Katy’s full interview
0.00 My name’s Katy and I’m a community midwife.
0.04 And how long have you been a community midwife?
0.07 I’ve been a community midwife now for about seven years and before that I was… worked in the hospital for three years.
0.17 And what does your role as a community midwife involve?
0.23 So we follow ladies all the way through their pregnancy – so from the moment they know they’re pregnant they’ll come to us and the… usually at their local GP or children’s centre – and then we book them – whichever hospital they want to go to – and then we care for them throughout their pregnancy. We do work in the hospital as well on the labour ward but mostly we’re out in the community so we don’t tend to deliver them, but sometimes we do. And then we look after them when they come out with their babies, in the community, in their homes. We do assessments and care for them until they’re ready to be discharged.
1:06 And how often do you work on labour ward?
1:10 So usually it’s about one shift a week and every so often we do a week of nights.
1:22 And what attracted you to midwifery?
1:26 I’d always wanted to do something in the medical line… I weren’t sure what. I’d applied to be a doctor at first, but didn’t get through. And then I had a friend that was a midwife and I liked the idea that you were a specialist in a particular area. And I went and I got a job interview for it – so I went for it.
1.51 What did you know about stillbirth before your training?
1.55 I think like before my training, I didn’t really know much at all about stillbirth. I’d not had any experience of that, I hadn’t even… I don’t think it even came into my mind to think about that when I was thinking about the job and the role of a midwife. It’s not something that you first think about. You just think it’s… of all the really lovely and positive and happy aspects of having a baby. So, I would say pretty minimal really what I knew or experienced.
2.29 And what were you taught about stillbirth as part of your training?
2.35 So we did do some work around bereavement and loss. And that really opened my eyes; not just to… even loss of babies at term, but very early on miscarriage as well and like the… just how much it affects so many people really: loss around pregnancy. As part of my own dissertation as well, I looked into this a little bit further by researching supporting parents who continued with their pregnancies when they knew that their babies were going to die from different abnormalities, and that really opened my eyes as well to like the grief process that people go through; the really damaging things that professionals can say as well sometimes to people when you’re trying to like help them, but you can end up saying the wrong thing. So it really opened my eyes to the fact that you have to be so careful with what you say, because nothing that I say can make it better…
3.43 And also it made me think a lot more about… not shying away from acknowledging this baby… You know like, asking the name of a baby for example when I’m speaking to parents and using that name and… Because this is their precious baby and I don’t want to like shy away from acknowledging that or dismiss that in any way.
4.15 Can you just tell me a bit more about actually how you learnt? Was it experiential on the course or was it academic or was it in group work? How did they teach you?
4.26 So, we did some group work. It was mostly academic like researching and looking into Sands and some of the other bereavement support groups that are out there. Reading stories about… from parents who’d lost babies. And then in my group, we had to present back as well, our findings. So, we actually made a short video around pregnancy and loss and we visited a crematorium and a little area in a graveyard which is set aside for children and babies that have died and… Yeah, so… mostly academic but it did open your eyes by reading all the stories and then having to present that back as well to the rest of the group.
5.18 And you mentioned that you were interested particularly in loss and bereavement. Can you tell me about that?
5.26 Yeah, I don’t know particularly why, but… I just felt drawn to look into that a little bit more. And even now like as a midwife, I find it – even though it’s the most horrible part of… being a midwife and being in pregnancy – I feel very privileged to care. And, I want to like actually go and look after women who’ve had loss in pregnancy and… I don’t really know why, but I just want to be able to… show compassion in that horrible time.
6.12 Can you tell me about the first time that you cared for a mother who had… had a stillborn baby?
6.21 Yeah, the first time was actually during… on the labour ward when I was caring for a woman who’d lost a baby that had died at 28 weeks… and I actually was there looking after her in labour and… This was my very first hands-on experience. It’s very…emotional for all involved. And in this case, the lady didn’t actually want to see the baby when the baby was born. So I was very careful to, like, provide all the dignity and respect that the woman wanted and also shield her from seeing this particular baby.
7.05 And when the baby was born we all cried in the room, because it was really quite emotional, even for… you know as a professional, you try to remain professional, but… you know it affects everybody in the room. And then, you know, I took the baby out of the room – because that’s what the mum wanted – and we just prepared the baby and we did some handprints and footprints and memories that mum could look at if she wanted to later on. Yeah, so it was very… I mean I can remember to this day; it was probably about eight years ago, so… it sticks in your… your memory because it’s… it’s not something that you want to see and it’s not something you want to experience.
