I’ll be writing myself that letter.

All healthcare professionals face incidents in their time. Its a big part of the job that no one outside of the profession really understands. I hope this sheds some light and if you’re planning to become a midwife/ currently a student/ newly qualified, I hope I haven’t scared you off, but this is an aspect of the job I wish I’d heard from the horses mouth. The tough times are tough, but I have faith that they don’t last. Here’s to hoping I’m back on my happy Midwife wagon quick sharp!

Lots of love

x

Can caring for others cause us to neglect ourselves?

One miserable day I was sat in my car with my head on my knees, urging my head to stop spinning because I had to move on to my next community visit. As I sat there cursing all of biology for this burden I asked myself why I hadn’t phoned in sick. I’ve since decided it was worth writing about where this thought process took me so here goes! (It’s a bit of a rabbit hole, you’ve been warned).

When us NHS workers are ill we know there is a lot at stake. When the dreaded day comes and there is no option but to call in sick, it’s, for lack of a better phrase, bloody awful. Most of us accompany our near death illness with a good helping of guilt for having burdened our colleagues with an ever growing workload. Sometimes the pit of guilt feels worse than any illness so we push through and go in regardless. That particular day I was the only midwife on in my team to cover visits, clinics and phone calls. That is why I was in the car rather than in bed. On reflection I hadn’t had much to drink at all, all week, and I had skipped breakfast to get into work a little early and lunch to squeeze in another visit. That was why my head was on my knees. I realised at that point that had I been off sick it would have been entirely avoidable had I made my own health a priority.

With an ever rising level of long term sickness across the healthcare sector, it’s clear that we need to tear down the illusion that we are able to cope under ever growing demands. We are human. We have the same chance of encountering life’s inevitable problems as the people in our care and that’s something to honour. It makes us better at our jobs when we can empathise, however, with this in mind, we need to recognise that our basic human needs matter just as much as our patients and should not be overlooked. Failing to respect our personal health and well-being needs in the short term must play a role in long term illness.

We encourage the people in our care to drink plenty of water, to eat well, to get a good nights sleep. We ask them to get 30 mins of exercise a day and to get into a good daily routine. We know this is all conducive to a happy, healthy lifestyle, yet we dish out this advise on three hours of broken sleep having stuffed only a couple of slices of toast, five sweets, three crisps, four sips of water and a cold coffee down ourselves in the space of 13.5 hours. But I know, i hear you! It’s not that straightforward.

When faced with a busy day at work we have to get on with it. The vast numbers of post World Cup babies don’t stop on their road to arrival because it’s lunchtime for the midwives. Joking aside, we all too often fail to make any time for ourselves to have decent food and water prioritising patient cares, paperwork, welcoming new people coming in and discharging people who are keen to get home. Even when we get to a point where we could have a break, there is a colleague who also hasn’t had a break who could do with some help. You don’t want to be sat there working your way through a microwaveable Thai green while someone else is drowning in paperwork. We often get into discussions about the impact of this in terms of the time unpaid, but there is never acknowledgement of what kind of an impact this has on our health. 

It is infuriating that eating and drinking is such a basic functional need, yet, we can’t manage to grant it to ourselves. Come on!!! I feel guilty not feeding my cat when she meows once to remind me. We don’t have snow days. We can’t count down to the 6 week break. We can’t circle the precious bank holidays on the calendar and make plans with the kids. We can’t count down the hours knowing that 5pm marks the end of the day until 9am tomorrow. We can’t make plans with our children, partners, friends at the weekend. We most likely won’t make that last minute catch up with friends. We can’t sleep at night because we’re on call, or sleep in the day because we have to let the world go on around us and make the best of it before a long night at work. We don’t know that Christmas will be a day for family. We can’t commit to a weekly bongo drum class because we have no idea when we’ll be working. We can’t merely go into work and try our best. That would be too easy! We must go in and do the right thing every single time. We can’t make human error, because there’s a life/ two lives at risk. To any single person that would be a lot of pressure to handle every waking hour you’re at work, which is often over 13.5 in a day. We make decision after decision with everything in the balance, yet we still can’t manage to drink water and eat a decent meal and we wonder why we feel so close to the edge sometimes?! A fellow midwife recently told me about a day she didn’t manage to get to the toilet for so long that she sent herself into urinary retention. Agh!! We sacrifice so many life balancing luxuries I think it’s about time we put some emphasis on the importance of meeting at the very least, our own basic needs. 

