Day One and Two: Full on!

Day One and Two: Full on!

Hello lovely readers: guess what? I’m in midwifery school again! And trust me, I never thought re-qualifying was going to be a walk in the park, but these last two days have been a pretty brusque reminder to just how intense this is going to be. And I know I’m capable (and thankfully, a lot of it will be familiar, at least), but man–here we go!

Yesterday was a general orientation to the program: the course requirements, the timetable, our first assignments. Thursday is a day-long orientation to the library, where I suspect we’ll be spending *a lot* of our time. We’ve received an independent study guide, a workbook on medications and abbreviations and prescribing in labour, and an inch-thick workbook on reproductive physiology, plus some fervent warnings to keep up with the work and not let it pile up. Right! We also spent yesterday and today working in small groups, getting to know each other, and discussing the role of the midwife and the principles of midwifery care, which is always nourishing and enriching work.

The class itself is fabulous–there are 28 of us in total, ranging in ages from 18 and fresh out of sixth form (sort of the UK high school equivalent) through late 40s with teenager children, all from very diverse cultural and social backgrounds, and with a myriad of reasons for wanting to be midwives. I was very relieved to discover that I’m not the only mature student, by a long shot, and not the only mother going back to university with children at home. In fact, most of the other mothers in my class have three children rather than just two, and a few of them even have four children (and one with a set of twins), so if they can do it (superwomen!), I can too. I made a comment along the lines of “wow, how do you do it?” to a mum of four in my class, and her response was “You just have to get super organised.” Right! Wise words; that is definitely the plan! We’re still just getting to know each other, but everyone seems very friendly and welcoming so far, and I suspect that the wonderfully stressful bonding experience we’re all about to go through will ensure some lifelong friendships. I still think of my midwifery school friends from my US qualification with such love and warmth, and even though most of us don’t talk or hang out much any more, I still feel like many of them are my sisters as much as friends and colleagues, and the feeling hasn’t faded through the years, despite the distance and limited contact (mostly through facebook these days). So there is definitely something to be said for midwifery school friends!

Tomorrow is our orientation to our clinical site. My first rotation will be community midwifery, which is an area I’m very excited to learn more about, as it doesn’t exist in the United States. At all. In fact, the UK’s commitment to community midwifery is a bit of a rarity even among European countries, and is very exciting. My limited understanding of it so far (I’m sure I’ll have a much better grasp of it in the weeks and months to come) is that community midwives are responsible for delivering midwifery care in womens’ homes. This includes providing home births, of course (which is my particular love, and where I want to be practicing when I finally graduate again), but the more remarkable feat of community midwifery is that here in the UK, ALL women (even those who delivered in hospitals) are given follow-up postnatal care by a midwife in the comfort of their home, usually 1-2 days after returning from the hospital, then again around Day 5-6 postnatally, and finally one more time around Day 10 when the woman and baby will finally be discharged from midwifery care. Let me say that again, because it still sounds so incredible to me: a midwife will come to your *house* in the first few days and weeks after you give birth, check your bleeding, help with breastfeeding, weigh the baby, perform the newborn screen etc. etc., and this is not some extra, luxury service for wealthy clients with private insurance, but ROUTINE POSTNATAL CARE.  In the US, postnatal care generally looks like this: you give birth, you’re seen in the hospital by a midwife or OB on postnatal Day 1- Day 2 (which is usually when you’re discharged if you’ve had a vaginal delivery; usually Day 3-4 if you’ve given birth by cesarean), and then…that’s it. Your next postnatal visit is booked for 6 weeks later. And to a new mom with a newborn baby, the chasm between Day 2 and 6 weeks might as well be the Grand Canyon. SO much happens during those first 6 weeks–so many questions, such a steep learning curve–and you’re basically on your own for most of it (unless there’s a rare complication that would necessitate an earlier visit). Add to this the fact that many women in the US are also expected to return to work around 6 weeks, and maybe it begins to sink in just a little bit how cruel and inadequate the US maternity leave/ postnatal care system is.

Which isn’t to say that UK postnatal care is perfect.  In fact, most of the complaints I’ve heard since I’ve been working as a lactation consultant here for the past 3 years is that postnatal care isn’t nearly supportive enough, and that the advice about breastfeeding in particular can be very inconsistent. Also, one of the reasons community midwifery follow-up happens so quickly here is because many women are being released from the hospital within 6-24 hours after giving birth, which can also be very disorientating and stressful, for first-time moms in particular, I think.

In any case, I am very excited about working in the community initially–and I’m even hopeful that I might be able to attend a home birth, if I’m lucky. Fingers crossed! But our clinical rotation is still 8 weeks from now, and first…there’s a whole lot of reproductive physiology to review.

