Podcast: What Does your Midwife Do? With Guests Midwife May Bourne and Midwife Sophie Hiscock

What Does your Midwife Do? With Guests Midwife May Bourne and Midwife Sophie Hiscock

Season 1, Episode 15

From booking to after your birth, your midwife is there to support you throughout pregnancy, birth and beyond. But what can you expect from midwifery led care?

This week I am joined by Midwives May Bourne (Founder of Positive Birth Jersey) and Sophie Hiscock (Founder of Village Midwife) where we discuss exactly what your midwife is there for and how to make the most of your care. We chat through the benefits of antenatal education and everything you REALLY need to know to have a good birth experience.

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TRANSCRIPT

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I know right now you have no idea what to expect from birth, what it's going to feel like, how it's going to pan out.

And so what you thought was going to be this glowing experience of pregnancy has turned you into a bunch of nerves.

Well, you were in the right place because I am here to hold your hand as you prepare for the birth of your baby through the birth-ed online course.

The course that gives you the information you thought you were going to get from your antenatal appointments and didn't.

The birth-ed course opens your eyes to everything you need to navigate your pregnancy and birth choices so you can feel confident, informed and ready to take back control.

Available worldwide for just £40 or $50, sign up now via the link in the show notes.

Thanks.

Welcome to The birth-ed podcast, where we open up conversations about all aspects of pregnancy, birth and parenthood.

So you feel fully informed, confident and positive about what this journey might entail.

I'm Megan Rossiter, founder of Birth-ed, and your host here at The birth-ed podcast.

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Believe me when I say we will leave no stone unturned when it comes to preparing you for your pregnancy, birth and the postnatal period.

Thank you Before we kick off today, I just wanted to take a moment to tell you about the courses offered by Birth-Ed, because we are actually a little bit more than just a pregnancy, birth and parenthood podcast.

We offer in-person courses in the UK and an online course which is accessible worldwide.

The Birth-Ed course is totally unique in that it offers both a comprehensive antinatal preparation, so covering everything, all your birth choices possible possible interventions, decision-making tools, your pain relief options, your birthplace choices, optimal positioning, kind of everything that you might want to know about having a baby.

But also included in that is a full hypnobirthing course.

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Hi, welcome to The Birth-ed podcast.

I am joined today by two very exciting guests.

I'm joined by May Bourne, who's a midwife and founder of Positive Birth Jersey, and Sophie Hiscock, who is also a midwife and founder of the Village Midwife in Bucks.

And today we're just gonna be chatting a little bit about the kind of the role of midwife, what you can expect when you meet your midwife in pregnancy and in labour, and our kind of approaches to antenatal education.

So ladies, welcome.

Thank you so much for joining me today.

Thank you.

Thank you.

So, before we kind of, so to kind of kick off, shall we, so sometimes people that I work with, we kind of know that you're booked in for midwife appointments and you get this kind of schedule when you book in, you've got your booking appointment and kind of various appointments throughout pregnancy.

But we often kind of don't really know what to expect from those appointments and it's kind of very exciting, but sometimes a little bit daunting.

So for somebody that's kind of just at the very, very beginning of pregnancy, just booked in with their midwife, can you kind of talk us through what that booking appointment is for?

Yeah, so I work in the community setting at the minute, which means I'm looking after women from about eight to 10 weeks of pregnancy at their booking appointment, all the way through their pregnancy, and then postnatally at home too.

The booking appointment, really, the purpose of it is to meet your midwife and get to know your midwife.

And I'm not sure how other trusts are working, how other hospitals are working, but in Jersey, we try and practice kind of continuity as much as possible in the antenatal period.

So the aim is that women will kind of see their midwife and only their midwife, one named midwife, hopefully for pregnancy, but I mean, you have to take into factor sickness and holidays and things like that.

But the booking appointment, really, we give women loads and loads of information in that appointment, including diets, information, exercise, information about their care pathway, scans.

We take a really detailed medical history from them, so looking at any medical conditions they may have, and talking about mental health, antenatal education, loads and loads of stuff.

Have I missed anything?

It's about an hour long, sometimes longer.

But I think the most important thing about it is history taking, so that your care can be personalized, really.

And we know what care path our women should be following, whether that's just seeing a midwife, whether that's seeing a midwife as an obstetrician, talking about birthplace, where they hope to have their baby, which I think is really early to talk about that, because lots of women haven't even, you know, the reality hasn't hit that they're actually pregnant, let alone they're gonna have to choose between a midwife-led birth center or a home birth or a hospital birth.

So yeah, there's a lot to take in.

I think women often leave that appointment being quite overwhelmed, but it's exciting.

It feels real, I think, after that appointment.

Yeah, and so, Sophie, whereabouts sort of seeing them after that?