We chose this profession because our driving force lies within the health and happiness of others, but when we’re signed off for stress or physical illness because we’ve run ourselves to the limit, was it all worth it? Some illnesses can’t be helped, but I really do believe that if we took on the advise we give to others for ourselves, we’d be in a much better position both physically and mentally and the NHS as a whole would benefit. If the amount of us off sick reduced there would be more staff around to share the load. This could ultimately reduce pressures across the board and give us that extra bit of breathing room to better look after ourselves as well as our patients. 

There is no factory that pumps out bionic Midwives/ Nurses/ HCAs and Doctors (just yet). We need to look in the mirror and reflect some of the love we give to other people onto ourselves. Recognising our most basic needs and voicing the importance of such may spark discussions to highlight barriers and create solutions, and hopefully encourage a change in perceptions. If you’re reading this at work, remember to keep yourself in mind today and tune in to what you need to help you feel your best. Let someone relieve you for your break. Relieve someone else. Take the time when you have it and make yourself an equal priority. Your body, mind and your patients will thank you for it! If you’re a patient remind your Nurse/ HCA/ Midwife/ Doctor to have a drink. It’s the little things sometimes, that make all the difference. We’re in this for the long run after all.

 

Thanks for reading

x

 

 

 

Out on the (not so) “Mean Streets”

Hi all!

For the last 6 months my job has been a little different. No, I’ve not become a Rock Star, sadly. I’ve been a Community Midwife! I know, cue the “Oos” and “Ahhhs”. For those who don’t have experience in the world of Midwifery, that means that I’ve stepped out of the Hospital and have been out in the community (would you believe it), running antenatal clinics for pregnant women, postnatal clinics for parents and babies, driving around doing home visits and much, much, MUCH more. I’m now back in the Hospital, but since I’ve been back I’ve had A LOT of questions about my experience, so here it is!

When I first found out I’d be going out on the “Mean Streets” as I’ve heard some call it, I pretty much pooped myself (in less angelic words). I hadn’t experienced community midwifery since I was a student, meaning I’d done a maximum of 4 weeks of Community Midwifery, 3 years ago, in Manchester. I was aware of how much Community practice varied across different areas within Manchester, never mind in a whole new area of the UK. Not cool. I was familiar with the notes that the Community Midwives wrote in, but beyond that, I was clueless.

So the dreaded day arrived. Thankfully I was warmly welcomed by the wonderful team headed by Cathy and Joan and my initial fears of being made to feel unwelcome were well and truly squashed. A huge relief! I was definitely in a state of denial until I physically got through the door on that first day so was wholly unprepared. I didn’t take a notebook. IDIOT. First tip to anyone moving out to Community- you will definitely need a notebook. On that first day I filled endless scraps of paper with information I’d need to know to function. It was a lot. The first two weeks were spent shadowing Cathy and Joan, scribbling down every bit of information I could, in the desperate hope that it would help me when the time would inevitably come that I’d be left to my own devices.

To my initial dismay, that dreaded day did arrive! I was on my own. The day was a quiet one, as orchestrated by Joan and Cathy to ease me in (thank you, thank you, thank you). I only had a few home visits. Easy right? Nah. Well, I managed to find a reason to ring Joan at every visit I had just to clarify that what I was doing was right. It was her day off but she’d made the utterly kind, but no doubt regretful mistake of telling me I could call her should I need anything. She answered every call and reassured me every time. My hero! I’m so grateful, and equally sorry for that first day. Every day from then on presented new challenges and learning curves but, mostly driven by guilt for being such a pest, I put down my phone and started to trust myself. Most of the time I had Joan or Cathy not far away for guidance should I have needed it, which made it all a much more manageable prospect. Despite this, some things were easier to adjust to than others.

