Ask a midwife: Your questions answered

A few weeks ago, I asked a question on social media; if you could ask a midwife anything what would it be?

I put your questions to Mandy Bellenger, independent midwife at Bellenger Midwifery:

1. What is the most frustrating part of the job?

Apart from not being able to predict the birth date for every baby? I am currently awaiting a baby to decide on his or her birth date. I am sure a decision will be made soon as it’s time to come out and meet the parents 🙂

Not being able to offer ALL childbearing women the Gold Standard of Care. One to one care has been proven time and time again as having a positive effect on optimal care outcomes. As an IM I am able to spend the time with women that they need to discuss with them fully options for care; labour; birth and very importantly, life after giving birth. Within the NHS I am afraid that there is little time afforded to such discussions as clinic appointments are around 15-20 mins. I am able to spend at least an hour with each client. More midwives are needed along with bigger budgets for the NHS Trusts.

2. What do you really want to say to Dads in the room?

“Be ‘with’ her…”

The most important role for ‘Dads’ is to walk the journey alongside his partner from pregnancy, through childbirth, and beyond into parenting. I am not saying that they have to get down the ‘business end’ and take a really hands on approach (although some Dads do like to be very involved), what I would like them to do is walk away from the experience of childbirth with a renewed respect for the amazing woman in their life. Guys, you are so very lucky!

I am also fully aware that some men are very worried about birth and may then unwittingly transfer their concerns to their birthing partner. This can make for an uneasy atmosphere in the birthing room. My best advice is to prepare, to read, to take classes with your loved one, and to take a full interest in what is going to be a life affirming and life changing experience for you both. You are about to become a dad!

3. Why are some against cord delayed clamping if having syntrometrine to assist delivery of placenta? What is your opinion on delayed cord clamping?

In the event that a managed/active 3rd stage (look it up) is chosen by a woman, there is no need to be concerned about delaying cord clamping for a period of time prior to the administration of syntometrine as long as mum is well and no concerns are held by the attending midwife.

Syntometrine works with the body to help to separate and expel the placenta with little blood loss. It is usually given via injection into mums upper thigh within a few minutes of birth and usually has a good effect within 10-30 mins of administration. Once separated, the placenta is then brought out of the uterus and out of the vagina by controlled cord traction (The midwife with gloved hands gently guards the uterus from the outside with one hand whilst the other gently eases the cord and placenta from the body whilst mum relaxes). A delay of 1-5 minutes has become common practice before this is offered and this allows time for the cord to remain unclamped and for a good exchange of blood to happen. Once the injection has been given the cord is clamped and the exchange of blood ceases (if it hasn’t stopped naturally already)    

Delaying cord clamping has been proven to hold benefits for new babies as is now seen as good practice as long as mum is well post birth.

I am a strong advocate of this practice and often give plenty of time for this post birth. Give those babies all they need.

4. Best pain relief tips?

• To relax and be assured that your body is amazing! Believe in your bodies ability to birth naturally.
• To read and absorb all the information that you can prior to labour and birth to allow you to understand what is happening in your body during each phase. This all helps the fear, tension, pain cycle (Worth exploring further). Learn all you can about your body and its ability to birth. Good preparation is key.
• I am an advocate of hypnosis for birth and recommend that women and their partners either consider taking a course or read the free information available on the subject
• Deep relaxation/visualisation and breath work are part of hypnosis for birth but are also practiced on their own to great benefit. Learning how to relax and to use some easy and relaxing breathing techniques can help with coping with the intensity of labour and birth.
• Water birth is an option that I recommend exploring further although this option is not for everyone. Warm water in which you submerge yourself to cover your pregnant tummy, has been shown to provide a good level of relief and comfort during labour.
• Massage and aromatherapy are also relaxing and worth exploring further

5. Does the job ever get boring?

My job never has a boring day! Being a part of each amazing journey into parenthood is very rewarding and each birth I witness is unique and moving. I truly love my work.

6. How do you switch off at the end of the day or is it not possible?

I like a glass of wine just as much as the next midwife but this is a rarity as I am often ‘On call’ awaiting that special phone call or text.

