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The History of the Midwife

 

The following post is a guest blog by Nicole Allen:

woman carrying newborn baby

We all know the process of childbirth, but it’s no less magical. Advances in science make the procedure very safe for both the baby and the mother in most countries. It’s routine for most hospitals, except in rare cases when the patient experiences complications. But this wasn’t always the case.

There are countless faces of midwives whose knowledge was passed on from generation to generation. Even today, there are would-be mothers in some parts of the world with no access to doctors who rely on midwives to deliver their babies.

“Midwife”, the common term used for a birthing assistant, comes from Middle English and literally means “with a woman”. In France, they call her (or him; there are male midwives) a “sage-femme” or “wise woman.” The profession predates the medical and nursing professions.

The Prehistoric Way of Giving Birth

Our many-time great-grandmothers birthed their babies with the help of midwives dating back at least as far as biblical times and probably before recorded history. The earliest evidence of the existence of midwifery can be traced back to an ancient Egyptian papyrus (1550 BC). This shows that midwives assisted women in child delivery for more than 2,000 years without assistance from trained professionals.

pregnant woman holding petaled flowers

The American Way of Giving Birth

In the early American colonies, children were birthed with the help of skilled and practised midwives who came from Britain, who in turn transferred these same skills to other women in an informal manner. Later, when West African midwives reached the shores of America to be used as slaves, they assisted in birth too.

After their emancipation, African-American midwives offered their care to poor women,  in the rural parts of the South and were called “granny midwives.”

The American Indian tribes women continued to practice their own cultural birthing tradition, too, which sometimes included a midwife, female friend or relative.

The family experience of home birth narrated by Dervla Murphy in the book Untangling the Maternity Crisis supported the fact that most childbirth during the early 1900s was done at home. She was delivered at home in 1931.

Childbirth then was a regular occurrence at home and did not stimulate anxiety. Midwives were a familiar neighborhood figure who carried a big black bag during the birth of a neighbor.

person touching person's belly

The Medical Way of Giving Birth

In the last half of the 1800s, when medicine was professionalized in the US, midwifery became threatened as laws requiring formal education were slowly extended to midwives. Even though there were few midwifery schools, midwives were still needed and could not be totally eradicated since some doctors were unwilling to cater to poor populations. Some midwives continued to practice until the 1920s without government control.

It was in the 1910s and ’20s, the doctors started to lay down the foundation of a pathology-oriented childbirth medical model and usurp the traditional roles of midwives.

First, two studies found that the training most obstetricians received was poor and that hospitalization during birth would improve it. The poor, who most needed midwives, could go to charity hospitals instead. This would give the doctors more practice as well.

Then, in 1914, “twilight sleep”—delivery where the woman is anesthetized with a combination of morphine and scopolamine—was introduced. It was intended to relieve the pain and remove the memory of giving birth. This was widely accepted and desired by upper-class women.

About this time, a Dr. Joseph DeLee described childbirth as a destructive pathological process that damages the mother and the baby, and the only way to minimize this was through medically attended childbirth.

This claim made it impossible for midwives to facilitate child birth and made the use of ether, sedatives, forceps, and episiotomies routine. Child birth went from a physiological process to one in which the course of labor must be tightly controlled.

The value of midwives is being relearned, but there are new concerns.

Help for trauma

In more recent years, an aspect of the midwifery profession that is being looked into is the difficulties the midwives themselves experience during delivery. For instance, if s/he attends a traumatic birth, oftentimes s/he alone is there to handle it.

A 2015  study on the emotional and traumatic work of midwives and the commonly adversarial relationship with obstetricians (aptly titled “Midwives Overboard!”) shows that midwives may end up developing psychological and behavioral symptoms of distress, including compassion fatigue, post-traumatic stress disorder (PTSD), and secondary traumatic stress.

The United Nations Population Fund (UNFPA)’s increasing interest in the role of midwives underscores their importance in delivering children. Midwives play an important role in the achievement of its millennium development goals: reducing child mortality and eradicating maternal death. Midwives are a key element in the delivery of sexual, reproductive, maternal and newborn health (SRMNH) care worldwide, especially in rural areas.

To improve the delivery of patient care as well as the staff experience, maternity services must invest in the mental health and the well-being of all midwives, including nurse-midwives and obstetric nurses.

blue and black USB cable

Also check out this article: Oh baby: seven things you probably didn’t know about midwives

Author Bio:
Nicole is a freelance writer and educator based in the Michigan and believes that her writing is an extension of her career as a tutor. She covers many topics like travel, mental health and education. She is a key contributor at Chapters Capistrano where she covers topics like addiction recovery, holistic treatments and health education. When she isn’t writing, you might find Nicole running, hiking, and swimming. She has participated in several 10K races and hopes to compete in a marathon one day.