8.04 You, you talked about the impact that that had on you. How, how helpful was your training in helping you to deal with that?
8.18 I think like… the training that we get is not particularly helpful… I think you can’t quite prepare for how you will feel and how it will be in that scenario. I think my own research into it had been… was quite helpful, so I knew at least not to say anything, apart from, sorry for your loss, like. Not to try and say something to make things better by bumbling in with words that could make things worse. But the actual training that I received I wouldn’t say is… was adequate – whether it’s changed now I don’t know but… it’s, it’s not really a big part of our training and perhaps it should be a bit more.
9.13 What do you think now – with hindsight and with your experiences – what do you think would be more helpful?
9.24 I think… certainly understanding just – as a professional – how you need to be so careful with what you saying because it’s a very raw time. Understanding, at a deeper level like, the grief process, because you never know where someone’s going to be at in that process. But understanding that there’s these stages of shock and, you know, grief and despair and blame and all these kinds of things. Like understanding those different emotions that women and families can go through helps you to understand the reactions and helps you to prepare yourself when you’re going to go into a situation.
10.24 How easy is it, as a professional, to separate your feelings and deal with them professionally and recognise how personally, as well, you might have been affected?
10.38 I think it’s… you know at the end of the day we’re just human beings and some days that’s easier than other days and… Like my role as a community midwife, I might be one minute in a house with a mum who has had a lovely home birth and everything was beautiful and the baby’s all thriving, and you know, I drive 10 minutes down the road and I go to a lady that’s lost a baby and it’s a completely different atmosphere and… it’s emotionally draining for us as midwives because you don’t know exactly what you’re walking into sometimes.
11.17 And… you know there’s times when I’ve… I, I can’t help it. I cry in people’s houses when they tell me their stories of loss or… I try and always be professional. I don’t always cry and it’s not the whole… it’s not the reaction that you have all the time. But you know it does affect you. But then we’ve got our colleagues and we can go and have a chat about how we feel with other colleagues and other midwives afterwards as well if there’s certain things that have… really affected me when I’ve been out on… out in the community and out in people’s homes and just trying to provide that support.
12.07 Can you tell me a little bit more about the support that you do get to help you with these situations?
12.17 So as midwives we do have Supervisors Of Midwives and that role is changing now, but essentially it’s about protecting women and the safety of women, but also about providing a safe place for us to go and discuss issues in a safe environment and… You know, it’s not a judgemental environment, but it’s… Supervisors are very experienced midwives, who’ve usually experienced all the things that we experience. It’s less… while midwives that don’t have as much experience perhaps in these areas – so, I myself have been to a supervisor just to speak about certain traumatic experiences that you’re involved with. And it just helps to provide that reassurance and can just be someone to listen to how you’re feeling and… just reassure you that… sometimes that you just, yeah, you did do the right thing or you said the right thing, or you could have done something a bit better or… You know, it’s just that great safe support really.
13.35 And how important do you think it is to have an emotional response to loss and a stillbirth?
13.46 I think it’s… I don’t know if you can say it’s important, it’s just part being… of human nature to have an emotional response, but I think it’s important to weigh your emotional response. This is not my, my experience, you know. It musn’t become about me, or my emotional response musn’t be inappropriate of… what’s going on with the woman. So, I can’t help having an emotional response sometimes, but I am careful not to… this is not about me. This is about the family and what they’re experiencing and it shouldn’t ever take over the emotions of the family.
14.37 How important do you think it is to acknowledge the different cultural and religious beliefs following a stillbirth or a loss?
14.49 That’s very important… especially where I work it’s… I mean most of my women are not White British. They come from all over the world and have… varied like… religious and cultural responses to loss and grief and death and… you know, I must respect their wishes. I must respect, like, what they want to do in terms of coping with their grief and their loss and whatever rituals and things they are… we try to facilitate those.
15.28 Like, at the hospital, we do have different chaplains for different… religious needs. And the bereavement midwives are really good because they are quite aware of some of the different cultural needs…with… in some religions for example they need to take the baby home. They need to take the baby… to be washed straight away and things like that, so we try to facilitate all that. It’s really important because we don’t want to put a stumbling block in anybody’s grieving process, so we try very hard to meet everybody’s needs.
