Eileen, junior registrar

‘How we feel about stillbirth is not really discussed’

Eileen’s full interview

Click on the orange timecode reference (e.g. 0.00) to skip to that part of the interview.

0.00 So my name’s Eileen, I’m a junior registrar and I’ve been working as a junior registrar in obstetrics and gynaecology for about 18 months now.

0.10 What initially attracted you to obstetrics?

0.14 Oh… I was really surprised that I wanted to do obstetrics, actually, because… well, obstetrics and gynaecology… in fact, I was thinking about this earlier today – because I was speaking to a medical student – and I remember thinking… before I started medical school the two things I didn’t want to do were, sort of, elderly care and… gynaecology; because who would want to look at vaginas all day? That’s weird! But then when I was in medical school… just the kind of, when we started doing physiology and the basic sciences… and somehow this idea that you got a baby at the end of it, just made it much more exciting than just yeah, the heart pumps, okay… it does that everyday. But this whole… that everything about the physiology meant that you were working towards this one crazy event of creating a new person… and then the more I started doing it… kind of like, learning more about it… you know, it’s so mixed… you can have… You’re kind of… you’re in the whole, caring for people who are really well and you’re being involved in this amazing experience that they’re going through – which is not a sad thing… you know, they are not there because they’re sick. But then the flip side is that when it…you know, when it… you get a lot of, really kind of acute emergencies, so it becomes very, very exciting… there’s lots of kind of interesting surgery involved. And then I was always drawn to the fact that you know, when it goes wrong, it goes horribly wrong and you have that, kind of, opportunity to try and make something that’s the worst day be… not the worst day. So it’s… yeah… it’s got a lot to offer kind of from a job perspective: it’s got a bit of everything. So that’s why I, kind of, wanted to do it from quite early on in my medical training really.

1.52 And during your medical training what have you been taught about stillbirth?

1.58 Gosh, that’s quite a long time ago. I’m trying to think back, um… Not a lot, to be honest. I don’t think… certainly not at medical school. I mean, at medical school I’m sure it was probably mentioned… at some stage but I can’t… I can’t think back to any specific… training, but to be honest a lot of it’s all a bit of a blur now. When you come through to… and actually even saying that, when you come through to, sort of… choosing to specialise… I can’t really think of any… any specialist training we’ve ever had on it. It’s very much a kind of… it sounds a bit, but kind of… learn on the job. You know, you see… a lot of medicine is still kind of an apprenticeship. You see… what people do. Sometimes you see and you learn what not to do and sometimes you see and you learn what to do, but… in regards to actually kind of specific training on… how to manage stillbirth, I think… I think not very much and I think even… maybe even more about miscarriage because… probably because as a more junior member of staff, so as like an SHO [Senior House Officer], you are very much involved in… in… in early miscarriage, that’s kind of… as a obstetrician and gynaecologist, that’s kind of… very much your bread and butter. You’re seeing women coming in with very early pregnancy bleeding; you’re seeing… so that’s… when you’re very junior you get taught things a little bit more. I think, as you move up in your, kind of, training it’s very much more, kind of, assumed that you know things… and that you know how to deal with certain situations rather than necessarily being taught it in that way. So, I think most people’s, kind of, experience of stillbirth probably comes from… their, you know, experience in seeing it and dealing with it, but also probably stems more from their training in… in how to manage early… very early pregnancy losses because that’s really the time that you get taught something about it.

4.01 And… what was your attitude towards stillbirth before your training?

4.09 I think it’s… I think before… before… it wasn’t really something you thought about. You kind of, like I said before, you know… you thought about pregnancy being this time when you get this amazing thing at the end and it’s… I think maybe you learn more about… about maternal deaths because… I think if you are an obstetrician… that’s, I don’t know, maybe that was a kind of bigger… something you heard about more, you know… maternal death is something that should never happen, whereas it’s more… or it always seemed more acceptable that there would be some instances where babies would die or they wouldn’t, you know, or they wouldn’t make it. But certainly, a maternal death is a never event, so… you, kind of, didn’t really consider it as much, or it wasn’t really ever touched upon as being something… to… yeah, to think about… and that… I think because… because it’s not, kind of, taught or considered it was always something that you think, ah, you know, the day… the day that that’s going to happen is going to be a bad day. The day where you have to be the one to break that news or to… have that occur, you kind of almost like just don’t look at it and hopefully it won’t ever happen. It’s not something that you really… even… I think even talking to, you know, when we have to… counsel people on risks in pregnancy, you know, say someone’s high risk, for whatever reason, whether it’s they’ve got diabetes or… they have, you know… very, very obese or whatever… you know, we know that factually there is an associated increased risk of stillbirth, I think… we still find it quite hard to talk about, as clinicians. We kind of… we’ll skirt around it, we’ll, kind of… talk about, you know, it can be very dangerous for the baby or, you know… you know… it could be quite a problematic outcome… you know, people don’t like to use the term stillbirth because, I think… in some cases there’s… people feel maybe there’s still not… sometimes there’s not that much you can do to prevent it and so you worry about scaring people by talking about it because… no one when they’re pregnant wants to be told there is a risk you could lose your baby. It’s just… not what anyone wants to hear, so… and unless you can say… you know, this is the risk and this is what we’re going to do to stop it, I think people are quite hesitant to, kind of, bring it up as a subject. So, yeah, it’s not something we ever really… I think people try and almost think about it as little as possible.

6.49 Do you remember the first time you cared for a mother who’d had a stillbirth?

6.56 Yeah, I didn’t really, kind of… do much of the caring directly for her actually. It was quite an unusual event because she had come in for an elective caesarian section, and I was doing…  this was when I was in an… an SHO actually… and so I was doing all the kind of pre-checks when you go in and talking to her and… and you know getting… it’s usually a bit of a rush, you’re kind of trying to get everything so the list starts on time. You know, have you got your bloods checked? Yes. Have you signed the consent? Yes. And kind of going through… And she just kind of mentioned that she hadn’t had any fetal movements since the day before and… I kind of thought okay that’s not… that’s not right. And so, you know, I think I went off and… and I can’t remember whether I went to go and speak to my consultant or registrar and said, you know… and they said, oh yeah, just pop the scanner on. And so I went to go and scan her, and… you know I… was still not that proficient in using ultrasound so, you kind of put the scan on and go… no that definitely should be a fetal heart and that definitely isn’t moving and the moment where you’re, you know… you think… yeah, this is really happening… and you immediately know that… you think ok, maybe I’ve got it wrong, maybe I’ve got it wrong, and you’re looking again and you think, no, you definitely haven’t got it wrong, but you can’t… you know that you can’t break that news to that person at that time because it’s not appropriate. As an SHO you can’t… you can’t, because you could have made a mistake. You know, there is a possibility. So you have to get someone else to then go and scan but then kind of… you know, people aren’t stupid. If you… People obviously – as much as you try and keep a calm face and keep a sort of, like a, everything’s okay… and you also don’t want to lie and say everything’s okay because it’s not okay. But you can’t… say exactly what’s happening either. So, you have to try and… yeah, but I think they… she could… the mum could immediately tell something was very wrong. But, I think she was too scared to ask me what was happening… so I just said that I needed to go and, you know, get… it was important someone else came and scanned as well. And then… and then, yeah… when someone else came and had to break the news that her baby had died. And, you know, there she was ready to have her caesarian section and had no idea that that could be the outcome. And she actually went on to have a caesarian section for that baby which is very, very unusual. But… given the clinical scenario, that’s what happened. But it was heartbreaking. It was absolutely heartbreaking… yeah…