Again, I think people get kind of a picture in their head of what they think is going to happen in these appointments, but to our question, you're kind of like a totally standard midwife appointment kind of at some point in pregnancy.

What kind of thing happens and why?

So after sort of 25 weeks, because I think we forget about the 16 week appointment, which we usually have, which is, I think people are a bit disappointed.

Let down.

Yeah, because some trusts, you can listen to baby's heartbeat.

Yeah, we do.

Yeah, some trusts don't.

Yeah.

I think it can be a bit disappointing because you get your blood results, and you're challenged to a midwife, and that's it, and you go.

I think 16 weeks is a really weird time because you've had your 12 week scan, and then you see a little baby in there, and you think, oh, I actually am pregnant.

Yeah.

Then often your early pregnancy symptoms lift, so you're hopefully not feeling sick, tired, hormonal, and then you think, oh my goodness, are I still pregnant?

I have not had any symptoms anymore.

And then you have to go for a kind of eight week period between 12 weeks and 20 weeks for your next scan.

And I think 16 weeks is like a bit of limbo.

Yeah.

It's that mid, that kind of second trimester is a, you feel like you hardly see a midwife at all, and it's a bit of a strange one, isn't it?

Yeah.

Yeah, there are big gaps, and then you get to 25 weeks.

Is that the same in your case?

Well, we have, yeah, we have kind of GP involvement in antenatal care in Jersey, so women generally see their GP at 25 weeks, and then they come back to us at 28 weeks.

It's interesting, though, that it's different.

It's different in trust, and I think that's why it's so important at the booking appointment to get sort of your schedule of care and what you expect.

Because I think our standard is, our schedule of care is booking with a midwife, 16 weeks with a midwife, 20 weeks GAM, 25 weeks with a GP on midlife, 28 weeks in midlife, 31 weeks, 34 weeks, 36 weeks, 38 weeks, 40, 41, 42, however many appointments you need after that, however long you're pregnant for, so.

Yeah, so it kind of, it really ramps up in the end of pregnancy, but the kind of middle bit.

So yeah, in that appointment, what are we looking for?

What are you checking with mom's babies?

So for about 25 weeks, we can measure the fundal height, so we can measure your bump and put it on a personalized growth chart, at most trust, and then we can listen to baby's heartbeat for about a minute, check baby's movements, talk to you about how baby's moving and how you're feeling, and then everything else really, your blood pressure, urine.

Oh yeah, gotta check your urine.

Yeah, you should have it hidden in a tissue, even though everyone else waiting on that has got urine in their mouth, but you've got it hidden in a tissue or your back.

But I don't know why people put it in their bag, because then what if it leaks?

So yeah, and then yeah, anything else you want to talk about, really.

Yeah, but they're quite short appointments, doesn't it?

Yeah, it's not an up-batch really.

Yeah, and I think that really hit me when I was pregnant.

So I was like, this is not long to talk about everything.

And there's such a gap between, I think when you're a midwife, you're like, oh yeah, you know there's a gap, logically, but when you're on the other side, I really was like, gosh, this is a long time.

Yeah.

And there are kind of, you kind of mentioned about some teams working with continuity, and so there are kind of different set ups in different trusts.

I actually felt we were very lucky.

We booked with the Home Birth Team at our local trust, and our appointments were always 45 minutes.

That's amazing.

Maybe longer, pretty much.

And they would come to your house, and they would talk you through anything you wanted to be talked through.

Sometimes they were probably shorter if you didn't really have questions and stuff.

But that kind of, it's amazing what a difference that makes.

It's always worth, I would say to everybody, go and find out what the setup is at York.

Because often, sometimes the kind of the birthplace chat doesn't even happen until kind of 36 weeks.

And you're like, if you go actually, are thinking about having a home birth there, and then you find out, oh my god, I could have had this continuity literally from booking.

So it's always worth kind of just putting feelers out and finding out what that is kind of early in pregnancy to see what your options are.

Yeah, and I think there's, I mean, there's different levels of continuity, isn't there?

Because you might have continuity in pregnancy to an extent, but then not knowing your midwife caring for you in labor, and then perhaps not knowing your midwife postnatally.

Or you might have continuity through the whole thing, which I think some trusts in the UK are working towards and achieving really well, as in women book, like you say, Megan with a team, and that team sees them through from booking, they attend their labor and birth, and then they see them at home postnatally, or attend their home birth.

And that's absolutely amazing.

And that's something that we were just chatting actually before we started recording about something called Better Births, which is trying to be introduced throughout the country over the next few years.

And that's one of the kind of the big things that they are trying to introduce to everybody.

So if you happen to be listening to this in like the year 2025, and hopefully you're listening and you're like, but we all have continuity of care.

But I think the way that that works is unlikely to be literally one midwife.

So is that your back and call?

But a small team of midwives that you should kind of get to know.