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A Call for Research Participants: Maternity Staff & Service Users Required

recruitment poster hEDS womens survey

We are currently looking for people who meet the following criteria to complete an online survey in relation to their childbearing experiences:

  • Women who have been diagnosed with either hypermobile Ehlers-Danlos Syndrome and (hEDS), Hypermobility Spectrum Disorders (HSD), EDS type III, EDS hypermobility type, or Joint Hypermobility Syndrome
  • Those who are over the age of 18 years
  • Those who have given birth in either the UK, Ireland, USA, Canada New Zealand, or Australia since 2007

If you meet the above criteria and would like to complete this survey then

please click HERE

What is the purpose of this survey?

  •          To identify the childbearing outcomes associated with hypermobile Ehlers Danlos Syndrome (hEDS) or Hypermobility Spectrum Disorders (HSD)
  •          To explore experiences of maternity care among women with hEDS/HSD
  •          To evaluate the impact of recently published maternity care considerations for that childbearing the context of a hEDS/EDS diagnosis
  •          To identify ways in which maternity care could be improved for women with hEDS/ HSD.

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recruitment poster hEDS maternity staff survey

We are also looking for maternity staff  (anyone who provides clinical care to childbearing women) in the UK, Ireland, USA, Canada, New Zealand, or Australia to complete a 20 minute questionnaire about providing maternity care to women with hypermobile Ehlers-Danlos syndrome (hEDS) and/or Hypermobility Spectrum Disorders (HSD)

If you are a maternity staff member and would like to complete this survey,

please click HERE 

Please note: To participate, you DO NOT need to have knowledge or experience of caring for women with hEDS/HSD.

If you are a maternity staff member and would like to complete this survey,

please click HERE 

ED Society site

What is the purpose of this survey?

To explore awareness and knowledge of hypermobile Ehlers-Danlos Syndrome and (hEDS) and Hypermobility Spectrum Disorders (HSD) among maternity staff To explore what decisions maternity staff may make when caring for a women with hEDS/HSD To indicate how maternity staff could be supported to care for women with hEDS/HSD. A 2018 review was published which detailed maternity care considerations for women with hEDS/HSD. For participants who have read this review, this survey will also explore whether and how understanding and practice related to hEDS/HSD may have been impacted. Please note that if you have not read this review, you can still complete this survey.

Image result for online survey

Types of staff we want to hear from:

  • Consultant midwife
  • Senior midwife
  • Midwife
  • Student midwife
  • Nurse midwife
  • Maternity support worker
  • Junior obstetrician
  • Obstetric registrar
  • Consultant obstetrician
  • Junior anaesthetist
  • Consultant anaesthetist
  • Obstetric nurse
  • Physiotherapist
  • General Practitioner (GP)…etc.

If you are a maternity staff member and would like to complete this survey,

please click HERE 

@JennytheM poem

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Follow this entire project online with #EDSMaternity

@GemmaSPearce @SallyPezaro@DrEReinhold@LaurenMPurdy

We will share the results when they become available!

Thanks to everyone who has completed & shared this survey so far!

Thanks

Follow me via @SallyPezaroThe Academic MidwifeThis blog

Until next time…Look after yourselves and each other 💚💙💜❤

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Midwives experience domestic abuse too…so how can they be supported in the workplace?

On Thursday October 4th 2018, The Royal College of Midwives (RCM) launched a report entitled ‘Safe Places? Workplace Support for those Experiencing Domestic Abuse’ at its Annual Conference in Manchester Central.

love shouldn't hurt-printed on back of woman

I was privileged to be asked to perform and write up the analysis for this report. The findings truly moved me. If you know my work at all, you will know that it is heavily focused upon securing the psychological wellbeing of midwives. This is because I do not believe that excellence in maternity care can be delivered to mothers and babies without the provision of effective support for midwives.

Findings here revealed that some midwives trained to recognise domestic abuse and support women, were sometimes not recognising that they themselves are victims of domestic abuse.

