Ruth, student midwife

0.00 I’m Ruth and I am halfway through my second year training as a student midwife.

0.06 Can I ask you Ruth what initially attracted you to midwifery?

0.10 I mean, I think it was something that I was quite interested in even before Scarlett died, to be honest. I think I just find it really interesting. I’ve always found science, biology, just really fascinating – really incredible… but I’d never really properly considered it as a career I don’t think, until after Scarlett died. And it was very much driven by the experience I had and the… the amazing care and support that I had from the team around me at the hospital where I gave birth… just, I just felt like I don’t think I could have got through it all without them and I’d like, I felt like I would like to be able to give some of that back to somebody else and that it would make a difference, and somehow I’d be doing something in Scarlett’s name… And, it’s probably quite an extreme thing to do, but you know I’m loving it. I definitely don’t regret it at the moment… and the experience I’ve had – so far at least – I feel like it’s been the right decision… and I’m able to use my own experiences to help other people get through similar situations.

1.15 Can you tell me about Scarlett and who she is and what your experiences with Scarlett were?

1.22 So, Scarlett was my first baby. She was born in… November 2011 and she died when I was 32 weeks pregnant… She… it was a very normal pregnancy. I had no reason to think anything would go particularly wrong, and as with I think a lot of people, the only real thing I can say looking back, is that she didn’t move so much in the few days before she died. And I sort of put it off and didn’t go to the hospital and then by the time I did go she’d already died.  So, I then gave birth three days later… and she was very beautiful and is an important part of our family and will always be… and yeah, that’s kind of who she is really… I… she was… She’s, you know, she’s had a huge impact on my life… and she wouldn’t be, I wouldn’t be the person I am now if it wasn’t for her… yeah, just very, very precious.

2.38 How long after Scarlett’s death did you make the decision that you wanted to become a midwife?

2.46 I think it was almost instant. I mean it can’t have been literally instant, but I think it was very, very soon afterwards I think, maybe within a couple of months. Probably really after I’d started to have a lot more contact with the bereavement midwife who was looking after me. I think that’s probably what did it… because in the immediate aftermath I had a lot of contact with her, a lot of support – a lot of emotional support, but also sort of a lot of sort of clinical support, in the sense that, I found seeing a counsellor was helpful for a couple of sessions, but then I remember just thinking I was going over the same things over and over again. And because of the sort of person I am, I’m very scientifically minded and I wanted to understand what had happened? Why it had happened? What were the chances of it happening again? Would I ever have a baby? – bearing in mind I had a miscarriage before Scarlett as well.

3.42 So, I was starting to face those horrible days of what’s wrong with me, can I ever do this and so I needed to understand why and what it meant for me in the future and those kinds of answers weren’t ever going to come from a counsellor – because she was only there, to give me really, emotional support and to give me someone to talk to. And I’ve never really had a problem with talking to somebody, so I was able to do that outside of those sessions really.  

4.09 Whereas the bereavement midwife was able to kind of go on this… I guess a sort of scientific journey with me, in understanding a lot more about pregnancy, what can go wrong and actually, frankly, I think it’s amazing that any of us ever go right, because it’s just so incredible. And maybe it’s that – part of that journey – that made me become interested in it, and made me become really, really interested in pregnancy… So, yeah that was probably, probably what… what made me want to look into it.  

4.44 And then I had a number miscarriages afterwards and so again that journey continued… And I got to know quite a lot of other clinicians – be it sort of doctors in other sort of specialist hospitals, or other midwives that I came across over the course of that journey. And every time… you know, people were giving me care in various different aspects of my, sort of, obstetric life, but all those people were incredibly inspirational and I think I’m very lucky to say that I don’t feel like I could have had better care.

5.19 I feel like everything that was done for me, has made a positive difference to me. And that’s a very inspirational experience. It makes me… you know, really determined to be the sort of midwife that I want to be… and I… and I know I’m lucky. You know, I’ve met a lot of other parents who’ve lost babies over the last 5 years and it’s heartbreaking when you hear some of their stories. And some of it is just down to really poor care afterwards – really poor sort of emotional support and then support through their subsequent pregnancies and not understanding quite what having a stillbirth or… or a miscarriage, or to be honest, any kind of baby loss, it doesn’t have to be you know, a stillbirth at term or a neonatal death or whatever. Gestation is no indication I think of grief and everyone grieves very differently.

6.21 But I feel like… you know, it’s very, very sad when you hear that people have not had that support. And then sometimes it’s sort of clinical negligence issues. And I have to say that terrifies me – it really does terrify me – because I’m going into this because I want to make a difference to those people. I want to make difference and make sure that they… do have the support that they need and that they have someone to come to with their questions.  And I know I won’t be able to give them the answers, but maybe I can give them some ways of thinking about it so they… they feel like they’re in control of what’s going on. Maybe that… that’s it: it’s control. It’s… it’s feeling like you are somehow in control of your body which is totally uncontrollable. And that’s what the support I had gave me, and that’s what I would like to give to other people.

7.11 But if, you know, things go wrong sometimes and health care professionals are fundamentally still human beings and human beings make mistakes and the thought that I could at some point in my training… in the course of my career, do something that could lead to a negative outcome… is terrifying. You know, and I would hope I would never do anything that, you know, I’d knowingly do wrong, but sometimes accidents happen. Sometimes, you know, you miss warning signals or… you know, CTG’s, [cardiotocography], so the sort of… the way of monitoring baby’s heartbeats when you’re in labour or when you’re pregnant – particularly if you’re high risk or there’s anything you’re worried about with the baby, you would put a CTG on.

8.03 And they’re known to be subjective and lots of people will look at them in different ways and it’s something that I know I feel as a student, I know I don’t think I have good enough training in at the moment and it’s something that I’m addressing, because I want to feel like I can interpret them in the best way possible. But I might make a mistake one day and if I do that and it leads to the death of a baby, I actually don’t know what that will do to me. I feel like I’m quite a strong person, I feel like I can cope with looking after people who are going through stillbirths. I feel like I can give good advice in helping to prevent stillbirth where possible, but if… if I make a mistake that’s pretty, pretty scary.

8.44 And I don’t think I’ve really necessarily had any sort of training in… in… in how to cope when that sort of thing happens. I don’t think it’s something that really we cover at university. It’s more about trying to avoid the mistakes, obviously, but there’s nothing that has really sort of prepared me for what happens if something does go wrong. I guess I’ll find out at some point maybe.

