Staying Calm When Birth Takes a Dangerous Turn | Life of a Midwife Ep. 10

0:28Is your kid's birthday coming up? Everything to celebrate anything.

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2:18Birth is unpredictable and for midwives each one brings a different set of challenges but staying calm isn't about never feeling the pressure it's about knowing how to respond when the storm arrives in this episode we hear from two midwives about navigating those unexpected moments. First Marie, who knows that the support of a team can make all the difference when times are hard. And Bethany, who reminds us how trust and instinct can help create calm even when things suddenly change. I'm Giovanna Fletcher and this is Life of a Midwife.

3:04Marie's career has taken her through busy teaching hospitals, high dependency and some of the most complex situations in maternity care. From her very first birth as a qualified midwife she's learned that things rarely go exactly to plan.

3:23First one as a fully qualified midwife, funnily enough, was an obstetric emergency as a shoulder dystocia. I remember it very clearly. There's very few obstetric emergencies that you don't get some sort of amber flag so you say along the way and I remember thinking this woman's going to have a shoulder dystocia and yeah sure enough sadly I was proved right and then funnily enough my second birth as a qualified midwife was also a shoulder dystocia and I did start to think it's the universe trying to tell you something here. It's the weird way that these things roll.

4:03I don't think there's been many times where I've thought I'm really out of my depth here. The majority of the time I've worked predominantly in large teaching hospitals, so large university teaching hospitals, they're busy and by that you do tend to get a lot of people around so there is an inherent safety in thinking I can lean over and you know pull the emergency bell here and somebody's going to come so that's reassuring really and sometimes it's probably a bit early to be getting into this but sometimes as well I feel and it's almost like a circuit breaker thought in my mind in the most horrendous of situations something completely banal will just pop into my head and I think oh I'm thinking about that there was a case that I recall of a woman who she was having a really torrential hemorrhage after the baby was born and all the textbooks will quote to you that the circulating volume through the placenta is like 500 mils a minute so therefore you know you can lose litres very quickly and yes you know I've seen women bleed a lot very quickly but nothing like this was just it was like a hydrant and luckily enough there was a consultant obstetrician just outside in the corridor who came in and she had a lovely mohair sort of jumper on because she'd come from clinic and I remember thinking she was like you know trying to sort out clots and we're trying to get this one to theatre and I thought I hope that jumper's not dry clean only because it's gonna be in a right state and I just thought what are you doing like what's that yeah but I think it is just it's just sometimes I don't know, it's just like a little circuit breaker.

5:52At the moment of qualification, I did postgraduate training in high dependency care and worked predominantly in high dependency. And because we were like a tertiary referral unit, we would get sick people from the neighbouring thing. So we would just got a lot of interesting sort of complex cases. but it did become a bit of a joke of how just nothing could go to plan for me I mean as demonstrated by those first deliveries it just it became just a bit of an ongoing joke. This one afternoon I was working on the labour ward and one of my closest friends was the labour ward coordinator and a really excellent midwife.

6:35They said, oh, there's a low-risk primep, so low-risk birth time mum coming in. She's only coming down here because the birth centre is full, and we had a bit of a laugh about, oh, you know, that'll be a challenge for me, and, you know, see if you can cope without putting a candela in, Marie, and, you know, ha, ha, ha, ha, ha, and I was like, oh, no, it'd be nice to have some physiology, you know, this is the base level of what we're meant to do. It'd be cool. And we had some doughnuts, and the woman was coming down the corridor and I stood behind the door of the labour ward and said to my friend, God I've just got to eat this, I haven't had anything, like I'm just going to stuff this Dana in my mouth and then I'll you know I'll go and see her.

7:13And I went out into the corridor, her husband was parking the car, I took her into the room and she was contracting, she was leaning over the sort of end of the bed, I put my hand on her back and I said oh how long have you been contracting like this for? and she was like oh you know two hours or something and I said okay I said well in between contractions like we'll have a chat about you know your birth plan and what we can do and how things are going I said hopefully your husband won't have too many problems in the car park blah blah blah blah and she turned to me and said oh my god oh my head and just collapsed

7:57I just remember we worked and it must have been for about three hours I think stabilizing the woman she was really she had quite a lot of what we call cerebral irritation so basically her blood pressure was so high it was making her personality a bit distorted and she couldn't really retain any information properly so she just kept asking me what the time was and what day it was and where she was all the time as well obviously she's contracting because she's in labor this is you know um she was a bit photophobic so we were operating in half light we just had worked together for such a long time that it was like a wonderful marriage I knew exactly what she was doing I knew exactly what we were thinking of what we were going to do next and you know the consultant anesthetists and obstetricians that were in the room were saying oh we need to do this and we were like yeah yeah we're on it we're on it we're all thinking the same thing we're all acting towards the same goal so probably about yeah three hours I'd say or four hours later it was the end of our shift and we'd managed to get her stable enough that she we could move her around into high dependency and there was going to be a plan later on she got an epidural and it was going to be a plan to you know discuss delivery with her

9:18and as we left the room together me and my friend I looked at her as if to say well you know that took a turn didn't it and she said but you're glad you had that donut now aren't you and we burst out laughing and that case she is a consultant midwife now and does a lot of training and blah blah and she she uses it as a case study and calls it the donut case And I said, that poor woman, she knew that she was the donut lady to us because of that, because it all just goes wrong. But yeah, nuts.

9:55I mean, I guess it's a bit like you have a shared experience that is so out of what normal people's reality is. You're dealing with people in a really human, primal way. There's blood, there's poo, there's sick, there's screaming, there's life, there's death.