9.42 What effect did it have on you? That experience?

9.51 I think it’s… in a weird way, you kind of… I think sometimes in medicine you have to… we’re taught to, sort of… to sort of deal with those kind of situations, in the sense of like, you know… that’s it you’ve, kind of… you’ve become an obstetrician now. You have dealt with those cases because you have to learn to deal with them. So, actually it’s a bit like when you first have any sort of surgical complications: you feel like the world’s crashing on you, you must be the world’s most terrible surgeon, but actually you’re taught to deal with it. It’s like, no, this is an odds number; you will come across these cases; this is what’s going to happen. This is you learning to do the job when you come across cases like this, because it’s… Even though… even though you don’t have any… you know that… you know that you haven’t been responsible for it, you still somehow… take some of that responsibility with you because you were there when it happened and you had to be the one to, sort of, be involved in that situation, so somehow… it’s your fault? In a way, like, that it’s occurred. That you had to be there to make… I don’t know you’re involved in that memory. So you have to find a way to, sort of, make that make sense to you as, you know, this is part of the learning curve and this is… now I’m going to be more of a… I am more of what I do, by having that experience.

11.18 But it’s hard because then I had to… I can’t remember what was happening that day… in fact, actually thinking back now I don’t think I was meant to be doing that theatre list. I think I just happened to be helping out, so then I had to go and do whatever I was supposed to be doing which I think was clinic or something, but then you… there’s no time to sit and think about it. You can’t let yourself get too upset because you’re on to the next job and, you know, there’s 20 women waiting to have their antenatal appointment and they all need… your care and you can’t allow yourself to, kind of, get bogged down in all that’s going on and what you really want to do is sort of sit and reflect and maybe cry that this poor woman’s lost her baby. But actually, if you do… you might miss something in the next person’s history and that could mean that their child’s at risk, so… you, kind of, have to compartmentalise and, sort of, put it in a little bit away that you can kind of… and you do. It does come up occasionally. It might be a case like – in fact, I was thinking about a case the other day because I’m doing revision for exams at the moment and I was reading one of the guidelines and it was talking about risks and things that can happen and it was about fetal maternal haemorrhage, and that’s what we thought had happened in that particular case. And so immediately that’s what I thought of ‘cause I’d been to visit the baby afterwards and I remember what the baby looked like… and, you know, and she was very pale and looked like a little doll and she was really beautiful and so you immediately start thinking of those cases when you’re reading about something like that. Which I think is good because then it means that you… it brings to life more what you’re doing and it means that… when you are – it doesn’t just mean something in a book anymore. It’s all real people and real cases, so it, kind of, becomes alive, but… yeah, even though that was years ago, it still… has an effect, even though it didn’t that day almost. I had to just, kind of, get on with it, but it will always be the first baby… that I came across, so… you don’t forget them.

13.30 You mentioned that you went and visited the baby. Did you go and visit the parents at all again?

13.38 No, I didn’t actually because it was very soon… The mum was actually still having her surgery at that point and I think in that situation because… I wasn’t… I’d seen her so briefly and I was quite junior and… I wasn’t the one to break the news to her, really. I kind of felt it wasn’t… necessarily appropriate… because I would be going more for me and not for her? I wasn’t going there to do something for her, really. And, I think, that’s… that’s something we always struggle with actually, I think, when we’re caring for women. It’s always a really, kind of, fine line about… wanting to make sure that you are giving people the space that they need, but also wanting to make sure you are showing that you are there if they need something. Like on, particularly on night shifts, I think there’s this, kind of… because, you know, we tend to start our ward round… you know, we hand over at eight o’clock in the evening and we usually do a ward round of the whole ward and then we may do another one before the hand over in the morning at eight. And… often there’s this, kind of, feeling when you have cases of stillbirth, women who are delivering or have delivered… normally people who have delivered maybe in the last… in the recent day… and you’re the night team that’s coming on, so you’ve never met these people, you… they’ve just gone through something very, very traumatic and it’s always a, kind of… actually, you know their midwife who’s with them is working with them one on one and… you, you’re kind of thinking, actually, if I was in that situation would I want this, kind of, group of people, who I’ve never met before, coming in to just, kind of, say, oh yeah, so in the nicest possible way, you’ve lost your baby… can we do… you know? Sometimes feels like it’s not really that appropriate, that actually, it’s better… but then you do sometimes worry, do they think that we’re not coming in because we can’t be bothered? Or, do they think we’re not coming in as part of the ward round because they’re not important or… we’re just too busy to be bothered? You’re kind of… It’s hard… It’s hard to know what the right thing to do is, and I think, usually when we don’t, it’s because we think, actually there’s no clinical need to. And if there’s no clinical need to people often will want to be left alone with people that they know and love and who are going to really be supportive, rather than someone they’ve never met. But it is always that difficult thing of… I think, even… lots of cases of deciding – especially when the outcome has been bad – are you going for yourself or are you going for the patient? Because if you’re going for yourself… I think that’s not… often not really appropriate.

16.41 Since that time – you mentioned it was many years ago – have you cared for many other families who’ve experienced a stillbirth?

16.50 Yeah, not… I’ve cared for lots of different families at different stages. I think because of our kind of… the way our… the way our work works – where we’re on shift patterns all the time – you, kind of, come in and when you’re on labour ward – so you’re covering the whole of labour ward – there will be women coming in who are either often starting an induction process if they’ve had a stillbirth and they’re, sort of, coming in to actually have medicines to help them deliver their babies or they have… they’re actively delivering or they’ve recently delivered – and so I’ve been involved in lots of women at different stages throughout that process… or actually having to speak to a woman who’s been diagnosed with having… having just recently been diagnosed as having lost their baby, and… but I haven’t since then been… I think, maybe it’s because it was the first time that it had happened? But… and because I was there at the moment that I knew something was wrong, I think, that’s the case that always stands out most to me. But, yeah, there’s certainly been lots of other families… who, yeah… as soon as you start thinking about it, they, kind of, float up in your, kind of, visual memory of, oh yes, there was that family and that had happened or…

18.12 Like, one in particular I’m thinking of is… I’d seen them very much after they’d delivered. I think maybe they’d delivered in the evening and I was in the afternoon or something… and they were just really upset, as you can imagine, and… and I remember it being difficult because the mother was so distraught and you know… and just asking, why? And why’d this happened? And having to give the honest answer that we didn’t know and that we may never know. And trying to give some comfort and reassurance that… you now, because obviously the immediate thing is that she thought she’d done something wrong and it was her fault and… and how do you…? Yeah, I really remember, sort of, thinking… how do you convince this person that that is not the case? When you know that if it was you, you would think the same thing because that’s human nature to think that. And as a mother that is just automatically what you are going to think. And I’m a, you know… who am I? I’m a stranger who’s never met you before and how can I find the words to tell you… that it’s not your fault?