9.09 That brings me to asking about your training. Have you been taught about stillbirth in your training so far?

9.19 Yeah we’ve been given some training… In the first year we had a sort of an afternoon, so a three hour session, which doesn’t sound very much, but actually my course is very… its actually quite low on contact hours. There’s a lot of… I guess, a lot of emphasis – as with a lot of adult learning courses – to… to give you, the bare bones and then get you to go away and research things. So, but we did have a three hour session, so that for us was quite a long period of time where someone came and talked to us about stillbirth and we listened to some… we watched some videos – clips of bereaved parents talking about their experiences. And we were able to have an open discussion, and actually there’s somebody else on my course who has also been through a stillbirth and we’ve had very, very different experiences.

10.07 She had a really, really challenging situation where there was clinical negligence, whereas I had almost the opposite extreme, in terms of my experience. And I think what we were able to bring to the discussion, people found helpful. But I’m very conscious that everybody feels very differently about their own experience and so I’m… I’m always very conscious when I talk about my experience, I sort of, always open with, this is how I felt about it, this is what I found useful, but don’t assume this will be the same for everybody because everybody feels very differently. Everybody grieves very differently. Everybody approaches it very differently.

10.43 But, so we had that big discussion, then within the hospital that I work in, we had a session, again another maybe hour or two with the bereavement midwife there – who interestingly operates in a very different way to the bereavement midwife that I had looking after me. And I don’t think there’s any magic way of dealing with it. I think one of the challenges that she struggles with is that the hospital I work at is a very big unit, it’s a very high-risk unit, we have a lot of high-risk women and as a result we do have quite a lot of women coming through the doors, who have… who have stillbirths or neonatal deaths. And so… there is quite a lot of it at the hospital and I think it’s one woman and I think she struggles to give a lot of the emotional follow up for a long period of time that my bereavement midwife was able to give me.

11.33 And I think… I think it’s really sad because I think that’s what the women are crying out for. But, as I say, she’s only one woman, how much funding is there for these people at the hospital? So, she’s very good at giving you the, this is what you need to do, as a midwife, these are all the forms you need to fill in, these are the things we can offer the parents, these are the facilities that we have, this is the set up.  But I don’t feel like we necessarily got a lot of training from her in terms of what to say and how to behave with someone.

12.03 And so… actually it was interesting only a couple of weeks ago… we have sessions at university, when we are in a placement block, so we are working at the hospital, we have sessions where we go back into the university for a day and we have training. It’s called Campus-Based Skills and you’re working on things that you feel you need more training on but you’d like to practise them in a safe environment where you’re not practising on women or babies.

12.30 And the university’s great in that you can choose what you want to study. So the first session is always a bit of a reflection about what we’re finding difficult or experiences that we’ve had, that we’d like more support or training or more information on. And the last session that we went to, bereavement came up as being something that people felt very unsure about how to support women – but actually something that everybody desperately wanted to do right.

12.59 I think… I think certainly the students I’m with – and there are, you know, 50 odd of us – feel very strongly it’s something they would like to do, that they would like to do well and they’re very aware that what they do or say… can have a massive impact on that woman’s experience. Not only at the time they’re delivering that baby or at the time they receive the diagnosis or whatever, but actually their whole sort of grieving process and how they cope with what’s happened and how they, sort of, rebuild their life afterwards.

13.30 So, I think it’s great that people have that awareness, but they don’t necessarily feel they’re equipped to deal with that. You know, when you’re in a room with a woman who is in labour, it can be quite a long time and… you know, if somebody’s having a baby that is healthy and fine, it can be a wonderful experience and there can be a lot of chat, all the family can all be there and they can be chatting to each other and you can… you can have some really fun times sometimes. I mean, don’t get me wrong not every labour is like that, but, you know, it can be a really, really lovely atmosphere to be in. But it can be a long time, and if you’re facing a 12 hour shift, sometimes without a break, because people are stretched and we’re understaffed – 12 hours in a room with a woman who is literally on her knees with grief, is incredibly difficult. And even if you think you’re the best person in the world with supporting someone, you can run out of things to say quite quickly.

14.24 So I think people don’t feel… necessarily well equipped to deal with that yet. So the university have said, okay, we’re gonna put on… they’ve actually given us a whole extra day of training which is amazing. They’ve listened to what we’ve said, and… and so, I don’t know when it’s going to be, but some point over the course of the second year, they’re going to get somebody to come in and talk to us about bereavement training and… and specifically dealing with, you know, what to say, how to support women, how you can help them create memories, how you get them through a very difficult labour – so that’s going to be great. I don’t who’s, I don’t know the details about it yet. But then on top of that our midwifery society, I’ve sort of fed that information back to the… the chairwoman of that and she’s going to try and get in touch with Sands to get them to come and do one of their bereavement training days – which they do for students as well as qualified midwives. And I think it’s probably a slightly different training package, depending on where you are in your career or training. So I think we’re going to get quite a lot.

15.27 Again universities are all different, so… I’m sure everybody has to have some training. But I don’t know how good other universities are at providing that level of… I guess choice, really, in terms of how you want to go about your training and what areas you need more support in. So yeah, no… it will be really interesting… to see what other people have to say. Because as I say, I’m very conscious that my experience is very personal and I feel like I went through a very positive grieving process. I had a… a wonderful delivery. I feel very proud of how I got through the time, you know, people find it amazing when I say, actually we had some laughs in my labour. You know, I distinctly remember watching you know, reality TV programmes and having a really good giggle and eating lasagne whilst having gas and air at the same time. And it’s all a bit surreal, but it was because I was surrounded by the people that I love, who were able to give me support, and incredibly supportive midwives who joined in sometimes when it was appropriate and gave us space when it was appropriate not to. And emotions were up and down but the way they coped with it was brilliant and it made a big difference to me. But I don’t want to transfer that automatically onto every woman I ever deal with because not everyone’s like me, you know, so…

16.45 Have you, as of yet, had to care for a family going through a stillbirth?

16.52 I guess, with a technical definition of stillbirth no – and I haven’t looked after anybody in labour who’s gone through any kind of baby loss. I have looked after… I’ve been to visit somebody postnatally at home, after they had what we would term as a late miscarriage. So she was 19 weeks when she lost her baby. And… I… it was a busy day, we had 6 people to go and see and I think we purposely left her till the end, because we felt like she might need more time and we didn’t want to feel like we were having to rush because we needed to go and see somebody else.

17.31 And so I sort of built it up all day in my head and I was really nervous about it, because it was my first experience of it and I remember… being really worried that I wouldn’t be able to cope. You don’t really know how you’re going to cope until you’re in that situation and… anyway so I went in with the midwife that I was working with and she sort of started, she sort of led the sort of meeting – I don’t really call it an appointment – but the sort of session we had with her, and… and she was great. I don’t think she said anything wrong, but it became quite apparent to me, I felt, that she didn’t necessarily have all the tools to be able support the woman because she didn’t necessarily know what support there was available for her.  