16.12 And can you tell me where you get that learning, and that… you know lead from?
16.20 For me personally that’s just come from experience from being amongst different people of different cultures… As a midwife, you know, our role as well is… is not to be subjective but to be objective and to… to be an advocate as well for women – that is a part of what a midwife is: to be ‘with woman’ and to be… to advocate for whatever needs they are. So it does come from our training, but it comes as well from experience and… it… it’s supported by the help that we have from the bereavement teams around us.
17.07 You’ve mentioned the bereavement teams and a bereavement midwife. Can you just explain to me, as a community midwife, how your role is different from a bereavement midwife?
17.21 So the way it works where I particularly work, the bereavement midwives is hospital based and they will provide all the immediate care with the delivery of the baby and immediately afterwards there’s a mountain of complicated paperwork to do with registering the birth; registering the death; if they want to have a funeral; if they want to have the baby cremated or whatever. So, there’s a lot of stuff that they’re dealing with on that side. They also know a lot about… support groups and provide some support groups in the hospital so parents who’ve lost babies can meet together to mutually support each other.
18.14 And then my role is very different because I’m… I suppose, primarily, we’re out there in the community doing, yes… looking after the physical needs after you’ve had a baby. There’s… you might have stitches, you might have… medications that you need, you might have to have your blood pressure checked, so we’re carrying on with all the postnatal aftercare, but we’re the ones who go to the patient houses.
18.45 We’re providing emotional support as well afterwards… you know, for up to four to six weeks after having a baby – or having a… the baby that’s died as well we will provide that support for that length of time. And the bereavement midwives they don’t actually usually visit them at home. So we’re… that’s how our roles kind of differ and… but we do communicate with each other and they… women can also ring the bereavement midwives any time. And sometimes women don’t want to see community midwives. They’re happy just to, you know, speak to the bereavement midwives over the phone. They don’t want to see any community midwives and that’s fine too.
19.31 And does the opposite ever happen? Where people would, you know, like to talk to you in their home and then don’t feel that they don’t want to go into the hospital to talk to a bereavement midwife?
19.42 Yes…it does happen. I would say not very often because they feel a great amount of support from the bereavement team. But, sometimes it’s very painful for a… women or families to go back to the hospital where they might have lost a baby and so yeah, sometimes they don’t want to have that support or that input from them. But I would say most of the time that they do appreciate that and… and need it because they’re… we don’t have all the expertise necessarily in all the paperwork kind of stuff and helping them to direct them to the right funeral arrangements and all things like that. We… that’s not something that we really have a lot of training in.
20.34 You’ve talked about in your role about, you know, attending a home birth and then visiting a woman after a stillborn child. How do you think stillbirth should be dealt with in antenatal care? …As a topic do you think that it should be talked about more – that women should be made more aware?
21.04 Well, part of our… health education of all women, we will talk about things which reduce the risk of stillbirth; so we’re trying to like promote health in pregnancy and we know things like smoking in pregnancy could be a risk. So we’re trying to raise awareness of stuff like that. Other things like really educating women on movements of their babies because we know that… reduced movements might be one of the first indicators that something’s not going quite right. We’re very strict now on all sorts of things like growth measuring and stuff like that. And any indication that something is going off, we will refer women in and we try… well, I certainly try and to be honest as well about why we’re doing these things.
22.02 And part of that is a risk of… stillbirth and… but it’s a hard balance because you don’t want to like scare people to death as well. But… part… its a major part of our role is managing the pregnancy and making sure that we avoid such things and do everything we can to refer people to the right places should anything be going… kind of deviating from the normal pathways. But how heavily you go into that just in general about stillbirth, I’m not really sure but… we certainly do definitely… you know, raising the awareness of that with the… the monitoring and the health education that we’re trying to provide to women.
