I am repeatedly hearing women state that they must not sleep on their backs and are really concerned because they wake up on their back and have somehow harmed their unborn baby. I have been meaning to write about this for sometime but the straw that broke the camels back for me was a couple of days ago when a new client told me her previous midwife had told her not to back sleep or she could suffocate her baby!
Goodness me how on earth did our human race survive this treacherous journey called pregnancy and child birth? In one breathe we tell women they are not ill but going through a life event then we give them a whole list of what they must and must not do, places they must not go, things they must not eat and now which way to even sleep!
Rest assured dear sisters you can sleep how ever you feel most comfortable and you will do yourself or your baby no harm at all. In fact truth be known the worry of trying to sleep in a position you are self imposing on your body and the subsequent lack of sleep due to be less than comfortable will do you more harm.
On thinking long and hard I do believe that this myth has come about through a small grain of fact that has grown into huge Chinese whisper. In my opinion the myth has grown from the early days of dense paralysing epidurals and woman being left for hours alone in labour and on their backs.
It is true that there are huge oxygen carrying blood vessels in the lower back that if squashed by a heavy baby filled uterus did in the past lead to out of breath mothers who, due to the paralysis of an epidural were unable to move and the consequence was oxygen deprived babies. Once it was realised this was happening women were placed on their sides with a pillow wedged under them so they did not roll onto their backs, following administration of an epidural block.
These days epidurals are nowhere near so dense and most woman can move themselves around in the bed once it has been administered and can easy change position with minimal help.
As for a non labouring pregnant women, well that is whole different story because if she does happen to be squashing those all important blood vessels the first thing she will feel is a lack of oxygen which will lead to her feeling breathless and she will wake up and move! The baby will not suffer in any way. The human race has mechanisms to help us survive and will not allow us quietly suffocate ourselves (or our growing babies) in our sleep.
So sleep, pregnant women, however it suits your comfort.
Sunday, 27 September 2009
Thursday, 12 March 2009
Aquanatal class a huge success
Another success for Kent Midwifery Practice as last week saw the launch of our new Aquanatal classes. Having spent the previous couple of months learning exercise in water for pregnant women then making posters, distributing them , compiling health forms, registers, dance routines, looking around at venues and talking to pool managers.... phew! I was exhausted just thinking about the actual day. I then started to worry if any pregnant women would even turn up!
I had promised a free lunch as well as the first class free but that meant unless I was fully booked at every session I would make a loss. While I had not intended making a profit I certainly did not want to be actually funding the whole venture too.
A couple of weeks prior to launch I had interest and received some cheques in the post to pre book a group of sessions. I had been told by other midwives who run classes around the country that in their experience initially 6-8 women may come but that word of mouth will make the class grow. By the night before I had 8 women already booked and paid for so I was feeling a bit optimistic.
D day arrived and off I went with my student midwife daughter as my biggest support on the day. Women started to arrive at 10.30 as requested, to complete the health check forms and sort out any last minute fees.
By the start of the class to my utter amazement we had only one less than full capacity of women and I was ecstatic, 14 women turned up and as I was driving to the class another rang and booked for next week. So we now have full capacity for the next 4 weeks.
As for the actual class? Well it was great, we had loads of fun and no-one drowned!!
I remembered my routine and all the women said they loved it. After the class we all sat down with a nice cool drink and lunch and had an antenatal discussion.
The women told me they loved the breathing exercise and references to what will happen in labour as well as the discussion around food and what constitutes a good pregnancy diet.
This week I have music to add to the aquanatal moves and I am planning to talk about the progress of labour.......
I had promised a free lunch as well as the first class free but that meant unless I was fully booked at every session I would make a loss. While I had not intended making a profit I certainly did not want to be actually funding the whole venture too.
A couple of weeks prior to launch I had interest and received some cheques in the post to pre book a group of sessions. I had been told by other midwives who run classes around the country that in their experience initially 6-8 women may come but that word of mouth will make the class grow. By the night before I had 8 women already booked and paid for so I was feeling a bit optimistic.
D day arrived and off I went with my student midwife daughter as my biggest support on the day. Women started to arrive at 10.30 as requested, to complete the health check forms and sort out any last minute fees.
By the start of the class to my utter amazement we had only one less than full capacity of women and I was ecstatic, 14 women turned up and as I was driving to the class another rang and booked for next week. So we now have full capacity for the next 4 weeks.