18.15 So I sort of… you know, I guess… took over, sounds like I was kind of coming in; I wasn’t really taking over like that, but I guess I sort of began to lead the conversation a bit more. And so I talked about Sands. You know, this poor woman had never even heard of Sands and I think it’s really sad that she left the hospital with nobody having told her of the existence of Sands. So I was able to tell her who they were, what different support they offered… you know, because there’s so much information on their website, they have their… their telephone helpline, but they also have local groups, so I could point her in the direction of the local group.

18.53 And I guess I knew all of that because I’d gone through that phase of trying to find someone who could help me and spending hours trolling through the website and working out what different… levels of support there were for me and what I would find useful. I didn’t access everything that Sands have to offer, but I definitely dipped in and out of different bits of it. But I was able to give her all the numbers and the website and… and no one had told her that. And I think that’s quite sad that no one had ever… had actually had that conversation with her before… before she’d left the hospital. And it may be that she was given a leaflet.

19.29 I think we’re really bad when we discharge people, of giving them a huge great big wad of paper. And I understand why we do it, because when you’ve just had a baby – regardless of whether you’re grieving or not – frankly you’re usually knackered and your brain isn’t necessarily working that well and so your ability to recall any information that’s given to you is quite difficult. So I understand why we give them paper, but sometimes you do end up… I remember when I had my… all my children coming home with this pile of paper that sat on the table for weeks and weeks on end. And then you’d go through and think, oh that would have been quite useful, but you just hadn’t read it because you’re too tired and hadn’t had chance to look at it.

20.06 So it may be, that she’d been given a leaflet but hadn’t read through it… and so actually, that’s where the role of a midwife is great, because you do have that one on one time, and you can go through things with her. But the midwife I was working with didn’t necessarily know all the ins and outs of how Sands works to the same that extent I did. Now similarly there’ll be other areas of my training where I probably won’t have a clue either, you know, there are various complications that can, you know, arise either in pregnancy or postnatally for the woman and… yeah, I’m sure there’ll be situations where I go to a home visit and I’m not armed with as much information. And it’s probably incumbent on me to go and make sure that I know what support there is for various different conditions that women might come across afterwards. But yeah, the midwife I was working with didn’t really know about it.

20.58 And anyway, so we had this long chat with her and I felt like I had this real connection with her and it made me, it’s bad to say that it made me feel good, but actually it did make me feel good, that I had helped this woman… and I think I had helped her. She certainly, sort of, behaved as if what I was saying to her was really useful and… anyway, I walked out of her house afterwards and burst into tears – but happy tears because it was… it was genuinely a huge sense of satisfaction of this is what I am doing this for. This is why I am training to become a midwife and I’m going to be good at this.  And… I was really, really proud.

21.37 So yeah… actually in some ways that was probably quite a good way to start… you know, my sort of exposure to women, going through these kind of challenges and difficulties… because it was just a one off, relatively short visit. And… you know, it’s sort of, on my… very high on my list of things I want to achieve this year – in my second year – is I’d like to look after a woman in labour having a stillbirth, because I feel like I’ve proved to myself that I… that I can do it and I’ll be able to cope and I wont’ be an emotional wreck and it won’t bring up too many difficult memories. I think what it does is it brings up the memories that are helpful. So it brings up the memories of, oh someone did this for me and it made a massive difference. And again it’s not going to be, oh you must do this, it will be a, we could do this for you if you think it’s something that’s helpful.

22.33 So it’s really having a long list of things that can be helpful for people and offering them as and when it’s appropriate. And a huge amount of midwifery is about very quickly building a rapport with the person you’re looking after and working out what is good for them and what is not good for them. And it’s, you know, it’s about asking open ended questions, its about allowing the woman space to talk and… and by listening to what they’re saying being able to then offer them things that are appropriate… So… but again because I know what things are available, then hopefully I’ll be able to offer them more things than, than… sort of your average person would, just because I’ve had sort of personal experience of them or I’ve heard of other people doing things that they found helpful. So yeah, that’s on my list for this year.

23.32 And is that attainable…  is that something that’s possible through your training to ask to be … to care for a woman in that situation?

23.41 Very much so. I mean, I think that’s one thing that’s really interesting about midwifery generally and it’s something really attracted me to it right from the beginning, aside from any you know, desires to look after women through stillbirths. But actually if there’s something you’re interested in, it’s a very flexible career choice, I think. It allows you to follow paths that you think are interesting and areas that you think you will do the most good and… and be able to help the most.

24.12 So, as part of my training, yeah, I man… basically when you rock up, say… say I’ve been posted to labour ward for a period of however many weeks. Usually you’re in a placement area for two or three weeks… I’ll be assigned to a mentor and theoretically you work with that mentor. But when you turn up, there’s always a board up with all the names on it and you know, the gestation and what, where they’re at in their labour and that sort of thing. And will always say on there, if there’s somebody who’s had what we’d term as an intrauterine death. It would be on the board very clearly.

24.48 So there’s absolutely no issue with me, going to the nurse in charge… the midwife in charge of that shift and saying, look this is something that I’m really interested in.  I’d really like to do this. Would it be possible for me to work with, I don’t know, Joyce or Mabel? Or whichever it is… the midwife who’s looking after that woman – even if that’s not my mentor – to say, actually can I work with them today just so I can help look after this woman?

25.11 So… and I think… I have already spoken to the bereavement midwife at the hospital and talked to her about it and she said, yeah and there’s no reason why you can’t do that, as well. So… yeah, it’s something that you can do. I mean, similarly I think some people you know, slightly, you know, they wait until – and I think it’s right – they wait until they are ready to do it. And I’m not sure everybody would want to… to sort of, put themselves in that situation very early on in their training. You know, people feel like they want to have the tools to be able to help women the best before they go into that situation. So yeah… it’s pretty straightforward to do.

25.54 And it… yeah…there are actually some skills you have to get signed off as part of your… so we have a portfolio of skills and you have to get various things signed off over the course of your time in placement. And… there are some on there that are related to bereavement, but its not, as far as I’m aware, certainly in the second year portfolio, there’s nothing in there that says I have cared for a woman whose going through a stillbirth. But you do have to demonstrate you’re aware of things like the Sands memory boxes and that sort of thing, which I guess you can do in discussion with your mentor if you don’t get first hand experience.