“I was allowed to stay overnight on my delivery suite to avoid going home to my abusive partner”

“I was made to feel I was a nuisance, constantly asking me and contacting me, pressurizing me in to coming back to work. I gave in and did but I was soon off again as I still wasn’t well, and I then left midwifery because I didn’t want to be dismissed. I didn’t receive any support that was effective for me”

“I have and was been treated very badly by my place of work, absolutely no support or care and compassion”

“I was given a specific senior midwife who I could go to for support, to discuss things at times when home was particularly bad and to deal with any sickness absence – helpful as one person knew what was going on and I could be truthful, especially about the reasons for sickness absence sometimes”

“All staff should be asked about domestic abuse or violence on a regular basis”

“Police and social services were unhelpful, and no support provided. Neither I nor my children were offered counselling or directed to appropriate services despite asking several times for help. One police officer even commented that due to my ethnicity I could handle the situation myself.”

person holding white printer paper

Based on the findings the RCM has put forward the following evidence-based recommendations. These will enable maternity service managers and NHS Trusts/Boards to support staff experiencing domestic abuse more effectively.

  • All NHS Trusts/Health Boards should develop specific policies to support who are victims of domestic abuse, aligned to existing guidance from the NHS Staff Council developed in 2017.
  • NHS Trusts/Health Boards should provide and publicise confidential domestic abuse support services for affected staff, including access to IDVAs, external counselling and legal services as appropriate.
  • NHS Trusts/Health Boards should ensure that all managers and supervisors are trained on domestic abuse issues, so that they can recognise signs of domestic abuse in their staff and confidently undertake their safeguarding obligations.
  •  NHS Trusts/Health Boards should ensure that staff at all levels are trained on domestic abuse issues and made aware of relevant workplace policies as part of their induction programme and continuous updating and are made aware of support services.

It was a pleasure to work with esteemed colleagues at the RCM to put this report together. Midwives and maternity support workers are a highly valued workforce whom we rely on to provide optimal care for mothers and babies. It is our sincere hope that this report will enable maternity service managers and NHS Trusts/Boards to support staff experiencing domestic abuse more effectively.

“Thank you to all of the midwives and maternity support workers who took part in this survey. The wellbeing of maternity staff is intrinsically linked with the safety and quality of maternity services. Your thoughts, feelings and experiences have helped us to arrive at a deeper understanding of the resources required to support those experiencing domestic abuse.”

woman carrying newborn baby

If you would like to follow the progress of work going forward..

Follow me via @SallyPezaroThe Academic MidwifeThis blog

Until next time…Look after yourselves and each other 💚💙💜❤

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How does patient and public involvement work in research? An example exploring midwives’ workplace wellbeing.

Patient and public involvement or #PPI is defined by INVOLVE (part of, and funded by, the National Institute for Health Research) as: 

“Research being carried out ‘with’ or ‘by’ members of the public rather than ‘to’, ‘about’ or ‘for’ them. This includes, for example, working with research funders to prioritise research, offering advice as members of a project steering group, commenting on and developing research materials and undertaking interviews with research participants.”

three person pointing the silver laptop computer

In our latest publication, we explain how patient and public involvement works in maternity service research. Here, we asked childbearing women about their experiences in relation to the workplace wellbeing of midwives. We also asked them how they felt about new research looking to create and test an online intervention designed to support midwives. We did this via a discussion group, where participants were offered refreshments and remuneration for their time. Our aim was to answer the following questions:

  1. What are the perceptions of new mothers in relation to the barriers to receiving high quality maternity care?
  2. What are the perceptions of new mothers in relation to the psychological wellbeing of midwives working in maternity services?
  3. What are the perceptions of new mothers in relation to a research proposal outlining the development and evaluation of an online intervention designed to support midwives in work-related psychological distress?

These PPI activities helped us as researchers to do the following:

  • Better understand this research problem from the perspectives of new mothers
  • Validate the direction of future research plans
  • Explore new areas for data collection based on what really mattered to mothers and their babies
  • Improve upon the design of the proposed online intervention based on what really mattered to mothers and babies.

You can read our full methodology via the linked citation below:

Pezaro, Sally, Gemma Pearce, and Elizabeth Bailey. “Childbearing women’s experiences of midwives’ workplace distress: Patient and public involvement.” British Journal of Midwifery 26.10 (2018): 659-669.

This article was launched in the October edition of the British Journal of Midwifery at the Royal College of Midwives annual conference in 2018 .

white and black Together We Create graffiti wall decor

Put simply, the findings in relation to what participants said were analysed thematically and turned into meaningful insights or ‘PPI coutcomes’. In this sense, we used a co-design approach to inform the direction of new research. How did this work exactly? See figure below.