And I follow some teams of community, well, caseloading midwives, really, I guess, on Instagram in London.

I can't remember exactly which trust they work with, but they have complete continuity.

And I think they have many teams of four or five midwives.

Actually, Sophie and I were talking about this on the journey here from the tube, but you have small teams of, I don't know, three to five midwives, and you'll be allocated one of those midwives, but you'll have an opportunity to meet all five.

Yeah.

So that when you go into labour, it might not necessarily be your names midwife that attends with you, because she might not be on call or she might be on holiday.

But the aim is you will know who is with you in labour, because you've met them previously as part of a Meet the Midwives team.

So it is amazing, and it's so beneficial.

We know women and babies and families.

Yeah, yeah, it is.

We were looking at some of the statistics and things, and it kind of, having that continuity of care, it reduces the rate of preterm birth by 24%, which is quite staggering.

So birth by 15% reduction in epidural use and 16% less if you yield to me.

It's pretty, yeah, it's really impressive.

It's massive, isn't it?

You can't really ignore...

Yeah, I was at a conference recently.

It was about breastfeeding, but they had, they were talking about continuity of care at the conference, and it was fascinating, because the doctor that was doing the talk basically worked out financially how much money it saves by implementing continuity of care.

And it was in the billions.

It was like when you, by reducing that preterm birth rate, you then eliminate all of that care that those 25% of preterm babies would need.

Increase in breastfeeding rates with more personalized, continued support from one midwife.

And we know the benefits of that as well.

So it's absolutely massive.

And I think there might be an initial cost outlay at the beginning of setting up, but in the long term, it definitely pays off.

Yeah, this kind of looked at over the span of a person's life.

So it looked at, yes, the cost of the cot and the care and whatever a preterm baby might need, but then the potential for needing, yeah, or speech therapy or kind of ongoing health conditions that can kind of be associated with it.

And when you add it all up for all of the baby, I was like, wow, it's amazing how just a tiny change can make such a big difference.

So hopefully that should be coming everybody's way.

So I think something else worth pointing out there is that you, and again, lots of people don't necessarily realize this, and it obviously depends on which bit of the country that you are in, but you can choose which hospital you give birth in, as in you could literally pick any hospital in the entire country for your care.

Is there just one hospital in Jersey?

So if you're listed up in Jersey, unless you're planning on getting a flight in labor.

Yeah, so less choice if you are on an island surrounded by water.

But if you have more than one kind of trust locally, then it's worth finding out what their systems of care are, what their outcomes are.

All of that kind of thing is worth finding out before you even kind of okay with them.

When I worked in, I used to work in Cambridge before I moved to Jersey.

And obviously, that's a, you know, we had lots of choice surrounding Cambridge with different hospitals to go to.

So yeah, women can, I mean, it depends how far you want to travel.

But we used to have women traveling sort of an hour to come to Cambridge Hospital to give birth.

So yeah, we didn't have a lot of choice, I think.

I think the only issue is if you're planning a home birth.

Yeah.

Because where I teach sort of my anteater course is right in the middle of two big hospitals.

And so I get people actually transferring, you know, obviously their pregnancies and everything.

But if you're planning a home birth, it has to be the geographical area of that hospital.

And the same sometimes with postnatal care, isn't it?

Yeah.

You sometimes get switched over.

Definitely.

And then you are leaving that continuity at the postnatal.

Exactly, yeah, that's the only issue.

But definitely, even in my course handout, I have all the statistics of all the different hospitals.

So that's where I can compare the outcomes.

Yes, amazing.

They're quite different.

Yeah.

So, wow, you get people reading them and going, oh, that's interesting.

And they have different policies on different things.

So you get, in different scenarios, different things to be offered completely differently.

It's really interesting to compare.

And that's hard for women, I think, as well, because they think, well, how can one person or one trustee say something and then the normal one say the complete opposite or offer me something entirely different?

Especially within an anti-natal group.

Yes.

Yeah, it's funny, I remember the trust that I worked at didn't offer induction for IVF babies.

And then I was teaching somebody anti-natal classes and they were saying that they had been told they had to have an induction because they had no sex.

Yeah.

Yeah, and it can completely transform your birth.

So that's a really good thing to point out, I think, just to know, even if it doesn't alter where you give birth, just to know that actually it's a choice.

And if you were giving birth somewhere else, you might be being recommended something a little bit different.

And fundamentally, I think that comes back down to women knowing their options.

And actually, if they're unsure what's being offered is standard or unique, or is there another option, which there always is, and then actually going back to national guidelines and exploring what they are.

I mean, they're the National Institute for Excellence, nice guidelines, which kind of are the national guidelines on pregnancy, labor and birth.

So I'm post-natal, so I think, again, having that knowledge and knowing you can explore yourself further, what the guidelines actually say nationally, not just locally, is huge as well.