26.29 I think in some ways I’m probably quite lucky – if lucky is the right word – in that it’s a busy… a busy maternity unit, a lot of high risk women… just the sheer number of births that we do every year means that you are statistically going to end up with quite a few stillbirths. So, the opportunity will nearly always arise at some point over a three-week period. And… so yeah, so I think I’m probably quite lucky in that sense. People who are working in smaller hospitals or… you know, may not get as many opportunities so maybe it’s more difficult for them, but if the situation arises you can always ask to get involved.

27.09 Sometimes though, it will just get thrown your way and you won’t have asked for it. It will just be there. And again… again, I think if you feel uncomfortable about doing it, you could probably say the first time, do you know what, I don’t feel ready to do this yet, could I work with somebody else today? You couldn’t say that over and over again, because ultimately it’s part of your job as a midwife to support women in all situations.

27.32 But, you probably could, as a student, say, I don’t feel ready to do this yet, and I think that would be fine. But I think it’s a really good thing to do as a student because you are not the primary person responsible for that woman and if you go into a situation where you feel emotionally overwhelmed and you’re not… you don’t feel like you’re coping with it very well, you’re not able to support the woman in the way you want to, you can say, do you know what, I just need to step outside right now. And you can go and have, you know, 10 minutes to yourself, just to sort of compose yourself, process it a bit in your head, and the support’s there for you as well.

28.07 So you’ve got… link lecturers who are from the university, who work at the hospital, or you have what’s called a clinical practice facilitator – so somebody, a midwife based at the hospital who is responsible for all the students and their learning needs. So you can go and debrief with her afterwards, so all that kind of reflection is very helpful as well. So you’ve got the support. So I think actually, it’s a really good thing to do as a student because you’re faced with it in again… in a relatively safe environment where you can step away, you can get support or you can process it in a way where, if the first time you look after a woman going through a stillbirth is when you are a qualified midwife, you don’t have those opportunities to the same extent. So I think it’s a great thing to do as a student.

28.49 And actually, there’s somebody in my cohort who was what we call caseloading a woman. So one of the things you have to do when you’re studying, is caseload 4 to 6 women over the course of your training. So you basically follow them throughout their whole pregnancy. You go to all their appointments, you try and be there when they have their babies and you visit them postnatally. And you, you usually sign these women up when you’re booking them at their first appointment – so some time between 7 and 12 weeks and you go to all their appointments. Now, obviously statistically, some of those women are going to end up having stillbirths and actually, there’s a friend of mine who her very first lady that she caseloaded, that happened to. And I think she coped with it amazingly.

29.31 She’s naturally just somebody who does really well in those kind of situations. She’s incredibly empathetic. But I think she found it hard, but I think – and I hope – but I do think she had quite a lot of support from the people around her to help her sort of cope with it emotionally herself as well. A bit of a baptism of fire I think, with your first one. But she did brilliantly and I think as a result it’s made her really interested in stillbirth, which in itself I think is great, because we need midwives who are interested enough to want to help women in that situation… yeah, no, she was… she was great.

30.09 That brings me quite neatly – I wanted to ask you how as a midwife you separate your personal and your professional response to stillbirth, when you’re caring for a woman or a family in that situation?

30.24 I think it’s rarely appropriate to talk about your own experiences because it’s about the woman, its about her experience, and her experience is likely to be very, very different to yours. Even if you’re quite similar people and you approach things in the same way, I still don’t think it’s appropriate to say, when I went through this I did this. In the same way I wouldn’t do it about my children who’ve been born healthily, I wouldn’t necessarily say to a woman, well I found this helpful…  You know, what you can say is, some people find it appropriate to do x, y and z or have found it helpful to do this. And that might be your personal experience, but equally it might be the experience of other friends that I know who’ve also had stillbirths. Because, what you find is when you have a stillbirth, you hang onto other people who’ve also had stillbirths and you… you learn a lot about how people approach things.

31.20 So it’s personal experience in that it’s… stuff that I’ve learnt outside of midwifery… but yeah, I don’t think it’s ever right to sort of say, I did this. You should do it. But you can, you can use it to… help frame your ideas to give someone that support or ways of making memories, or… it may be something that the hospital doesn’t routinely offer but you know that, either you or other people, have found it appropriate and then it’s a good idea to go to the hospital and say, actually, lots of women I know have found this helpful. It’s really easy to do. Please can we start doing it? Or, can we start offering it to women?

32.00 So you can use your personal life, but you just don’t necessarily word it in such a way… There are times when it’s emotionally challenging. I mean, I’m working in the neonatal unit at the moment. In your second year you do a number of rotations outside of direct midwifery, so you understand how different areas of the hospital interact with each other and, you know, mostly we look after healthy women and they have healthy babies, but obviously complications do occur and sometimes these people, these babies do end up needing special care… because they’ve either… they’ve either got congenital – so they’re born with problems – or things go wrong that were unforeseen or whatever.

32.40 And…yeah, I’ve been looking after a couple of babies in the last few weeks who were born at 25, 26, 27 weeks and some of them have quite complex health needs. But then you… then you come across a baby that was born at 31, 32 weeks and… they’re going home four weeks later and I’ve definitely have had moments where I’m a bit… what if? So, it’s been quite challenging the last couple of weeks actually. But yeah, there have been times when I’ve been like, maybe if I’d have got to the hospital, what would have happened? Would I have had… a baby that was fine just like that baby is? Or actually, would I have had a baby who had of been alive, but had really, really challenging, complex needs for the rest of their live? Potentially a relatively low quality of life or a very difficult quality of life? And… I’m not sure either of those is either good or bad. They’re just… they’re just avenues of thought that you have… and it stirs up a lot of emotions and sometimes can be quite challenging. But, I… I tend to find it doesn’t really affect me during the day when I’m looking after babies. It’s when I’m having a quite moment; so if I’m having a break or when I get home, on my bike ride on the way home – I probably shouldn’t think about things when I’m cycling home like that, but…

33.53 But it is… it is those times when you start to think about it and then you do get emotional about it. You know, I think having a stillbirth is… it sets you up for a lifetime of what ifs. What would they have been like today? What would have happened if I’d done this? And… so it does, it definitely does affect you. But I’ve… so far I’ve not found it… difficult to sort of separate it when I’m at least in the work environment. And actually, midwifery is a very reflective career and… we do a lot of reflection sessions and I think some people sot of think it sounds a bit naff, but it can be really helpful and it’s how you learn, you know. Yes, you can learn on the job but the best way to learn is, take stock of something and then when you’re out of that clinical situation and you’ve got some fresh headspace and you’re not tired, you can then think about what happened? How you dealt with it. Why was it important? What would you do differently next time? And you can go away and read about it or speak to people and try and understand better how to deal with a situation.