19.39 I think it’s… it’s so hard ‘cause you… you have to try and not get upset because that’s not your job… and you have to… as someone that goes to tears quite quickly and in that situation, you can’t do that. But you, kind of, want to just sit and cry with them. And, I think there’s just… never going to be the right words to… to say in that state, or… know how to… because everyone’s so different as well. And what one person needs to hear is not what another person needs to hear. And we’ve… we’ve just met and… you’re going through the worst day of your life. And, I know, that if I say the wrong thing that could be the thing you hold on to. And that’s always really scary, actually, to think that… and I think especially when people come in… and it’s, yeah… if people come in and things have just happened and it’s very fresh for them, I think that is often really what people remember, is what people say to them in the first kind of… hours or minutes after they’ve found out that they’ve lost their baby. And if you say the wrong thing in that moment, that can go on to shape how they view that whole event… which is petrifying.

21.35 And, you know, we work in an area of London where, kind of, the cultural background is hugely diverse. And, you know, religious background, and… and so to know how to, kind of, respond someone, trying to read the cues of… social cues and body language of what they’re looking for and what’s going to be the right or the wrong thing to say… is really challenging. And I think people genuinely do have the best intentions, but I’ve seen people say things that you’re, kind of, standing behind them going, oh, why did you, you know? Why would you phrase…? ‘Cause you can, I think, as being… especially, that’s why… you know, being… when you’re an SHO, and you’re slightly more junior, or even as a registrar now, if I’m with a consultant… sometimes it’s easier to be standing back in the room where you’re not the person leading that conversation, because you can have a much broader overview and see people’s responses to things and that’s in itself is a very good learning experience. But it’s hard because sometimes you can see someone that you know and respect and you know they’re a good clinician, you know that they care deeply, you know that… that, you know, this is… that they want to do the right thing and you see sometimes people say things and the room shifts and you just thing, agghh, that wasn’t the right thing to say. Or, that was a bad way to phrase something. And it’s hard because that wasn’t their intention. And, I think it’s very… and once you’ve said it, you can’t take it back… you know.  Even if you’ve said something and you can see that it wasn’t the right thing, there’s nothing you can do about that once it’s out there. And it’s such a delicate relationship you have with people – which is maybe also another reason why sometimes we shy away from wanting to come in too often. I think probably because as much as we say – and there is definitely… it is an element of not wanting to invade people’s privacy – I think there is also a fear of, you know… of going in and saying the wrong thing and, a kind of… a concern of that if you… yeah, that if you go in, you may cause more harm than good. And I think it’s that very tricky balance of knowing… the right thing to do when, and when to kind of just leave people to it.

24.00 You’ve talked about the complications, because of the differences… the cultural and religious differences of your patients, but are there certain things that you think are helpful or unhelpful to be said in that situation?

24.17 I don’t know if I’ve got enough experience with… like with this area yet to really kind of… to say that I’ve definitely got things that I would always kind of go to as being something to say. I mean… saying that, I think it’s really important to reiterate that it’s not your fault, because, I think that is… a thing that people carry. And I think it’s important to, sort of, say it out loud, because, I think… it’s something that… you know that people are thinking, but you know that people often don’t say it, you know. And you do draw also from your experience with, you know, early pregnancy loss, as well. It’s something that people will… people don’t say that that’s what they’re telling themselves, but that’s what they’re telling themselves. And I think often saying that in the presence of the partner and the… so that it comes out as being something that we know is the issue. And, also, to the partner – this isn’t something you’ve done either. This is something that has happened that is not anyone’s fault… and that, you know, it’s… you can’t change, you know… you can’t… it’s not like if you didn’t pick up that heavy bag of shopping that this was going not happen. Or, you know, you can’t go back and wish you’d come in sooner or… it’s just… it’s something’s happened and there’s no one’s fault involved. And that you’re sorry and that, you know… that, you know… that you give condolences; that you recognise that this is the most difficult thing that you’re going through. And that we are really sorry it’s happening and we want to do everything we can to try and make it as easy an experience as it possibly can be – but it’s not going to be one. I think probably just recognising that… that… this is really hard and we are going to do our best to help you, but it’s just going to be hard… Yeah, I think that’s probably the best… the best you can ever say, really.

26.54 Do you feel that your training equipped you for those situations?

27.03 Probably not. I think there’s still… I think there’s probably still quite a long way that… medicine as a whole, and, you know, my experience of the last, I don’t know, what? Like six, seven years has been very much obstetrics, but… I’m sure it’s the same in other parts of medicine, that there’s still a long way to go with how… how we’re trained in these, kind of, sense. I think there still is very much a, sort of, you know… as a doctor you just get on and deal with what’s going on. And, I think, the problem with that is that inevitably rubs off in the way that you deal with patients, because if you deal with yourself and your colleagues in that way, it’s very hard not to let… to… to put that onto patients as well? Does that make sense? Because, if you can’t recognise that… you’re not… if you’re not given the space to recognise that this is a really difficult situation for you to deal with and for your colleagues to deal with, I don’t think… you can then, like, really have the space to… to recognise how difficult it is for your patients. I think it’s… we’re so… I think there’s still a lot of, kind of, tendency to just… you just need to… like, that’s obstetrics and it’s hard and it’s difficult and you just need to get on with it. And I think that that’s not… helpful for us, because I think that’s automatically reflected on how we deal with our patients. But it’s… it’s difficult because… how do you… how do you balance that? Because…

28.56 I think… yeah, I think there does need to be some training in to how you can go from… having that really emotionally, kind of, tense and challenging conversation with one woman… a woman one minute. And the next minute, you may be having to make a life or death… you know, decision about someone else’s baby because if the emergency bells goes and it’s a night shift and you are the registrar covering labour ward, that may be the situation. And how to, kind of, switch your brain between those two things is quite challenging. I mean, you do. But I think part of how you do that is you – when you are at work – you have to keep the emotional side down a little bit because otherwise you don’t have the space, somehow. And also just to, kind of, how you… keep in the back of your mind being able to give enough time to a family, while also constantly reassessing in your head what’s going on in 12 different rooms and whether or not you should really be somewhere else – because that person’s bleeding, and that person’s having that happening and that baby maybe isn’t doing so well – and how do you, kind of, compart… how do you manage that?