As for the actual class? Well it was great, we had loads of fun and no-one drowned!!
I remembered my routine and all the women said they loved it. After the class we all sat down with a nice cool drink and lunch and had an antenatal discussion.
The women told me they loved the breathing exercise and references to what will happen in labour as well as the discussion around food and what constitutes a good pregnancy diet.
This week I have music to add to the aquanatal moves and I am planning to talk about the progress of labour.......
Thursday, 5 February 2009
I am an Inventor.....Presenting the HOWES birth Mirror
I am feeling quite proud of myself this morning for two reason. One reason is that I have invented a new product for my profession and it feels like it is going be a success.
Having released the details of my lovely new Howes birth mirror I sold some straight away!
Of course some of my dear colleagues had already ordered one from me, but I was never quite sure they thought it as great as I did and weren't just ordering one to be supportive (or they felt sorry for me), but to get orders from the public via my website Kent Midwifery Practice , and even an enquiry from the USA, had me jumping around like a teenager.
The second reason I feel proud of myself is that the hours, days and weeks I have spent recently learning about public relations have paid off. I know that because, having released the details of the Howes birth mirror through a prestigious press release wire distribution service, I not only got great feedback from them that I had written and presented it professionally, I also had several calls from journalists and publications saying they want to do a feature on me and my new invention. WOW!!!!!
You may wonder why that is important to me? Well, I was voted press secretary of Independent Midwives UK a couple of years ago and I want to fill my obligation appropriately in order that my colleagues can have full confidence in me.
The job has not been without heartache, worry, humiliation and sleepless nights over the last year and at times I wanted to retire and just stick to what I know I am best at (being a mother and a midwife) but, as the old saying goes, "if you stick your head above the parapet you get shot at" and, using the words of another strong woman, "I am not for turning".
So, after a short spell of feeling ridiculously sorry for myself after some public midwife-bashing, I dusted down and took myself off to meet a lovely man by the name of Richard Milton, journalist and writer of 25 years, who runs a PR training course in London. I spent a ridiculous amount of money for a self employed, moderately-paid midwife, but every single penny was worth it. He taught me so much about dealing with the press and getting your message to the right audience.
Midwives can really get a raw deal - most of us are too busy with midwifery to play the politics game, unlike our doctor colleagues, whose skills in debate and satirising their opponents are honed during their training.
This could be because midwifery as a profession - both independent midwives and those working in the NHS - is not well represented in the media.
Things that midwives say - and write - can be misunderstood and misrepresented, and as a profession maybe we all need to work on putting our case more clearly - and carefully!
Things that midwives say - and write - can be misunderstood and misrepresented, and as a profession maybe we all need to work on putting our case more clearly - and carefully!
Now I just have to learn about marketing and selling........
Friday, 23 January 2009
whose risk?
When my Kent Midwifery Practice blog colleague Eleanor told me the story of her client and their perception of risk, I thought it a really good subject for a new post. Then I was approached by a midwife who is researching the subject and looking at it from a midwife's perception and how she considers risk. I have now agreed to be part of her research and have been thinking about it a lot myself.
Risk and how, as humans, we view risk has been the subject of many studies around countless topics and is a subjective judgement made depending on the characteristics and severity of a risk. The influence of the media on the perception of risk is a clear demonstration of how something which is very low risk but is considered an emotive subject could actually cause a red herring effect. That is demonstrated by the whole "stranger danger " subject , making parents almost paranoid to let their children out of sight as they think the risk is too great.
What could be a more emotive subject to a woman than the baby she is carrying? Given a choice all women would eliminate any risk from pregnancy and childbirth but especially any risk to her child. I cannot think of one mother who I have cared for who given the choice of saving her unborn or new baby's life or taking her own life, would not have prioritised her baby.
One mother said to me "Virginia they could have taken my arm if my baby was in trouble". This woman was recovering from a nasty infected episiotomy which was performed in haste and panic by medical staff who believed her baby's heart had stopped abruptly prior to his birth. However what had really happened was the heart monitor had stopped abruptly.
So thinking about that I considered how mothers think about risk. Can we consider birth to ever be without risk? No, we cannot, but that is not to say birth is a "risky business" unless we consider that life is a risky business or driving our car is a risky business. Both those things we do on a daily basis without giving it any thought whatsoever. Who makes the decision on what is an acceptable risk around all the issues of childbirth and what is not? It should be the mother of course, but it rarely is.