Running my own clinic was always going to be daunting. For anyone unsure of what that involves, there is a Midwife employed by Blackpool Hospital linked to most GP practices in the area. The Midwives look after all of the women who present as pregnant at that GP practice. The caseload of women at my GP practice was around 30-40 women. Initially, I found it a little awkward taking over from Cathy. Some of the women had seen her throughout their pregnancy and suddenly they were lumped with me. I could understand their disappointment! I was slower and less experienced so it must have been a shock to the system for them as well as me, but as weeks passed, I got to know the women, and the women me. I realised I wasn’t as useless as I thought (hopefully they did too) and I became more efficient, confident and built some really close, positive relationships with the women in my care. That was one of my main loves of the Community Midwife experience. When working in the hospital, you rarely see women more than once in their pregnancy. The contact you have with families at the Hospital, during labour for example, although intense, is short when you compare it to the months and months of interaction you have with women on Community. Not only do you have face to face contact every so often, you’re also their first port of call if they have any questions or concerns, so phone conversations were also regular. I enjoyed recognising women and having knowledge of what had happened in their lives and pregnancies. It felt like old school, “Call the Midwife” Midwifery in some respects, which I loved.

Keeping an eye on 30-40 pregnant women however, was a challenge. Making sure that they turned up to their appointments and chasing them up when they dropped off the radar was one of the more frustrating, and particularly challenging parts of the job. I soon picked up tricks of the trade and found myself exercising surprising skills in respect of tracking people down. I didn’t realise being a midwife also entailed turning into Sherlock at least once a week.

Another task it took time to get my head around was “Consultant Antenatal Clinic” and my role in that. If women have any risk factors in their pregnancy we refer them to see a Consultant Obstetrician. They work weekly out of either the Hospital or outreach clinics. Every week around 20-25 (give or take) women would come to be seen by the Consultant at our outreach clinic. My role was to see them before I passed the notes on to the Doctor who would then call them in. Often there would be one Midwife, a Healthcare Assistant and two Doctors (a Registrar and a Consultant). I soon learned that these mornings would be both physically and mentally, very demanding. On paper I only had 5 minutes to see every woman to check their blood pressure and urine, take any bloods required, palpate her tum, have a listen to baby, measure bump and answer any questions. It’s safe to say that it took longer than 5 minutes.

Time pressure was HUGE. Efficiency was vital, and missing something? Not an option. On top of that I also needed to keep an eye on what the Doctors needed, making sure to book women in for follow up appointments for example. I would often have to tell myself to “just keep going”, as the notes of waiting women piled up. When there were two Midwives, the pressure was somewhat less, but a lack of space at the clinic meant that progress was still slow as with only one room, we could still only see one woman at a time. The “luxury” in this case was that while one Midwife checked urine, the other could check blood pressure. Every week, we got there, but more often than not, running way over time. Women were thankfully incredibly understanding, and dear Diane and Vicky kept me going with tea and biscuits (even the odd sip and nibble was a god send) and sat in with the Doctors for me so I was less divided. We got through it. It upsets me that I came away with that thought after seeing the women. I know they will have felt rushed through and frustrated with having been waiting for long periods, and all I could do at the time was apologise and explain the situation the best I could. This weekly experience really opened my eyes to the reality of the lack of time and resources we have. A team of what used to be eight Midwives years ago, is now down to two. Clinics for 20- 25 women, sometimes more, squeezed into one morning is really stretching the band. On top of this, visits and appointments would continue on into the afternoon.

On days like that, team work across areas was so valuable. Day to day, teams with less of a workload than others would often offer to take on visits from other teams and Midwives from other areas would come and offer a helping hand as able. But what happens when everyone is busy? It is often that I think that teamwork and individual dedication are the only things keeping the NHS going. If it wasn’t for Midwives staying behind later than expected, working through lunch, turning up early I really dread to think what would become of maternity care overall. I digress. That’s a topic for another day.

Beyond this, what came to be the most demanding part of the role for me personally was the social aspect of the work. I live and work in an area where like all areas, affluence and deprivation live side by side. Every family I come into contact with has their own set of individual circumstances. Women walk through the door, not just a body with a bump, but women with a life and we need to consider all aspects of that life. Yes, physical health is important and we ask all of those questions to ensure that we provide appropriate care to ensure a safe mum and baby, in the physical sense, but women also walk in with a social and emotional status and individual needs that we must recognise. A family dynamic, a housing situation, a financial situation, a level of education, mental health needs, previous pregnancies, previous partners, social service involvement, police involvement, experience of domestic abuse, addiction, to name but a few. From a holistic perspective, the potential vulnerabilities and needs of families is endless. The questions we are prompted to ask as standard ensure that these needs are highlighted, but taking action to safeguard vulnerable families was a responsibility I struggled with.