Figure 1. Overall findings

Initially, we considered that it may have been useful to include midwives in PPI activities, as they were to be the intended recipients of the intervention proposed. However, INVOLVE briefing notes state that:

“When using the term ‘public’ we include patients, potential patients, carers and people who use health and social care services as well as people from organisations that represent people who use services. Whilst all of us are actual, former or indeed potential users of health and social care services, there is an important distinction to be made between the perspectives of the public and the perspectives of people who have a professional role in health and social care services.”

A such, we could not include midwives in these PPI activities due to them having a ‘professional role in health and social care services’. Nevertheless, as midwives were the intended end users and direct beneficiary of the intervention proposed, we argued that they should “not necessarily be excluded from PPI activities simply because they treat patients”. This debate lends itself to further academic discussion and we welcome ideas on this going forward.

two person standing on gray tile paving

Both national and international strategies and frameworks relating to healthcare services tend to focus on putting the care and safety of patients first , yet these findings suggest that to deliver the best care to new mothers effectively, the care of the midwife must equally be prioritised. As such, we now intend to seek further funding to continue this work and secure excellence in maternity care.

If you would like to follow the progress of work going forward..

Follow me via @SallyPezaroThe Academic MidwifeThis blog

Until next time…Look after yourselves and each other 💚💙💜❤

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The pregnant midwife: A personal reflection on having a baby as a midwife

I have always had a passion for matters around pregnancy, birth and babies. For years I have enjoyed being a midwife, clinically in research and in teaching. My passion started at around 4 years old when my brother was born. Mesmerized by a growing belly and the fact that another human was coming in to the world, I read my mother’s antenatal books from cover to cover. Having just experienced the birth of my own baby, I felt compelled to write my own reflections and experiences down….

Please note: For personal reasons I would request that close family members do not read any further.

*Long post alert*

What happens when the midwife has a baby? We are people just like any other having a baby…right?…probably. Did I know too much?…Did that affect my choices? did I have a better choice and/or experience because I had ‘insider knowledge’?… One thing is certain. Having a baby as a midwife was unique for me.

The stick turned blue

Yes, our little Autumn baby was planned….and thankfully, we had no trouble conceiving our little darling, who was due to arrive conveniently after I had  been awarded my PhD. But my period being late and the pregnancy tests showing up negative confused me. This was my first experience of feeling as though ‘I should have known better’! … Of course, though I knew that all I was looking for was a little Human chorionic gonadotropin (hCG), the cheap sticks I had bought clearly were not sensitive enough to detect it…it took a friend to prompt me to spend a bit of extra cash on the test. Of course a fancy pants digital stick did the trick….Silly me. The midwife should have known better (was one of my first thoughts… and a recurrent theme throughout my pregnancy)! The pressure was on!

Of course when the stick did officially ‘turn blue’ my heart jumped into my mouth, knowing that this was an ‘oh sh*t’ moment. No take backsies. Yet, I have no idea why I panicked …it was planned after all! Perhaps it was because..

  1. My parents would know for sure that I was sexually active (ridiculous I know…especially as my husband and I have been together 18 years)!
  2. I really would need to finish my PhD in time
  3. Life was about to change for ever
  4. I think this pregnancy is a good thing (probably)

My unicorn was on her way..

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Choosing my care givers

Unlike many women who my just meet the nearest or most convenient midwife. I had the luxury of knowing a myriad of great midwives who could provide great care for me and my baby. I also had the luxury of knowing how and who to ask directly for what I wanted. I felt spoilt. This felt like a luxury that many women don’t have…but it was also a perfectly reasonable thing to be able to do. I was able to chose a midwife who I knew was ‘on the same page’… and who would care for me continuously throughout…Do all women get this opportunity?

Pregnancy symptoms

For years I have been caring for women with ligament pain, pelvic pain, odd sensations and physical stresses and strains. Being pregnant myself meant that I could finally feel what I had been describing… ‘Ahh…that’s what hey mean by feeling a ‘twang”

One great benefit of being a pregnant midwife is also knowing what symptoms to worry about and what symptoms not to worry about. I imagine that this may have enabled me to experience somewhat less worry than others experiencing such things for the first time….In the beginning anyway!

To tell or not to tell…that is the question

Other than the midwives I knew, there were other care givers throughout my pregnancy who were meeting me for the first time. They all began with the usual spiel about risks/benefits/routine and procedure. The question is (or was).. do I let them go on talking like I know nothing.. or do I let them know that I am a midwife who is used to spouting this spiel myself.