We are just about there in the UK with regards to the safety of homebirth. Studies which demonstrate homebirth as a safe option for most women have just about been accepted by our medical colleagues [1, 2 - refs below]. Except for the most obstinate practitioners who refuse to keep updated despite the evidence having been around for a decade or more, most obstetricians will support a homebirth as long as a woman does not have any risk factors.
Yet all women, even the ones considered as low-risk, have risk factors - for a low-risk woman has a 2.7% chance of an unexpected complication occurring in labour [3] A complication that may need urgent assistance and delay could result in the problem becoming compounded. That is considered a low risk.
Let's consider a woman who has a nuchal scan to screen for a baby to be affected with trisomy 21 (Downs Syndrome). She has a 1:250 or 0.4% risk of her baby being affected and is told that is low. Who made that decision? Some women would consider it a no-risk situation; indeed some do and refuse to have the screen at all.
The number of babies that die unexpectedly following a prolonged pregnancy further than 42 weeks is approximately 2:1000 or 0.2% [4.] but that is considered so high a risk that 20% of UK women have labour induced [5], and that number of women are included in the 1:4 or 25% of women that make up the caesarean section rate in the UK.
When she has a section, the woman faces up to sixteen times times the risk of death, and ten times the risk of emergency hysterectomy, than a woman giving birth vaginally [6]. Yet a woman who plans a homebirth roughly halves her risk of ending up with a caesarean and all the risks it involves, compared to someone of the same risk level planning a hospital birth [2] She also roughly halves her risk of her baby being born in poor condition [2] - so why are some risks considered more acceptable to take than others?
Once the woman has had the caesarean section she is told she now has a 1:200 or 0.5% risk of a scar dehiscence which is considered high-risk and the medical profesion would be highly unlikely to support a decision for a home birth. However that number includes induced and augmented labour and benign dehiscence that is seen at elective caesarean section - most studies find a greatly reduced risk of rupture in spontaneous-onset labours which are not augmented with oxytocin. Maybe if figures were quoted for both actively-managed VBAC labours and for spontaneous, unaugmented VBAC labours, the risk perception would change and the place of birth and labour management would be more open to discussion
The most bizarre I think in the calculation of risk is the 1:10,000 or 0.01% of vitamin K deficiency bleeding. It is recommended that mothers agree to injecting a substance into all newborns because they are, apparently, fundamentally flawed and do not have normal levels of vitamin K at birth. Who says what is abnormal and what is that abnormality measured against? Sara Wickham considers that statistics for Vitamin K are the same risk as wearing a hard hat every time you walk outside your front door in case a roof slate falls off and hits you on the head. [ 7.] I think maybe a little more research is needed in relation to cost-effectiveness if that is the case. There has never been a follow-up study on children whose parents refused vit K. There could be a huge saving for our cash-strapped health service if the Vitamin K bill was reduced.
Key findings from major studies [8]such as Starr, were that the experts are not necessarily any better at estimating risk than lay people. Experts were often overconfident in the exactness of their estimates. I accept that the Starr study may be a very old piece of research but it surely is very relevant in our modern nanny-like society. Starr also found that people will accept risks 1,000 greater if they are voluntary than if they are involuntary. Information if presented in an unbiased way will assist women in their individual perception of risk and may even play a part in women taking responsibility for their choices. It may even reduce the ever growing litigation bill for medical negligence.....
At Kent Midwifery Practice we are clear that the mother is the only person who can decide what risks are acceptable for her family. It is not acceptable for professionals to say that lay people should not make their own decisions because they think that only they, the professionals, understand risk; nobody will care more about the risk to an unborn child than its mother.
The job of the midwife, whether independent or NHS, is to give the woman the information she needs, and to help her to understand how different risks apply to her. We all take risks; it is the pregnant women who should decide which risks she will take.