We have a specialist team of Safeguarding Midwives for the most vulnerable families. They were a saving grace in terms of their vast experience and knowledge, but they are very unfortunately, massively overstretched. It’s impossible to ensure that every vulnerable woman is seen by a Safeguarding Midwife, so, where possible, women with lesser levels of vulnerability are managed by Community Midwives with the input of Safeguarding Team as required.

I was naive as to how much time goes into managing the social needs of families in Community Midwifery before I experienced it for myself. I spent a great majority of my time, between visits and clinics on the phone to social services and probation, gathering histories, compiling information and actioning referrals to ensure the right support and management plans were initiated to meet individual needs.  I found that I took a lot of my concerns home with me. On reflection, I recognise that I wore the responsibility of keeping vulnerable families safe, too heavily. I spoke to my manager (Sorry, and thank you Angie!) one morning and broke down due to weight of the responsibility I was carrying. This has been my biggest lesson, and the recognition that I need to work on my resilience and work/ life compartmentalisation has been valuable for my personal growth. I learned that I could only do everything I could do, within my scope of practice, and having done that, I had to let it go. Recognising, and meeting the holistic individual needs of a family over a period of 14 hours is much different to recognising and meeting those needs over a period of nine months. I have a huge amount of respect for community midwives, and safeguarding Midwives in that respect.

So! Am I glad I did it? Extremely. Would I do it again? Maybe. But for now I’m ready to be back in the Hospital, rebuilding my confidence in that environment and facing different challenges that will no doubt present themselves. It’ll be interesting to see how this bucket load of new knowledge and experience will impact on my practice within the Hospital. I’m hopeful that it will help me to be a better Midwife overall.

To my Community team (especially Cathy and Joan), thank you, endlessly, for your patience, kindness and support over the last 6 months. Thank you for the much needed hugs and kind words of reassurance. I couldn’t have done it without you, well, not with as many laughs/with my sanity intact anyway. I will miss you all. And good luck in your new ventures!️

For anyone about to face the “Mean Streets”, they’re not so mean. Enjoy getting to know Women and their families, I did, and it really is a privilege you rarely get to experience working within the hospital. Soak up every bit of knowledge you can from the more experienced bunch. They are incredible and their lessons, so valuable. For the more complex stuff, seek support and advise from your safeguarding supervisor (you will have one) speak to the vulnerables team; again, incredible sources of knowledge, or speak to a Manager. Ask questions, lots of them, take a notebook, you’ll need it, keep a phone charger in your car (Google Maps is life). The on-calls are fine. You eventually learn to sleep ensuring your phone is on LOUD and your partner has called you fifteen times just to check you’ve got signal, it’s on and it’s loud enough. Mileage is very worthwhile keeping on top of. The extra money will help cover your petrol. I could go on forever, but I wont, but do ask me if you have any questions. I’m not the most experienced by a long shot, but I’ve been in your shoes recently. I might be able to help somehow. For the experienced super hero Community Midwives out there, be patient and kind with the newbies. It’s a scary prospect at first.

Lots of love, as always.

Happy 1st “I’m a real Midwife” birthday to me!

The New Year approaches! And with that, so too does my “I’m a real Midwife!” one year anniversary. First of all, I cannot believe how fast this year has flown by. When I started I could not even begin to imagine how I might feel one year on. I had so many hopes and fears. I hoped that time would bring greater confidence, resilience, knowledge and faith in myself. I hoped I would eventually feel that I “fit in” and would feel part of a team. I hoped I would have a positive impact in my work and above all, I hoped I would be a good Midwife.

I didn’t start off on the best foot. I had a rocky ride leading up to qualifying and ended up relocating rather quickly and unexpectedly as my relationship of 8 years broke down. Moving away from Manchester I left behind a relationship, a house, a job offer and friends. Blackpool was a completely fresh start for me, chosen because it was close to family. I hadn’t left Manchester with much. My financial situation was dire, as it is for anyone who’s been a student for any length of time and I was at a personal low point, but qualifying as a Midwife was my biggest achievement to date and I knew that my first job would be the doorway to whatever my independent future may hold. It was kind of a huge deal.