35.04 So it lends itself quite well really to having a big emotional… conflict, I guess, within your head because you have… you do get the time and space to work out why you felt the way you did and whether there’s something you can do differently next time. And I think also, it probably all just becomes… is easier the right word? You certainly will… you’ll alter the way you deal with situations the more often you come across them. So, I’m sure over time it will become a bit… easier to cope with emotionally… yeah…

35.41 Can you tell me specifically… if you do feel emotional, what practical things – or things you do do, to deal with that?

35.51 I talk about things. I just… I’m a talker. I’ve always been a big talker. So I will generally talk to my colleagues, sometimes talk to my husband – but I don’t think he necessarily understands it quite to the same extent. I don’t think you can really understand what it is to be a midwife until you’re training to be a midwife. It has demands on it like no other. You know, I did a pretty full on job before I started training to be a midwife but I don’t think I’ve ever worked so hard in my life. And… so yeah, so I do… I talk to people about it a lot, particularly other students because we’re all at the same place to some extent. I talk to other people who have had stillbirths but don’t necessarily, you know, aren’t sort of in a health care role.

36.39 I talk to my bereavement midwife, I’m still in touch with her. I’m lucky we’ve become good friends – so I talk to her about it. And also the sort of… the support at the hospital, so… the… our… our clinical placement facilitator, is, she is amazing. And I happened to mention something on Facebook – of all things – the other day about being in NICU [Neonatal Intensive Care Unit] and saying it making me want to come home and give my boys a… you know, cuddle them tighter sort of thing. I’ve now got two young kids at home, and… and she just, she said, ooh, are you okay? I’m here if you want to talk. And it was… I haven’t needed to talk to her about it, but it’s really lovely to know that the opportunity’s there. So that’s really how I deal with it. And I do think it’s good to sort of try and… park it a little bit if you’re struggling and then come back to it another time.

37.30 But again, as a student you’re able to walk away from a situation if you’re finding it too difficult and I think the whole point of training is to try and throw yourself into as many of these kind of situations as you can, when you’re able to walk away. So that when you’re faced with it as a qualified midwife – when you can’t walk away from it – you’ve got the tools to at least start to know how to deal with these kind of situations.

37.53 But I’ve never had any problem with… with getting the support that I need. And to be honest, I’m sure if I phoned Sands, you know, if I was really struggling, I am sure they would probably still… there’d still be somebody on the end of the phone to talk to me about it. I think they have quite a lot of midwives that are still very much involved with the organisation as well, so… yeah, there’s lots of support out there really.

38.15 Can you tell me a little bit more about the support that’s available to you through your tutors and your training as a midwife in that situation?

38.26 So, I mean, you could probably always talk to the bereavement midwife at the hospital that you’re working at. You know, I do know her. I don’t know her as well as I know my own bereavement midwife, but I think any other student could go and talk to her if they wanted to and I think certainly the colleague of mine who… who had a lady she looked after as a… when she was caseloading her earlier on… she went and spoke to her.

38.54 But I think the key, the two key people that we have is – you have what’s called a link lecturer. They’re somebody based at the university, they are a lecturer from the university but they are associated to your hospital and they tend to come in, you know, sort of once a month – or something like that – and they’ll let you know when they are coming in and you can go and talk to them in placement. Equally they’re always on email or at the university so if you want to go to university you can talk to them there. And I guess the idea is that they are up to speed with the way your hospital works so they would understand the situation you might have been in or… what things there are, you can and can’t do at your hospital. They understand what your trust protocols are and that kind of thing.

39.35 Then you’ve got your clinical practice facilitator who is a midwife at the hospital. And she will – she sort of organises where you’re going to work and any challenges you have with mentors or shifts you can’t do or whatever. She’s your point person from a hospital perspective. But they’re very much there to talk if you’re having any problems. And I would say that I haven’t needed to use ours, but she’s amazing and I know that if I did, I would absolutely go and knock on her door and she would always make time to talk to me, so… so they’re great.

40.06 But then you also have… I have a personal tutor at university who is… she is a midwife – she’s not associated with my Trust particularly ,but she’s generally there for me if I have any problems on the course – and that can be emotional, or it can be academic, or whatever so… in the way you have a personal tutor in most degree courses, they’re there to do the same sort of thing. But I could go to her with those kinds of concerns, or issues, or challenges that I was having.

40.37 So they’re the main people really, but I do think it’s… it’s really important to talk to your colleagues as well. I think the best people to understand how you might feel are people who are also in your situation. So reflective sessions with other student midwives; you know when we have these sessions at university – these campus based skill sessions – the first part of those sessions is always a reflection. So we’ll literally have an hour and a half… and you might think we’re just sitting down and having a good old gossip and sometimes it does just feel like a little bit of a, oh goodness this happened and wasn’t it dreadful? But actually a lot of the time it’s, I was exposed to this and I found this difficult. And somebody else will say, I had exactly the same thing but this is how I dealt with it. And you we will be like, oh, why didn’t I do that? That’s really helpful. You know… you all have similar… similar experiences so I think it’s really, really helpful to talk to other students in the same situation.

41.32 But it also may be that you’re working with a mentor who you really get on with. So when you’re in the hospital you tend to be assigned to what’s called a sign-off mentor in each placement area that you’re working in. So I’ll have a sign-off mentor for antenatal, I’ll have a sign-off mentor for labour, I’ll have a sign-off mentor for postnatal ward, same for community. And you’ll work with them for three weeks at a time and I think your… the NMC, the Nursing Midwifery Council, I think basically dictate that you’re supposed to spend at least 40% of your time with your allocated sign-off mentor. And that allows for the fact that your mentor might be coordinating so they’re not doing much clinical, or they might be on holiday, or you might be ill, or whatever, and you need to make hours up. So you don’t have to spend all your time with them, but you should be spending a really good chunk of your time with them. And sometimes you get on with them and sometimes you don’t – so they can be more or less useful depending on who it is.

42.26 But I’ve been really lucky actually I think I’ve always had brilliant mentors. I don’t think I can think of any time I’ve had mentors I’ve not really enjoyed working with. And… and the general approach I’ve taken to training – and I think it’s a piece of feedback that people often give to new students is – you will get out of training what you put in. And if you’re interested and you ask questions, by and large, your mentors will respond by teaching you and giving you more and then giving you more opportunities and it’s very much a symbiotic relationship. So if you are struggling with something, or you’ve got questions about how to cope with a certain situation, or you want to pick their brains about their experience, that’s what they’re there for, you know. They’re not just there to show you how to take cannulas out and to do vaginal examinations. You know, it’s, it’s very much… it’s very much an emotional thing as well and learning from their experiences.