In not telling them, I felt like a fraud.. Like I was making a fool of them… But in telling them of my profession, I felt as though I would be giving up my status as a ‘regular’ maternity service user. My cover would essentially be blown.

A desire for honesty got the better of me. I told all new care givers that I was a midwife. The following happened:

  1. Clinicians dropped any facade of being ‘ultra professional’ – They became more friendly… like we were ‘on the same team’.
  2. I was told frequently ‘Well you know all of this already so I won’t repeat it’

As they did this, I felt a mix of emotions. On the one hand…I felt truly part of the team…a sense of power and autonomy…On the other hand… I felt like I no longer had the safety net of being ‘nurtured’ through my pregnancy. Was I missing out?..I’m not sure. But I was no longer treated as a ‘regular pregnant woman’.

Choosing my own care pathways

In my experience as a midwife, I have seen how some professionals can dismiss the thoughts, feelings and desires of women wanting to make decisions in relation to their own care pathways. For more on this, please see Michelle Quashie @QuashieMichelle 

As such, I sometimes had to fight hard to make sure that the women in my care got what they wanted. I was expecting to have the same fight.

However, I found that once people realised that I was a midwife, they were more willing to trust that my own decisions were informed decisions. They seemed less intent on trying to persuade me one way or another. They seemed to respect and accept my choice more than I had seen some maternity staff respect the choices of other women.

For me this highlighted issues around respecting women’s choice. When do we feel that women can make their own choices without question?…and when do women’s choices cause clinicians concern?….

Whatever the opinion of others… I, as a midwife could seemingly make any choice I wanted with ease…. Is this the same for all? I think not.

Image may contain: ultrasound

Birth choices

I have actually known what my own birth choice would be for a long time now. My main fear was that my choice would be made unavailable to me. Pre-conceptually I had consulted the obstetric team to discuss my birth choices…Would they be facilitated? because if not…did I really want to get pregnant in the first place?… the answer was ‘Let’s wait and see once you get pregnant’…Damn. I was really looking for a signed deal beforehand.

Once I became pregnant of course, they held all of the cards. I was pregnant…. trapped… The baby had to come out somehow, but I was beholden to them.. as they were the ones who would decide whether or not to facilitate my choice. This also altered the power balance and really made me feel vulnerable… at the mercy of those with the power to say yes or no. It was not a nice place to be.

My midwife, and my consultant midwife were 100% supportive of my decision, but they were not in a position to sign on the dotted line. I wanted a beautiful planned cesarean section. Something which goes against the grain for some.

When it came to meeting the consultant team, I was nervous about what they would ‘allow’. Now… I hate the word ‘allow‘ in maternity services, but this is how it felt. I was asking permission to have this… asking them to facilitate this. They had the power to say no. As a midwife, I believe I knew the right things to say to maximize my chances of them agreeing to my birth choice. I also had all of the up to date guidelines and research to back up my arguments should I need them. I was still nervously holding my breath.

There was some resistance, I had some extra appointments and some hoops to jump through, but with some firm words and some strong midwifery back up, I was able to get my birth choice ‘agreed’ or ‘allowed’.  Though the clinical reasons for my birth choice are too complex to explain here, it felt as though my decision making was not so trusted by other professionals in this case. I also had to repeatedly sit and listen to the list of risks involved, and be repeatedly asked if I had wanted to change my mind. Would this be the case if I had chosen a vaginal birth?

The sense of relief was immense…I could finally start to look forward to the birth and enjoy my pregnancy!

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Though this relief could have come much earlier for me… having the obstetric team on board pre-conceptually would have made my experience so much better!

What I really wanted to do was have my birth choice go unquestioned. I wanted to know all of the facts and then be trusted to make my own decision. Doesn’t every person want this?…

A “good birth” goes beyond having a healthy baby…

But I felt as though I may be denied my choice if it did not conform with what the health professional believed was the ‘right’ decision… This was utterly terrifying. The consequences of my choice being denied would literally mean that I would have less control over what would happen to my body. This was a horrifying thought. I would literally be forced to have a vaginal birth against my will. This is literally how the reality  felt.

For more information around birth rights see: @birthrightsorg

These experiences in relation to birth choices got me thinking about ‘informed’ choice in maternity care…

Everyone is ever so concerned about gaining ‘informed’ consent (and rightly so)… but is it disconcerting that we forever talk about the risks of Cesarean section and rarely the benefits? Equally…do we (as healthcare professionals) inform women of the risks of a vaginal birth? or a hospital birth? Wouldn’t that be ‘true’ informed consent?

