area of focus:
What you should know about pregnancy.
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Having a baby is a momentous time in a woman’s life.
For many new to pregnancy and the birthing journey, it is a time of excitement, new adventures, and fears. It is also a time of information overload… from others’ stories, books, magazines, and all forms of media, including the NHS health sites. High drama and medicalisation are often integrated into these areas of general information rather than be specific to your own situation. It can therefore be easy to forget what is really important to you, and you need to remember this is a ‘life process’, and not a ‘medical event’.
Whether you are planning for or expecting a baby, it is possible to find a midwife who can fully support you and ‘walk beside’ you. They will be responsible to care for all your needs as you grow, birth and nurture a new human being in ways that are important to you, no matter your circumstances. Ultimately you are birthing your contribution to society and the world.
The midwife is the specialist in maternity care and is the only professional trained to give full care throughout the childbearing year. She (he) does this on her own for the normal, physiological maternities, but also in conjunction with other appropriate professionals where the needs of the mother dictate.
Midwifery Approach to Care
This is important but also achievable despite any challenges or barriers the mother will encounter.in her childbearing journey.
The most effective care is given when mother and midwife develop a trusting relationship, with continuity of care given by one or two midwives. One in which there is mutual respect and confidence in both parties; recognising and valuing a holistic approach to the life process, whilst ensuring appropriate care. In this way your midwife will provide care, at one of the most vulnerable times of your life; providing pregnancy, birth and postnatal care and support. This care must be given according to the best available evidence, meeting both your needs and your values. Your partner, family and friends also play a significant role in your and baby’s life; these relationships also need to be appropriately valued.
It is very important for you to make informed decisions at each step throughout the childbearing process. This is one way to ensure that care is acceptable to you. Some mothers complain of having ‘things’ done to them’, but you are protected by a recent landmark decision in the law, known as the ‘Montgomery judgement’. It directs all healthcare professionals to give women all the evidence about the care offer, in order that an ‘informed decision’ is made by the woman. Respecting you as the expert in your body also means that your care provider obtains your permission to examine you, taking great care to be gentle. If you request it at any point, the examination must stop; otherwise the clinician could be committing an assault.
Pregnancy care in the antenatal period
Whether you are planning or have discovered you are pregnant, you may refer directly to your NHS or independent/private midwife. You may also ask your family doctor to make the referral.
Pregnancy is largely cared for by your midwife starting around 9 weeks of pregnancy. She will see you around 10 times until you give birth. At each visit a timely, holistic assessment is made and recorded. Physical measurements of how your body is responding to the growing baby are shared with you, giving time and attention to any queries and concerns you may have. These records are yours, and this personal time is about you and how you are, your general health and wellbeing, including diet, exercise and preparing for the time of birth.
Many classes, courses and videos available to help with preparation, some of which you may find useful within the wide range available. Many women take to reading books written by midwives and others in the birthing world, to try to understand what childbirth and rearing babies is about.
The NHS website also gives a lot of information on what is available and offered within the usual UK maternity standards. Preparation for birth begins in the antenatal period. Your diet, emotional wellbeing and amount of exercise you take will enhance your childbearing journey. Non-combative exercise three times a week is good for a healthy mind and body. You may choose to pay for popular aquanatal, yoga and pregnancy pilates classes, meeting other women, and which are a brilliant way to prepare for the birth and postnatally. It is also important to consider the simple, less expensive but equally effective ways; swimming and regular walking. Both of which can be shared with your partner or friend.
You could spend hundreds or thousands of pounds on equipment for your new baby, or you could invest in the essential things like a safe place for baby to sleep which is extendable for the future as baby grows. Similarly items we must have by law such as suitable car seats are available within a wide price range. The most important factors are the legal standards which manufacturers have to meet. Family, friends and colleagues are also often eager to ‘get something for the baby’; let them help you in your purchases. Babies grow into adults with many needs and wants over the growing years… you could consider putting some savings by, for the years when the ‘new baby’ is no longer a novelty but dependent more on you in those later times.
Labour and Birth
The birth is often described and seen as the most important aspect of pregnancy. Whilst it is a momentous occasion, having well thought out and timely antenatal preparation along with supportive midwives, will help you and your partner to achieve your best possible birth. You will have had detailed and timely discussions in the antenatal period, and have been writing down those things which are important for the birth attendants to support you with. This is often referred to as a ‘Birth Plan’. It may include simple but important things such as waiting for the umbilical cord to stop pulsating before your partner is supported to cut the cord. It is all up to you what you choose as important for your birth.
Childbirth may be a new experience, however, you are the expert in your own body, how you respond to being treated, pain and discomfort, how you approach problems and so on. Having you baby is life changing and your way of birth needs to support you to do this well for yourself and baby. This is your day! You are excited, and nervous at the same time… the journey is as yet unknown.