22.56 Can you tell me about your work in caring for families in subsequent pregnancies following a loss or stillbirth?
23.07 Yeah… obviously when a lady’s family have lost a baby and they are pregnant again, they’re really anxious – and understandably so. So, again I want to acknowledge that baby that has been lost – so I’ll always ask, you know, sensitively about if they’ve named the baby, and was it a girl or boy? And things like that… as I don’t want to be like you know skirting under it or trying to deviate around it. These are precious babies so… we do have case whole… caseloads of women, so sometimes I might not see the same woman for every single appointment, but for somebody who’s had a pregnancy loss… I would definitely try to provide continuity of care; make sure they know that I’m the named midwife, so they’re not having to maybe tell the story over again or… They need continuity of care and they will have… specialist input as well from the obstetricians, and extra scans, and extra appointments and things like that…
24.26 …so just to be able to provide a little bit of reassurance that the pregnancy is going to get a little bit more intensive monitoring this time. And if there was any reason that was found to contribute to the stillbirth, you know, we’ll try to like mitigate for that in this… subsequent pregnancy, so… I think continuity is a really important thing, which I would you know really try to make sure that happens for those women.
24.59 And as a community midwife are you able to spend more time with a woman, i.e. give her more appointments in the community or have longer sessions with her?
25.12 Yeah, we’re under a lot of pressure all the time. We only have… like your typical thing is: your initial meeting is 15 minutes; your booking interviews an hour long, and then every appointment after that is 15 minutes… So yeah, we’re under pressure to… under time pressures and got busy caseloads. But if I feel like I need to give extra time to a woman I don’t hesitate to give them an extra appointment. If they need reassurance – like just want to come and have their baby listened in to, or something like that – then that is absolutely fine and I’ll facilitate that, either in my clinic or… you know, popping round at their house when I’m out doing visits or something. So, I would always try to give them that extra reassurance if that’s what they needed – despite like the pressures on your time because it’s so important.
26.13 Can you tell me what the attitude to stillbirth is amongst your colleagues? Is it something that you talk about?
26.22 Yeah we do talk about it and… it’s when it happens it’s always a very big shock really and because we care about the care that we give, we care about the women that we look after and their families… so especially if it’s… a lady that we have been looking after that unfortunately has had a stillbirth then we all do get affected and want to know, you know, what… why? What’s happened? What… we talk about the… we talk about things in great detail in the office and you know could anything have been done differently? Things like that. So… and we do, you know, unfortunately in the rare cases when something could have been different, we do have serious case reviews and risk assessments and all that kind of stuff. And sometimes things are presented back to the whole team… if there has been something that as professionals we could have done differently to maybe have a different outcome.
27.39 What facilities and support can you offer families? You mentioned a bit earlier on that you’d taken some footprints and fingerprints; can you tell me a little bit more about that?
27.51 Yeah, so, we do provide little memory boxes for families, so it might be… little blankets or clothes that the baby’s been wearing. We’ve got little boxes for… you can a take piece… we cut a little locket of their hair – if the parents want. We take photographs – not all parents want to see the photographs, but put them in envelopes and the parents can take them with them and open them when they want, or they don’t want to sometimes they’ll get kept in the notes and… the notes are kept for at least 25 years, so if anybody ever wanted to come back and look at them in the future, then they’re there to come and have a look at.
28.42 Yeah… taking handprints and footprints and put these on little cards that parents can keep. We usually… keep the name bands for the parents that the babies had, so they can keep all these little memories and keepsakes in a box. And sometimes parents never look… don’t at them for a very long time but, they’re there if they ever want to have them.
29.12 And then, apart from that, we do have the support groups, where parents can come – coffee mornings and things like that. Some are with parents who don’t have other children, because we know it’s painful sometimes if you go somewhere where there are children as well. And some are with parents who’ve got other children as well and also lost a baby. So there’s different ways to support them afterwards and then they get signposted as well to other wider support groups, like Sands and… places… and counselling and things like that, so they can provide extra support if they’re needing it.
29.58 And how important as a community midwife, do you think it is to help families have memories?
30.07 I think it’s really important… even if it’s not something they want to look at right now it’s there for them… to… this… to acknowledge and to know that this baby was a… was and still will be a part of their lives forever. And I think it helps with their, their own grieving and the rest of the family’s grieving, to have these memories and to… whatever it might be – they might write a poem, they might write their thoughts, they mightn’t do anything and just put in this box – the cards that they get from people. It can be part of the working through the grief and healing through the grief for the parents. So, I think it’s really important to provide that, but if parents don’t want it, that’s fine too, you know. But, it’s… it’s an important step in the grief process.