As a midwife, I have to admit that my favorite type of birth to be in attendance of is an uninterrupted home birth….they are fab!… but that is my preference as a midwife. My preference as a mother was a cesarean section, and I have to ensure that I remain objective in respect to all women’s choices regardless of these facts.

At the end of the day.. a baby is coming out of you. There are a variety of ways in which this can happen. Should there be a default or ‘preferred’ way? or is this ‘preferred’ way subjective to each and every woman? If so then we must stop talking about the ways in which we might prefer women to give birth…and instead celebrate women’s choice in pursuit of their own subjective ‘positive birth’.

See here about the myths associated with positive birth

In my case, I felt a solidarity with Helen George from Call the Midwife, who was shamed for choosing to have a cesarean section. I also identified with some of the reasons she gave for her very personal choice. Of course there are many other reasons why women may choose a cesarean section. Some have been explored in the following paper:

Why do women request an elective cesarean delivery for non-medical reasons? A systematic review of the qualitative literature

From my perspective…the ‘rights’ and ‘wrongs’ of one’s birth choices are too subjective to ever cast judgment upon.

Challenging poor practice

The care I received from the English maternity services in my area was fantastic….For the most part. Unfortunately I did encounter one incidence of poor practice. Sadly this episode warranted escalation.

As a midwife, I know my duty is to take further action (escalate) mistakes in practice where appropriate. However, as a mother, I was nervous about escalating the poor practice of someone whom I relied on for my care (and to facilitate my birth choices). Would they take revenge? would I loose my place of birth? or would my birth choices be taken from me?…It was a very vulnerable position to be in.

“After all…If you complain to the chef..they may spit in your food.”

Thankfully, with the support of my midwife, I am now working with the General Medical Council (GMC) to ensure that other mothers and babies can be protected from the same actions being repeated.

Aside from this… as a midwife, I feel highly privileged that I was able to spot this poor practice and call it out. Another pregnant woman (non-midwife) may not have spotted this poor practice, and been put at risk unknowingly. This highlights how vulnerable women may be, as they trust us all with their (and their babies) lives. Here the role of the midwife as an advocate becomes even more important for those who cannot always safeguard their own care.

Patient & Public Involvement in research

INVOLVE briefings state that there is an important distinction to be made between the perspectives of the public and the perspectives of people who have a professional role in health and social care services. As midwives are not considered to be patients under this guidance, I have felt unable to participate in Patient and Public Involvement (PPI) activities during my pregnancy. This was difficult, as I would have loved to have participated in PPI whilst pregnant in order to contribute to the improvement of maternity services from a user perspective. This issue is worthy of further discussion… after all, health professionals can be ‘patients’ too right?

Antenatal education

My husband is surely sick of my chums and I always talking pregnancy and birth…and of course passion for the profession can get a little sickly for some. So, I wanted the father of my baby to hear what I already knew from someone other than me. I didn’t want him to rely on me for information…after all, I may come across as a know it all rather than an equal partner in his parenting journey. So we went to NCT classes.

The classes were great and the information was sound….Yet, as a midwife… I could feel myself wanting to ‘approve’ of the information given out to the group.

During the challenges set out for us as a group, I was anxious. What if I got a question wrong? or stuck an anatomy sticker in the wrong place?

oh the shame!

Thankfully, I made no mistakes and my midwifery knowledge held strong. Yet again, I felt compelled to disclose my profession to the group. Not to do so felt dishonest somehow, like I was tricking them into thinking I was new to pregnancy and birth from all perspectives…and not just from a parental one. As such, I was relied upon at times for the lived experience of maternity services. People were also generally glad to have me on their ‘team’ during group challenges.

At the end of the course, I think my husband was glad to learn from someone perhaps more objective than myself. I also think that hearing the facts from another birth educator strengthened my husbands faith in what I had been saying all along…For example.. he now trusts that it is indeed OK to have a glass of wine whilst breastfeeding (Very important)!

And just like any other mum of course… I needed to meet other people sharing the same journey as I was.

And so little ‘Loveday Alice Pezaro’ came into the world. I had the perfect ‘positive’ birth (for me).. The breastfeeding is going wonderfully…and we are now knee deep in baby sensory groups and Costa Coffee chats. This experience from the other side of the fence has provided me with more empathy for women and more passion for womens rights in childbirth. The journey was less scary than I thought it might be. But…………………

What if I can’t breastfeed?