The purpose of the known and trusted midwife is to enhances the birth process, allowing you to relax, to trust the processes, allowing your body to release its positive cocktail of hormones to facilitate your birth. Your midwife will be attentive, caring, working with your informed birth plan choices. Whilst she monitors all aspects of your labour and birth, she is there to ensure all appropriate birthing decisions are taken for you, to support that your whole needs are safely and appropriately achieved.
Hours after the birth and the following days and weeks.
Often when the birth is completed, most women need space and time to rest. You also need to hold and really see the baby, marvelling at your achievement in creating and giving birth to another human being, along with your partner. This is a precious time which should be unhurried, allowing the thoughts and insights of the birthing process to play out in your mind. During this time, the new baby will have its important examinations close to you, in a space of calm and hushed voices. Feeding at the breast will be encouraged and supported before helping you with your own personal hygiene.
The subsequent hours and days will continue the physical, emotional and psychological checks and support appropriately. This will continue your postnatal journey with your midwife, as you gain confidence and energy in your nurturing role.
This time may find you tired, (exhausted even) as you recover physically and emotionally from the birth process. Many things are a new learning, such as holding baby safely, feeding positions, what baby’s needs are when he/she cries. You may want to add housework along with caring for the baby and feeling a failure at a number of things at this time.
As with everything to do with childbirth, understanding the physiology of this postnatal period, already discussed with your midwife will help to balance your coping at this time. Your body is readjusting itself as you recover and develop your mothering knowledge and skills. Your midwife is able to give support for up to 6 weeks after the birth, although under the NHS this scenario is now highly unusual. Independent midwives are an available choice, if you feel that need. More usually your day to day support will be your partner, family and friends
Your midwife is responsible to ensure all routine checks for baby’s hearing, birth registration, NHS number and notification of birth are completed. She will help you revisit aspects of your birth you may wish to discuss. The finally she arranges for discharge to your family doctor and health visitor for continued care and support for the mother, her baby and family.
Most women remember their midwife long after she has left, and you may also find you do too.
The Confidential Enquiries into Maternity Care and the Impact of Inequalities
In describing the recognised maternity care pathway above, it is hard to see how dedicated professional maternity care could give the disparate outcomes for some women from particular communities.
The UN has identified racism as a factor for poorer treatment and outcomes. It has declared that people of African descent have the worst all round outcomes in all aspects of life including healthcare. It has also recognised that “people of African descent represent a distinct group whose human rights must be promoted and protected”. Birth is a human right. Midwives as the primary caregivers are accountable to ensure non-judgemental maternity care.
For many years now the United Kingdom statistics on maternity care has highlighted a significant difference in the mortality and morbidity for this group of mothers and babies. British Black mothers and babies have some of the worst mortality and morbidity of all groups. This is closely followed with slight improvements for other mothers and babies from non-white groups. Complexity of the structures, policies and processes within which maternity services sits, means mothers and midwives and others have to look to take action to improve these statistics.
For women to achieve good care they must be able to speak, be heard and take active part in their care as described above. This is even more important for the most vulnerable and those with the worst outcomes. Some who are frightened or have poor English also need advocates and interpreters. Women need to understand the systems of maternity care, know their rights in care and be able to access these when needed.
Every designated maternity service in England, has a group of women with an interest in best maternity care for all. They are known as ‘Maternity Voices Partnerships’ or MVPs. These groups must be fully representative and encourage diverse and effective membership in order to ensure care meets the needs and values of all; where informed decisions are the norm and outcomes significantly improve.
‘Continuity of carer’ from a known and trusted midwife is the benchmark for swift and significant improvement. In some instances, where maternity care actions are not meeting the local needs community groups and networks have grown in order to support and advocate for those women. It helps to allow the ‘unheard voices’ of the women to be heard and their needs met.
The complexity of the hierarchical healthcare system, means that Midwives and other professionals involved in maternity care, also need help and support in understanding how the systematic care provision affects the current statistical outcomes; including the part played by oppression. Most staff do care deeply for their work but are very busy delivering care to the best of their ability. They may be unaware of much, including the terrible statistics. In order to achieve any improvements, there needs to be full understanding of the origins of the disparate outcomes and a hard look the learning from anti-sexist and anti-racist training to facilitate requisite behaviour change and humanisation of the birthing processes. Openness transparency, and respect are needed at all levels of maternity care. When systems fail her, every woman needs to seek it for herself.
Important Sources of Information
NMC – Nursing and Midwifery Council https://www.nmc.org.uk
ICM Definition of the Role of the Midwife – https://www.internationalmidwives.org/our-work/policy-and-practice/icm-definitions.html
Commonsense Childbirth- https://commonsensechildbirth.org
NHS Maternity – https://www.nhs.uk/conditions/pregnancy-and-baby/
United Nations – https://www.un.org/press/en/2013/gashc4084.doc.htm
Montgomery Judgement- https://www.supremecourt.uk/cases/docs/uksc-2013-0136-judgment.pdf
Elsie Gayle is a registered midwife with a special interest in supporting the more vulnerable mothers and babies. Elsie tweets at @patchesgayle