REFERENCES[1] British Medical Journal No 7068 Vol 313, 23 November 1996[2] Home Births - The report of the 1994 Confidential Enquiry by the National Birthday Trust Fundpub. The Parthenon Publishing Group, 1997. [3] Effective Care in Pregnancy and Childbirth, eds. Enkin, Keirse,Renfrew & Neilsen, 3rd Edition (published 2000, OUP), p360[1a] Chapter 38, section 6. "The probability of requiring an emergency CS for other acute conditions (fetal distress, cord prolapse or antepartum haemorrhage) in any woman giving birth is approximately 2.7%"]. [4] Menticoglou SM and Hall PF. Routine induction of labour at 41 weeks gestation: nonsensus consensus. BJOG 2002;109:485-91 [5] NICE Guidelines on Induction of Labour, July 2008, S1. : "In 2004–05, 19.8% of all deliveries in the UK were induced." [6] BMJ. 1998 Aug 15;317(7156):463-5. Should doctors perform an elective caesarean section on request? Maternal choice alone should not determine method of delivery. Amu O, Rajendran S, Bolaji II. [7] Wickham, S, Vitamin K - A flaw in the blueprint?, Midwifery Today, 2000; 56: 39-41. [8] Social Benefits versus Social Risks by Chauncey Starr, Science ,1969 .
2009/1/23 Virginia Howes <virginia@kentmidwiferypractice.co.uk>
Risk and how, as humans, we view risk has been the subject of many studies around countless topics and is a subjective judgement made depending on the characteristics and severity of a risk. The influence of the media on the perception of risk is a clear demonstration of how something which is very low risk but is considered an emotive subject could actually cause a red herring effect. That is demonstrated by the whole "stranger danger " subject , making parents almost paranoid to let their children out of sight as they think the risk is too great.
What could be a more emotive subject to a woman than the baby she is carrying? Given a choice all women would eliminate any risk from pregnancy and childbirth but especially any risk to her child. I cannot think of one mother who I have cared for who given the choice of saving her unborn or new baby's life or taking her own life, would not have prioritised her baby.
One mother said to me "Virginia they could have taken my arm if my baby was in trouble". This woman was recovering from a nasty infected episiotomy which was performed in haste and panic by medical staff who believed her baby's heart had stopped abruptly prior to his birth. However what had really happened was the heart monitor had stopped abruptly.
So thinking about that I considered how mothers think about risk. Can we consider birth to ever be without risk? No, we cannot, but that is not to say birth is a "risky business" unless we consider that life is a risky business or driving our car is a risky business. Both those things we do on a daily basis without giving it any thought whatsoever. Who makes the decision on what is an acceptable risk around all the issues of childbirth and what is not? It should be the mother of course, but it rarely is.
We are just about there in the UK with regards to the safety of homebirth. Studies which demonstrate homebirth as a safe option for most women have just about been accepted by our medical colleagues [1, 2 - refs below]. Except for the most obstinate practitioners who refuse to keep updated despite the evidence having been around for a decade or more, most obstetricians will support a homebirth as long as a woman does not have any risk factors.
Yet all women, even the ones considered as low-risk, have risk factors - for a low-risk woman has a 2.7% chance of an unexpected complication occurring in labour [3] A complication that may need urgent assistance and delay could result in the problem becoming compounded. That is considered a low risk.
Let's consider a woman who has a nuchal scan to screen for a baby to be affected with trisomy 21 (Downs Syndrome). She has a 1:250 or 0.4% risk of her baby being affected and is told that is low. Who made that decision? Some women would consider it a no-risk situation; indeed some do and refuse to have the screen at all.
The number of babies that die unexpectedly following a prolonged pregnancy further than 42 weeks is approximately 2:1000 or 0.2% [4.] but that is considered so high a risk that 20% of UK women have labour induced [5], and that number of women are included in the 1:4 or 25% of women that make up the caesarean section rate in the UK.
When she has a section, the woman faces up to sixteen times times the risk of death, and ten times the risk of emergency hysterectomy, than a woman giving birth vaginally [6]. Yet a woman who plans a homebirth roughly halves her risk of ending up with a caesarean and all the risks it involves, compared to someone of the same risk level planning a hospital birth [2] She also roughly halves her risk of her baby being born in poor condition [2] - so why are some risks considered more acceptable to take than others?