This was another real fear for me…having supported so many other women to breastfeed… what if I couldn’t do it myself? I mean… if the midwife can’t do it…What hope is there? 😮😨😩

These types of fears and anxieties resonate with other midwives who find themselves becoming mothers…In fact, the very pertinent research of my friend and mentor Dr. Sarah Church demonstrates how;

“a reliance on professional knowledge may create opportunities for choice and increased autonomy in some situations, although the need for intervention during childbirth, for example, may challenge the degree of autonomy exercised by midwives and the choices available to them. As knowledgeable experts, midwives demonstrate a very different understanding of risk and safety in relation to their own experiences of childbirth. Professional knowledge may increase their anxieties which may not be addressed appropriately by caregivers due to their professional status. The use of knowledge in this way highlights potential conflict between their position as midwives and their experience as mothers, illustrating that midwives’ ability to exercise agency and autonomy in relation to their pregnancy and childbirth experiences is potentially problematic.”

Final thoughts and reflections

  • Being pregnant as a midwife increased both my anxieties and my autonomy.
  • My professional knowledge impacted significantly upon my own perceptions around risk and safety in maternity
  • As a midwife I knew how to best ‘get’ my birth choices.
  • I felt vulnerable at times, especially in calling out poor practice.
  • I felt as though I was treated differently because of my professional background
  • The pressure to ‘get it right’ was always on.

In conclusion, the whole experience of childbearing was much better than I thought it would ever be. I feared much more than I needed to, and in retrospect, I had a wonderful experience. If only I could have anticipated such good outcomes in advance…the fear of the ‘worst’ happening may have never been an issue. One thing is for sure. My experience of being on the other side of the fence will enrich my midwifery practice forever.

On another note..There are so many wonderful midwives and initiatives out there making births better for women and their babies…There are not enough words to mention all of their wonderful work in this single blog. But I would urge further reading around the following groups:

@birthrightsorg

@MatExpBazaar

@NatMatVoicesorg

@BirthChoiceUK 

@birthpositive 

…and Many more (happy to add to this list if suggestions are given)!

My baby ❤️ ‘Loveday Alice’

Image may contain: 1 person, baby and close-up

If you would like to follow the progress of my work going forward..

Follow me via @SallyPezaroThe Academic MidwifeThis blog

Until next time…Look after yourselves and each other 💚💙💜❤

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10 Top tips for caring for women with Hypermobile Ehlers-Danlos Syndrome in pregnancy for International Day of the Midwife #IDM2018 & #EDS awareness month

 or ‘International Day of the Midwife’ falls on May the 5th of every year. The theme for 2018 in three languages is…

  • Midwives leading the way with quality care
  • Sages-femmes, ouvrons la voie avec la qualité des soins
  • Matronas liderando el camino con un cuidado de calidad 

Also… Every May is Ehlers-Danlos Syndrome (EDS) awareness month around the world.

As such….for , and EDS awareness month… I shared 10 top tips for caring for women with hypermobile Ehlers Danlos Syndrome (hEDS) during pregnancy birth and beyond. These tips come from my latest paper, authored in partnership with Dr. Gemma Pearce (@GemmaSPearce) and Dr. Emma Reinhold (@DrEReinhold ), entitled …

Hypermobile Ehlers-Danlos Syndrome during pregnancy, birth and beyond

Here, we present care considerations for midwives and the multidisciplinary team caring for this unique subgroup of childbearing women. However, we hope that women with hEDS will also benefit from this paper, as they make decisions in partnership with their professional health care teams. You can read the press release from this paper here.

I would personally like to thank the board members of the British Journal of Midwifery for making this article FREE for all to read. I would also like to thank the Royal college of Midwives for sharing news of the article here…and the Nursing Times for sharing further news here.

So what can midwives do to maximize the quality of care given to women with hEDS throughout pregnancy birth and beyond?…First of all….Know the facts…

  • There have been no prevalence studies since EDS received a major reclassification in 2017
  • Earlier estimates from 2006 suggest a prevalence rate of 0.75-2% for hyper mobile EDS
  • hEDS is the most common form of EDS
  • Up to 78% of women with hEDS could also have a diagnosis of Postural Orthostatic Tachycardia Syndrome (POTS)
  • POTS predominantly occurs in women of childbearing age
  • EDS is considered to remain largely under diagnosed.