Breastfeeding News Roundup

Breastfeeding News Roundup

Breastfeeding has been in the news a lot the last few weeks. Here’s a quick roundup of some of the most interesting and exciting new articles regarding our first food, and why it’s so important.

First, a viral post about the microbiology research of a Vicky Green, a Biosciences student at South Devon College, who demonstrated the power of breastmilk by placing it in petri dishes cultured with some of the nastiest bugs around, including MRSA and E. coli. In the picture in the link, you can actually see clear rings surrounding each drop of breastmilk on the petri dish where the bacterial growth was halted by the breastmilk proteins. What’s even more remarkable is that she’s using the breastmilk from a mum nursing a 15 month old and a mum nursing a 3 year old, which just goes to show that breastfeeding DOES continue to play an important and vital role in nourishing our children and providing optimal health for them well past the first 6 months of life. Unfortunately, as an IBCLC, I hear all too often from clients that they were told by a (presumably well-meaning) GP or Health Visitor that there’s no benefit to nursing a baby past 6 months. Absolute nonsense, as this research so clearly demonstrates! And who knows, perhaps the protein in breastmilk will hold the key to defeating bacteria like MRSA in the future.

And speaking of nursing babies beyond infancy, Tamara Ecclestone recently posted a lovely photoshoot of herself nursing her 2 year old daughter Sophia and just about broke the internet in terms of controversial backlash, as people reacted so negatively to the photos that she was actually forced to defend her decision for posting the photos in the first place. Which honestly is just a very sad state of affairs. Also, the BBC article linked above doesn’t provide 100% accurate information. UK guidelines for breastfeeding are in line with WHO guidelines, and state that babies should be breastfed exclusively for six months and then continue to be breastfeed for a minimum of 2 years OR BEYOND, in addition to the food they’re eating. For the record, the right time to wean is whatever feels right for mom and baby, but the biological norm for our mammalian species is to breastfeed for anywhere from 2-3+ years, and as with all phases of growth or development, there’s a huge range of normal in terms of the right time to wean depending on the mother and baby dyad. It’s irresponsible to suggest that the UK guideline only encourages breastfeeding for the first 6 months. As for the controversy, unfortunately that’s nothing new. People are often outraged by the thought of breasts being used for purposes *other* than sexual, and sadly we hear of stories all the time of women being shamed for nursing in public, or told to use the toilet instead. And not surprisingly, most likely due in part to these cultural perceptions, the UK has one of the worst rates of extended breastfeeding of any developed nation in the world–even lower the the US’ rate of extended breastfeeding, which is quite surprising given that women in the UK routinely have 6 months of maternity leave (and often a year) compared to women in the US who often receive a scanty 6 weeks, if they’re lucky enough to receive anything at all. Clearly there’s still A LOT of room for improvement, and personally, as someone who’s still nursing her own two year old, I applaud Tamara Ecclestone’s decision to share her beautiful photos, which is an important part of how we can begin to normalize breastfeeding in the first place. The Milk Meg also has a wonderful article on this entitled: 9 Reasons my child is not “too old” to breastfeed.

And finally, this is a fascinating article by Kathleen Kendall-Tackett, IBCIC (who I saw at the LCGB conference last year, and is a fantastic speaker), discussing all of the ways that breastfeeding doesn’t just provide the optimal food for our babies, but also provides the best emotional and neurological foundation for their mental health. Breastfeeding encourages responsive parenting, promotes sleep (which in turn supports better parenting, as well as lowering the risk of postnatal depression–and breastfeeding is an independent factor for reducing maternal depression as well, regardless of sleep). Breastfeeding also promotes nurturance, attachment and bonding. As I often tell clients, breastfeeding is 10% about the FOOD we’re feeding our babies (and what incredible food it is!) and 90% about THE MANNER in which we’re feeding our babies, setting them up for healthy brain growth, emotional processing and psychological attachment in addition to optimal nutrition.

It’s ALL Happening: Midwifery Seminar, Timetables, Bursary Approved!

It’s ALL Happening: Midwifery Seminar, Timetables, Bursary Approved!