31.16 Can you tell me about how as a community midwife you’re able to support and help fathers in this situation?
31.28 We… we’re there for the whole family basically. And we do… I think in the past perhaps fathers have been left out of it a little bit and we’re… but we’re really aware that this is dad’s loss as well as mum’s loss and… so I will always be speaking to the fathers as well when they’re in their home, asking how they are and what kind of support they’ve got for each other as well. And fathers are equally invited and welcome to the support groups and… and the counselling sessions and everything that we provide. So, really we… we tried to look at it as a whole family support thing not just focusing on the woman – even though there might be some specific health / midwifery things that we need to do with the women.
32.30 With regard to stillbirth, are there any changes that you would like to see in the care that is offered to parents and families?
32.43 The… the way it is at the moment… you know, I think – particularly where I work – they’ve done a lot of work with supporting women with stillbirth and… I would personally like, as a community midwife, to be a little bit more connected with the bereavement team, because they’re not coming out to the house and we’re not going into their clinic appointments either.
33.12 So… maybe even we could have like a bereavement liaison community midwife or something? And I have personally tried – they have like a bereavement forum where the doctors meet and the bereavement midwives meet and I have attended one. But, I’d like it a be bit more intentional, so that we can understand a little bit more of the processes – like about the paperwork and how helping parents to direct them to the right funeral services and things like that. Because all that kind of information, I always feel a little bit inadequately prepared to answer if parents ask me and I have to refer them off to there. So little bit more… coherent working between us two really… between the hospital and the community.
34.09 How important is it to address the issues of education and the awareness of stillbirth generally when dealing out in the community with GPs and families?
32.23 I think it’s, it’s really important. I think, from my own like study of what professionals say, it seems that we often times getting it wrong and… you know, amongst professionals, what women have actually described professionals saying to them – like not just midwives but doctors, and other family members and other people – saying things like, oh, well you can try again. Or, you know, never mind you… or… you know, like, just silly words that you’re trying to say something to help someone, but ended up… ending up like just hurting them further, so… I think… you know, understanding that… just understanding more as a whole group of professionals and educating people in general about stillbirth and how to react better is really important. Yeah.
35.30 Can I ask you about… now that you’re pregnant – if you tell me how pregnant you are – but can you tell me a bit about how that’s impacted upon your role as a community midwife and maybe dealing with these issues of stillbirth and loss?
35.49 Yeah, I mean this is my first baby and I’m 27 weeks now. So, I kind of think if the baby is born now then at least it will be okay like: so, you think! I think, as a midwife you start thinking of it differently and like getting a little bit paranoid about movements and things like that. I recently went… to my… with my cousin who had a stillbirth two years ago, and they were having like a memory time – on the baby’s birthday – which they invited me to because I’d supported them quite a lot after having… their stillbirth. And, I didn’t think it would affect me as much as it did actually, but being pregnant I think… I don’t know, it made me much more… acutely aware of my own baby and…
36.55 … you know, you start worrying about your own baby and things like that and… a little bit more than I thought it personally would affect me… so they’ve… again they’ve asked… they’ve never looked at the photographs of their baby. And they’ve just asked me, a few days ago, if I would join them when they have a look at the photos of Paul… And I was just speaking to my husband last night and saying, you know what, I don’t think I’m going to do that whilst I’m pregnant because I feel like it be a bit… much for me personally. They’ll be all right about that – I know they will be fine about it, but… it certainly affects you – when you’re pregnant as well – in a different manner.
37.47 And you mentioned your husband there, but as a midwife, you know, is there support that you can… extra support you can get, you know, to talk about that issue of, you know, your professional and your personal situations maybe, you know, impacting upon each other?
38.06 Yeah, I mean my husband’s really good and he’ll sit there and listen to me and… he’s… he’s fine and… I’ve got wider support in my family – with my mum – and even within my church family and stuff like that. So it’s not a… I’ve got plenty of support to speak about that and… you know, you don’t… I don’t speak about it to everybody, but you have those certain people that you do speak to and they’re great sources of keeping your head straight too.
38.49 Are there any reflections – or advice – that you would like to offer your colleagues or your families in relation to working with families who’ve had stillbirth and dealing with grief?