Yeah, it's so important, and people don't know about it.

Regularly people go, oh, but I've been told that this is the case that's going to happen to me in my pregnancy, and I'm like, I have to do it.

You could go to another consultant in the next room in our state of clinic, and they could advise on a completely different.

That's really hard as well.

Yeah, especially big babies.

That's a whole nother podcast right there.

Cool, so let's kind of take it through then to, oh, actually, I suppose what we could chat about here is something that we're all kind of involved in, is kind of the benefit of, this is gonna sound like a sales pitch now, the benefit of antinatal education.

But I suppose finding out about what your birth choices are, what is happening in your body in labor.

And so what can you say kind of either evidence rise or just from your experience working with women kind of antinatally and then in labor, what kind of impact does that, a decent antinatal education have?

I think it has a huge impact.

People often start my course with one set idea of what they're allowed to do.

That's always the key word.

And then by the end of it, it's completely different.

Like, especially people saying, actually, I think I want a home birth because I've realized that actually this is a natural process.

This isn't a medical event, needs loads of intervention if I'm low risk.

And that is transformative.

And I think having the support, like you were saying about guidelines, having someone you can text and go, look, I've been offered this, and I'm just really having a wobble.

And someone that's always sort of an independent person.

That's why I find it's really beneficial.

I think the key thing for Antenatal Education and the way that we teach with Positive Birth Jersey is, and I know very similarly to how you two teach as well, is all about decision-making.

And I think people always have this idea about Antenatal Education, and it's gonna be how to change a nappy, and how to, I don't know, swaddle a baby, and things like that.

And that is also, you know, it's not just a lot of stuff to know.

But actually, I think people come along and they don't realize just how many choices and decisions they're gonna have to make in their pregnancy.

And again, that's massively overwhelming for women.

But one of the key things that we focus on, and I found on and on and on about, is the ability to say no, as well as the ability to say yes, but actually the ability to ask questions and ask for a second opinion, and ask what the benefits and risks are, and all of that stuff.

And I think people often, we have even dads sitting in the group saying, so are we allowed to turn the lights off?

Are we allowed to say, oh, can we have five minutes?

And that comes up all the time.

Are we allowed to turn the lights off?

And I just think, oh my goodness.

This is probably one of the key things we're gonna learn, is you're allowed to do actually whatever you want.

You know?

And that for me is a really key part for international education.

It's not just all the practical, useful knowledge about labor and birth, but the decision-making abilities and the abilities to actually have a say in your care and answer questions.

It's so, so important.

So important.

Yeah, I totally agree.

And that for me, that's what I find, I don't know if you find the same, but that for me is what makes a positive birth.

It's like, actually what happens on the day, happens on the day, if it's happening because you feel like you made the decision and it was the right thing for you and your baby.

And you felt supported through it, then you come out the other side thinking, yeah, I'm bloody amazing.

And I think when I did my midwifery degree, I did my dissertation on post-traumatic stress disorder after birth.

And some of the key themes that came up, it wasn't actually about on paper what perhaps we would perceive as a traumatic birth or a scary experience.

People could have really scary experiences, but not feel at all traumatized or upset by it because they felt informed, they felt that people spoke to them with respect, they felt involved in decision-making processes.

Or you could have women who, again, on paper as midwives, we might say, oh, lovely, a nice quick water birth with women, went home six hours later, but perhaps those women felt completely out of control, they wouldn't listen to them, they weren't spoken to kindly, and that's where the trauma comes from.

And that's all the evidence of the whole thing, isn't it?

Yeah, massively.

So working kind of as midwives then, do you find that the information that you get across in your antenatal classes, do you find that there's kind of not time to have those conversations in the kind of normal midwife appointments, or are you able to share everything that you want to, or is it kind of a little bit time-pressured?

Yeah, definitely is time-pressured.

I'm back in the hospital now, but when I was in the community, you just, especially when you know that there's several women waiting outside the door, or one thing, you know, you had a complex appointment and it took longer, you just don't have the time to get in.

And I think you never know what women want to talk about when they come through the door.

So it might be that someone's had a really bad week and they actually just want to talk to you about how they're feeling or have a cry.

And then before you know it, your 20-minute appointment's gone and you haven't even done a blood pressure in you and you kind of listen to the baby and things like that.

So to then squeeze in the information about breastfeeding and home births and cesareans and epidurals and water births and decision-making and things like that.

Yeah, yeah, yeah.

It's a huge amount of information.

I always say, what takes us 12 hours to teach in an antenatal course?

So you have to try and get that into a 20-minute appointment.

Yeah.

Yeah.

Okay, so moving on then to kind of towards the birth itself.

When you are supporting a woman in labor, what kind of, what exactly, well, I know, but what exactly does a midwife do?

What can women expect from their midwives when they kind of go in, in labor, meeting their midwife that's going to look after them throughout labor?

