Donna's Stories
Rosie*'s Story
Being a community‐based midwife, means that our contact with women is on a one‐to‐one basis, outside of the hospital environment. Often in GP surgeries, clinics or women's homes. As such, we have the opportunity to bond with the women in our care and provide them with not only clinical care but continuity, friendship and support in a way that is less possible within a busy hospital‐based setting.
I have found that having had the opportunity to build relationships with women during their pregnancy, they will seek my support more willingly than other healthcare professionals as there is a level of trust that has been built.
I recently saw Rosie for her antenatal check. I could tell the moment she came into my room that she was distressed, as was her partner John. They had received the news that their baby was very likely to have a life‐limiting condition. They had attended a number of scans to confirm this, and only a matter of days before hand, had the confirmed diagnosis. Although they had been given the clinical outlook from the medical professionals they had seen, in their words: ‘no‐one had given them the space to understand what this would mean for them, and what their choices were’.
This is not normally a conversation held in a community setting, as there are specialist healthcare professionals that are trained in this field; but they wanted my support. From a deeply personal perspective as a mother I was desperately upset for them, while also knowing the clinic appointments are only 20 minutes long, and I knew that this was not going to be a quick chat and I had a busy clinic. I was worried that I wouldn't have all the answers, but I gave them the space to talk about everything that had happened. Rosie cried, and John just held his head in his hands. Sometimes all the clinical training in the world can't give you the words for a time like this. I held Rosie's hand and asked how I could help. She needed someone to talk to her in ‘lay’ terms; simply to discuss what their options were.
I gave the couple what information I was able to and then made phone calls to the relevant support teams to get advice. There were no decisions made in the room at that point, but I assured Rosie she had my support in whatever decision she made. They left with a clear idea of what their options were, and in circumstances like this, that is whether to continue the pregnancy or not.
I have to be honest that when I started my midwifery journey, I had ‘rose coloured spectacles’ about the role of a midwife, bringing new life into the world. I still have a great belief that all birth is sacred, but there are times when my personal and professional beliefs are challenged. No textbook or hospital policy can give you the insight needed to deal with deeply emotional situations such as talking to a woman about whether or not to continue her pregnancy. I could only support Rosie in the right choice for her. I told her she was a brave woman who would make the right decision for her and her baby and family.
Forty‐five minutes later the couple left the clinic, and I cried on my own. There were now two women in the waiting room, eagerly waiting for my care and attention to discuss their continuing pregnancies. I composed myself and carried on with clinic, apologising to everyone for the rest of the clinic about being late, but assuring them that they would have my care attention for however long they need it.
Being a midwife is a privilege, walking ‘with women’ at every point during their pregnancy, birth and beyond and is often full of pure joy and the wonder of new life, yet can be interspersed with tragic and ethically challenging moments where the support of a midwife is second to none.
Lois*'s Story
Whilst working on labour ward, I cared for a woman who had her first baby. Our shifts are 12.5 hours long, so we spent a good amount of time with Lois and Jake, her birth partner. I got to know them well and at the end of the shift I left and wished them well.
Three weeks later I came onto shift and Lois's name was on the board as having just arrived in triage. I offered to go and see her as I already knew her. Upon greeting the couple, Jake was holding the baby, who was well and settled. However, Lois had been suffering with her mental health since birth, despite good family and community midwife support. Jake stated that overnight Lois had been having psychotic episodes and had come to triage.
Lois remembered me and embraced me when I entered the room, so very happy to see someone she knew. She was very lucid, and I was able to take her observations and talk to her about her baby. She had struggled with breastfeeding over the last few weeks but was now feeling like it was going much better. I helped her get comfortable and she breastfed her baby beautifully and calmly.
I stayed with her the whole day and was present when all the relevant medics and psychiatrists reviewed her. She was veering between being lucid and experiencing psychotic episodes all day. The first line decision was for Lois to be medicated initially; however, this would mean stopping breastfeeding as the drug would pass through the breastmilk to her baby. She was adamant that she would not stop breastfeeding as it was the only thing she was doing well for her baby.
Lois's capacity was limited, and as her midwife I needed to advocate for her. I knew how much breastfeeding meant to her, and there is very good evidence that links breastfeeding and emotional wellbeing of a new mother. The psychiatrists were adamant that Lois would need to stop immediately and take the medications. I stayed until she was lucid enough to ensure that she had an understanding that for her benefit and of her baby, the medication was the best option for now. However, this wouldn't mean stopping breastfeeding altogether. I got a breast pump for her, with a view to keeping up her milk supply whilst on the medication.
Jake was bereft and felt unable to help, so I arranged for a nursery nurse to show the couple how to correctly make up a formula feed and to sterilise the feeding equipment.
As a midwife I would always support breastfeeding continuation for the benefits of both mother and baby, but ethically at this time, stopping breastfeeding was the only option to try and help with Lois's psychosis. But keeping her milk supply established, using a pump, would give her the option to return to breastfeeding once the medication was stopped.
A Woman's Story
Emily's Story
I see birth as a huge part of my life experience, something that is completely transformative, in every aspect of life. When I became pregnant with my first child, I actively sought out and became informed about how I was more likely to achieve a positive experience. This led to the knowledge that having a known care provider throughout my experience is more likely to lead to positive feelings, even if things don't go as expected. My babies were all born at home, I saw making this decision as me being in control and more likely to have the experience I wanted. However, I did have the constant worry that a midwife would not be available to attend my births due to shortages.
I was fortunate to see the same midwife for my first and second pregnancies. In fact, I swapped my maternity care to a different GP practice (we had moved to a new house) to see the midwife I ‘clicked’ the most with. However, it turns out I didn't receive any midwifery support during my first and second births. The first was because I didn't realise I was in active labour and