I wanted my job at Blackpool hospital SO much so that I completely crumbled under the pressure at interview. I had applied late given my rapid change in circumstances and was warned that it was unlikely I’d even be offered an interview. I desperately applied through a band 6 post (one higher than my newly qualified self), but against the odds I was invited to interview. It was a dreadful blur. I don’t remember the details but I knew for certain that I’d messed up, however, by some great miracle they saw something in me and gave me a chance (Thank you so much Carol and Moira!). I was offered a 12 month contract, which did initially play on my mind, but, I was ecstatic to be offered my dream job, permanent or not.

When I started I was nervous and worried that I might not live up to the role of dun-dun-dun! “The Qualified Midwife”. I put a lot of pressure on myself to be perfect, when I know that it was unrealistic. No one wants to make mistakes, but no one starts out knowing it all. I felt like a fish out of water at first. The policies and procedures, the paperwork and the culture all differed to where I’d spent three years training and on top of that I was now expected to do it alone. Initially I buddied up with another Midwife in a period called “supernumery”, to support me in my transition from student to Midwife, and from my training trust, to Blackpool. This is standard practice for new staff across the board, however, enforcement of this is notorious for falling short due to staffing issues. I count myself lucky in that I feel I did get a good supernumery period. There were occasions where I had to get on with things on my own because it was just too busy, but I never felt entirely alone/ unsupported. Maternity staff in their entirety where so welcoming and understanding which made the initial transition less daunting than I imagined it would be.

Left to my own devices I had a few “oops” moments, as expected. Sparing the details, I will never live down the infamous case of  “the keys”. I’ve learned from the mistakes I’ve made along the way and will continue to do so, as we all do. None have been detrimental (touch wood) but I do burden myself with the idea that there are mistakes that cannot be made in my job. I’ve had more sleepless nights than I’d dare to count considering “what ifs” and worrying about something I might have missed. I’ve made phone calls to work in the middle of the night where things have popped into my head that I’ve worried I didn’t mention at handover. As tough as it is to switch off, I know that it’s only because I truly care, and in that sense, I have confidence in the quality of the care that I provide, because I am deeply conscientious. A year on, these worries remain and probably will do for the entirety of my career, but I know that I would rather worry too much than not at all. I have also accepted that I will never know it all, and that’s one of the great joys of the job. It really is a never ending opportunity to learn and grow.

This year I have struggled with feelings of inadequacy. Soon after starting I overheard midwives discussing what I would be best suited to doing on a particular shift and the answer appeared to be, nothing. Noticing I’d overhead this conversation one of the midwives approached me and apologised, explaining that there was no ideal circumstance for me to be put in, because women were either too high risk or were being discharged, of which I had no experience at this stage. I did feel useless, but I accepted the justification for the comments made and pushed forward, doing my best in what I was asked to do. I struggled to accept that I was bringing enough to the table when I knew I was the least experienced. As time has passed and my experience and confidence has grown, I’ve felt increasingly valued and no longer compare myself to others with more years behind them. A year on I feel an equal, valued member of the team.

Another hurdle I’ve struggled with this year is time pressure. I was initially very slow. I took a long time to finish the seemingly endless paperwork because it was unfamiliar. Before I did anything I would think it through over and over to ensure that I was justified in my decision, because again, I was unfamiliar with policies and procedures. I found that some of my colleagues were more understanding/ tolerant of the pace of my work when I started than others. I recognised in myself that I was slow and actively sought to address the issue and improve my efficiency. In a fast paced environment as a delivery suite can be, with limited beds and staff, I knew that it was important to be efficient whilst also being careful not to sacrifice the quality of care provided. Naturally, with practice and repetition my time management greatly improved, but I still do battle with a desire to do absolutely everything I can for a woman and her baby, yet ensure that I am efficient with my time. I find that my worst days are those where I feel I have no time to do my job. When I am unable to spend time supporting women because I am so stretched. I know that this would be rectified by better staffing levels as my time would be spread less thinly across the women and babies in my care, although with funding cuts for training and general NHS budget constriction I fear that this is a hopeless quest. I just vow to myself never to let the pressure of time impact upon the quality of the care I give when it is within my control.

Despite the hurdles, one year in I know for certain that this is what I was meant to do. I cannot imagine doing anything else or loving anything as much as I love supporting women. I know that my opinion on my career choice will come into question again and again over time as I have good and bad days, but I hope that I continue to recognise that the good far outweighs the bad. One year on I definitely feel part of the family, as both a Blackpool Midwife, and also just as; me and who I am beyond midwifery which is a wonderful milestone to reach. I’ve also been assured that they won’t be letting me go come the end of my 12 months, so that’s a relief!