43.23 So I think there are lots of ways you can… you can approach it, and lots of ways you can get support and lots of ways that you can learn. But sometimes you have to seek it out yourself rather than it being given to you on a plate. But that’s kind of what adult learning is about. But even more so I think in healthcare, because there are so many scenarios that you can come up with. They can’t sit there and say, this will happen to you like this and it will present itself to you in exactly this way. You have to learn from people’s experiences and it may be that an experience is slightly… different to what you’ve experienced, but there are aspects of it that resonate and you can take, you know, different tips and things from… from those situations and apply them to your own.

44.04 You mentioned about talking to your colleagues and the value you find in that. Can you tell me a little bit about some of the attitudes you’ve encountered at work around the subject of stillbirth?

44.18 I think, I think it’s quite mixed. Generally because I’ve been quite open about my experiences I suspect, if somebody was dismissive about it at all, they probably wouldn’t… voice it to me because they probably know that I’d be touchy about it or would quite happily answer back to them about it.  I don’t know. But generally speaking people are very supportive of it. There have been a couple of situations that I’ve found upsetting to hear.

44.49 So… I remember once some midwives talking about a woman who’d delivered a baby at sort of 16 weeks. It was very… it was relatively early. And they wanted to hold the baby and have some time with the baby and… and I remember the midwife sort of talking to another midwife in the office and saying, oh, you know, she wanted to hold this baby but there wasn’t a baby. And it was, you know…

45.12 And I… that really upset me because I just thought, actually to that woman, that was her baby and yes, it might not have looked, you know, in the same way as a term baby would; but it was still her baby and it was probably the most beautiful thing to her. And I’m sure… I mean, she didn’t say these things to the woman, but you know those conversations are happening behind closed doors and I think that’s… terrible. You know, you’ve got to give those women the respect that they deserve, even if the door’s shut behind them.

45.44 So that, that really made me cross but it was quite early on in my training and I didn’t necessarily have the… the guts to speak up about it –  in a way that I think maybe I would now, I don’t know… It’s difficult when you’re hoping to get a job in the Trust that you’re working with as well. But I think we have to have the courage to… to stand up to that kind of attitude because it… it is wrong.

46.05 And I think the only other sort of negative thing you hear is that, you know, it’s not necessarily women that come in with reduced fetal movements regularly, because we take… we do take that seriously because we know that that is an indicator. But it’s if a woman comes in who’s had a whole heap of other problems they’ve come in fo so… or I’ve had itchy hands which can be an indicator of something called obstetric cholestasis, or they’ll come in saying I’ve had blurred vision, which can be an indication of preeclampsia and… and you… and sometimes it can – if you look through their history – it can look a little bit like they’ve read through a list of what can go wrong in pregnancy and they present with every possible symptom. And then they come in with, and say that my baby’s not moving as much. And then you do start to hear midwives slightly questioning it.

46.51 I don’t think it’s necessarily a sort of stillbirth thing. It’s more just attitudes of midwives sometimes towards people that they might view slightly, as being a hypochondriac and they are sort of wanting attention. But actually, do you know what, if it is that they want attention, then that in itself is something that we clinically should be aware of. Why does that woman want attention? What is it that’s going on in their life that means that… that they’re seeking that attention? Is there something else going on at home? Are they, you know, struggling, you know, emotionally to deal with the pregnancy as it is? So that… in itself that’s still a warning sign. But so I do think there can be a tendency to slightly… just sort of slightly brush them aside. We would still give them the clinical attention as per the protocol but you wouldn’t necessarily be engaging your brain as much to, okay what’s going on here? You might just be a bit more dismissive of it.

47.47 But obviously if they came and you put them on the monitor to check how the baby was doing… and the baby looked as though it wasn’t okay, then you would clearly still do something about it. But I think generally we’ve got better about having, you know, good protocols about what to look out for. We’ve recently incorporated – well in the last year or so – incorporated the new, some people call it GAP some people call it GROW, but it’s basically the idea is that you’re measuring people’s tummies during their pregnancy and you are, rather than just saying all women should have tummies that are 20 centimetres big when they’re 20 weeks pregnant – which is roughly what it used to be – we now have a chart which is specific for each woman depending on their age and their ethnicity and the weight of any previous babies they’d had and their height and things like that. And so it’s customised and then you plot it on… on that sort of chart for them.

48.45 We’ve incorporated that recently and we do take it quite seriously if, if you know, women’s tummies aren’t growing in the way that they should be doing – according to the chart. So that’s been a thing that we’ve incorporated recently which is good. I think there have been a lot more scans as a result, but… I think it’s almost… it’s sad but I do think it’s a bit of a sort of checklist. They’re… people do hide a little bit behind protocols; so if the protocol says that someone needs a scan or they need to be monitored because of something that they’ve said, then they’ll do it. Rather than necessarily listening and building up a whole picture of… of quite what’s going on. And you know, it’s difficult to say because some midwives are excellent and some are not so great and that’s the case the world over in every single job you could come across. So it’s difficult to make sweeping statements.

49.40 Generally speaking I think people’s attitudes to stillbirth are, are appropriate, you know, in that it’s a very sad thing and women who go through them need you know… good emotional support. And it’s interesting seeing how midwives respond to women who’ve had experiences and then have subsequent pregnancies. So… you know, I’m often sitting there in the antenatal office vetting through referrals – so you’re looking at people’s previous histories and working out who they need to be seen by, when they need to be seen by and what we should be offering them. And I think it’s sad in the way our hospital works is that we don’t have the opportunity to then refer people for early scans if they’ve had any challenges. We still don’t do anything differently until they hit 12 weeks – which I think is a shame and I think it’s… sometimes it’s not that appropriate either.  

50.34 But , you know, you’ll come across women who’ve had a really challenging, you know, situation – be it multiple miscarriages, be it stillbirths, be it babies born very early – and, you know, sometimes, you’ll… you’ll just sort of read someone’s history and think, oh my goodness, this is horrible. And… and because of the person I am, I tend to sort of share it with whoever, whichever midwife happens to be next to me. I’m like, oh my goodness this poor women listen to what she’s had and you know… and actually you do tend to get a reciprocal response back of, gosh yeah that’s horrible. That poor woman. And sometimes we can refer them to a specialist team in the hospital who are particularly there for vulnerable women.