It’s all starting to get very, very real! I went to my new university on Friday to attend a midwifery seminar, which they hold every 6 months or so. It was a fantastic morning listening to some very interesting speakers and topics (I’ll give you a run-down below). I also received my student timetable for the first year of the course (let’s just say….lots and lots of work ahead, and very few holidays), and yesterday I also got a notice from the NHS that my fees-only bursary has been approved. What a huge relief that is! And for the record, I am an incredibly lucky student, as I am part of THE VERY LAST COHORT of incoming midwifery students who will be eligible to receive an NHS bursary. Starting in Aug. 2017, all incoming midwifery and nursing students will have to pay for their education (to the tune of 9,000 GBP per term), whereas if you are lucky enough to begin your education under the old scheme (as I am), your fees will be covered for your entire course (i.e. 3 years worth of education). As you can imagine, there are a lot of organizations (most notably, the RCM and RCN) which were quite distressed about this change, as it may limit the numbers of incoming student nurses and midwives and destabilize the future of maternity care in the UK. I am not entirely convinced about this, as midwifery and nursing education has ALWAYS been paid for by students in the US, without detrimental effects on the number of students choosing to enter these professions (but obviously coming out with lots and lots of student debt at the end of their education, which isn’t necessarily a good thing at all). In any case, though, as an American student approaching midwifery education here in the UK, I must admit that I am absolutely floored (flabbergasted! Amazed! Delighted!) that my education will be covered by the NHS, as I would never in a million years dream of free tuition in the States for any degree. It feels completely surreal to me, especially as I spent years and years paying off my student debt from my US midwifery and nursing education. And I am counting my lucky stars that I am slipping in just under the wire and will have my fees covered, but at the same time saddened that this incredible system–a system that values a student’s time and energy, and understands that properly educated professionals require investment–is being dismantled.

I met a few of the students who will be in my course, though, as well as a few of the professors, and everyone was incredibly kind and welcoming. I even met a third year student who gave me her phone number (unprompted by me!) and told me that I could get in touch with her at any point if I needed help. What a kind thing to do, and such a wonderful example of mentoring.  All of it seems very encouraging, and is making me think (again!) that I’ve chosen the right university to study at. The atmosphere was warm, the students were engaged, and the questions being asked were perceptive, smart and on-point. I am very excited about learning here!

The first speaker at the seminar was the one and only Professor Cathy Warwick, CEO of the Royal College of Midwives (and how fantastic that she’s speaking at conferences at my university??). Her presentation was on the importance of challenging the status quo in order to better deliver personalised care to each woman, which is a core value reflected in the National Maternity Review’s Better Births policy, but is not always easy to implement when a woman’s desires for her birth clashes with the institutionalised norm. She discussed many of the common situations where care is provided based on ritual (i.e. we do it this way because we’ve always done it this way), rather than evidence of best practice (examples of these sorts of non-evidence based rituals include transferring women between wards in a wheelchair when they’re perfectly capable of walking, not allowing fathers to stay overnight in early labour, routine use of external fetal monitoring on admission, transferring women from birth settings in an ambulance regardless of the reasons for the transfer etc. etc.) Prof Warwick pointed out that delivering personalised care presents big challenges for midwives on a systemic level, but that in many situations massive system changes aren’t needed. She spoke, for example, about how you can begin as simply as removing the word “allowed” from your vocabulary (something I can 100% get behind). The woman in labour is the one in charge of her birth. As midwives, it’s our job to support and empower her, but ultimately she should be the one making decisions (in collaboration with her midwife and birthing team). Telling a woman she isn’t “allowed” to do something goes against this sentiment. Ideally, a woman should be able to do whatever she likes in labour and on the ward (within reason), so long as the risks and benefits of her choices have been fully explained to her and she has been given the opportunity to make an informed decision. It’s HER birth, after all. Prof Warwick also pointed out that in some cases, women are labeled as “birthing outside of guidelines” as if they are stubborn and intractable and taking unnecessary risks with their babies, when in fact they are successfully advocating and demanding the type of birth experience they want and are legally entitled to. A better question is: how do we support women who challenge birth conventions/ norms of institutions, and choose to birth outside of these norms? As a strong advocate for home birth, this is something I have encountered many times before, and something that independent midwives facilitate, as many women who choose independent midwifery care are doing so because the institutionalised care offered to them was not in sync with what they desired for their birth. (And I must admit, I found it incredibly encouraging to be hearing this from the CEO of the RCM, especially in light of the recent difficulties imposed on Independent Midwives by the NMC). Safety and risk is perceived differently by every woman, after all; what feels safe to one woman could feel like the definition of risk to another. Prof Warwick also spoke about the need for not only continuity of care, but continuity of carer, and was quite adamant that figuring out how to deliver this type of continuity is something that can only be done by midwives (and that most likely the way forward will be different for each individual midwife, in terms of case-loading v. shift work v. shared call), and that midwives need to be given the power and flexibility to find their own solutions.

