Having a baby is one of the most exciting things that you as
a family will do. However is can be filled with anxiety and some confusion
wondering what’s for the best, and what advice and research to trust. Women
have been having babies for thousands of years, and unfortunately this makes
everyone think they are an expert. The one person you will be able to trust is
the midwife.
My name is Charlotte, I am a qualified nurse and have worked
in accident and emergency and on a busy surgical ward. I topped up my training
and became a midwife in 2011. Since then I have worked in a very busy referral
unit dealing with extremely high risk pregnancies before going back to my
training trust and working as a midwife on delivery suite and the
antenatal/postnatal ward.
Around 5 years ago I started working on the community
midwifery team and have worked in a range of areas, including those of mass
social deprivation and in very rural locations. Last year I took a very big
step and left working for the NHS fulltime and bought a franchise of a world
renowned company ‘Baby Sensory’ although I still am a midwife and still
actively involved within the midwifery world.
The term midwife means ‘with woman’ and is a role that can
be undertaken by both men and women. Families are often a bit put off by the
idea of a male midwife but really don’t be. They are no different to a
gynaecologist or a male nurse. The role
of the midwife is the same regardless what area we work or what our own beliefs
are. Midwives are governed by a wide range of policies and procedures that are
at both a national and local level, along with our registration which is
governed by the Nursing, Midwifery Council and renewed each year and validated
every three. So you can be safe in the knowledge that all the midwives looking
after your care are trained at the highest level.
Midwives work at a completely autonomous and independent
level, meaning that if you are a healthy, well woman with no other risk factors
you may only ever see the midwife during your pregnancy. You should get to know
the midwife well over the course of the next 10 months (yes 10 not 9). In an
ideal world you should have the same midwife throughout your antenatal care and
this is considered best practice, obviously sometimes it can be hard with
staffing issues within hospital trusts but we hope that in most cases this is
so.
Telling the
midwife you are pregnant and being booked in for your initial appointment.
Below I’ve outlined the appointments you can expect and what
happens during each of them.
Booking appointment*
Medical history, family history, BMI, Blood pressure, blood tests, urine tests.
This is normally where the midwife will decide whether you need to be referred
to see a consultant or whether you can stay midwifery led, whether you might
need a glucose test to see if you could be diabetic (this is often dependant on
your BMI at booking, family history and ethnic origin).
*how you schedule your
booking appointment will depend on where you live, give your GP a call and they
can advise how to do so
11+1-13+6 - Dating scan, to see how many babies are
there, and what date we expect your baby to be due. People often refer to this
as the 12 week scan but it doesn’t always happen at 12 weeks. It’s at this
point that you will be offered combined screening which hopefully will have
been discussed with you at your booking appointment. This blood test along with
the results from your scan are sent to be analysed and this can give you a
likelihood of your child having any of the conditions tested for. This test is
not definitive but if you were to come back high risk you would be offered
further testing.
16weeks General
appointment with the midwife. We can arrange further appointments now we know
your due date, such as an appointment to check for gestational diabetes, and
appointments to see the consultant at a specific point in your pregnancy. We
also do a routine antenatal examination. Blood Pressure, urine check, and most
excitingly for you we may well try to listen to baby’s heartbeat. Now this
isn’t always the case and will be dependent on your hospital policy.
20weeks Anomaly
scan, this is not to check your baby’s sex and in some trusts they will not
tell you even when asked. This scan measures your baby, checks for any
abnormalities of the vital organs and checks the volumes of water surrounding
baby. Think of it as a baby MOT.
25 weeks Routine
Antenatal- we can also give you your maternity certificate which is proof
for your employer that you are pregnant and what day your baby is due (this can
also be useful for paternity leave, benefits and housing) and we may try to
listen to baby’s heartbeat
28 weeks Routine
Antenatal and Blood Tests-The blood test is to check your iron level and
make sure your body is coping well with the pregnancy It is also at this point
that we will start measuring your tummy to see how well baby is growing, and
using a chart specific to you we can assess the growth of baby. If your baby is
growing nicely this will show on the graph. If baby goes suddenly very large we
can do testing to see if there is a reason, and if baby isn’t growing well or
suddenly drops in size we can also evaluate why this is happening. As a whole
midwives are very experienced at this and if the same midwife is seeing you
each week it’s much easier to detect abnormalities quickly. We may try to
listen to baby’s heartbeat
31 weeks -Routine
Antenatal - Blood Pressure, urine check, and we may try to listen to baby’s
heartbeat
34 weeks- Routine
Antenatal - Blood Pressure, urine check, and we may try to listen to baby’s
heartbeat
36 weeks- Routine
Antenatal and Bloods- Not done in
all trusts but a way to check you are well enough for delivery and that your
iron is high enough.
38weeks Routine
antenatal - Blood Pressure, urine check, and we may try to listen to baby’s
heartbeat
40weeks - ooh
exciting day (your friends will drive you mad asking if the baby is here yet,
tell them only 10% arrive on that day and why it’s called expected due date not
a definite one). We won’t do much with you except a normal antenatal check and
make sure you are all ready.
41 weeks-
dependent on the policy in your hospital trust and also dependant on how your
pregnancy is going you might be offered a ‘membrane sweep’ at this point. This
is an internal examination where the midwife or sometimes Dr. will try to reach
your cervix using their fingers and once through the softening cervix will
sweep the membranes over babies head. I don’t think anyone would ever say this
a nice experience but it shouldn’t hurt. Although I tell my ladies that if I’m
just going to tickle them with a feather I might as well not bother. So I’ll
always do a good job to make it worth it, I do pride myself on a good sweep
with very good results on the whole. I’ve had my fair share of babies born
within a few hours of a sweep.