51.19 One thing that we’re not able to do at our hospital because of how big the unit is and the fact we’ve only got one bereavement midwife, is that, I’m not aware that she then, will look after women subsequently; so caseload them during their next pregnancy, to make sure they’re getting emotional support specifically related to the fact they’ve had a previous stillbirth.

51.39 Whereas the experience that I had with my bereavement midwife is that I was able to go and see her and have contact with her when I needed it in my subsequent pregnancies; which made a big difference to me because she understood my history and my background. And to me that’s what… that’s almost one of the most critical roles of a bereavement midwife, is giving that subsequent support because the next pregnancy is fraught with worries and risks and concerns and… and yes, you know, after you’ve had a stillbirth you are more likely to have another one.

52.12 The risks are still very small, but it’s there, and you know it’s there as that woman going through that pregnancy. And you’re convinced that it’s going to go wrong, because of course it will go wrong. And… and so you need someone to constantly be reminding you that actually it’s a very low risk and we’re looking after you and we’re checking out for stuff and… obviously these women will have extra scans, and those sorts of things, but again it’s the emotional side of things rather than just the… the tests and the checks and the scans and… its having… it’s knowing that you can pick up a phone and talk to somebody, when you… when you want it and I think it’s a shame not all hospitals are able to do that.

52.48 On that note, are there … with regard to stillbirth… are there changes you’d like to see in the care offered to parents generally?

52.57 I mean, I think every hospital should have a bereavement midwife and not all hospitals do. I get the impression that’s changing. I think increasingly hospitals do have them, but not all do, and there are times when actually you need more than one. You know, I think the hospital I work in needs more than one. It’s too big a unit to just have one woman. I think it’s really important that people who’ve had stillbirths have emotional support in their subsequent pregnancies and that means that they need to know who they can pick up the phone to when they’re worried. They need to be able to come in and be monitored, to be honest kind of whenever that they feel they need to be – and it doesn’t… shouldn’t have to be waiting until that woman’s worried about her baby’s movements. It may just be, you know what, I’m having a really bad day today. I’m sacred. Please can I just come in and somebody listen to my baby? And you know that takes 10 minutes to do.

53.51 And I know we’re all very, very busy and… and that’s a challenge. You know the NHS is stretched and maternity units are… are stretched. And I think that’s… quite difficult. I’m not sure what the answer is. I’m pragmatic enough to know that it’s not a bottomless pit of money. And so it is very, very hard to resource… But I do think that women should… should basically be able to come and have, you know, someone listen to their baby, kind of whenever they want.  

54.22 You know, the reality is that, I think, every woman who’s had a stillbirth will have regular growth scans anyway. But again it will depend from hospital to hospital as to how regular those are. So I think in my Trust, you probably get growth scans every 4 weeks and I don’t know enough to know whether anyone can ever request more than that.

54.44 But I know that when I had my pregnancies after losing Scarlett, what was wonderful was at the end of every appointment the consultant – who was the fetal medicine consultant, who was scanning me – would literally start with, so when would you like to see us next? It was very much that I was allowed to dictate my care and that’s what we should be doing. You know, that’s what all the Department of Health recommendations are, is that we should be providing women-centred care. That is the mantra for midwifery care; it’s women-centred care. And so if you have a woman who has these complex needs, particularly complex emotional needs because they’ve had a subsequent… they’ve had a previous stillbirth, then we should be providing them… basically crutches to get them through those next pregnancies. And if it is basically having an appointment once a fortnight, where you… where somebody will listen to your baby, then we should be doing that.

55.43 You know… I know that if I listen in to a baby and the heart beat sounds fine, it’s only indication that the baby is fine at that moment. But to the mum, that might be the difference between getting them through the next week and I know that it isn’t an indictor of how that baby will do over the next week, but that doesn’t matter if it helps that woman. So, I think we need to listen to women more.  We need to just find out what… what will work for them. And I think it’s more difficult with a bigger… bigger unit – unless you have a bigger team of bereavement midwives. You know, where I gave birth it’s a relatively… it’s a smaller unit, so the bereavement midwife there is… has more opportunity to be able to look after these women. I think she’s also Wonder Woman and I don’t know how she actually gets any sleep, ever – because she works so hard. But I think she… I think it’s slightly helpful because it’s not quite as big a unit; so she’s able to look after women more subsequently.  And not every woman will want it. That’s why I come back to the whole women-centred care. You’ve got to ask a woman. Maybe it’s something we should be asking when they come for their booking appointment.

56.52 It should be a part of that initial booking interview. If you’ve got somebody who’s had a previous stillbirth, what can we do for you in this pregnancy that will make it easier for you? You know, would you like to see us more frequently? And the answer may be no. You know, some people are very, very relaxed in their next pregnancy and some people aren’t. So ask them what they need and… you know, within reason we should be able to offer it. I mean ok, we’re not going to… we’re probably not going to admit someone onto an antenatal ward for 9 months, you know… but it would be a very unusual person who would probably want that. But we should be able to have them come in once a week if necessary just to have that bit of reassurance.

57.32 With a woman without a more complicated pregnancy history, how do you talk to women at booking in, about stillbirth?

57.44 I make a point of focusing on reduced fetal movements. But it’s something I really struggle with. The number of times I’ve come out of an appointment – not necessarily a booking appointment – because I think the booking appointment is… there’s a lot of information coming in. So in some ways actually it’s much more important, once you’re getting to 24 weeks plus, to make sure that message about reduced movements is going in. But the number of appointments I come out of where I’m just like what… what… what do I need to say to these women to make them hear what I’m saying? You know, they’re listening but they’re not actually hearing what’s happening. You know, they’ll say, oh yeah, the baby’s not moving very much.  Hasn’t been moving very much for three days but I knew I was coming to see you on Friday, so I didn’t see the point of coming to the hospital. And I’m like, argh! You know, how many times have I told you, do not wait.

58.37 So I think what I definitely say that is… that is different perhaps to the way some other midwives phrase it is, I give the usual spiel of, you know: you need to let us know if your… if your baby is moving less you come into whichever department it is that they come into, but I always say to them, don’t wait until the next day. Even if you’re seeing us a few days later, still come and see us that day. It doesn’t matter what you’re doing, this is the most important thing. Come straight away – which I don’t think other midwives necessarily use that terminology.

