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I was motivated to write this blog, due to recent excellent advisory by Anne Cooper @anniecoops on Twitter regarding the new NMC rules.

 

I was introduced to Twitter at a training workshop  with regard to Leadership back in Feb 2013. It scared me, fascinated me, frustrated me and opened a door to a completely new world.

My friends and other colleagues had been using Facebook for ages to keep in touch and share photos etc. Sharing their lives, as it happened, a technological revolution!  I did not join in this revolution as I was frightened about my details, my life, being available to the world. As soon as you “friend” someone, their friends are available to see.  But what if you did not want their friends to see, but did not want to hurt someone’s feelings by not making them a “friend”. Mmm a great dilemma, so I declined.

It soon became clear that employers were looking at people’s Facebook pages to see what kind of person they might be employing – so the drunken photo sent in haste was there for all to see.  The broken relationship shared at length, again there for all to see. Glad I had not joined in.

Then, as I have said, I was introduced to Twitter by Annie Cooper during a session on Leadership and the light bulb went on. If you are the kind of person who likes to share their opinion, their experience, their knowledge and skills – Twitter offers a real opportunity to do just that and reach a very wide audience.

I am in my early fifties and am at the point in my career where I want to share and influence and help. I need a medium to express my ideas and work with other professionals and mothers, to explore and potential affect the modern world of maternity care. I did not want to go into the sphere of clinical teaching or the university, but I needed an outlet for my maternity brain.

I have been Tweeting now for fifteen months and have written around 250 tweets at the time of publishing this blog. I am still a learner and find Tweetchat’s a bit confusing at times.  But I love joining in on an interesting topic.  @wenurses and @wemidwives  have lovely chats.  Have just got the idea of hashtagging things( #),  if you want others to find what you have said, if they search.  Finding linking tweets to other things still a little bit crazy, but I am on my way.

It is fascinating and humbling, that I have the President of the RCM and the RCM itself following me. I am honoured, but this is what Twitter does. It flattens the world hierarchy giving you access to people and organisations in a click. I also have direct contact to my inspiration @inamaygaskin and have also discovered many empowering midwives I did not know existed: for example  @SagefemmeSB (Alias Sheena Byrom.  Marvelous.  It has also been enlightening to read the tweets of student midwives, mothers and fathers.  A whole world of maternity care wisdom that I had not been able to access before..

I Tweet as a Midwife professional , not as me the private person.  My tweets are restricted to the discussion of maternity care/health issues.  I want people to read what I say. I want people to read my blogs, when I have more than 140 characters to say something.  I want my current and future colleagues and managers to read what I write.  I just see it as an extension of me as a professional.

This is the difference from where I was fifteen months ago. I feel I am using Twitter – not Twitter using me. It is a tool of communication that can be exploited for its best intentions.

Best advice:

  1. Remember that what you write is available to the world. I repeat THE WORLD.  Make sure that that is what you want before you press send.
  2. Try not to react to a tweet. Think about what you want to say. It is very hard to take a tweet back. Be kind
  3. 140 characters, appears restrictive but really allows you to write what you mean succinctly.

 

To all fellow Maternity Care Tweeters -thank you for your insights,  information and support.  I love Twitterville.

 

 

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Choice and Permission

May 8, 2014

I was inspired to write this after reading an article via Twitter about permission in pregnancy http://www.bestdaily.co.uk/your-life/news/a567116/i-was-not-allowed-the-words-that-steal-our-birth-power.html   Mili Hill

 

I feel sad that women still in 2014 do not feel empowered to ask about their care, to ensure they understand why things are being done to them. Yet they still allow care, that they don’t really agree with, to happen.  There was book I read a long time ago about how people psychologically take on the role of patient as soon as they enter a hospital.  They allow examinations and interventions that in normal life they would reject. But because they are in a hospital setting they allow staff to do all sorts of things to them.

Women must be doing the same within maternity  care – thinking that the professionals must know best, allowing themselves to be driven by the midwives/medical staff  they meet.  This puts us (the professional) in a particularly precarious position, where our judgement about what should be happening takes over from what might be best for that particular women.

One of the reasons why I came into the Midwifery business is because it is still an area of medicine where often we still don’t know all the answers. We still don’t know why women go into labour and why the gestation varies woman to woman.  We still don’t know why some types of analgesia work for some women and some do not.  Why the length of labour varies from woman to woman. Why some babies die in pregnancy despite all care being taken.

We have gathered recently lots of evidence that leaving women alone to do their own thing in labour, if they have a routine pregnancy, is better than accessing interventionist care in an obstetric led unit. But still some women will have good outcomes, others will not, wherever they are cared for.

I wanted to work in an area of healthcare where the individual woman and her family would be the centre of care and her not be a victim of cart blanche interventions. However I watch, and administer myself, prophylactic Anti D Immunoglobulin at 28 wks, when all the evidence suggests that giving it in response to a clinical bleed has been shown to have the optimum effect. Even if women have had the prophylactic dose she still needs the extra if she has a antenatal bleed.  This seems to me to have more to do with large drug companies making money out of the process rather than actual clinical need.

I also offer syntometrine for the third stage of pregnancy because it is my professional duty to share the evidence which shows that the placenta will be delivered more quickly and with less blood loss than physiologically.  It is only the rare woman who listens to the other evidence about the blood loss not making any difference to recovery after the birth and the possible effects on breastfeeding.  Most of the women I encounter hear the “quicker” and the “less” and opt for the drug.  Who am I to say they have not made the correct decision for them.  Even though my personal philosophy is, if you have managed the birth of the baby without intervention you are likely to manage the delivery of the placenta without medication.  But I don’t push my own philosophy, I trust the woman to make her own decision.

Some midwives will say that their women never have syntometrine.  I then have to think is that the woman’s choice or that of the midwife.  I cannot believe that all the women under the care of a particular midwife, if they were allowed to review all the evidence, would all opt for a physiological third stage.

So where are we in the modern, maternity world?  The internet offers vast information on the topic. The literature available is vast.  Professionals are ready to discuss the relevant evidence if necessary. But at the end of the day the choice has to be the woman’s and I do mean the woman’s choice.  The role of her partner is for a completely different blog I feel.

 

This is why I have some difficulty with the cart blanche approach of “normal birth” for all.  This will be appropriate for most births but for many it will not.  To make it a demand of the health service challenges the idea that for some, a normal vaginal birth would not be the best approach.  The “normal birth” fraternity tend to be middle class, vocal women who feel they are fighting against a system that is not “allowing” them to birth naturally.  I really have never ever been witness to anyone undergoing an emergency caesarean section, because it is what the surgeon or midwife wants.  It is always about what the clinical signs are telling them at the time and them wanting to achieve the best outcome for the mother and child.

I was witness many years ago to a mother declining a caesarean section, despite appalling fetal distress. She declined for so long that legal means; to prove her competency to make that decision; could not assist and yes the baby died. This was her choice. But how she will live with it for the rest of her life. I am not sure.  The professionals had a really difficult time after this incident coming to terms with what they had “allowed” to happen.

 

This month, this April 2014, my current stance is that I will work women to achieve the best outcome for her pregnancy and birth. We will discuss the various options, when decisions are required, but that I will abide by her choice. I will give her the benefit of my years of experience and my knowledge and skills acquired over 28yrs as a midwife. But at the end of the day I need to know that what is happening is understood by her and is what she wants in the circumstances that arise.

It is my opinion that if this philosophy were followed more we would have less incidence of claims for negligence  and poor care.  The woman would understand at all points and would know she had made the choice for whatever occurs so will live with the outcome.   So my personal fight is to support women in the choice they make for themselves, not playing politics with birth