The next speaker was Margaret Nyudzewira, a public health advocate and co-founder of the charity CAME Women and Girls Development Organisation (CAWOGIDO), who spoke to us about breast ironing. While I’ve been aware of the dangers of Female Genital Cutting (FGC, or Female Genital Mutilation, FGM) for years, and have encountered it a few times as a midwife in Brooklyn, the practice of breast ironing is fairly new to me. Strangely enough, I first learned about it just a few weeks ago when a midwife friend posted a link to a photographer’s riveting portraits of women and girls who’ve experienced breast ironing.  The practice involves using a tight elastic band, pestle, ladle, hot stone, shell, or even hot seeds or heated leaves, to massage and flatten developing breast tissue on young girls, and can lead to many serious medical complications, including chronic pain, scalding, burns, infections, cysts, abscesses, tissue damage, the inability to breastfeed, and of course psychological trauma. Breast ironing is most often done by the girl’s mother (but can also be done by a grandmother, aunt, or tribal practitioner), and comes from a place of love, or more specifically, fear for loved ones–fear of unwanted sexual attention directed towards their daughters, fear of rape or sexual assault, or fear that early marriage or teen pregnancy could education and curtail opportunities.  And similar to FGC, this practice doesn’t occur only in Central and West Africa, but in the UK (and the US) as well (although the numbers are difficult to track, and very few studies have been done on the rates of breast ironing in the UK). In Cameroon, 50% of girls on the coast, and 24% of girls nationwide, experience breast ironing.

But one of the things that struck me the most was when Ms. Nyuydzewira said quite emphatically: “It is NOT part of our [Cameroonian] culture to harm girls and young women.” And that is absolutely true. While the practice of breast ironing itself is brutal and debilitating, it’s really important to keep in mind that the practice and the culture are not exactly one and the same. As a (white) midwife approaching a cultural practice like this (which runs counter to my own beliefs, and feels very foreign to my own cultural upbringing), I think it’s crucial to come from a place of support rather than a place of judgement.  This is one of the reasons I have come to call it Female Genital Cutting over the years, rather than Female Genital Mutilation (which has our cultural judgement baked into the very name itself) or Female Genital Circumcision (which to me seems to condone the practice, on some level, and also equates it in the mind with male circumcision, which is a false equivalence), especially when I’m discussing it with women/ patients directly (I understand that more generally, in health policy and research, it is more often referred to as FGM). Some women brought up in cultures which practice female genital cutting, for example, may view FGC as no more strange to them than piercing bellybuttons or lips or eyebrows is to us, even if the implications, the actual act itself and the repercussions of it can be much more damaging to them than a bellybutton piercing.  When viewed within their culture, it may be seen as a mark of belonging and identity, a much anticipated rite of passage, a way of fitting in, a symbol of their womanhood, a manifestation of their virtue and honor, and on its most basic level, the way that vaginas are supposed to look–beautiful, even, to their eyes. On a personal level, I disagree with these assertions and find FGC abhorrent, but as an outsider to these cultures, I can’t approach a woman by telling her that she’s been mutilated as the starting point for any future conversations with her–that will immediately close her off to me and only serves to project my own cultural bias over her own.  Instead, gentleness and sensitivity is needed more than anything else. Rather than imposing my own viewpoint, I would have to elicit the woman’s own views on the topic first, and use that as the starting point for whatever would be most useful to her moving forward: education and resources if desired, medical care if needed, mental health referrals if she feels depressed or traumatised by her experience, or silence and non-judgement if she views it in a positive or neutral light (and should this viewpoint ever change, I can then step in at that point with whatever help or support is most appropriate at that time).  To me, this gets to the very heart of my own personal philosophy of midwifery care: LISTEN to women, and DON’T JUDGE. In any case, now that breast ironing is also on my radar, I will be more alert to it if/ when I ever encounter it, and in a much better place to offer sensitive care on this very complex issue. Overall, it was a difficult and disturbing presentation to listen to, but I’m glad that it was part of the seminar, as these things are really important to think about in advance of encountering them!

There were two other speakers at the seminar: Debra Sloam, Midwife and Infant Feeding Specialist from Frimley NHS Foundation Trust, who spoke about her MSc research on student midwives’ attitudes towards offering breastfeeding assistance (as suspected, I will most likely have a lot more time to help women breastfeed as a student than I will as a working midwife), and Dr. Kim Russell from the University of Nottingham, who discussed her action research on challenging midwifery barriers (real and perceived) to facilitating water births on the wards.  These were both interesting and engaging presentations, and I’m really glad I was able to attend the seminar.

Two more weeks until classes start!

 

My First Week Away From Them

My First Week Away From Them

I just spent a week away from my boys–the longest time I’ve ever been away from them since my eldest son was born five years ago. I went skiing with some good friends, entirely on my own, while my partner held down the fort in my absence.

I think I’ve been dreaming about this week away for nearly five years now. In the early, bleary-eyed days of new motherhood, when I was certain the exhaustion would kill me, I dreamed about mere hours away.  A week was unimaginable, but I would fantasize about someone taking my son and holding him for three hours while I took a nap. And in all fairness, there are several occasions when I can remember exactly that happening. My in-laws would babysit every now and then, or my partner. Once two work colleagues took him for a walk for two hours while I slept on the couch, and once, in desperation, I went to a friend’s house 10 blocks away and slept in her bed for three hours, as I found it nearly impossible to sleep–really sleep, deep and undisturbed–if the baby was anywhere in the house with me. Even his slightest whimpers, faint snufflings in his sleep, would set me bolt upright, in those early days, so any chance of a real nap would have to be done away from him.