Once the woman has had the caesarean section she is told she now has a 1:200 or 0.5% risk of a scar dehiscence which is considered high-risk and the medical profesion would be highly unlikely to support a decision for a home birth. However that number includes induced and augmented labour and benign dehiscence that is seen at elective caesarean section - most studies find a greatly reduced risk of rupture in spontaneous-onset labours which are not augmented with oxytocin. Maybe if figures were quoted for both actively-managed VBAC labours and for spontaneous, unaugmented VBAC labours, the risk perception would change and the place of birth and labour management would be more open to discussion
The most bizarre I think in the calculation of risk is the 1:10,000 or 0.01% of vitamin K deficiency bleeding. It is recommended that mothers agree to injecting a substance into all newborns because they are, apparently, fundamentally flawed and do not have normal levels of vitamin K at birth. Who says what is abnormal and what is that abnormality measured against? Sara Wickham considers that statistics for Vitamin K are the same risk as wearing a hard hat every time you walk outside your front door in case a roof slate falls off and hits you on the head. [ 7.] I think maybe a little more research is needed in relation to cost-effectiveness if that is the case. There has never been a follow-up study on children whose parents refused vit K. There could be a huge saving for our cash-strapped health service if the Vitamin K bill was reduced.
Key findings from major studies [8]such as Starr, were that the experts are not necessarily any better at estimating risk than lay people. Experts were often overconfident in the exactness of their estimates. I accept that the Starr study may be a very old piece of research but it surely is very relevant in our modern nanny-like society. Starr also found that people will accept risks 1,000 greater if they are voluntary than if they are involuntary. Information if presented in an unbiased way will assist women in their individual perception of risk and may even play a part in women taking responsibility for their choices. It may even reduce the ever growing litigation bill for medical negligence.....
At Kent Midwifery Practice we are clear that the mother is the only person who can decide what risks are acceptable for her family. It is not acceptable for professionals to say that lay people should not make their own decisions because they think that only they, the professionals, understand risk; nobody will care more about the risk to an unborn child than its mother.
The job of the midwife, whether independent or NHS, is to give the woman the information she needs, and to help her to understand how different risks apply to her. We all take risks; it is the pregnant women who should decide which risks she will take.
REFERENCES[1] British Medical Journal No 7068 Vol 313, 23 November 1996[2] Home Births - The report of the 1994 Confidential Enquiry by the National Birthday Trust Fundpub. The Parthenon Publishing Group, 1997. [3] Effective Care in Pregnancy and Childbirth, eds. Enkin, Keirse,Renfrew & Neilsen, 3rd Edition (published 2000, OUP), p360[1a] Chapter 38, section 6. "The probability of requiring an emergency CS for other acute conditions (fetal distress, cord prolapse or antepartum haemorrhage) in any woman giving birth is approximately 2.7%"]. [4] Menticoglou SM and Hall PF. Routine induction of labour at 41 weeks gestation: nonsensus consensus. BJOG 2002;109:485-91 [5] NICE Guidelines on Induction of Labour, July 2008, S1. : "In 2004–05, 19.8% of all deliveries in the UK were induced." [6] BMJ. 1998 Aug 15;317(7156):463-5. Should doctors perform an elective caesarean section on request? Maternal choice alone should not determine method of delivery. Amu O, Rajendran S, Bolaji II. [7] Wickham, S, Vitamin K - A flaw in the blueprint?, Midwifery Today, 2000; 56: 39-41. [8] Social Benefits versus Social Risks by Chauncey Starr, Science ,1969 .
2009/1/23 Virginia Howes <virginia@kentmidwiferypractice.co.uk>
Monday, 22 December 2008
Useful Phrases, by Mary Cronk MBE
Mary, an internationally-respected midwife who will no doubt be known to many readers, has this advice for women who are worried that midwives or doctors will not treat them with due respect:
I am sure that many others will explain your absolute right to refuse any procedure for any or no reason. The law, and good practice, is quite clear. A sensible person will listen carefully to any explanations to why a procedure is proposed, and then should she choose not to have XY or Z she just says "no" or "no thank you". The "allowing" is done by YOU.
An asssertive approach is worth cultivating. You may care to commit the following phrases to memory and practice them frequently in front of a mirror.
- "Thank you so much Midwife Sinister/ Mr Hi-an-my-tee, for your advice. We will consider this carefully and let you know our decision." Sweet Smile!
This one is most useful in the antenatal stage, though it can be used in labour. It can just take a minute to consider what you either want to know, or what you decide. - "Would you like to reconsider what you have just said!" Fierce glare.
This is useful and, for example, applies to the misuse of the word "allow". - "I do not believe you can have heard what I have just said. Shall I repeat myself? "
- "I am afraid I will have to regard any further discussion as harrassment."