Tips for midwives

  1. Discuss individual needs with women, as no two cases will be the same. Do this early, and always in partnership with the woman and the wider multidisciplinary healthcare team.
  2. Consider early referral to obstetric, physiotherapy and anaesthetic teams in partnership with the woman.
  3. Consider the need for alternate maternal positioning during pregnancy, birth and beyond. To minimise the risk of injury, positioning should be led by the mother.
  4. As wound healing can be problematic, the use of non-tension, non-dissolvable, deep double sutures, left in for at least 14 days is advisable.
  5. Wait longer for local anaesthetics to take effect and consider giving maximum dosage. Always be led by the mother on whether pain relief is sufficient
  6. Always consider the significance of a routine observation in light of existing POTS and/or EDS symptoms
  7. Promote spontaneous pushing rather than directed pushing during birth
  8. Promote effective pain management and the use of therapeutic birthing environments to promote reductions in stress
  9. Consider additional joint support for newborns suspected of having hEDS
  10. Document all joint dislocations and bruising marks on the newborn from birth to avoid misdiagnosis and/or wrongful accusations of mistreatment.

Research into EDS and childbearing is in it’s very early stages. We hope to build on this work to make a difference for all women with hEDS during pregnancy, birth and beyond.

pregnant belly

If you would like to follow the progress of this work going forward..

Follow me via @SallyPezaroThe Academic MidwifeThis blog

Until next time…Look after yourselves and each other 💚💙💜❤

 

 

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Highlights from the Third Annual #BirthTrauma conference #birthtrauma18

birth trauma study day

Image credit: Scriberia Ltd (@scriberian).

The first week back in January and I am invited by the wonderful becca moore @dr_bjm to share some research thoughts and ideas at the 3rd annual birth trauma study day in London = 

First of all..thank you for arranging and facilitating this day. It really is growing in strength and popularity year on year as this topic gathers momentum. You are a true #maternityleader for making this happen. Thank you also to those who participated in such important debates and discussion…and to those supported me to present my work as a new mum (baby Loveday is now 6 weeks old and as you can see….she was able to join her mum on stage 🙂

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The discussions that followed on Twitter were also pretty awesome and continue to thrive online. I can see may collaborations being born out of this day…what change may come I wonder? – #BirthTrauma19 will be even bigger and better…that’s for sure!

What struck me most about the speakers involved in this conference, is that every one of us was drawing from some kind of personal experience. Our past traumas had been turned into passion…fire and fury to make a change in the world…to make is better for the next person in some way.

“We had turned our wounds into wisdom.” – Me

Thank you to those who engaged in my presentation. I was thrilled to share some of my PhD work and the findings of other research studies to raise awareness of psychological distress in midwifery populations. The beautiful images below capture some of the key messages from my slides.

selfcare

Image credit: Scriberia Ltd (@scriberian).

small things

Image credit: Scriberia Ltd (@scriberian).

64%

Image credit: Scriberia Ltd (@scriberian).

Further statistics around midwives at work can be found here.

Traumatised midwives

Image credit: Scriberia Ltd (@scriberian).

compassion fatigue

Image credit: Scriberia Ltd (@scriberian).

I also really enjoyed the ethical debates around providing online anonymity and confidentiality for midwives in psychological distress who wish to seek help. You can read the wider arguments for this here. Do you have any further thoughts on this? I would love to hear them!

Once again…Thank you so much to everyone for making this event so amazing. The quote that I believe summed up the vibe in the room was this…shared by @millihill .

 

“If we can find ways of harvesting the energy in women’s oceanic grief we shall move mountains.” –Germaine Greer

🎓🌟😀

Overall take home messages…

  • Tailored care is needed for every family
  • A healthy baby is not ALL that matters
  • Good outcomes include good psychological outcomes
  • Kindness and compassion cost nothing yet can really make a difference
  • Appropriate use of language can make or break the birthing experience
  • The power of listening can never be underestimated
  • We must remember that fathers and wider family members may also be affected by trauma in the birth room.
  • A traumatic experience is always subjective. What is traumatic for some, may be unremarkable for others.
  • Mothers can have a positive experience of a clinically complicated birth, or a traumatic experience of a seemingly straightforward birth.
  • Any past trauma can always be re-awoken
  • The best care is delivered by a workforce that is healthy and cared for.

If you would like to follow the progress of my work going forward..

Follow me via @SallyPezaroThe Academic MidwifeThis blog

Until next time…Look after yourselves and each other 💚💙💜❤