What practically is going on there?

I mean, I think from your first mission to hospital or the birth center in labor, or whether that's a midwife coming to your house if you're choosing to have a home birth, it's, I guess, first of all, I think, just being there and getting a feel of what's going on as a midwife.

So actually, I think sometimes just observing a woman's behavior is, I think, really, really important.

You can often tell a huge amount without actually touching or doing anything physically, just by observing what's going on and the noises a woman's making and how she's behaving.

I guess, and then more practically, what comes into that is initial assessment of mom and baby.

So that's kind of making sure that mom is physically well.

Again, your usual antenatal check, blood pressure, urine, palpating the contractions to see how strong they are and how long they are.

And then listening to baby, feeling mother's abdomen to see how the baby is positioned and how well engaged the baby's head or bottom is, depending on how they're choosing to lie.

And I guess taking a whole assessment physically at mom and baby, but then, emotionally, massively important.

So looking at how women are managing their labor, how comfortable they are, whether they're needing any further support, whether that's water or pain relief options, eating and drinking, going to the toilet, bladder care.

There's so much stuff going on.

And then also they're being for the birth partner as well, whether that's someone's partner or their mom or their sister or their friend.

Actually, I think birth partners, I always say, I think are massively neglected in the birthing room, not deliberately, but your focus is so much on the women in labor.

Often, you forget the birth partner, and I think we have a really massive duty of care to them as well, you know?

Yeah, absolutely.

Something that I always say to kind of clients when they're asking these questions about, well, what does the midwife actually do?

Is, I would say midwives are a bit like chameleons.

They can literally be whatever you need them to be.

So some people want a cheerleader that is with them the whole way through, never leaving their side and kind of literally talking them through and reassuring them the whole time.

Some people need a midwife that literally blends into the furniture and you don't even know.

Yeah, and kind of goes and leaves them totally to it.

And something that I always just think is amazing about midwives is how you can just, you can pick that up very quickly about what it is a woman wants from you.

And you're not gonna leave the room and leave them on their own if they're the kind of person that desperately needs their handheld and to be reassured, but you're not gonna sit there and cheer in their ear if they are totally in the zone and wanting to kind of be totally left to it.

Yeah, definitely.

And I think it also depends on the birth partner.

You know, what the birth partner's doing, how equipped they are to support their partner.

Yeah.

Or daughter, whoever.

Yeah.

And I think that makes a big impact as well.

Yeah, hugely, huge impacts.

But I think, you know, it is so true what you say, Megan, about midwives having multiple roles.

You know, you could be massaging, you could be supportive of someone with breathing techniques, you could be helping them with their breathing techniques, their relaxation techniques, hypnobirthing, you know, anything.

You know, midwives, I think, are multi-talented and quite clever.

Not just the physical, that's the thing.

I think people think, oh, they're just coming in to check.

Yeah.

And everything emotional and holistic is left to the birth parent or doula.

Yes.

Ideally, and doulas are amazing, but ideally, we will be doing sort of all the support.

The emotional support as well.

Yeah, absolutely.

I just heard the dad from a couple of weeks ago actually say to me in an 1980 appointment, they'd moved from, I think it was Canada or America or somewhere, they said, oh, I didn't actually realize what midwives did till we moved to the UK.

So, you know, actually, you guys don't really exist in the way that we've seen you work here, where we live.

Yeah.

So I think there's a lot of common misconceptions that midwives cuddle babies.

Yeah.

They always say, oh, it's such an amazing job.

I've always wanted to be a midwife.

I'm so jealous.

I mean, it does happen sometimes.

So, so yeah, not just cuddling babies, drinking tea, a little bit, a little bit more than that.

But yeah, actually we do have people listening kind of from even in different parts of the world.

So it's probably worth pointing out.

Yeah, but this is kind of how care works in the UK.

And for most people, care is midwifery led.

Sometimes that's kind of shared care with a consultant or an obstetrician.

But even care in labor for somebody that's under the care of an obstetrician, the kind of the one-to-one care is still from a midwife within that room.

And that is different to how they work in places like America, where most people still book with, you can book with a midwife, but most people book with a doctor.

What we know about midwifery care is that it improves outcomes.

So that's why we practice in that way in the UK and kind of parts of Scandinavia, I think New Zealand.

I might be wrong now.

I don't know my entire world maternity history.

But what we do know is that it kind of improves birth outcomes, improves outcomes for women and for babies, which is why the majority of women in the UK will be looked after just by midwives.

And unless there's any complexities in pregnancy or birth, most people don't meet an obstetrician at all in their care.

Yeah, definitely.

And I think it's also worth noting that we are autonomous practitioners in the UK.

Yeah.

Because I think that's not always the case.

Like in America, there's obviously midwives who are also more like obstetric nurses.