10:22And, you know, people feel the same things. And that's where you can read books about birth and parenting from years and years and still identify the same emotions and things. Because, yeah, that core message doesn't change, I do think.

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11:51For Bethany, working as an independent midwife has given her a different perspective of the job but being a steady presence for mums always sits at the heart of her care So I had one of the most incredible births I've attended almost a year ago actually

12:11She wanted independent care because she just wasn't getting the support that she needed within the NHS sadly She'd been told that she was, you know, her shed scans, told that this baby was huge But they couldn't facilitate her birth on the birthing unit And she'd had some previous medical care within a local hospital that had left her with a lot of fear and a lot of panic about going into hospital. So she just came to me, you know, really, really concerned about, you know, how this birth was going to go, what was going to happen. She came to me at 37 weeks and usually I don't book clients this late on because with independent midwifery, the relationship building is really, really important.

12:50You know, I like to see clients as early as I can because we get that time for them to trust me as much as for me to trust them as well because you, in a way, are putting yourself in a bit more of a vulnerable position, you know, working outside of the NHS. You know, people do scrutinise the care of, you know, independent midwives. And, you know, I've had people say, are you actually a qualified midwife then? Are you OK to do it? You know, and it's like, well, yeah, I've just got just as many qualifications as anybody else working. I've just chosen a different path to work in.

13:19There was just this connection I thought, you know, I really feel like that I can, you know, hopefully support and be there for them.

13:29She said to me, she said, I'm going to have this baby at 39 weeks. And I was like, yeah, yeah, of course she will. You know, thinking nobody ever gives birth before 40. I hadn't had any client's birth before 40 weeks. Most of my clients are like 41 weeks and over. But she was adamant. She was like, this baby is coming at 39 weeks. And I was like, OK, we'll see. We're thinking, I've not seen it yet. But lo and behold, 39 weeks hits, 3 o 'clock in the morning, I get this phone call, I'm in Laby, you need to come over now. I was like, oh, my God, OK. right so you know got to her this was the first birth I had with my colleague Kirsty and I got there and my client was just so chilled laughing and joking between the contractions contractions would come she'd just be a bit quiet and then she was laughing and joking again and I really found it really really hard to read her I was thinking I cannot work out where we're like where we're at so I just thought you know I just and I'd written in her notes not in established labour at the moment so just to observe because you know she didn't want examinations she just wanted to you know let her body do its thing which is absolutely fine by me and then all of a sudden things just changed really quickly and I was like oh I think I need to get kirsty like something in me I was just like yeah I don't know I feel like things are maybe progressing I don't know it's just I think the tone of her voice changed during the contract still in between she was laughing and joking like you know I've never seen somebody so upbeat during their contractions it was yeah quite amazing.

14:56So I called Kirsty and I said oh can you come and she was about 45 minutes away and then when Kirsty got there again I was like I I can't work out where we're at because I you know suddenly thought things were happening and then not. So me and Kirsty went out the room had a little chat and we came back in and my client went oh I can feel the baby's head. I was like what? She went to the other head's there and so cool calm and I was like oh okay you know got the mirror oh yeah there's baby's head and literally within like five ten minutes this baby was out obviously she'd been told by the hospital this baby was you know really really big and it was gonna be a really really difficult birth I'm saying she needs to be in hospital etc and she just made it look so so easy she was moving her body really really instinctively I just let you know I tend not to say anything during births the only thing I got her to do because as the baby's head was coming, it took a little while and I was thinking, oh, this does maybe look like it's a good-sized baby.

15:54So I just got her to go into a really deep squat, a really deep, like, lunge position as the head came out. Baby came out beautifully and he was, he was really, really big. He was, like,£9.11 for her first baby, which was just incredible.

16:14When he came out, he was quite shocked at home and he did need a bit of resus. He only needed some inflation breaths, so it's often a case with most babies when they need a bit of resuscitation. They just need that help with that big first intake of breath that they take to help expand the lungs and to kick the fluid out the lungs. He was absolutely fine, really great. And then my client had quite a big blood loss afterwards. So we had two emergencies to deal with at the same time and we did the Nendi to transfer her to the hospital. One of her real worries was having to go into the local hospital because of that, you know, the trauma that she'd had before but she coped with it so, so well and she actually said to me, you know, afterwards she was like, I wasn't panicked, she said because you and Kirsty didn't look panicked at all she said you were just both really calm and, you know, I mean we worked really, really well as a team you know, as soon as I said to Kirsty, can I have so and so she'd already had it there or she'd already, you know we were kind of, when you work closely with someone you know what their next thoughts are before you've even sort of said it.

17:16It just really brought it back to me about how important it is for that relationship building and the care afterwards. You know, I did all the postnatal care for her afterwards and we were able to sit and reflect and talk back on her birth and how that was for her.

17:33I think with any emergency, there never is like a state of panic because I think, you know, if I were to start flapping and panicking, then what is that going to do to the energy in the room? I think it's always afterwards that I then step back and I go ooh that was quite a big situation we've just dealt with there and then that's the importance of having colleagues and people you can have a chat with and talk it through with afterwards. I don't ever think about it as it's going along I think because you just kind of get on with the skills that you've got. These are skills that thankfully we don't have to utilise very often but it's ingrained in us that, you know, with training that we've done and you chat through and refresh your sessions so that when it actually happens it's just kind of second instinct.

18:18A bit like driving a car, you just get in and you just do it. When these things crop up you just rely on them skills that you've got there. It's the afterwards that you step back and you go, oh, OK, I just need a breath.

18:39Thank you so much for listening. Please do like, subscribe and leave us a review. We would love to know what you think. And if you're a midwife and would like to take part in this series, you can find contact details in the podcast description.

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