59.10 I worry that I’m missing other… other kind of conditions that women may have that are equally just as important, you know. If someone’s having blinding headaches with blurred vision they equally shouldn’t be waiting until they see me three days later either and maybe I need to, sort of, hammer that home a little bit more as well? But obviously stillbirth is really important to me so I do tend to focus on it a lot. But that’s… that’s the really key thing that I say to them. And actually I’ve never yet… I don’t think I’ve ever yet gone as far as saying, your baby might die. Because I think you’ve got to balance that risk. I think I might have done actually when someone had done the classic, oh you know, I… I… I… it’s not been moving as much but I haven’t… I thought I’d come in a few days later. I think I have then said to them, you know… I don’t know, I… no, I’ve never said, your baby might die. But I have thought about whether I should have said it or not. But I… I use different words, so…

1.00.12 Midwives are dreadful at saying, it’s a sign that your baby might not be very happy. You know, happy is a really bad word to use. I tend to try and say things like, it’s a sign your baby might be unwell. It’s something that we would be concerned about. The word concern is a word that really resonates with people I think. So, yeah, it’s something that we would be concerned about. Or, I am concerned about this. So they’re the kind of words that I try and use. And I’m aware that I do focus probably too much on stillbirth, but I don’t think… I don’t think I’ll be able to change that. I think it’s just going to be the sort of midwife that I become; because it’s important, it’s part of my sort of fundamental values of the midwife I want to be.

1.00.57 But it is difficult, it’s really difficult, how do we get women to really listen to what we’re saying? And I’m not sure the booking interview is the most appropriate time to do it. It’s important that we deliver that message but if I say to somebody at seven or eight weeks – I mean, our hospital we book at 12 weeks, but some hospitals will book at seven or eight weeks – if I say to you, oh, if your baby’s not moving very much then you need to come in. They won’t remember that when they’re 24 weeks pregnant. Because frankly at seven weeks they’re still throwing up and generally feeling pretty miserable; they haven’t even thought about their baby moving yet because it’s such a long way away before they’ll feel those movements. In some ways it’s kind of not appropriate and we maybe… we maybe overload women a bit too much in that booking appointment.

1.01.40 Maybe some of the information that we give at that point should be given later. You know, you’re supposed to see somebody at 16 weeks. At our hospital the women see their GPs at 16 weeks and maybe we need to be educating GPs to give this message a little bit more? Because around about 16 weeks you might be starting to feel movement, so it is a point where you can start to put that message into women’s brains. You know, so save some of that information that we give to them at 12 weeks and give it them a little bit later on when it’s perhaps a little bit more appropriate to do so.

1.02.15 From your position as Scarlett’s mum, but also as a student midwife, what advice or words of wisdom would you give to pregnant women about stillbirth?

1.02.30 Nobody knows your baby better than you do. I can tell you all the things in the world that I’ve learnt clinically, and I can tell you statistics, and I can tell you the likelihood of things going wrong or whatever; but all I would say is, you need to listen to your baby, because I can’t feel your baby everyday. You’re the one that… that knows what feels right for you and sometimes it can just be intuition. And sometimes it might be something a bit more obvious, like the baby moving less or… I think… I think when you ask women after they’ve had a stillbirth, a lot of the time they just knew – but they were slightly in denial about it. And I’m saying, don’t be in denial about something. If you think something’s not right, come to the hospital and be bolshy. You know, have the confidence to say, I know my baby. I don’t feel like something is right. Please listen to me.

1.03.29 And… again use the concerned word. Say, I am concerned about my baby. Please will you listen to him or her? Will you just check that everything is okay? Because I guess, you know, healthcare professionals are busy and sometimes miss things and sometimes we shouldn’t be… we’re not as, you know, alert to people’s requests and emotional needs, as we should be. And sometimes you might just have to… be strong and… and… and be noisy about it. But I don’t know your baby – but you do. And that’s really the most important thing, is have that confidence and that courage that, that you know when things don’t feel quite right.

1.04.13 I also wanted to ask about the care following a stillbirth that’s offered to mothers. Do you think the care that’s offered to mothers and fathers is the same?

1.04.25 No [laughs]… But I don’t think they should be offered the same care because they need different care, you know. But again it’s about listening to people. You know, different people cope in different ways and men and women cope in different ways. But some men cope similarly to the way women do and vice versa, you know. You can’t, I don’t think with something like bereavement you can have a one-size-fits-all. It’s a very personal approach. But I do think we tend to forget the dads. And… and that’s something that you can do in the labour room but also postnatally and in subsequent pregnancies.

1.05.04 You know, subsequent pregnancies a lot of the time you might not see the dad. You know, the woman’s coming when they’ve got… they’ve come from work, or whatever, and the dad doesn’t come along to the appointment. And how often do we check in? Maybe, you know, even if we can’t check in with the dad, maybe we should ask the mum, how’s daddy feeling? You know, how’s he coping with it? Is he nervous? Is he… does he need any help? Does he need any support’? You know… and it may not be that the midwife is the appropriate person to give that support, but it maybe that we can point them in the direction of someone that can help them. I think they do tend to get lost. I think, you know, dads often feel that they need to be strong for the mum and… and they sort of bury their feelings and they probably then resurface later… and it becomes quite difficult.

1.05.50 But it’s not just the dads, as well, it’s sort of extended family, you know. And this is coming from me as Scarlett’s mum, rather than necessarily as a student midwife, but… you know, I know that my parents… they felt… they… they… it was really… a really big deal for them, because not only could they see their baby girl going through all this pain, but they’d lost a granddaughter as well; a very much, a very loved, a very wanted granddaughter. And I know that Sands have a section on their website about advice and support for… for extended members of the family, but I don’t think as healthcare professionals we necessarily focus on anybody other than the immediate family.

1.06.30 You know, I said I think dads get forgotten, if dads get forgotten then anyone else is totally out the picture. So, it may just be a question of checking in and asking. You know, often, I think, if you offer support people won’t necessarily take it but they really appreciate the fact that it’s been offered to them. So it could just be as simple as asking, how’s everyone else in the family getting on? Is there anything we can do for you? And the answer will probably be no; but thanks for asking and the fact that you’ve asked has made a world of difference. So I think that’s probably the easiest thing to do, is just ask the question.

1.07.03 Is there anything else you’d like to add that you don’t feel you’ve had an opportunity to say?

1.07.09 I don’t think so, I think you covered everything really… you know, I feel incredibly privileged to be doing what I’m doing. And I really hope I can make a difference. And certainly my experiences so far, I feel like I have – I hope I have. And I’m actually in a weird way looking forward to doing more of it, because then I feel like I will be… you know, achieving what I wanted to achieve, and Scarlett sort of lives on and has a… has a purpose and a meaning in my life. So yeah, I’m loving it. I’m really pleased that I’m doing it. And yeah, I hope I can just carry on making a difference.