Even a year on I am still in awe of the fact that I’m actually a Midwife. I find myself reflecting and continue to feel pretty bad ass. It is the most amazing feeling to support a woman and her family whether it be through to the birth of their child, or establishing breastfeeding or guiding them on how to change nappies. To experience that special bond, and see the look of sincere appreciation for the work that I do is what keeps me coming back every day.

So there it is! My first year. I’ve definitely learned more than I could ever have imagined and am entering year two as a much stronger, more knowledgeable, more confident and passionate Midwife. Bring on the next! Thank you to everyone who’s supported me through this challenging transition, especially the BVH maternity staff. You’re all incredible ❤

For those of you out there who are approaching day 1, or are working your way through your first year, I hope that you’ve read something you can relate to. Don’t beat yourself up for not being able to run before you can walk. Absorb every piece of advise/ knowledge you can grasp and keep pushing forward. With each day comes new challenges and experiences and it’s all of those little moments added together which have you looking back and realising just how far you’ve come. We have ALL been there. Every Midwife faced their first day once. We’re all in this together!

Have a wonderful 2018 everyone ❤

 

Mental Health Awareness: Life with a label.

Today is World Mental Health day. You’ve probably all seen or heard of the campaigns in the media encouraging people to open up and talk about mental health, so here I am, sharing my experience! My hope is that it encourages others to do the same/ reaches someone who needs to know that they’re not alone. This is my first blog post, and a sensitive one to start with, so please be kind.

Four years ago I was diagnosed with generalised anxiety disorder. A nurse once read those words on my health record and said, “you don’t look the anxious type”. No, I probably don’t, but that’s an important lesson in itself. Most of the time, mental health battles are the best kept secrets.

For me, anxiety crept up on me. There was no single defining moment that I can recall. I didn’t have one big panic attack which marked the start of my experience, which makes it difficult to explain, but I’ll give it my best shot.

In 2013 I started my midwifery degree. I experienced a lot of new, initially intimidating environments and met a lot of new people. I was completely out of my comfort zone and my day to day life suddenly became a lot more challenging. On placement, every move I made was being watched and judged. It was intense, and a shock to the system. Up until this point I’d always been a very calm and collected person in times of stress, but as the year went on I began to struggle more and more to retain control over my mind and body’s response to these new stressors. It initially began with high pressure tasks. When placed under pressure I started to shake uncontrollably. I would become red and tearful, my heart would be thumping, my head pounding. I always managed to hold it together, but only just. The only thing close to describing the feelings I experienced would be, that it was like being in one of those nightmares where you’re being chased, and want, with every inch of you to scream for help but you can’t. The room would be silent but inside I’d feel close to exploding. It was mortifying to know that people could potentially see this, although the reality is that it was probably less noticeable than I ever imagined. I was embarrassed and frustrated with myself, and the worry of behaving in such a way, and people seeing me do so led to a crippling fear of “the next time”.

It started with understandably worrying things, like exams, however, I did become concerned when it started to creep into more mundane scenarios. At this stage meeting up with friends became an impossible task on occasion because I was irrationally petrified. After a hysterical cry at home because I didn’t want to go out, blaming an unflattering outfit and bad hair, I threw my heels on and dragged myself to a friend’s house party. All I can remember is being so consciously aware and embarrassed that my legs were shaking. Leg shaking became a hurdle for me from that point on. It sounds silly I know. I often said that I was cold the first opportunity that I got, to in some way justify the anxious shakes I had. I would settle into the night and enjoy myself, but the thought of going became an exhausting anxiety fuelled nightmare. Going to university or work was also becoming too much to bare on occasion, and I became almost reclusive. I say almost, because at this point, where I realised it may start to affect my social life and career, I went to the doctors for the first time.