And then, as he grew older, I began to dream about entire days away, and even entire weekends. I would imagine how glorious it would be, how unfathomably luxurious, to have an entire day to myself. To do the things I used to do, the things I took for granted, before I had children. To sleep in late, have a lazy morning in bed reading the paper, showering for a full, uninterrupted 20 minutes, enjoying a leisurely brunch at a local restaurant, lingering over my coffee–hell, on some days even an uninterrupted 5 minutes on the toilet felt luxurious, the stuff of fantasies.  I couldn’t imagine an afternoon spent browsing through bookstores or watching a movie, cooking a complicated meal from a new recipe book, knitting while watching TV, drifting off to bed whenever I felt tired, rather than trying to sprint through the evening’s interminable to-do list with the bed at the finish line and the distance between us growing longer and longer.

My partner would leave, often for work but sometimes for pleasure, and I would think about how much easier it was for him to have a week or weekend away. He was less tethered, his life carrying on in many of the same ways that it had before children, whereas for me my post-kids life was unrecognizable to my pre-kids life. I was often unrecognizable to myself.  Some days I would cry bitter, jealous tears about this. Some days I felt like I was the default option, taken for granted. He could head off on stag-dos and weekends away because I was at home, maintaining the routine, ensuring that naps were had and noses were wiped, food was cooked and cleaned up and cooked and cleaned up again, bodies bathed, teeth brushed and bedtimes kept. Needs were met. That was partly where the bitterness came from; that needs came before wants for me now, and that there was never time or room or energy for my wants, whereas my partner could still occasionally fulfill some of his wants.

But little by little, I started to have opportunities to leave. First an evening out with girlfriends after putting the boys to bed, so that they never even knew I was gone, and then an afternoon here, a morning there. A day spent at a conference now and then. I started working again, one day a week as an IBCLC at a breastfeeding drop-in (strangely enough, my day spent “working” often felt like a holiday), and then I began working two days a week, and then three. An avid runner, I began to train for another marathon about a year after my second son was born. I spent hours away, running. And then, for the race itself, I left for an entire weekend away with my partner, while the grandparents watched our children. Brief glimpses of my former self, snatched here and there like an exhausted swimmer coming up for air.

But now, for the first time, with a five year old and a two year old, I am finally in a place where I can go for a week and not feel like my absence will be harmful to them. In fact, I feel quite the opposite–that it would be good for all of us.  Good for me to be away, good for them to realize that they can manage without me (for a little while, at least), good for my partner to be on his own, and understand what it feels like to be the one left behind, holding down the fort, and good for them to see their daddy not just helping me, but single-handedly doing all of the tasks I normally do.  Good to change the routine and remind ourselves that we’re all flexible, that we can adapt. And for the record, my partner is an incredibly capable and involved dad. Leaving him alone with the kids for a week is by no means beyond him, or even a stretch for him, and I had absolutely no qualms about it. They’re in good hands.

And so, here I am, on my own for a week…and it’s been WONDERFUL! But it’s also felt like I’ve had an arm chopped off. I keep feeling the phantom twinges of my family all around me, as if I’ve lost something really important and keep forgetting what it is. I walk into restaurants and start to ask for a high chair before remembering that it’s not needed.  During dinner, I keep feeling like I should be doing a gazillion different things besides just eating my meal and enjoying the conversation. I should be reminding the older one to use his cutlery, reminding the younger one to sit still or he’ll spill his water, trying to get both of them to have a few more bites or else there won’t be any pudding, snapping at both of them to stop harassing each other, refilling plates and making pointed reminders about using napkins, cutting meat and retrieving forks off of the floor etc. etc. It’s as if I’ve gotten used to juggling eight balls while also eating a meal, and now all of a sudden the balls have disappeared…but I still feel like I should be juggling.

And how strange it’s been to move through the world unencumbered again!  To only have to think about myself and my own needs. To be the one traveling light, to sail through airport security in a matter of minutes. To board a plane on my own, with a good book to read and no mental checklists involving emergency snacks and drinks, knowing exactly where various toys, books, games and Lovies have been stowed, checking the batteries on the iPad which is the inevitable emergency back-up to the games and books, and making sure that nappies have been changed and wees had before boarding. To just get on a plane, sit down, put on my seatbelt and be ready to go. How unbelievably decadent! I can roll out of bed and be ready to go 20 minutes later, whereas usually dressing, cleaning, feeding and preparing my children to leave the house is a 1.5 hour long endeavor. The freedom and ease is staggering!