This is used if the person does not respect your decision or persists in pressing the subject. - "What is your NMC or GMC pin number?"
This is used if the last one is ineffective. If the person asks why you want their pin number, inform them that this is something they might like to consider. - "STOP THIS AT ONCE".
This to be used in extremis. I am delighted to tell you that this was used AGAINST me by a woman to whom I had taught it. I was doing a difficult VE and was being too persistent. I stopped at once and learnt a lesson.
Do not argue; learn the phrases and keep them or similar for use if necessary. I am informed that it is usually only necessary to be assertive once or twice to have a much more respectful attitude from the people who are actually your professional SERVANTS.
Sunday, 30 November 2008
Risk in Midwifery - who decides?
Risk is an interesting issue in midwifery and obstetric care. Risk is discussed all the time with women, but it often means different things to different people. Who decides what is high risk? High risk to whom?
This reminded me of a hospital appointment I attended with a client, her husband and their consultant. They were discussing risk in relation to their impending twin birth. The consultant, whom I trust and respect, was saying that he recommended an epidural for twin labours because of the high risk that the second twin might need to be born quickly by cesarean section or assisted delivery. My clients husband asked what he meant by high risk – the consultant replied that about 5% of second twins are born by emergency cesarean section. The husband laughed and said that 5% was nothing and as a racing driver, he faced death or serious injury every weekend – somewhere in the region of 50%! From his perspective, a 5% risk was minimal, but from the obstetrician's view point, this was a huge risk! The couple therefore decided that 5% was an acceptable risk of an unplanned caesarean for them and so declined epidural anaesthesia.
From their viewpoint, the benefits of mobility in labour outweighed the small chance that the mother would have to have an emergency general anaesthetic if she needed a caesarean section and there was not time to administer regional anaesthesia.
NB The risk of the second baby dying in labour was much less than this - around 3 in a thousand for term second twins - second twins have a higher mortality rate than first twins or singletons. See for instance Birth order, gestational age, and risk of delivery related perinatal death in twins: retrospective cohort study. - Smith GC, Pell JP, Dobbie R. in BMJ. 2002 Nov 2;325(7371):1004. -
This reminded me of a hospital appointment I attended with a client, her husband and their consultant. They were discussing risk in relation to their impending twin birth. The consultant, whom I trust and respect, was saying that he recommended an epidural for twin labours because of the high risk that the second twin might need to be born quickly by cesarean section or assisted delivery. My clients husband asked what he meant by high risk – the consultant replied that about 5% of second twins are born by emergency cesarean section. The husband laughed and said that 5% was nothing and as a racing driver, he faced death or serious injury every weekend – somewhere in the region of 50%! From his perspective, a 5% risk was minimal, but from the obstetrician's view point, this was a huge risk! The couple therefore decided that 5% was an acceptable risk of an unplanned caesarean for them and so declined epidural anaesthesia.
From their viewpoint, the benefits of mobility in labour outweighed the small chance that the mother would have to have an emergency general anaesthetic if she needed a caesarean section and there was not time to administer regional anaesthesia.
NB The risk of the second baby dying in labour was much less than this - around 3 in a thousand for term second twins - second twins have a higher mortality rate than first twins or singletons. See for instance Birth order, gestational age, and risk of delivery related perinatal death in twins: retrospective cohort study. - Smith GC, Pell JP, Dobbie R. in BMJ. 2002 Nov 2;325(7371):1004. -
Saturday, 15 November 2008
Sharon's Story Part 3 - Supervision of Independent Midwives
This post continues the discussion of Sharon's Story.. the previous two posts described the birth and postnatal transfer. Now I want to look at the Supervision angle.
Virginia, in the story you say that you consulted with your supervisor before transferring Sharon to hospital. What is the relationship between a Supervisor and an independent midwife? When do you consult her, normally?
Midwifery is the most regulated profession under the health umbrella. We are more regulated than nurses and doctors. We are obliged to keep updated and can be called upon at any time by our regulatorybody, The Nursing and Midwifery Council (NMC), to prove we are keeping updated. Midwives keep portfolios as proof of updating.