And it is different in the UK.

Like you said, you could just see a midwife.

You could just see a midwife all day through your pregnancy.

You could have a home birth or in a birth center.

Yeah.

There's no doctors around.

And then all your postnatal care is with a midwife as well.

Yeah.

And I suppose that another reason for that is that giving birth for most people, maybe not for most people, but should be most people, is a physiological process.

It's a normal bodily function in the same way that breathing is, in the same way that eating is.

We don't go and see, what's the name for, like a digestive doctor?

No, but like someone that's, I don't know, someone that, the doctor of the gut, someone to tell us the answers to this.

We should probably know something.

I don't know either.

I know.

Okay, challenge for anyone listening.

Do you know the name, or are you a doctor of?

That deals with guts.

Guts, yeah.

Anyway, you don't go and see you if you have just not, if you're just eating normal food, dynastic food in the way that we all do.

And giving birth is kind of the same thing.

So midwives are kind of specialists in normal birth.

When I say normal, what we mean is physiological birth.

They're very well trained in complexities of birth as well.

But when there are complexities, then it would kind of be shared care generally between an obstetrician and a midwife.

And I think it's really important to say that if women are having obstetric-led care for medical reasons, or health reasons, or pregnancy-related reasons, I still think seeing a midwife is really important.

So, for example, I still really, really encourage women to book in to see me as their named midwife, even if they've got an appointment with a consultant two days before.

Because actually, I think that continuity with your midwife is still super, super important.

And I think that shouldn't be kind of lost as well in this system, which sometimes happens.

Yeah, particularly if you're seeing kind of lots of different healthcare professionals for kind of various reasons.

The purpose of every healthcare professional is kind of different.

And generally, that meeting with an obstetrician is to care for whatever the complexity is.

But the physiology of pregnancy and the physiology of birth is still happening.

Like even if there's complexities thrown in, that still needs to be supported.

And emotionally as well.

I think that's a massive role of the midwife is just emotional support.

And I think if women maybe think, oh gosh, I'm not really sure what that meant in an antenatal clinic last week, or I'm not sure about this or that, or I forgot to ask that question last week in an antenatal clinic, come and see your midwife still, you know, and benefit from that.

It's really important.

Yeah, absolutely.

So the kind of the final question then that I think is a kind of helpful thing for women to have a think about, to kind of to know, is what can women do whilst we're still trying to improve the system itself?

What can women do to kind of get the best out of their midwife, whether that's kind of antenatally or whether that's in labor itself?

So let's start kind of antenatally.

What would you recommend women are doing, are asking to kind of get the best care for them?

That's a tricky question.

I don't know so much, isn't there?

I know, and I think, yeah, antenatal education might be a step, because then you know you can ask the right questions, and you know that you can ask questions.

And we invest so much when we have a baby into all these expensive things.

And often then people look at antenatal courses, and they're like, oh, that's so expensive.

But they've just bought.

A thousand pound pram.

Yeah.

Yeah.

It's crazy.

So yeah, I think it's definitely investing in antenatal education, because then you can get the most out of those appointments, and you can ask the questions.

And I think just asking questions is so important.

And I can guarantee that if you think, oh gosh, I won't ask the midwife that, because that's embarrassing or that's stupid, the person before you probably should ask exactly the same question.

No question is too big or too small in those midwifery appointments.

But again, I think something really important to say is just knowing that you can ask for second opinions, and you can ask to see other professionals.

And even, you know, we say this in our courses, this is so, so rare that this ever happens.

But if you want to change midwife, whether that's in pregnancy or in labor, because perhaps you don't quite gel with them, or you're not sure they're quite on board with your way of thinking, or for whatever reason, it is okay to say, you know, or could we speak to the midwife in charge?

Is it possible to change midwife?

I mean, that conversation is never nice, is it?

You know, it's always been like, oh my goodness, it's awkward.

But actually, you know, this is a really important time of your life.

And I think if you don't feel comfortable with who's looking after you, then that's really important to speak up.

It sounds quite negative, that, but do you think it's important?

Yeah, like you say, it's totally rare.

I don't know anyone that's ever actually had to do it, but you absolutely can.

It's important, just to say, I think.

And just know that you can, know that you have the option.

Like if you had a midwife who was like, oh, I'm not really, it hasn't got the expertise in water birth, so, and you were on a layboard, and then you wanted to use the pool.

That's not a reason not to use the pool.

Absolutely, and it's knowing that you can say that, so that's the important thing, isn't it?

And often when it comes to kind of in labor itself, I suppose that's where birth partners being on the same page as you is so important.

And that's another reason why I think antenatal education is so important, because most people will bring their birth partner to their antenatal courses, whereas very few people bring a birth partner to every single one of their midwife appointments.

And so it just means that you're both on the same page and you're opening up those conversations.