Our culture is really good about focusing on the positives of motherhood and glossing over the negatives, but in truth, motherhood is usually always a mix, and it’s important to acknowledge the dark as much as the light. So much love you feel like you’ll burst (!!), on a daily basis, but also so much uncertainty, responsibility, tedium, loneliness and isolation (and in many cases, depression and anxiety as well). Lots of dark in addition to the light, and rarely a perfect balance of the two. And in those first few days and months, nothing can prepare you for how swift the bulldozing of your identity and former life can be! I feel like the process of becoming a mother razes your identity to the ground, and then, in the wreckage of your former life, you slowly begin to rebuild your identity from the ground up, trying to figure out how to reincorporate all the pieces of who you used to be into this new shape.  And bit by bit, over time, you remember the things you used to enjoy and do on your own before motherhood, and learn new ways to do them again. But this week has made it very clear to me that you never go back to being the person you were before you had kids, even when you do get to the point that you can leave them for a week. All of those months and years fantasizing about time away, so that I could be who I used to be, even for just a little while, is impossible.  That person is gone. Those things I used to love to do before children, I still enjoy, but now they don’t feel like they’re quite enough for me, on their own, because I guess it takes more to fill me up now.

And I miss my kids like crazy. This time away has been nourishing and vital, and very eye-opening, but I feel like what it’s done more than anything else is give me energy to plunge back into the fray of parenting again. And be a better mother for it, as well. I can’t wait to see them again!

NMC threatens Independent Midwifery again

NMC threatens Independent Midwifery again

Back in 2013, Independent Midwives (IMs) in the UK were facing a crisis: a new EU regulation was coming into effect in October of that year which would require all IMs to carry malpractice insurance (and would therefore make it illegal for IMs to practice without indemnity insurance). At the time, it was difficult to find an insurer willing to cover IMs, and given that the pool of IMs sharing the costs of insurance was small, the quotes from insurance companies at the time were prohibitively expensive. Thankfully, after several petitions, protests outside of parliament, and a long and drawn out campaign by IMUK, a resolution was found in early 2014 that enabled self-employed IMs to purchase insurance through a pooled indemnity scheme set up by IMUK itself rather than using a third-party insurance company, which allowed IMs to continue to practice legally.

However, this past Friday (the 13th, no less!), the Nurse and Midwifery Council (NMC) made a decision that the IMUK indemnity scheme does not provide adequate coverage (i.e. sufficient funds), particularly if a serious case of malpractice was ever brought against an independent midwife using the scheme. From the NMC’s statement on their website:

The NMC’s investigation found that the indemnity scheme provided for IMUK members was not able to call upon sufficient financial resources to meet the costs of a successful claim for damages for a range of situations. These include the rare cases of catastrophic injury, such as cerebral palsy. This could have the effect that mothers and babies who suffer injury through the negligence of an attending midwife are not properly compensated for their injury. (NMC, 2017)

Which basically means, that as of Friday 13th, 2017, any independent midwife using the IMUK scheme is now considered to be practicing illegally, unless they can find a different indemnity insurer to cover them ASAP.

As you can imagine, this has created quite a bit of chaos. Women who chose independent midwives for their care and have developed trusting relationships with them throughout their pregnancies are now being told that their chosen midwife can’t attend their births, and that they’ll have to find alternative arrangements, in some cases with only days to go until their due date. Even more cruelly, the NMC has specified (on Page 2 of their guidance) that IMs using the IMUK indemnity scheme will not be allowed to attend their clients’ births in any capacity, even in a non-midwifery role, which is particularly harsh given that the general standard of care during home to hospital transfers is for the IM to remain with the client in a doula/ emotional support role even as the midwifery role is transferred to NHS midwives.

In an urgent letter written to the NMC on Friday the 13th, Rebecca Schiller, CEO of Birthrights (the human rights in childbirth charity) expressed her dismay over the NMC’s decision, criticising many of the  implications of this decision:

While we are aware that some women may be able to transfer to local NHS home birth services, we are concerned about the safety implications of this. Local NHS home birth teams will not have antenatal records relating to women who book later in pregnancy and there will be a very limited opportunity for a named midwife to build a relationship. In some areas there are limited, unreliable or no home birth services at all, which may have prompted the woman to use the services of an independent midwife. Furthermore, many NHS home birth services are unwilling to support women who are making an informed choice to birth at home outside of guidelines. In these cases we believe that women will be unable to give birth at home with appropriate clinical care.

As the regulator for the midwifery profession in the UK, it’s certainly important that the NMC sets and enforces clear safety guidelines. However, the amount of indemnity coverage a midwife has does very little to ensure safety. All it ensures is that in the event of a tragedy, the affected family will be able to sue the IM who did the delivery for a larger amount than they otherwise would be able to.  As Richard Chappell at Philosophy.net succinctly summarised in his article about the decision:

NMC Chief Executive and Registrar Jackie Smith has responded with the claim that “The NMC absolutely supports a woman’s right to choose how she gives birth and who she has to support her through that birth. But we also have a responsibility to make sure that all women and their babies are provided with a sufficient level of protection should anything go wrong.”