At this appointment I was terrified (as per usual by this point). I remember explaining my new, excessive physical stress response and the doctor was very understanding. He talked through counselling options with me, and offered me beta blockers in an aim to manage the physical display of my anxiety. Despite his understanding and kindness, I left the appointment feeling deflated and weak. I didn’t want to have to take medicine to be ok. To be “normal”. I didn’t want to have to rely on a tablet to make me cope like I had been able to do just fine, once upon a time. I wanted to be ok. At this appointment he’d also given me the diagnosis of “generalised anxiety disorder” which hit me pretty hard. I was suddenly this person with a disorder and was mortified that that label would now follow me around. In my records, in my general living of day to day life. I didn’t want it. I was worried that I wouldnt get a job once I declared it, which I knew I had an obligation to do. I compared myself to other “normal” people and felt inadequate and broken. This is all a bit blurry but I’m pretty sure I spent the day crying and talking to my partner, who will have been supportive and understanding. I don’t think I paid much attention to what he or anyone said. I also told my closest friends, and mum. I was grateful for the support but embarrassed all the same. I was also worried that people would just think I was after attention. Everyone’s anxious at some point after all. What made me different?

I approached my medication all wrong for a long time. I would avoid taking it until I really had to. I would wait until I felt bad and then take it. I found myself back at the doctors within a few months crying uncontrollably, only to be told that I needed to take them every day, regardless of how I felt, to keep on top of these feelings. I felt pretty stupid. How had I not considered that myself? On reflection I was in denial that i needed them. Following my second visit I started to take them daily, and it did help. Although I initially felt a little lightheaded and was consciously aware of my heart beating slower, which made me feel a bit sick, but I wasn’t shaking! My heart wasn’t racing. I didn’t look terrified to anyone anymore. I continued to feel worried, but that was as strong as the feeling became. It was no longer gut wrenching physical fear. I was able to complete tasks with a sense of control over my body which was such a relief. In my head I was still excessively worrying, but my body was suddenly saying “it’s ok, we’ve got this” and it really did change my life. A lot of people believe that tablets are not the answer and I respect that root causes are important to address, but in taking these tablets my body is learning that it doesn’t need to run away when things get tough. Where I still feel anxious sometimes, I no longer additionally worry about having control over my whole body, which for me, became the most crippling factor. I have that control back, and that’s thanks to the tablets. I take propranolol 40mg daily and I probably will do for a long time to come, and I’m finally ok with that. Mental health isn’t visible like a broken bone, but sometimes it does fracture, and needs support to heal all the same. I never have had counselling and feel that I probably should consider it. It’s been a long time since this began, and sometimes I just brush off that a lot of traits which are probably anxiety are just me, because I’m so used to it now. I have restless nights. I sit and go over and over small awkward moments that happened years ago just to torture myself with those feelings of embarrassment. I’m still reluctant to socialise some of the time but I make myself get up and go because I know how much I enjoy myself when I get there. I frustrate myself with how much I know I should complete tasks that make me worry, and instead choose to avoid them, brushing them off because- not today, I can’t face it, knowing full well there will have to come a day where I do.

Every day is a learning curve, and at the moment I’m trying to get to grips with the idea that having anxiety disorder doesn’t automatically make every feeling I have, wrong. I’m quick to beat myself up for being worried or for thinking negatively of a situation, but I have to have some faith in my instinct, because I do find, more often than not, that I’m justified in the way I feel in the end. It’s easy to lose faith in yourself when someone tells you that your thought processes are disordered.

Through this experience I’ve learned a lot about myself. Some of me I like and some of me I don’t, but the biggest realisation for me has been the recognition of my strength. Some people assume that living with a mental health disorder makes a person weak. I can tell you  that it takes strength to stay afloat when it would be so easy to give in and sink. I stuck with midwifery which at times I thought would break me. I made it to the end of my training a lot wiser and more resiliant and I’m now a qualified midwife working at a fab hospital with amazing people, doing what I love. I’ve achieved a lot for myself, and my life is pretty amazing. I’m so incredibly grateful for everything I have. I declared my anxiety to occupational health so they’re aware, but it’s well controlled and doesn’t impact upon my ability to do my job well. I joke that if I was a cave woman I’d probably survive that little bit longer since my fight or flight instinct is so naturally strong. Silver linings hey?!

If you’re worried about yourself, or someone around you, talk. If it’s you, I encourage you to go and see a doctor like I did. They’re there to offer support and guidance, and it was the best thing I ever did for myself. We only live once and I’m the first to deny that there is such a thing as normal, but everyone deserves to live healthily and happily. There are options available to make life with anxiety disorder more manageable. Don’t suffer in silence.

Thanks for taking the time to read this. This is just my experience. Remember to be kind. Any one of us could be facing a battle that cannot be seen.