Whoever your birth partner is, whether that's a kind of romantic partner or somebody that's there as support, having them on the same page as you to help communicate, because it's difficult to communicate when you're in labor.

Absolutely, and that's where birth preferences, I think, are key, and thinking about your birth preferences.

So perhaps writing those down on a piece of paper and having them to give to your midwife when you attend a hospital or birth center, or if they come to your home, if you're having a home birth.

And I think, again, it's not about saying, right, every single thing on this birth preferences sheet is going to happen, but the whole beauty of birth preferences, I think, is the writing of them, and the thinking about your options and educating yourself and your birth partner, being aware of those.

Because like you say, if you're in your birthing bubble and you might not actually have the ability or want to say, oh, actually, we'd like a delayed core clamping, we'd like to breastfeed.

So having a birth partner to say, oh, I know what our preferences are, we've spoken about them, we've looked at them together, and I know about them is so powerful.

So I think birth preferences are key, and they can be discussed with your midwife at any stage in pregnancy, really, or your doctor at any stage in pregnancy.

And I would always encourage perhaps, maybe women who are having elective caesarean sections, talk about your preferences with the doctor doing the caesarean, because they need to know as well.

And I think it's just about working as a team with your care providers and being in it together, I think, not having things done to you, but being involved with what's happening, you know, is really, really important.

Yeah, do you, Sophie, do you think the same about birth preferences?

Yeah, I'm a little bit, I have a lot of birth preference templates.

Yeah.

One's for caesarean and one's for reduction of labor.

Yeah, yeah.

And then, and I think that's really beneficial.

I think people think, well, that's a little bit obsessive, but actually, your preferences might be completely different when it comes to induction of labor.

Yeah.

And so having a plan for that is really useful.

Yeah.

And caesareans.

Because I do it again, a caesarean, it's all out the window, but absolutely not.

And having just a small section of preferences, if your labor or birth takes, you go down the caesarean section route, or whether that's elective or planned or not planned, actually saying, well, what's still really important to me is that perhaps I would like to see the birth of my baby with the drapes being lowered, or I'd like my baby to receive as long as possible for delayed core clamping, or I'd like immediate skin-to-skin in theater, my partner to trim the cord, you know, all of those things.

Lots of women think, oh, I didn't even know I could ask for that in a caesarean.

Yeah, yeah.

Absolutely can't do it.

And I think that's exactly the same as you, is that I get everybody that I work with to plan for all of those situations, because you don't go into birth, people go in going, but I don't want a caesarean, okay.

But sometimes it ends up being the right choice in the moment and you're so much better.

And it's always, of all the classes, of all the ones that we teach, the one where we talk about instrumental birth, we talk about unplanned caesarean sections, it's always the one that at the end, everyone kind of has got the, they're holding a little bit of tension.

Everyone's like, I don't really want to talk about it, but you've got to talk about it now, because you don't want to be talking about it for the very first time when someone's suggesting it in labour.

And we always say that in our, it's our session three in the classes that we teach with Positive Birth Jersey over in Jersey.

We always say in session three, oh God, I hope this doesn't come across as a really negative session, because a lot, we give a lot of information about induction, like you say, instrumental birth, caesarean sections, perhaps when things don't go from A to B, but A to B to C to D to D, all the way down the alphabet, and dealing with those potholes in the road.

And I think, yes, it's perhaps not everyone's ideal, but for some women, it does happen, and therefore it's far better to be prepared about all your options than just one.

And I think traditionally, when I look back on when I did my training to be a midwife, hypnobirthing was still viewed as this kind of, it was.

It was this hippie thing where people were told it wasn't going to hurt, and they didn't need any pain relief, and if they did, they weren't doing it right.

It was all about vaginal home water birth, and all of that is so different from, I think, how we teach it now and how I want to teach it that actually encompasses all types of birth, all preferences and all ideas and all roots and loads of information about everything.

And I think that is so amazing to have.

And we have a second time mum sitting on the course saying, I wish I'd done this first time around because things would have been so different or I'd have felt about it so differently.

Yeah, yeah, and it's just that understanding of how your body works, what you can do to support it because there is stuff you can do.

It's not cross your fingers and hope for the best.

Like there's practical, really quite easy things that you can do to make your body work better.

And so much of what we focus on, I think you guys do as well, is it's stucking all of the odds in your favor so that those things are really truly only happening when they actually need to.

And I think it was in the episode that we did with Sheena Byrne, we looked at the statistics.

And it's something like once cesarean rates are kind of over 20% worldwide, you don't see any improved outcomes for mums or for babies.

But in the UK at the moment, the rate of intervention is something like eight in 10.

Like eight in 10.

And I saw a study from, I think it was either Sweden or Switzerland, SW something.