30.25 Yeah, as I say, I think medicine’s still very much a, kind of, a… an apprenticeship. You learn by watching other people but there are, you know… there are some… there are certainly areas that we should probably be taught more on and I think probably stillbirth is one of them. Because, there’s all the… you know, it’s not just the emotional dealing with the family; there’s all the paperwork from our point of view – the legality-side. How to talk to people about…whether they… how… how in depth investigations they… they want; whether they want a post-mortem; explaining those things. And, yeah, we do get a certain level of training on that and that is part of things we have to get signed off to progress within our… within our training, but, you know, there are certain levels that can be kind of slightly becomes a bit of a tick box exercise. Have you cared for a woman with stillbirth? Tick, yes. Have you… do you know what post-mortem is? Tick, yes. You know, rather than actually looking at it in a little bit more in-depth, but, you know, the problem is is you’re fighting for space on a curriculum with lots of other things. Plus, the service… training is becoming more and more about service provision, it’s about keeping beds moving and patients moving through the door and clinics running and… so the time for training is becoming less and less, unfortunately, and that’s across the board. But, so things that are so much more delicate, I think, often get pushed to the back of the queue which is by no means a good thing – or an acceptable thing – but… yeah, it certainly happens.

32.17 You mentioned about post-mortems and further investigations, can you tell me how you talk to families about those… about those investigations and considering a post-mortem?

32.32 Yeah, it’s… it’s very difficult. I’ve been very lucky in the sense that I’ve worked in units that have really, really brilliant specialist midwives in that area; so I’ve not had to do a huge amount of it, actually… because I’ve had… I’ve been working with really, really good teams and often the midwives caring for patients – because they spend that much more time with them – have… have, kind of, consented for those things. Certainly, I often find that it’s quite useful to give patients written information before, because, like I said, if you’re in a busy labour ward and you know that you’re going to get possibly called off at any moment, it’s… I find it quite useful to have patients read through the written information first so that they can get a general idea and then we can go through that with them, but also it then means they often will have questions specifically and they will… already have an idea… you can kind of, once someone’s read something about it, you can very… quite quickly judge who is, you know, very much wants something and who very much doesn’t want something. So that you’re not then feeling like you’re trying to push someone in a certain direction – which is really the last thing you want to be doing.

33.54 So I find that’s quite useful and I think certainly it’s trying to get across that… that, you know, we are happy with whatever level of investigation a parent wants: whether they want nothing or whether they want everything. That is very much up to them and that we are willing to support them in… in whatever that decision is. And then trying to, kind of, as I say, go through a little bit more carefully about what… what those steps are.

34.25 So whether it’s just simply having blood tests to see for mum whether there was any other, kind of, contributing factors, possibly, such as, gestational diabetes that has not been previously diagnosed; thyroid problems that were not previously diagnosed; infections… and you’ve got to balance also making sure that you’re not missing a medical problem that also is going to impact mum’s health and you want to make sure that you’re looking after mum as an individual as well. And then going on to sort of more… I guess, invasive: whether it’s just still doing things like swabs from the baby and swabs from the placenta, through to then possibly taking biopsies from the placenta – possibly from the baby as well – through to a more extensive post-mortem which, you know, involves a large cut on the baby and actually taking out organs and handling them individually – and possibly taking samples from those – and how comfortable the family is with that as an idea. And you know making clear that when these things are done, they are done in a way that is dignified and that the people who are carrying them out are professionals who, you know, do understand that this is someone’s baby. That, I think, is quite important for parents to know, that these people are trained professionals in what they do. They are not just, you know… they will do this with a sense of gravity.

35.50 But, I think it’s also really important, you know… for parents to understand the realities of… of these investigations. That just because we do do a post-mortem doesn’t mean we necessarily find the answers. That we may well do a post-mortem – and all the investigations – and find things that are possibly… complications, but that may not even be what’s led to the stillbirth. And that we may find things that… we may find out what has happened but whether that will impact or influence our ability to prevent it in the future: it may not. So, trying to give honest… honest answers – and I think you don’t want to create a false sense of hope that, you know, if you go through this procedure we’ll be able to make sure this doesn’t happen again – which is of course what we want to be able to say.

36.47 You know, you so, so want to just be able to say, this is the worst thing. Nothing like this is going to happen to you again. We will make sure we protect you. But unfortunately, it’s not the reality and it’s not fair to, sort of, suppose that is the case. But it’s a really hard thing… talking about… putting cuts on someone’s baby. No one wants that for their child, but at the same time, if that’s going to… you know, the reality is although we can’t guarantee we will learn anything, it is… it gives us the best chance. It gives us the best chance to, kind of, find out as much information, which, we hope, will help us give you the best care possible if you choose to have children in the future. If you choose to pursue another pregnancy we hope to be able to, you know, take the bad things that happened to, kind of, make the best of the future. But we… we just don’t know.

37.47 Is there a, sort of… an aspect of your… your role in that situation that you find particularly difficult or particularly rewarding or…?

38.02 I think it’s always… I don’t know if it’s an aspect of it, I think it’s more just individually… you know, you kind of, you do have… the most rewarding is when you feel like you’ve connected with someone and you feel like you have been able to have some sort of positive influence on… the experience. That… you said the right thing and you presented something in a way that you feel has been useful. Or you were able… just you were able to conduct yourself in a manner with which created the least harm in that situation. And I think we, a lot of the time, you do get a sense for that. You know, the worst or most difficult thing is if you feel you got it wrong. And, you get a sense for that as well. And, you know, it’s horrible to go home thinking that you… and it’s not even that you’ve done something wrong, but you’ve just not quite been able to connect with someone. You’ve just not quite been able to have the, kind of, impact you would have hoped on their experience, to, kind of, try and make it a little bit easier. And that’s you know that’s going to happen; we’re all different people personality-wise and what, you know… what we need from people is very, very different. So, I think that’s probably… the, kind of, highs and the lows of it.

39.30 I think it’s always quite hard going through paperwork, I find, because a lot of it feels so impersonal. You know, you want to, like you say, you want to be able to sit down with someone and just be like, this is terrible, I’m so sorry, and, kind of… and having to sit there and trawl through a load of paperwork with them – and, you know, this is this blood test, and this is this blood test, and this is what we’re doing for this reason. You, you can tell it’s like… it’s the last thing anyone who’s in that situation really wants to have to go through and sign loads of documents and, kind of, go through the legalities of things. It’s just not… it’s very hard to make that a therapeutic process. People are tired, you know, they’re emotionally exhausted, they’re often physically exhausted, they just want to go home. And so, you know, that… that is not really an easy… like, it’s the, kind of, it’s often the thing… I find often the most difficult to kind of actually, kind of… trudge through, really.