We have a system of promoting excellence in midwifery care and that system is known as Supervision. It is not supervision as most people understand the word, where the midwife is policed or told how to practice. Rather, it is a support system to enable midwives to practice with confidence, therefore preventing poor practice. Each Midwife will have her own personal named Supervisor of Midwives (SOM). If a midwife has a practice issue, she can talk to her SOM in confidence for guidance and support. The Supervisor has a duty to help the midwife in order to ensure good practice, but also to fundamentally protect mothers and babies. A SOM has a duty to promote normal childbirth and to support women’s informed choice.
You can read more about the supervision system on the Nursing and Midwifery Council website, under the Midwives' Rules and Standards.
If carried out to its full potential and aim, Supervision is an amazing support system. It is not an hierarchical system. A supervisor of midwives could be a head of midwifery, but she will also have a named SOM herself. If any accusation of bad practice is made about a midwife, supervision is used to address the issue and determine if it has foundation or not. There are correct procedures to follow.
As in all walks of life, sometimes ideals and intentions are not met and the same can be said of supervision. Midwives may, perhaps due to previous bad experience, see supervision as a punitive system. That is not how it should be. My career and experience has shown me both sides - but not equally so, I am pleased to say. Luckily (!) I experienced poor Supervision early on in my career many years ago, and so my learning curve about it was very steep. Now, and since becoming an independent practitioner, supervision has been excellent for me. It comes from the top down and the Local Supervising Officer, Helen Odell, follows the guidelines for supervision as they should be followed and actively supports all midwives in her geographical area.
My own named Supervisor of Midwives is a constant support and sounding block for me and I am often on the telephone to her discussing issues of practice. It is not easy for her as she needs to approach our relationship a little differently as I work differently to the other midwives she supervises. I will always call her in the event of a dilemma, difficult situation and even when an unusual yet fantastic situation occurs.
I am very passionate about my profession. This passion has not gone away since the day I started. In fact it gets stronger as my knowledge grows. Yes, my knowledge continues to grow, as no matter how or what your professional status is, there is room to learn more and improve. Someone could be in a profession for 30 years but if they continually repeat practice over and over it does not necessarily make them experienced. Experience can be measured in type, not quantity of time. If the passion and commitment ever goes then that is the time I will get out. If ever I am bored with it, I will not be giving women a good service.
Did you have any further discussions about this case with your Supervisor? Did she review the case? Were any issues raised about your practice?
As I put this story on my website and it was unusual, it was drawn to the attention of my supervisor and the LSO, Helen Odell, and quite rightly procedure was followed whereby the case notes were reviewed. The case notes demonstrated a much fuller picture than the brief story which was originally put online. I was commended for the care I gave.
You wrote the original article in a very candid and open way. Can you explain to us the difference between a midwifery reflection and a case study? It sounds to me like a midwifery reflection is opening your heart, and a case study is covering your back!!!
Midwives reflect, midwives question. We reflect on ourselves on what we did what we could have done better and what we may do again should the same situation arise. Unless you can see where you go wrong how can you strive to improve. When we reflect we are critical about ourselves, we admit to failings, we even admit to others failing or how we felt towards others. However, if we write a case study then it is fact and will include everything but not the feelings or thoughts of the person writing it. A case study is a detailed analysis of a person, a collection and presentation of the facts. A story, however, is a bit of both, but aimed at a certain audience and written in a way to make something interesting.
Weren't you a bit naive, putting what was, really, a simplistic summary of a complex case online in that format? Surely it would leave you open to criticism from those who did not know the full facts of the case. If you don't mention all of the factors you considered, some people may, also naively, assume that you did not actually know about them!
Yes, I was naive. I was trying to write a representative, descriptive story that emphasised my commitment to woman-centred midwifery. It was aimed at women looking for a midwife. Women who may have had similar bad experiences, or who were going through some of the issues now. Women who may have no or limited knowledge on the subjects concerned. I wrote it in an attempt to empower women. If I had been writing for a professional audience, the emphasis and level of detail would have been quite different.
Well, I'm glad you published the story, as it has raised plenty of issues for discussion. Thank you very much, Virginia; I'm looking forward to dissecting some other unusual stories at a later date!
Virginia, in the story you say that you consulted with your supervisor before transferring Sharon to hospital. What is the relationship between a Supervisor and an independent midwife? When do you consult her, normally?
Midwifery is the most regulated profession under the health umbrella. We are more regulated than nurses and doctors. We are obliged to keep updated and can be called upon at any time by our regulatorybody, The Nursing and Midwifery Council (NMC), to prove we are keeping updated. Midwives keep portfolios as proof of updating.