And it was very recently, I think it came out last week, and it was something like 94% of births had some kind of, that doesn't mean instrumental birth of cesarean, but it might be augmentation of labor or induction or some kind of intervention.

So what you wanna know is how to massively reduce the chances of those things happening.

But if they do have, yeah, it's nothing that you can go and buy as in like, oh, I don't know.

I always say some, not gonna name any shops, but there's some mainstream shops where you might walk in for a shopping session with the shop assistant, and before you know it, you've spent a thousand pounds on a pram, baby monitors, you don't actually need till the baby's six months old, sterilizers, special swaddle blankets.

Actually, none of that is going to improve your birth experience.

You know, none of that is going to, and actually, you probably can't buy anything that's going to improve your birth experience, perhaps other than if you opt to pay for private and in-natal education.

You know, in Jersey, we're really lucky.

We have really good states funded and in-natal education.

You know, in some NHS trusts I worked, we had none.

Yeah.

In Jersey, we have really good in-natal education that's free, as well as private options.

So, you know, I think it's not necessarily having to pay for in-natal education, but I do think something like hip and a birthing, it talks through all of your options and decision-making skills.

And that, for me, is probably one of the best things that you can get from birth is...

So that if you are thrown a bit of a curveball, for whatever reason, you've got tools to still make it like a really good way to give birth.

Yeah.

Like you were saying earlier about instrumental births, you know, the birth partner in those scenarios is often ends up at the back of the room.

I know, yeah.

That's the thing.

And so that's why it's crucial for them to know about this stuff.

Because, you know, a lot of women are like, oh, I can't even remember really what happened at that point.

I was in a bit of a haze.

I was in sort of a bubble.

And the birth partner is the one watching.

And we have all this evidence for partners having sort of PTSD and post-natal depression themselves.

And that is why antenatal education for sort of everyone is so important.

Yeah, yeah, I totally agree.

So yeah, if you're planning on attending, I found an antenatal course recently where the dads or the birth partners weren't even invited to come.

My friend did that exact course, and I also found it quite strange.

I was like, what?

So waiting for the breastfeeding session.

Yeah.

Yeah, I know.

There you are like champion.

And that's the thing, birth partners are basically your voice.

That's actually no pressure at birth partners.

You are the advocate as well.

And especially with things like breastfeeding, you're there like cheerleader, when it's like 10 p.m.

and you've been cluster feeding for hours.

You need that other person to go, do you remember in that class, you said, the air is normal.

Yeah, exactly.

So yeah, bring your birth partner along.

If you don't have a birth partner, then a doula or a friend, or literally anybody.

We've had lots of mums do our course without birth partners, and they've just been absolutely incredible when it comes to labor, and again, that's the beautiful role of a midwife, is that with woman.

Essentially, that's what it means.

Midwife actually translates as with woman.

Yeah, I have to say, I've loved births.

When someone has another birth partner, you feel like this amazing connection, and it's so special.

Or women-only births.

I love that, when I've been at births where the woman has her sister or her friend, and her mum is a birth partner, and it's like, oh, this is just so lovely.

My own birth, I had my mum and my sister, and it was just like all these women.

Yeah, absolutely.

Thousands of years ago.

Amazing.

Okay, so we're gonna have to wrap up, I'm afraid.

I think we can probably chat.

I think we probably will go on and chat all day.

But to kind of finish us off then, what we kind of always end with is a final question where I ask you if you could gift a pregnant or a birthing person one thing, what would it be?

What's a good question?

I think they're going to give you the same answer.

I can't pick, well, if I could have picked one, it would be antenatal education.

And I'm not just saying that because I teach it.

I'm saying it because I love it, and I think it's so, so important.

And for me, teaching the information that we give in our course, you literally see light bulbs above people's heads.

And it's like this realisation, oh my God.

And it's absolutely incredible.

And I think you can definitely tell the difference when someone comes into their birthing time feeling well-informed and educated and empowered to say yes and empowered to say no and to be part of that experience.

So antenatal education, I think, is absolutely priceless.

But the other thing I also would choose would be food after birth.

Meals, seriously, I mean, having someone bring you hot meals to your door in the post-natal period, I think that is also invaluable.

I'm sure you two would agree.

Yeah, oh yeah, sure.

That was my mum's job.

Yeah, I have to agree.

I think it would probably be antenatal education.

And if it wasn't that, it would be probably an independent midwife.

Yes.

That's a bit controversial since I work in the NHS.

And the NHS is amazing, but while we're still catching up.

Or a doula.

Yeah, or a doula.

Amazing tools have.

That continuity of support, that feeling of being able when you see a familiar face.

Yeah.

And I've seen it in women, sort of when you go in the room and they're like, oh, what a relief.

Yeah.

She's here.

So yeah, that's why I give them.

Amazing.

Thank you so much for joining me.

Fantastic.

Thank you so much for listening to this week's episode.

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