40.31 How helpful – I mean, you’ve, kind of, touched on this a little – but how helpful do you think it is to have an emotional response in situations like this?

40.39 You know, I really don’t know. Erm… I really don’t know. Erm… because… yeah, I… and maybe that would be something that would be useful for us to know as doctors, because we don’t… we don’t really get told that. I mean, you know, as I say, I’m someone that goes… I cry easily, I mean I cry at adverts, you know. I will given – if I let myself – quite easily get upset, and you think, ooh, is this? If I? You’re trying to hold back tears sometimes and you… get yourself together, this is not about you, because I think we are taught – we’re not taught – but you… that it’s just not professional, and actually that’s not your role to be doing at that time… Especially, if it’s… I think it’s different if it’s say someone that you have formed a relationship with: maybe it’s someone that you’ve seen in clinic over many weeks and you know that person, you’ve, kind of, seen them, you’ve joked with them, you… and I think certainly then there is no way, I… if that… if I had patient – one of my patients that I’ve built that relationship with – who came in, all trying on my part is not going to be able to not be emotional. But I think when it’s someone that you’ve never met before – which is most often the situation unfortunately when these horrible things happen – it’s often a complete stranger. You… yeah, I think, the feeling we get – or at least I think the general feeling – is that it’s kind of not appropriate.

42:14 But I don’t know. Maybe it would… maybe it would be? Maybe people would find it comforting to know that the people looking after them care to that extent – and we do. You know even if… I’m just immediately thinking about, sort of, being in handover room and there’s often… because often people will be diagnosed with a stillbirth and then they will go home, and then they will come back to have their induction process, and so we’ve often got on the board that someone’s coming in on the Saturday or the Wednesday, or whatever and… and there’s always a kind of, you know, you see it, the staff are like… that’s so sad, oh, and that poor lady, you know. People do, kind of… they’re not… we’re not even talking about it, but it was just automatic if someone sees that on the board it’s… people feel for that person. They may never meet them, they may never have never met them, but they do care and they do… you know it’s always if you’re on a ward round and there’s someone, it’s always like, oh, isn’t it awful? Isn’t it so sad? And we see them lots but every time we care because, you know, every time we know that that’s our job. We spend all of our lives trying to… have well mums and well babies. You know, we don’t… you can’t do this job where, you know, you spend evenings and weekends and however long, kind of, studying and training if you don’t care. It’s just that maybe sometimes we don’t always feel it’s appropriate or know how to show that… and it can seem like it’s… people are, kind of, I don’t know, deadened to it because we do do it all the time, but actually… you couldn’t do the job if you didn’t care. It’s just too hard; it’s just too much hard work… if you didn’t give a crap, it would… There are a lot of easier jobs to do, so that’s why we do it.

44.18 So how do you separate that personal and professional response? How do you do that?

44.26 I don’t know. Erm… I think there’s… There’s a time when you kind of… sometimes you… sometimes it’s important not to too much. Certainly, if it’s an emergency then that becomes very different, you kind of… everyone has their own, kind of, I think, person they become in an emergency and I certainly become quite… I wouldn’t say calm, because that’s probably a little bit… I’m probably not as calm as I think I am… but, you know, I’m kind of like, I slow down and you go into, sort of, autopilot, in a way. But, I like to keep the personal just below the surface because, I think, that’s… that’s what makes it enjoyable for me. So it’s… but it’s that very, very difficult balance of bubbling the personal with what you’re… you… it’s a fine balance and sometimes… it may become… you don’t get the balance right. And, certainly, you know, I’ve had patients that I’ve cried with and I’ve thought actually, was that… was that appropriate? I’m not sure it was. Maybe I should have been a bit more professional.

45.38 But, certainly, you know, I… I talk to friends. You know, I have… most of my friends aren’t medical; I don’t really have a lot of kind of doctor friends. And so, you know, I think in some ways in that way it’s easier to talk on a more personal level about cases that you’ve had that are difficult, because they see the humanity in it a lot easier than if you’re talking about cases with someone that’s also a professional; you kind of immediately share the professional side of the things. But, yeah, I can talk to my friends who are, you know, work in the arts, or in journalism, or whatever they do, and they will automatically be like, wow, that’s so terrible or that’s… you know. You can talk about the more human-side of it a lot easier and I think I find that very useful to be able to have that: those friends to go to, to talk about those things, and to gain… to keep your humanity in it, and to gain that perspective, so you don’t lose that. But, I think, you know… at least that’s what I… I love people, and people are so interesting and individual and you get such an amazing, kind of, insight into all these different people’s lives by doing the job that I do that I definitely feel like… having… keeping that, kind of, personal relationship very close is what makes it so much more rewarding and enjoyable. And, yes, sometimes you have to push it aside to do your job properly, but you need to keep bringing it back to, kind of, make the experience fulfilling and worthwhile. But whether I get the balance always right I don’t know… I don’t know. Yeah.

47.36 And if you feel emotional at work, what support is available to you as a clinician?

47.44 Erm… I think that depends very much on where you’re working, what your department dynamic is like… Yeah, I mean, I’ve had… you know, bad cases where I’ve immediately gone and I know the person I’m looking for. I’m looking for that one friend, that consultant, and I grab them and take them into the broom cupboard and cry my eyes out… or, you know… and they are there to sort of say, it’s fine, it’s going to be okay, and you know talk you down, and talk you through what’s happened or what’s going on. And you know, there’s, you know… yes, technically we have our educational supervisor and this supervisor and there is a… there is a structured system so that if you had a serious problem there are people to talk to, but I think the reality is like whenever you work in anywhere, you have people that you build specific relationships with and those are the people you go to to, kind of, run through things and it’s your colleagues that – you know maybe your junior colleges, or your… you know, your working in parallel colleagues – but they’re the people that you build specific personal relationships with that you tend to go to really when you have, kind of… emotional days or days that you find… difficult to deal with.

49.06 I think there’s still not… there still probably isn’t as much kind of holistic care for ourself. I have a friend who works in… worked in the, kind of, charity sector dealing with quite difficult situations with… she was dealing with women who’d been exploited and, you know, they had so much more, kind of, about having… teaching each other about self-care and… you know, group talks about, talking about cases they were dealing with to sort of share those experiences. And it was great because I learnt a lot from her about that and the importance of this idea of self-care – sorry, what’s that? I’ve never heard of it before. But actually it is so important and I think probably we as… that’s not in our… that’s not in our vocabulary and I think we probably do need a lot more of that to help us, kind of… deal with… you know, whether it’s… whether it’s something as catastrophic as someone losing their baby or simply, you know, making a bit of a mistake – that actually no harm came from it – but you know we take it seriously and we beat ourselves up about them, so probably do need to learn to… rely less on this, kind of, structure of, this is your supervisor and that’s who to go to, and just a more generalised way of how to, kind of, deal with the… the kind of fall out from working in a… in a world that is so full of highs and lows.