In other words: nice as a women’s right to choose might be, what’s really important is that she can sue for many bucketloads of money (not just a few bucketloads) if anything goes wrong.

BirthRights has also questioned the timing and manner in which this decision has occurred, as it’s left many women who had booked independent midwifery care without a clear way forward.  The NMC has been particularly opaque about what amount of coverage would meet their safety standards, despite both IMUK and Birth Rights asking for clarification. For example, in the NMC’s own policy guidance on indemnity insurance, they state:

We are unable to advise you about the level of cover that you need. We consider that you are in the best position to determine, with your indemnity provider, what level of cover is appropriate for your practice. You should seek advice as appropriate from your professional body, trade union or insurer to inform your decision. You need to be able to demonstrate that you fully disclosed your scope of practice and to justify your decisions if asked to do so. (NMC, 2017, Page 3)

Therefore, they are raising an objection to the amount of coverage IMUK decided upon, while simultaneously stating that the amount of coverage can be determined by professional body, insurer or trade union (i.e. IMUK)–not exactly helpful in terms of figuring out what amount of coverage would satisfy requirements.

The NMC’s press release also implies that the NMC has been in talks with IMUK about the inadequacy of their indemnity cover since 2014 and that if their clients now feel suddenly surprised by this decision, it’s the fault of the IMs for not updating them about this issue. However, the final decision was only reached 3 days before Christmas, which left IMs and their pregnant clients scrambling for alternative care arrangements over the holiday season.  Additionally, in the NMC’s press release on their decision, they go out of their way to stress that this only affects a small percentage of midwives in the UK (approximately 80 out of 41,000 midwives), as if that makes it ok.  But this small number includes nearly every independent midwife working in the UK, and the women the IMs are caring for are as equally entitled to their chosen provider and manner of birth as any of the other women cared for by the 41,000 other midwives in the UK. As Milli Hill wrote in the Telegraph back in 2013 when the insurance coverage was first threatening independent midwifery as a profession:

If … Independent Midwifery becomes illegal, this will be a grave blow to birth freedom in the UK. The NHS will be left unchallenged, a monopoly, and a system that already seems to be over-stretched and flawed will be left to continue without an alternative for anyone to compare it to. Women who seek an different option to the mainstream will have no choice but to birth unattended, or perhaps in secret with an midwife practicing illegally. Will this really improve birth safety?

Independent Midwifery provides the gold standard of midwifery practice in the UK: trusting relationships, continuity of care, respectful, informed choice, and freedom to birth where and how the woman would like, and is therefore something that needs to be protected, even if the number of women choosing this type of care is ultimately small.

As it stands right now, talks are ongoing between IMUK and the NMC, and IMUK has filed a legal challenge to the decision, while IMs are seeking out alternative indemnity cover. The RMC has also proposed that honorary NHS contracts could be a solution for IMs in the short term.  If you get a chance, please sign this petition in support of IMUK. This post also explains more of the history of independent midwifery and the insurance issue that has come up since 2013, and of course, you can continue to follow IMUK and Birth Rights for further updates. Hopefully a resolution will be found soon!

 

2 Minute Menstrual Cycle

2 Minute Menstrual Cycle

The menstrual cycle takes a lot of study to fully understand–and that’s just the hormonal side of it! The life stuff takes even longer to unravel; I’m still learning how to work with my cycle, every month. It’s a life-long process. This video illustrates it brilliantly, though. How amazing women are! To think that there is a monthly cycle within us, surrounding us, that enhances our capabilities on some days, and on other days requires inward thinking, self-care and reflection. Learning how to be consciously aware of the hormonal and emotional tides within our bodies is a powerful act of love and self-respect.

The Wasted Hour

The Wasted Hour

We’re mammals. We like to ignore this most of the time, but when you attend births, it’s something which is impossible to forget. And like all mammals, we’ve been programmed to perform an elaborate bonding dance in the first hour after birth, often referred to as The Golden Hour*. During this time, babies are primed to respond to their mother’s voice, to look for her face, to root and nuzzle and find their mother’s nipple, to fix in their mind the image of their primary care-giver, and to breastfeed. Simultaneously, mothers are primed to fall in love with their babies. In fact, the hormonal cascade of labor is actually designed to change the brain chemistry of the woman who just gave birth, increasing her desire to nurture her newborn. Oxytocin, the hormone of love (and breastfeeding), peaks at its highest level immediately after the delivery, ensuring that motherly love—strong enough to move mountains, to fight like a tiger for your cub, to throw yourself in front of a moving bus to save your child without thinking twice—is cemented into place.

