Confessions Of An…NHS Midwife

In a few months’ time, I will have been a qualified midwife for six years.

I’m not actually sure, but it definitely runs into the hundreds! I stopped counting after I finished my training. As a student, I was required to deliver (or 'catch') at least 40 babies but I trained in a very busy hospital, so I managed to catch 76 by the time I qualified. It’s about quality, not quantity, though – women are so much more than numbers in a log book.

I’ve always been fascinated by women’s health. My first birth was quite difficult and nothing like I expected, which prompted me to ask some serious questions about why the system seemed so stacked against a positive experience. I began to find my job in television less and less fulfilling, and the prospect of making a difference to women during pregnancy and birth became increasingly compelling. I left my job and made the leap gradually, first working for six years as a doula, then retraining in midwifery.

My own! My first daughter’s birth, although difficult, inspired me to make a change. I probably wouldn’t have gone on to study midwifery if I hadn’t had such a rough time of it. And my second daughter was born in a really empowering home birth, so I feel like I can empathise with women who’ve had very differing experiences too. I couldn’t possibly choose a favourite birth in the context of my midwifery practice – they’re all special.

The most difficult births are the ones where there is an immediate threat to the life of mother and/or baby. Birth is usually a straightforward physiological process but midwives see all kinds of emergencies over the course of their careers, and these are the really testing times. With every birth, we’re looking after two lives and trying to keep two people safe. That is the ultimate goal.

Definitely the connection that can be made between midwives and the women in their care. It’s not all about that peak moment of birth. In fact, like most midwives, I don’t work in the labour ward, and most of the care I give is geared towards the nine months leading up to birth, and up to six weeks afterwards. I find joy in those moments when I know I’ve helped someone feel safe, empowered and appreciated, and that can happen during a quick antenatal check, or when providing urgent treatment for sepsis, or listening to the story of a woman who’s been trafficked. My job is so varied that I’m lucky to find these moments of joy in so many different scenarios.

Providing effective, compassionate, woman-centred care in a system that’s often understaffed and under-resourced. Unfortunately, this is a running theme across the NHS at the moment. We’re all trained to provide world-class, gold-standard care, and it’s incredibly frustrating when the system that surrounds you won’t allow you to utilise your skills to the best of your ability. Some days, the best you can hope for is to keep everyone safe, but that should be a given. It can be exhausting trying to do your best within a framework at breaking point.

You just grind on and get through it. As students, we know that 12-hour shifts are likely to be the norm, so it’s a pattern I’ve grown accustomed to since I started my training nearly nine years ago. Time management and self-care are important.

Without wishing to sound overly negative, I think many midwives in the modern NHS think about quitting, even if only fleetingly, more often than the public might imagine. Burnout is real. Midwifery within today’s system is physically and emotionally demanding, and everyone has their limits. Hardly a day goes by when I don’t wonder if I’ve reached mine.

Birth is such an intense time. When a baby is on the way, I’m completely focused on the moment: what I can see and feel, what sounds the woman is making, how her body is working, what might happen next and how I can respond to that. She has put enormous trust in me, and deserves my full attention.

The cliché idea of midwifery is that we spend all our time holding hands, delivering babies and cuddling newborns…very warm and fuzzy. In actual fact, while emotional support is important and some midwives do work in the labour ward, I can’t remember the last time I cuddled a newborn. Modern midwives perform an extremely complex and highly skilled role within an intensely pressurised system. Nowadays, we have to be experts in the normal and the unusual, and everything in between. We coordinate women’s care from start to finish, we manage social needs as well as physical ones, and we work in a variety of settings, from clinics to triage units to wards and research labs and beyond. Things have changed a lot since Call The Midwife, but many people still have an outdated understanding of the breadth and complexity of our role.

People often don’t understand how frequently midwives encounter pregnancy loss, by which I mean miscarriage and stillbirth. These things happen much more often than the general public is led to believe, and although awareness of this issue is growing, the topic is still fairly taboo. As midwives, we know that not all pregnancies have a happy ending and we are often the ones to diagnose and manage a tragic outcome. We accept from the earliest days of our training that this will be part of our job, but it never gets any easier.

Women are stronger than they think, and this applies to both pregnant women and midwives (who are, with the exception of a small but growing number of men, mostly women).

We talk about fertility a lot more than we talk about loss, but the two subjects are intertwined. I didn’t realise until I became a midwife how many women struggle to conceive and carry a full-term, healthy pregnancy. If you don’t know how common this is, it’s easy to imagine that everyone around you is breeding away quite blissfully, yet nothing could be further from the truth. Fortunately, assisted conception is a fantastic growth area for technology, and I’ve looked after women who have had amazing, successful treatments that would not have been possible in years past.

I once inadvertently soaked myself in a woman’s urine by forgetting to close the tap on her catheter bag. I was a student at the time and felt completely mortified, but my mentor found the whole thing hilarious. Midwifery has a tendency to take itself quite seriously – and so it should – but I’ve also laughed harder in this job than I could ever have imagined at the outset. Midwives are hilarious people. We have to be, to relieve some of the pressures of the job, and birth also has its funny moments. We have to be able to laugh at ourselves on occasion, and over the years, any midwife becomes pretty unembarrassable.

Undoubtedly, the worst thing is when a baby has died. There is no sadder time in a woman’s life, and as the mother of two children myself, it grieves me every time I encounter a woman in that position.

As with life, there will always be people you connect with and people you don’t. I’m not naturally a very extroverted person, so developing a quick rapport with women is a skill that I’ve had to learn (and am still developing), but I hope that the women in my care feel relaxed, appreciated and safe. 'Liking' a patient is neither here nor there – every woman deserves compassion and respect.

Keeping in touch with patients can be a tricky issue; we have to respect the boundaries of our role and maintain professional behaviour at all times. The nicest thing is when a woman I’ve looked after before returns to the maternity unit in her subsequent pregnancy – it’s always a great surprise, and so nice to catch up on all her family news.

I don’t think a good midwife necessarily needs to have had children of their own, but I would like to think that my two very different birth experiences have given me an insight into how some of the women in my care might feel. Women often ask whether I’ve had children of my own, and for better or for worse, I think sometimes they do like to know that I’ve been down that road myself.

I would love it if my book could, in some way, transform public understanding of the modern midwife’s role. There are so few accurate representations of what we do nowadays, and I think that if people could see how complex and challenging our role really is, and how much we can contribute to public health and wellbeing, our profession would benefit enormously. In turn, that newfound respect would benefit the ones who really matter: the women embarking on their journey to motherhood.