50.44 In terms of the different places that you’ve worked, can you tell me a little bit about the facilities that you’ve seen at hospitals… for families who are going through a stillbirth?

50.56 So, I think there is, again it’s very dependent on where you are unfortunately, and some places are much, kind of, better designed, and I think the newer… so, the hospital I’m working at at the moment, their maternity unit’s been… designed quite recently and I think people… people have thought a lot more about how to… care for women who’ve… who’ve gone through something traumatic like a stillbirth. And so, for instance, in this particular department the… most departments will have a particular room that they try and have further away from the rest of the… kind of, the quieter end of the labour ward, where we will try and care for women who’ve, who’ve gone through something like stillbirth, so they’re not having to be constantly exposed to sounds of labour and sounds of babies and things. But this particular unit even has a separate entrance to the labour ward, actually… sorry, to the area where… where that room is so that family and the partner doesn’t have to continuously come through the main entrance, which I think is really… a nice way of managing it.

52.07 And there is often an area, most… rooms will have an area – close by or just adjacent to the room that’s, kind of, dedicated for this purpose – that will be a place where the baby once it’s born can be, can be stored and looked… so that parents can have access to, to kind of, be close to the baby – if they want to; to see the baby – if they want to. But there’s a separate area so that maybe if they’re not wanting to do that all the time, that that doesn’t… yeah, that’s feasible.

52.43 Having… having a specialist midwife, I think, is really, really important because… you know, as I say, we do shift work and people come and go, so just having that one port of call, that person that you know knows what you are going through, and understands the whole system, and is, you know, gonna check your bloods for you, and keep all your paperwork together and… is really, really important, I think… I’ve never worked somewhere that hasn’t had that, but I find it… I don’t know how a unit would be able to… cope with not having someone that’s dedicated to that role because it’s such an important role.

53.20 But, I think those are the main, sort of, facilities that are really available and, you know, in some places… so it’s… it’s always very difficult… sometimes if it’s… you know, if someone’s picked up that their baby has passed away on an ultrasound scan, finding a space to be able to speak to them because often they’re brought to… you know, as a doctor, I’m often asked to see someone in the maternity… what’s equivalent to what we call the maternity day unit which is often the place where women come to have… if they’re unwell or to have certain checks throughout their pregnancy, and it just feels like the most inappropriate place to see someone in that situation, because it’s busy and there’s lots of people around and… and trying to find a quiet space in a hospital is just like, you know… it’s as rare as hen’s teeth. So… there are some… again, I think, as hospitals modernise… we are trying to… we’re understanding the importance of having those spaces available.

54.24 So, a hospital that I recently worked at, actually, their antenatal clinic had just been slightly redesigned… and they had included a kind of… an extra room, that’s not a consultation room, but it’s a quiet room that can be used for that purpose, and, actually, I used it for that purpose before I left and I remember thinking, yeah, this is… this is really important that we have this room here. And it had some sunlight in it and it wasn’t, kind of, you know, completely a dark space that, you know, is sort of huddled away – ‘cause you also don’t want to feel like you’re being hidden away somewhere away from everyone else, that you know. You need a space that still is light and has, kind of, you know, circulating air, you’re not, kind of, pushed away in the back of the, kind of, labour ward where no one can see you. So, it’s a sort of, balance between those two things of… of not being forced to being exposed to everything else that’s going on and, sort of, having that rubbed in your face, but at the same time not feeling like that you’re, kind of, hidden away in the back somewhere as well. And again, it’s how do you… how do you strike that balance in the realities of the NHS? It’s tough and I’m sure we don’t get it right most of the time, but you know, certainly, I think, there is a shift to try and be more aware of it.

55.46 How much do you talk with your colleagues about stillbirth?

55.56 Not a lot. Erm… I think it’s everyone’s… it’s all our worst nightmare, because, you know, when you used to talk about… when you were talking earlier about women and, sort of, you know, saying it’s… trying to convince someone that it’s not your fault… you know, we feel that as well. And it’s that… it’s that constant… in the back of your mind, like…whether, you know, when you’re in antenatal clinic… I had a clinic last week where between me and one other person we saw 40 patients in like three hours and you’re thinking, have I missed something? What if I’ve missed something really important? What if I’ve missed something that’s then going to lead to that person losing their baby? You know, it… it haunts you. You go home at night and think, did I put that form in?  Did that scan form go in? Have I…? You know… What if I haven’t? What if that’s the…? You know, it, it does kind of… it’s that constant… you know, I think people often at work will have something that… is their, kind of, bottom line: if it goes wrong, this is what’s going to happen. And when your bottom line is, if you do something wrong the baby might die: it’s quite a big bottom line to have.

57.12 And… and I think people… you can’t… you can’t really think about it all the time. And the reality is that there are a lot of safety checks in a hospital and, you know, I’m sure that if we’ve… people are very good at looking after their own health most of the time, and if you didn’t get a scan that you were supposed to get – especially women who are pregnant are pretty motivated in saying, oi, I didn’t get that scan I was supposed to get, and it will happen – but I think it’s… yeah, it’s not something that we… talk about that much. And I think partly… I think partly also because we’ve moved much more to… to working in shifts now, so we don’t it’s… it’s not the old system where, you know… it used to be that you would work with a consultant and you would do that consultant’s antenatal clinic, and you would do that consultant’s ward rounds, and you would do that consultant’s… So you had a much clearer cohort of patients that you looked after. Whereas now, you know, I will be doing one consultant’s clinic one day and then the ward round, and then… it’s much more… you don’t see that same continuity of care. So, there’s not the same link up, of saying… and you don’t work in small teams as much any more, so it’s not so kind of, this patient that you’ve looked after this has ended up happening to them and then you as a team reflect back on… on that.

58.37 I think when… when they happen and when you are involved in the care of those patients then yes, you do… talk to your colleagues, I think, who are involved in that case or the midwives who you are working and are involved in that case. You do talk about it then, but it’s more as an immediate event in relation to those patients rather than necessarily… kind of, in general. And there are cases, you know, if you’ve… I mean as an obstetrician the… the absolute worst thing that can happen, I think, probably – apart from a maternal death – is an intrapartum death: so if you are looking after a woman in labour and her baby dies in labour, that is, kind of, ground zero of things that are not supposed to happen. So, if ever… and luckily it happens very rarely, but if ever you are involved – or not even involved, you know… I’m thinking about a case that I knew, I know of that happened reasonably recently, and it is a case that…that kind of case you do talk about with your colleagues because you do want to learn from that case. You want to talk about what went wrong. Is it something we could have done…? Is it just something that we couldn’t have predicted? How could we have done it differently? If I was in that situation what could I have done differently? So, I think, those kinds of cases we do talk about more. But, I think, as a generality – and certainly with how we feel about stillbirth or how you cope with stillbirth is not something that is really discussed between colleagues, no.