We have a system of promoting excellence in midwifery care and that system is known as Supervision. It is not supervision as most people understand the word, where the midwife is policed or told how to practice. Rather, it is a support system to enable midwives to practice with confidence, therefore preventing poor practice. Each Midwife will have her own personal named Supervisor of Midwives (SOM). If a midwife has a practice issue, she can talk to her SOM in confidence for guidance and support. The Supervisor has a duty to help the midwife in order to ensure good practice, but also to fundamentally protect mothers and babies. A SOM has a duty to promote normal childbirth and to support women’s informed choice.
You can read more about the supervision system on the Nursing and Midwifery Council website, under the Midwives' Rules and Standards.
If carried out to its full potential and aim, Supervision is an amazing support system. It is not an hierarchical system. A supervisor of midwives could be a head of midwifery, but she will also have a named SOM herself. If any accusation of bad practice is made about a midwife, supervision is used to address the issue and determine if it has foundation or not. There are correct procedures to follow.
As in all walks of life, sometimes ideals and intentions are not met and the same can be said of supervision. Midwives may, perhaps due to previous bad experience, see supervision as a punitive system. That is not how it should be. My career and experience has shown me both sides - but not equally so, I am pleased to say. Luckily (!) I experienced poor Supervision early on in my career many years ago, and so my learning curve about it was very steep. Now, and since becoming an independent practitioner, supervision has been excellent for me. It comes from the top down and the Local Supervising Officer, Helen Odell, follows the guidelines for supervision as they should be followed and actively supports all midwives in her geographical area.
My own named Supervisor of Midwives is a constant support and sounding block for me and I am often on the telephone to her discussing issues of practice. It is not easy for her as she needs to approach our relationship a little differently as I work differently to the other midwives she supervises. I will always call her in the event of a dilemma, difficult situation and even when an unusual yet fantastic situation occurs.
I am very passionate about my profession. This passion has not gone away since the day I started. In fact it gets stronger as my knowledge grows. Yes, my knowledge continues to grow, as no matter how or what your professional status is, there is room to learn more and improve. Someone could be in a profession for 30 years but if they continually repeat practice over and over it does not necessarily make them experienced. Experience can be measured in type, not quantity of time. If the passion and commitment ever goes then that is the time I will get out. If ever I am bored with it, I will not be giving women a good service.
Did you have any further discussions about this case with your Supervisor? Did she review the case? Were any issues raised about your practice?
As I put this story on my website and it was unusual, it was drawn to the attention of my supervisor and the LSO, Helen Odell, and quite rightly procedure was followed whereby the case notes were reviewed. The case notes demonstrated a much fuller picture than the brief story which was originally put online. I was commended for the care I gave.
You wrote the original article in a very candid and open way. Can you explain to us the difference between a midwifery reflection and a case study? It sounds to me like a midwifery reflection is opening your heart, and a case study is covering your back!!!
Midwives reflect, midwives question. We reflect on ourselves on what we did what we could have done better and what we may do again should the same situation arise. Unless you can see where you go wrong how can you strive to improve. When we reflect we are critical about ourselves, we admit to failings, we even admit to others failing or how we felt towards others. However, if we write a case study then it is fact and will include everything but not the feelings or thoughts of the person writing it. A case study is a detailed analysis of a person, a collection and presentation of the facts. A story, however, is a bit of both, but aimed at a certain audience and written in a way to make something interesting.
Weren't you a bit naive, putting what was, really, a simplistic summary of a complex case online in that format? Surely it would leave you open to criticism from those who did not know the full facts of the case. If you don't mention all of the factors you considered, some people may, also naively, assume that you did not actually know about them!
Yes, I was naive. I was trying to write a representative, descriptive story that emphasised my commitment to woman-centred midwifery. It was aimed at women looking for a midwife. Women who may have had similar bad experiences, or who were going through some of the issues now. Women who may have no or limited knowledge on the subjects concerned. I wrote it in an attempt to empower women. If I had been writing for a professional audience, the emphasis and level of detail would have been quite different.
Well, I'm glad you published the story, as it has raised plenty of issues for discussion. Thank you very much, Virginia; I'm looking forward to dissecting some other unusual stories at a later date!
Subscribe to:
Posts (Atom)