39.08 I’ve probably said it a few times now, but I feel like the most important thing is to… not try and say something to make it better, because you can’t. So trying to limit yourself to saying, I’m sorry for your loss – in terms of the words. And not being afraid to… to ask like, what’s your baby’s name? If they want to show you pictures, not being afraid to look at that and… just say, you know, your baby’s beautiful. And, and not to shy away acknowledging the life that was and the life that will continue to impact on the family’s life for the rest of their lives.
40.09 You mentioned about your church family and I wondered if you wanted to say anything about how your religious beliefs affect your attitude towards pregnancy and loss?
40.25 Yeah, I’m a Christian and I think it does… you know, being a Christian affects every part of my life and is even part of why I wanted to be a midwife in the first place because it was… originally I thought I would take it abroad and do some kind of like mission kind of work in the Third World as well – and maybe I will one day. But, for me, being a Christian like and… my attitude towards pregnancy and loss… from the moment of conception, I believe that that is a life. I believe that every life has got real value and… I want to acknowledge that in the care I give. I know that this is not what God intends for people – to lose babies and go through horrible, terrible experiences – but I believe, you know, the world is… in this world like – and in this life – bad things happen, but God is not the author of these things and he can be a great source of comfort, to help you through these things.
41.48 So part of me, I suppose part of me, when I’m caring for someone who’s lost a baby – whether that’s an early pregnancy or right up to term – I want to provide a sense of love for that family in their grief and to know that their… I don’t know like to… to give that love that I know that God wants to impart on them, really. And, hopefully they can gain strength in their own families and their own faith and everything. But, for me when I think about it, I feel like God’s heart is breaking for them – whatever religion they are – and I try to provide support – yeah, as professional midwife – but I am a Christian too, and I want to provide support for people who’ve got… who are grieving.
42.58 And finally is there anything that you would like to add – or that you feel that I haven’t addressed – that you as a community midwife would like people to know about?
43.13 I was just thinking about touch really. Sometimes I give women hugs, or just hold their hand, or… something like that. And it’s a funny thing because I’m not really a huggy, touchy person myself and so I won’t do it unless I feel like it’s… appropriate to do it, but I think sometimes just reaching out to somebody physically is ok too. And… it’s still professional, but, you know, your just providing that little extra touch – and it might not always be appropriate and that’s fine, but… yeah.
43.55 The other thing that I was just thinking about is, often when we’re going to somebody’s house who’s had a stillbirth, the way it is where I work, you don’t necessarily even… maybe never ever met that person before and you don’t know what you going into, so sometimes it’s a little bit… like you take a deep breath, because you don’t know whether you’re going to walk into somebody who’s completely broken down; someone who’s numb with shock; somebody who is going to be angry and want to have a lot of questions about what’s gone on, or… so sometimes, it’s, you know… it’s quite daunting – especially when you’re quite new to this kind of thing – because, you’re trying to be sensitive you know it’s a terrible time for the family… it’s just that, you know, you don’t… we don’t know what we’re walking into. And we have to like react on our feet to whatever that… the state of the emotions are at that moment.
44.58 And… we hope then… and want to react in a right way… the best way, you know, and be able to answer the questions in the most sensitive way and… and to support the families in the right way. But it’s not easy. Sometimes you just literally might never have met them, you don’t have a relationship with them, and then you’ve got to suddenly walk in on a very, very… intimate and difficult time in these people’s lives. And you don’t want to walk in with huge big, clumbering boots; you want to be a positive part of that.
45.38 And is there anything that you – being aware of this – can do to prepare yourself, or you would advise other midwives to think about or prepare themselves for?
45.51 Whatever notes – you’ve usually got some sort of brief about what’s happened on paper – so if there’s anything on there that’s like… got a question mark over it, I would ring the ward for more information. Speak… try and speak to a midwife who’s looked after them on the ward. Make sure you’ve looked at the gender of the baby and how many weeks old… you know, the little details so that you’re not like… looking like you don’t know anything at all.
46.24 So try to be prepared as you can about the situation… before you walk in. Certainly helps because it’s just not very helpful for the parents, if you then saying, oh, was it a girl or boy? Or whatever, you know like it’s… look like you’ve actually taken an interest in what’s happened before. That’s what I would advise.
Katy has been a midwife in the North of England for 10 years. For the last seven years she has worked as a community midwife in a diverse, multicultural area. At the time of interview she was 27 weeks pregnant with her first child.