1.00.31 Have you sort of experienced… I mean, what sort of attitudes – maybe they’re not discussed – but what sort of attitudes towards stillbirths have you heard expressed by colleagues or… encountered?

1.00.49 I mean… I think they are… I think they are kind of… seen as… I think probably much more so, like I was saying about maternal deaths being this thing that should never happen and can never happen. I think it’s not quite the same attitude to stillbirths. I think there is much more of an attitude of, this is something that is terrible, but sometimes it’s just one of those things. And… I don’t know if that’s something that should… shift. I think it’s something to do with the frequency – in the sense that it is something that’s more common. You know and that’s something certainly that people don’t talk about, the fact that it’s actually something that, you know… is a reasonably common thing. So, I think, yeah it’s, it’s… and because, so, you know, the vast majority of them we never find a reason for, it becomes that much more difficult to, kind of, know how to… because when you… when you don’t know what causes them – from a medical point of view – it’s hard to get, kind of… how do you think about it in any other way apart from it’s really sad thing that sometimes happens, because you don’t know what else to do to prevent it or to change it?

1.02.28 And, there are… you know, we know that small for gestational age babies… intrauterine growth restriction is one of the major, kind of, factors and so we’re always, kind of, looking out for that – and that’s something that we can actively do. And obviously all the other things that we get concerned about, but… other than that I think people just generally think of it as this just terrible thing that… that happens sometimes that we don’t really know how to stop or how to kind of make not happen… and so we just have to do the best we can to deal with… to look after women and, you know, we… we are medics and we very much want to try and get to the bottom of it and try and stop it happening again – because that’s all… that’s our job; that’s what we… that’s what we’re supposed… you know we’re supposed to make sure this doesn’t happen and then when it does, that’s kind of the thing… the thing we want to do is find out how we can stop it happening in the future because that’s… that’s… why else are we here? You know, there’s no point of us being here if we can’t stop stillbirth happening. But in the same vein, we know that we know that we can’t stop it always. So it’s kind of a bit of a… kind of double.

1.03.45 But I don’t think I’ve ever heard… I mean I’ve certainly never come across any, you know, views on it that have surprised me or, kind of, that I’ve gone, that’s a very odd way to respond. I think there is certainly just a very wholesale… whatever, you know, I’ve worked with colleagues from all different kinds of backgrounds and cultures and, you know… and whether or not people are from a culture where they express emotion more or less, it’s just a sad thing and a thing that people wish didn’t happen. And I think that’s just universal with anyone that works in this kind of field. I’ve never heard anyone express anything apart from that.

1.04.34 With regard to, sort of, practical advice and support to mothers following a stillbirth… what sort of practical advice and support do you give?

1.04.45 I think for me this is not something that I’ve been quite so involved in because, like as I say, specialist midwives and also, kind of, consultants because they do the, kind of, six-weekly – it’s normally around six weeks that you have a follow up appointment – who then go on to give… Because quite often, you know, when you are in the very acute phase when you’ve just left hospital – maybe 24 hours after you’ve you know delivered – you’re not really in a place where you’re, kind of, taking on huge amounts of information so our kind of advice – generally – at that point is much more saying, look we are here; if you need us please contact us; you know, we are willing and that’s what… we want to be here for you, if you feel you need us. And certainly from a medical perspective, sort of saying, you know, if you do… if you start to feel unwell, if you start to have any heavy bleeding, particularly kind of any signs of infection – so if you start getting, kind of, worsening abdominal pain, you’re feeling that your bleeding is increasing in heaviness rather than settling down, which is what it should be doing; or any offensive discharge; any high temperatures – then, you know, please come back and see us immediately because obviously one of the risk factors for stillbirth is infection and that may not present itself until slightly after, so certainly, kind of just giving that kind of basic medical advice of when to come and see us.

10.06.10 But I think it’s more at… you know, when you see a consultant at the, kind of, follow up appointment where they’ll be able to, sort of, sit down a little bit more away from the acute event and, kind of, give more advice on… on what we can do to, sort of, try and minimise the risks long term. And that will obviously be drawing in part on what your results have been and you know without judgement and without – definitely without placing blame – talking about just general health measures that hopefully could make a difference. You know, if you smoke trying to you know not smoke in a future pregnancy; we’re not saying that was why this had happened, but, you know, anything we can do to try and minimise the risks. Kind of those sorts of things… yeah, and then looking at your individual kind of risk factors. And I guess also then talking about decisions to, if you do want to get pregnant in the future and, and when’s the right time and when’s not the right time. And I think that’s probably something that is quite important to women to kind of… they worry about, and… And that we also know that there’s also quite a discordance among partners for that, in the sense that women tend to have more, kind of, psychological… are more prone to having a difficult, sort of, response – or having increased anxiety – if they get pregnant very soon. Whereas men are more prone to have much more anxiety if, if people… if it takes a long time to get pregnant. So we know there is often this kind of difference in the way that parents respond to kind of that decision to, to have another pregnancy. So, kind of, addressing all of those things and…

1.07.59 And also trying to catch up on how people are… Yeah, how people are coping and whether trying to identify, you know, the people who… are coping and… dealing with something that’s really traumatic and difficult and so obviously grieving and… you know having a very difficult time, but differentiating that from people who are, are not coping and who are… things are moving more into a kind of area where it’s becoming more problematic and they’re having a, kind of… more a, kind of, medicalised, kind of, depression response. And so being able to identify those people and offer them the appropriate help. And that may not be mum, that could be the… you know dad, or that could be children, or that could be grandparents or people in the immediate family, but making sure that, you know, we try and kind of be there to sort of help identify that and recognise that’s going on. But that’s not something that I have really been involved in because I don’t tend to see people at that later stage.

1.09.15 You’ve mentioned dads. What about dads in this situation?

1.09.22 Oh, I just… I always feel for dads in general. I think actually in obstetrics because I think it’s, it’s a really hard… really, really hard thing to… I mean, we don’t like to focus too much on… I think because we’re quite kind of, you know, generally pretty feminist if you work in obstetrics, you, you, you care about women and you know… because of the, kind of, historical… patriarchy that’s, that’s taken place and, you know, men having… being able to make decisions about women’s care, we’re very… I think very… we, we jump very quickly if we think that there’s a situation where a partner is kind of trying to impose his desire on a woman – and this can be in all forms of obstetrics. We very much want to represent and be caring for the woman as a patient. But at the same time we do recognise that, you know, they are going through this as a couple and that the father – in all stages of obstetrics – is involved… and is affected. And definitely when it comes to losing your baby… ahh, it just, it’s absolutely heart breaking to see… because he’s, he’s having his own experience of losing his child, but he’s also seeing his partner go through something that he can’t protect her from. And how… and, you know, and sometimes people get angry. And we know that and that’s… that’s, that’s okay. It’s difficult because sometimes it’s not okay… and, you know, if you’re making threats to people or staff, and we kind of… we do know why, but you also have to be… there has to be a line there. But it’s… it’s just… it’s heartbreaking. It’s heartbreaking to see someone be so… pained for themselves, but so pained for someone else at the same time.

