On this Mother’s Day, we celebrate the people that are there in a woman’s journey towards motherhood – her midwife.
Steph Marriott has been a midwife for the last four years and has worked with Better Start Bradford’s personalised midwifery care pilot for the past year.
Steph kindly took some time out of her busy schedule to share with us one of her typical working weeks.
On this particular week, my working week starts on Tuesday and I am working four long shifts ending on Friday. My day starts with a ‘booking appointment’ with a woman who is 11 weeks’ pregnant.
The booking appointment is the first antenatal appointment with expectant parents and I offer screening tests, we discuss her health, family history and any previous pregnancies. This appointment is the first of many we will meet: I love how this project allows us to really get to know expectant parents and families and build a trusting relationship throughout, and into the first few weeks after the baby is born.
My next appointment takes me to the other end of the whole project: I go to see a woman to do a discharge home visit. Baby is three weeks old and doing really well, mum is happy and breastfeeding. I had real concerns about this particular woman as she had an on-going history of depression and she felt quite socially isolated.
I was happy to see she was making plans to go out to groups and to meet other people. I felt quite sad to leave her as I had seen her from the beginning of her pregnancy, but it was lovely that she seemed so settled with her new baby.
You can sometimes have a rollercoaster of emotions and my next visit was not so happy. I had been supporting a woman from early in pregnancy with quite severe mental health problems.
We were having a meeting with professionals from different agencies – social care and the mental health team – to discuss her on-going care. Her baby is now three weeks old and doing really well, but mum is very poorly. We agreed that there would be no further midwifery care and while I feel sad, I am comforted that she is being cared for really well by the mental health team.
I finish my house calls by visiting a foster family that I support who are currently caring for a newborn baby, whose mum is recovering from an on-going illness. The family have fostered babies before and I am reassured that this baby is being well cared for.
I then return to the office to write up my reports and organise scans and appointments from this morning’s booking appointment before leaving for the day.
My first visit on Wednesday is with a woman who is having on-going support from children’s social services. Between myself and social services, we visit every day. These sorts of visits can be quite challenging for the mums as they might have a feeling of being watched, although of course the priority is helping them to ensure their baby is well cared for. We talk to the mum about caring for the baby, bathing baby, hygiene, safe sleeping and making sure the mum is well in herself. I am glad to see that she is coping and I think she appreciates someone regularly coming around.
One of my favourite types of visits is next on my agenda: a first post-natal visit. This is where I finally get to meet the baby of a woman I have been supporting since early pregnancy. This baby was born at 36 weeks and was fortunately a good weight so mum and baby have come home. As the baby arrived quite early we talked through ensuring the baby does not get cold and is fed regularly. Mum and baby are doing well, which is great to see.
A busy afternoon for me as the first of my two antenatal clinics of the week takes place. I have 30-minute appointments scheduled with seven women. Two of the women did not speak English so I needed interpreters that I had organised in advance.
One woman had previous complications in pregnancy, so I organised a specialist hospital doctor appointment and more scans during pregnancy. I organise several birth plans home visits with women in the clinic: this is an opportunity for them to discuss what happens during labour and create a ‘birth plan’ if they wish. One of the women is considering a home birth.
After my last woman leaves, I sort paperwork out from today’s clinic.
Thursday begins with my second antenatal clinic of the week. I have five women booked in today. One woman is 17 weeks pregnant; she tells me that she is feeling very sad and angry and isn’t sure why. We have a good chat about her feelings and the symptoms of antenatal depression. She agrees to be referred to another Better Start Bradford project, its Perinatal Support Service, which provides emotional support to families where a parent is struggling with their emotional health or wellbeing during pregnancy and the first year after birth.
After clinic I do a few postnatal visits. I have been visiting one woman every other day at home. She had dangerously high blood pressure in pregnancy but thankfully her blood pressure seems to be maintaining a normal level and I have organised for her GP to take over her care.
As I leave, I am contacted by the hospital as one of my expectant mums has gestational diabetes and despite them sending her several hospital appointments, she had not attended them. With my ‘detective hat’ on I go to investigate. The woman is found and we book an appointment for the following week – it turns out that there had been difficulty getting to the appointment so we organise the appointment at a time when her husband can take some time off work to take her.
My day ends with a return to the office. I file my notes and sort referrals from the antenatal clinics.
The last day of my working week arrives, Friday. I start the day with a pre-booking appointment. The personalised midwifery team’s enhanced care means that we can offer a pre-booking appointment prior to the ‘booking appointment’. We discuss screening options, healthy lifestyle and introduce Better Start Bradford to the family.
I then visit a woman who is expecting her first baby. We discuss her birth plan. We talked at length about the use of gravity in birth; if you are upright in labour it increases the chance of a normal birth. I also book her and her husband on an Opal team midwife-led ‘stork walk’ – a monthly tour of the maternity unit and birth centre.
My next appointment is also a birth plan discussion. The woman is expecting her third baby and it is seven years since she last had a baby. She is considering a home birth but one of her babies had been born very quickly and she is undecided about what to do. She is 35 weeks into her pregnancy so after discussing the options, I arrange to return in a couple of weeks to give her a little more time to consider the options.
I return to visit the woman who is having on-going support from social services. The mum and her eight-day-old baby are doing well so I have no concerns. I will visit her again when I return back on shift in a couple of days.
I finish off my morning by going to see a woman whose baby is three days old. The baby is her first and she had come out of the hospital the day before. While she is doing fine, she is concerned that she is not breastfeeding her baby enough and thinking of introducing some formula milk. No one had explained in detail how breastfeeding works, and she hadn’t realised that what her body was doing and what her baby was doing was completely normal.
My next mum and baby were due the new-born blood spot, also known as the heel prick test.
The test picks up if a baby has one of nine rare but serious health conditions, such as cystic fibrosis. This five day-old baby is breastfeeding fine, and is feeding when I do the test, which is a great distraction and form of pain relief for the baby.
Before I return to the office, I nip into the postnatal ward. If a mum is in hospital for a few days, they tend to welcome a friendly face and this is part of the enhanced service that the personalised midwifery team can offer. This particular mum was pleased to see me and eager to tell me all about the birth.
As I return to the office to finish my paperwork and my shift, I reflect on my week. It is so rewarding to be able to help these families and to be able to build a trusting relationship with the women I support.
From the ‘booking appointments’ to post natal visits, the continuity of care really does make a big difference and I find that they trust the advice that I give. As an personalised midwife, I feel I am able to provide the care that I was trained to give.
by Steph Marriott
Personalised midwifery care pilot