42 weeks - if you
have a stubborn little thing that just likes being in there too much you may
require induction of labour. The guidelines state this should be done prior to
42 weeks as this is believed to be when the placenta stops being as efficient
at fuelling baby. Although that being said that is just a guideline and
sometimes induction needs to be done before, or if a lady declines induction we
can wait, but careful monitoring is advised.
So what is the
role of the midwife in different areas?
The role of the midwife is so diverse it’s hard to explain everything that is covered by the midwife in day to day roles. There are many
specialities within midwifery:
There are specialist midwives for drug and alcohol
dependency, diabetes, chronic illness and high risk midwives, teenage
pregnancy, screening, nurse consultants, safeguarding midwives, breastfeeding
coordinators. Clinical midwives who work within antenatal clinic organising the
drs, midwives who work on neonatal unit (not all babies on neonatal are little
tiny preemies). Then we have midwives that train the midwives making sure we
meet the standards set out by the NMC or RCOG.
As a community midwife my job dips in and out of many of
these roles. Our job within the community it to build a strong relationship,
not just with mums to be but with partners and the wider family and friends
that live within your community. One of my favourite jobs in community is
getting to know future big brothers and sisters. Having a new baby in the house
can be hard for little ones so I enjoy engaging children as much as possible
when they come to antenatal checks. Whether that be getting them to help with
jobs like measuring tummies, listening to baby’s heart beat or just helping me
get equipment.
We want to build a foundation of trust where you and your
family members can tell us anything and use us to give advice and reassurance
where we can. Our other job in community is to monitor ‘deviations from the
norm’, if you attend your appointments regularly we can assess you closely and
look for any minor changed that could be the start of something more serious.
That gives us the chance to get you reviewed by a doctor or seen quickly and
hopefully before a condition worsens.
Where to birth
your baby:
In the U.K there are 3 main options for where you choose to
deliver your baby, and these options are often open for negotiation and
discussion.
Homebirth-my
favourite. I’m lucky enough to live in an area where homebirth is quite
popular which means as a community midwife I have been to my fair share of
planned births. I’ve also been to an awful lot of unplanned homebirth-foot well
of the car, in a corridor, in the back of an ambulance, in a house where the
electric had gone out, down the side of the toilet, on the toilet, in the
shower and bath…the list goes on (everyone was fine, even the shocked mummies laughed
about them later). If you are a healthy lady who has been well throughout her
pregnancy with a well-baby you should be offered a homebirth. There is a lot of
research about the benefits of homebirth for healthy women and these should not
be ignored. We give you a basic list of things to buy, an old shower curtain,
old towels, any prescribed pain relief that you may require and we bring the
emergency equipment, the gas and air, and the official equipment needed. Plus
it’s not as mucky as everyone likes to pretend…my guess is these people have never
actually witnessed a homebirth.
Midwife led unit/birthing
centre - If a homebirth is not for you, the most common option is to have a
hospital birth but in a midwifery led birth centre. There are often fixed
pools, at a homebirth blow up pools can be hired. Midwives run the unit offering
everything you can have at home such as aromatherapy, massage, physiological
third stage of labour, but with the option of transferring to an obstetric unit
if something isn’t quite going to plan or you want increased pain relief.
Families often like this option as its low risk but with the added benefit of
having the hospital on hand.
Obstetric Unit - Then
there is the final option which is to have baby in an obstetric unit. Now in
reality you should know in advance if you will be starting your labour journey
here as you or baby may have a medical condition or there may be certain
aspects of your birth that may have complications. Otherwise women should start
in a midwifery led unit. The obstetric unit is normally run by very experienced
high risk midwives who are used to dealing with emergencies, giving drugs and
using monitors. These midwives will often also work in theatre scrubbing for
C/Section and ‘taking baby’ at c/section where they care for baby and make sure
it is well following delivery. The baby very rarely is ‘taken away’ it’s
usually dried a bit so it doesn’t get cold and put in skin to skin with mum,
but whilst being looked after by the midwife for safety. Sometimes on the delivery
suite there may be families who are not in labour but require treatment. The
midwives here, are used to difficult situations and will give you and your
family the best care and attention.
We do an awful lot of training to become midwives and have
to witness and deliver babies, then witness instrumental and surgical
deliveries. Once we are qualified our training does not stop there. To keep
ourselves up to date we have to undertake practice scenarios every year and are
tested on our skills and knowledge.
So what can you do to
help us during your pregnancy?
We want you to become the expert on yourself. We want you to
pay attention to your body, get to know your baby and its movements, as this is
the best indication of how well your baby is coping. Remember your baby should
move in a pattern every day right up to the end of your pregnancy, and if this
pattern alters you should see a professional without delay. We want you to
attend antenatal classes, yoga, Pilates, aqua natal, hypnobirthing, meditation,
talks on diet and lifestyle because these make for healthy pregnancies. We want
you to do your research, come in and question us. If we don’t know the answer
we will try our very hardest to find out for you, or at least point you in the
right direction. Most importantly we want you to talk to us, be truthful and
let us know what you are thinking. You might not always like what we have to
say back but we will be truthful with you are help you the best we can. Our job
is to look after you and protect you and your families, your job is to let us.
Charlotte can be found on insta @babysensoryburnley
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