1.11.48 It’s really… and it’s really hard to know how to kind of… involve them and make them part of the, kind of, process sometimes. And I think we do try. And certainly I always try and make sure that you are speaking to both people, you know, and explaining to both people what’s going on. That it’s not just you’re trying to push out the father from that experience. They need to be taken in and I think as much as possible to sort of… help them be a couple in that situation; help them be… give each other support rather than separating out… separating them.

1.12.36 But yeah, it’s really difficult, because also, you know, men are not… I think in our society, men are not given space to grieve; and you know, how men are taught that… you have to be strong and you are… and I think a lot of men do feel like that… that they are… they need to be there… they need to be the strong one for their partner who’s, kind of, possibly falling apart… and I think that puts an incredible amount of strain on them and… Trying to create a space where it’s okay for them to cry and it’s okay for them to be openly upset because a hospital is a public space, it’s a, you know… we are… And we’re all women as well and I think that’s quite hard for a man – within our society – to be that vulnerable, openly with strangers. And I think there’s so much… feeling of loss of control when you are in that kind of situation where, you know, a traumatic experience like that… and I think especially for a partner who’s, you know, often within our society taught that his role is to protect – to protect his partner and protect his child – and that’s all just been stripped from him and he doesn’t have that anymore and… and he’s in a space where he probably doesn’t feel comfortable and it’s very… I think it’s incredibly very hard for him to know how to navigate that. And again, you know, what can you, what do you say? How do you make that easier? And, yeah… it’s very, very challenging but I think hopefully just by at least recognising that it’s happening… you can start to open up a space for him to be able to… to be in.

1.14.41 And I think, and I think trying to be understanding and recognising that when people are upset they often express that in ways that are challenging. You know, like I said before, people do get angry and… or just difficult. You know, people can behave in quite a difficult manner. Which is fine, actually.  You know sometimes it’s when you’ve have a hard day and you have to just remind yourself, this is not about you, this is not about your team or your hospital – that you think over all does a good job – this is about them and their experience and that’s okay… But yeah, it’s not easy for either… either partner.

1.15.38 You touched earlier on sort of subsequent pregnancies; what advice – if any – do you give to parents about getting pregnant again?

1.15.49 Um… as I say so this is not something that I would, kind of, have been so involved in the sense that I sit down and kind of give people advice, but certainly, you know… We will always say that it’s an individual choice about when you choose to have another baby. Or, if you choose to try for another baby and that’s, you know… that’s certainly an important thing. Just because you’ve… you don’t have to. And I think it has to be pressed upon that it’s… it’s individual. And the only person who’s going to know when it’s… if and when it’s the right time is you. We certainly, you know there is some data out there that… that it is more… you’re more at risk of having a kind of… you’re more at risk of having, kind of, more… more depression or anxiety if you get pregnant within 12 months of having had a stillbirth. That, that is a kind of… can be quite emotionally taxing for a woman; it’s not quite the same if you’re the partner in that situation. But, you know, studies are based on averages and people are not averages, people are individuals, so, I think, if you strongly feel that you want to, then, then that’s fine and you know…

1.17.31 I think people need to be aware that, you know, there are certain things that we would try and, you know, inform people of, such as, you know, when you’re not breast feeding and you’re not lactating your periods can come back quite soon after you’ve had a stillbirth and so it is possible for you to get pregnant before your next period. So it’s quite important that people understand that, so that if it’s you know… if it’s not something they’re planning that they are, you know, they’re taking precautions and using contraceptives because, I think, probably one of the things people don’t want to do is have an unplanned pregnancy probably very soon after something as traumatic as that. So again, it’s just about educating and touching on subjects that probably feel a little bit almost like inappropriate to talk about so soon after, but, kind of, making people aware of things like that.

1.18.23 And also just, I think, probably the best thing is just… you know, being open and honest with your partner about it and having that discussion about when is going to be right for you as a family, and, you know, how you both feel about it. Because as I say we do know that there is this slight disconnect between, the kind of – these are all very, very much generalisations but they’re kind of generalisations based on research that men tend to feel more anxiety if they, you don’t have children sooner, whereas women tend to feel more anxiety if you do have children sooner. So the best thing to do is talk about that because we know that that is an issue and it’s not just something that probably you as an individual couple are going through, it’s something that is, kind of, felt across the board and if you can kind of… are made aware of that, it, kind of, takes the pressure off a little bit. But, there’s just never a right or wrong thing to do. And I think that’s the most important thing to know.

1.19.29 Do you, sort of, have any other reflections or insights about the time that you’ve spent working with parents who’ve experienced stillbirth?

1.19.41 I think just that… yeah, you always… you always really hope that you get… that you’re able to get across… how much you are sorry that this has happened and… how… much you wish it hadn’t. And… and I think when you know things go wrong and you get an outcome that obviously is not what anyone expects… it’s so challenging and, you know, and there’s this, kind of, waves of… of emotion going on and, you know, there’s this difficulty of trying to navigate that to, kind of, provide clinical care and to provide a good clinical service and to carry that on and say, okay, what are… what are the risks clinically in this situation? What are the medical things that could be going wrong? Has the mum got a severe infection that we’ve not…? You know, kind of, we need to do the legalities; we need to make sure that… all this paperwork is done correctly because it’s legal. We need to make sure that the bloods are done correctly and we don’t miss something. That we… that mum gets her Cabergoline if that’s what she wants before she leaves to stop her having lactation so she doesn’t continue to produce breast milk. You know, all these kind of things that are your… you know, your kind of, that’s your job really, is to make sure those things happen, but trying… that’s kind of the nuts and bolts of what you have to do to… to do your job… but then… above and beyond that is this whole other thing which is how you care for someone who has gone through the worst thing they have ever gone through in their life – or will probably ever go through. And it’s… it’s a hard job to work out how you fit that all together and individualise that for the individual circumstance and the individual person. And I think… and we don’t always get it right.

1.22.18 But I think you can take solace that even if we’re not necessarily showing it… we do really care. And it may be that it’s not till we go home and have a very large gin and tonic later on that… we really allow ourselves to think about how much we really care about it – but we really do… And if we feel like we’ve done a bad job, there’s unlikely anyone who’s gonna kind of feel as bad about it as we have. And we all make mistakes and, yeah… we’re not always perfect, but I’ve certainly never met someone who’s works in this job who doesn’t really care… about the babies and mothers and dads that they look after.


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Eileen is a junior registrar in obstetrics and gynaecology. At the time of interview she had been in this role for about 18 months. Her training has included placements in a number of busy inner city, London hospitals.