Bonding is crucial to survival; evolution has demonstrated this again and again. It’s well documented that in nature, if an animal fails to bond with her baby, that baby’s chances of surviving, let alone thriving, are pretty slim. With humans, it’s not as clear cut. Obviously strong bonds can form even without sharing the very first hour of life together, as adoption and chosen family (as opposed to biological family) demonstrates again and again, but it takes a lot more work. The beauty of the Golden Hour is that the wheels have been so perfectly greased—all you have to do is show up and be present, and falling in love is just about guaranteed.

Or was guaranteed, even just a few years ago. These days, it seems as if we’re almost willfully trying to shoot ourselves in the foot, having gotten way too meta about the entire experience. Since nothing has really actually happened until it’s been posted on Facebook, the very first thing new parents are doing these days is whipping out their phones to share the good news with the world. Gazing in wonder at the new human being who’s just entered their lives is often done through the lens of the smart-phone camera. It’s all about the stats—weight, height, name, time of birth—which is then texted to all the anxious relatives, ensuring that in addition to their parents’ voice, the very first thing the baby will hear is a barrage of beeps, vibrations or ring-tones heralding the arrival of each new text or tweet; their parents are often lost for 10-15 minutes at a time as they respond to the deluge of sms congratulations.

When I first started my career back in 2003, smart phones didn’t exist yet. Parents brought cameras with them to the hospital and maybe snapped a few photos before cuddling with their baby, but that was it. How refreshingly quaint that now seems! These days, I find myself frequently reminding parents to put their phones down. The updates can wait, the baby needs your attention now. Back in New York, when my husband and I tuned in to an episode of the American version of One Born Every Minute, we watched a well-intentioned new father accidentally drop his phone on his sleeping infant while trying to take a picture. Phones have become so ubiquitous now that no one in that delivery room even blinked—except the startled baby.

Right now we’re in the middle of giving birth to the first generation who will come into the world with smart phones as a given. My two year old son seems to think everyone has a phone the same way that everyone has a nose. He’s already quite adept at unlocking mine. The other day, in an unguarded moment, I caught him queuing up Winnie the Pooh on my Netflix app. While the American Academy of Pediatricians and Royal College of Paediatrics have warnings about this, recommending that television and other entertainment media be avoided for the first two years of life, it seems impossible to enforce. Media is everywhere we turn.

Evolution is a very slow process. Birth and bonding hasn’t changed that much in the last two thousand years, nor has our mammalian hard-wiring, while technology seems to move at the speed of light by comparison. Who knows what will happen to our species over time if we continue to squander the Golden Hour*? Put down the phone. Falling in love will never be this easy again.

*For the record, it’s not just a Golden Hour…it’s more like a Golden First Six Weeks! The many benefits of skin-to-skin contact–increased oxytocin release for both mum and baby, improved breastfeeding success, comfort, stable newborn core temperature, bonding etc.–can still occur well after the first hour of life. So even if the first hour wasn’t that golden (because you were separated from your baby, or under anesthesia, or in too much pain during a repair to be able to hold her) you can make up for it by putting your baby skin to skin as soon as possible. And for as much as you’d like to in the weeks to come!

Mission Statement

Mission Statement

Every new project and endeavor needs a Mission Statement. I wrote this 12 years ago, when I was attending midwifery school for the first time, but I have found that it sets a lovely tone for the inaugural post of this website. It is my hope that these goals will not only guide and shape my growth as a midwife, but also come to suffuse everything I do: my practice, my values, my beliefs and dreams and aspirations, what I fight for and work towards, and not least of all, this website!

My mission as a midwife is…

…to provide insightful and compassionate clinical care for women throughout their pregnancies.

…to educate women about their bodies and to foster a sense of trust in their bodies and themselves.

…to offer sound advice and ready emotional support.

…to respect a woman’s choices, background and culture.

…to view pregnancy and birth as a normal, healthy process–a state of wellness rather than a state of illness.

…to provide a birth alternative to women and their families which is non-invasive, holistic, and woman-centered while remaining evidence-based and clinically sound.

…to help women guide themselves through the labour process; to be an ally and an advocate, as needed.

…to never forget the rest of the family–the husbands, the wives, the significant others, the older children, the soon-to-be-new-grandparents–and to involve the family as much as possible; to encourage bonding and to support the family as a unit.

…to promote midwives and the practice of midwifery–to get the message out, to stir the pot, to educate the general public about how much we have to offer.

…to make the right call at the right time–to intervene when I must, but to be able to decide to do nothing, to watch and wait, to trust the woman’s body and instincts.

…to educate women about pregnancy and birth; to provide as much information as possible, so that women can make informed decisions.

…to never lose sight of the sacredness of birth.

…to welcome new babies into the world with gentle, competent hands.