It can sometimes be difficult to switch off especially when you are so involved in such special journeys. I make myself available to my clients 24/7 incase they have any questions or concerns but I do try to take some protected time off occasionally. This is not just a  job it’s a lifestyle choice 🙂

7. Do you think labour pain varies from person to person… position, size of baby etc?

How we perceive pain is unique and individualised. We all feel ‘Pain’ in different ways. I tend to describe labour as ‘Intense’ not ‘Painful’ and encourage all my clients to fully explore the journey of labour and birth before the event. Knowledge is key towards achieving a positive birth experience..

If a baby is in a less than perfect position then it is likely that they may cause a little more discomfort for mum. The body will work really hard with your baby to turn and position them into a good position but sometimes a little help is needed and with knowledge and understanding a calm assisted birth can be achieved with little fear and a positive outcome.

     8. What the funniest thing a woman has ever said in labour? 

“I think I will come back tomorrow…I can not do this today” She was serious, she got up from squatting near the window and walked out of the door! The funniest thing was, she was at home. Once she realised this, she returned to the room as she realised that she had work to do! A few moments later a baby was born to the delight of all in the room 🙂

9. How to write a birth plan. What would you plan for your own birth?

I ask that each couple discusses and writes down their ‘Preferences for Birth’ as birth can not be ‘Planned’.

I strongly suggest that each individual looks at all aspects of the birthing journey and reads, attends some classes, or at least enters into some discussion with their midwife so that they are aware of all choices and options available. This then allows them to start to make informed decisions regarding care during their personal labour experience. As I stated earlier, Knowledge is key.

Explore your ‘Wants, Wishes and the What If’s’

I would practice what I preach although I hope I do have lots of knowledge and experience by now 🙂

As a huge advocate of homebirth and waterbirth; for my own birth I would choose to birth at home in a warm birth pool as long as myself and my baby were healthy.

10. How do you remain calm in stressful situations (when things aren’t going to plan) – are there any techniques to keep your cool?

It would be rare for anyone to actually notice that I am a little stressed. I always work hard to remain calm and comforting at all times even when things are not going as ‘planned’. I am an expert in normal birth and so am quick to notice if things are not flowing as expected. I then calmly refer to the experts in abnormality (Dr’s) and will calmly transfer a woman’s care to them. I will always remain on hand as an advocate for the woman and stay close to explain all aspects of her continued care. It is important to keep a couple fully informed of all events and to give my calm reassurance.

I am fully trained to deal calmly with emergencies in the home setting and give care as needed within my scope as a midwife. I must point out that true emergencies at home are very rare indeed!

11. When new parents bring gifts what do you really want to receive?

I am honoured to receive any gift from grateful new parents. I never expect gifts and am always honoured when something is offered. As I said earlier, I love my job so being your midwife throughout your amazing journey is reward enough for me.

12. Do you accept that some people need a c-section – and that the ‘too posh to push’ stereotype is actually dangerous?

Yes indeed, some women and babies do need a little extra support and help when birthing and sometimes a caesarean section is required.

“TOO POSH TO PUSH” –  Indeed that statement is unfair. Obviously there will be women who do choose to birth via a caesarean because they do not wish to experience a vaginal birth, this is their decision and theirs alone. Who are we to question their reasoning behind their decision? As long as a woman is fully informed about all her options and how her body can birth naturally, then she should be able to choose the birth that is right for her. As a true advocate for normal birth I give all the information that I can to support a woman’s decision, if she then chooses not to have a vaginal birth then that is her choice and she will then be given the option to discuss her decision further with an Obstetrician.

All women have the right to choose. This is your body, your baby, your birth.

13. What makes a good midwife?

That’s such a hard question to answer. We are all individuals and each midwife brings a different quality in to midwifery.

Having a genuine caring and calming persona is undoubtedly a good attribute to have as well as true empathy for women. Being a true advocate for women and choices is also a great quality to hold and your strength in this area will increase throughout your career as a midwife.

This job is not just about loving babies 😉

Childbirth is amazing and needs to be brought back to women and embraced!
Thank you so much to Mandy for answering these questions – I hope it has helped some of you to understand pregnancy, birth and the role of a midwife a bit better. For me, this has simply reinforced how much this is the career for me, and I can’t wait to be able to work with women and their families during such a special time in their lives.