1.Can you tell us a bit about your job as an independent midwife? What influenced your decision to choose this career path? (include a few words about your personal as well as business development, please)
I trained at the University of Leeds and at St James’ teaching hospital, I found the experience of being a student in a large tertiary unit really useful but I never felt at home in a hospital environment. Birth is inherently a normal process that can occasionally not go to plan, and I could see the influence of being in a place so unfamiliar to them, the women did not labour in the way we had been taught about.
I got my first job as a midwife on a NHS Homebirth team where I had an opportunity to caseload women and be with them while they had their babies at home. It was so amazing and I knew that I wanted to continue my career caseloading full-time and focusing on being with a woman at her home while she welcomed her baby.
I found that the NHS was not structured to support the women that needed extra support during pregnancy and in the postnatal period and very rarely did women see the same midwife more than once. This meant that they would get conflicting advice and feel really unsure what to do at any point in the journey of welcoming their baby into the world.
I came to independent practice because I wanted to give women this time and couldn’t deny the scientific evidence supporting this type of care, showing a reduction in adverse outcomes for women.
It also is a much more enjoyable way for me to work and to continue to develop my practice.
I moved back up to be closer to family and have been working on building a practice since then, liaising with local birth workers and NHS trusts.
2. What are the benefits of hiring an independent midwife? (what service can be provided and how flexible it is)
Hiring an independent midwife means that you get more time than a 20 minute clinic appointment, usually appointments last for a few hours, so that there is time to go through everything that you might want to talk about surrounding, pregnancy and having your new baby. It also means that I will be there at the birth with you. We will focus on discussing everything around birth so that I know exactly what your ideal birth looks like, what is important to you and dispel any fears you may have ahead of time.
I can do one-off appointments to plan you birth and I can do a full package of care, from booking in until 28 days after birth. I can provide a homebirth service and I can come with you into hospital as a birth support. Independent midwives cannot provide clinical care in a hospital setting unless we are employed by that trust.
Being an independent midwife you have more time to focus on each client that you have so you can spend the time doing research around different things specific to them, so I can come to you with lots of information so that you feel able to make the best choice around your care at each step of the way. I work with you so that you feel empowered to make the right choice for you in every situation.
3. There is a visible trend in various media putting more and more focus on ‘empowering women during labour’. What does this mean to you?
Empowering women to me is the ethos of why I want to be a midwife. I have seen time and time again, the impact of a birth where a woman does not feel empowered to make her own choices. We as midwives are so privileged to support women through a very vulnerable time in their lives where they feel very raw and exposed. Getting it right and having that woman leave the experience feeling like she faced each challenge with a supportive team, confidence in her own ability to know what is best for her baby and her body, is paramount. That is the feeling I want all women to have when they birth their baby. It is a powerful experience and one that will change you forever for the better if you feel empowered so that you are making the care decisions and the healthcare team are simply telling you what your options are, whether it’s choosing to have a blood test or where you want to have your baby.
4. What techniques can be used during labour to offer active support and empowerment?
I like to prepare women before labour so that they know what I can offer on the day and what they can opt to have. If I am caring for someone I have never met before in labour I like to come in and say, “What would you like me to do for you?” because I am a service provider, it is then up to that woman to opt in to each part of the service.
I explain why I am going to monitor the baby in labour and why I might suggest a walk up and down some stairs. You need to feel in control of what service you receive to support the birth that you are having.
Every woman has an amazing intuition and I consider listening to that as a vital part of assessing the birth and its progress.
Overall I like to be a cheerleader for the woman, and sometimes that looks like sitting in the next room and listening intently to each change of labour and sometimes it is massaging her back through each surge and reassuring her that she is safe.
5. What can a birthing mother do to feel empowered and to preserve her strength and control during labour? (how to prepare yourself)
Trust your instincts! If you want to sleep, sleep! If you want to eat, eat! Move around in the way that your body is telling you too, because it is amazing at what your body can do without any help at all.
I would also recommend reading up on some books such as “The positive birth book” it goes through the stages of labour in a different way and I think it is pretty accurate, each phase of labour is a different length in each person, and no one has any idea how labour will be.
I would also recommend going along to a support group like a positive birth movement as it is a great chance to talk to birth nerds like me and ask them lots of questions.
Don’t be afraid to say, “all I want is a sleep right now, what are the pros and cons of leaving everything as it is so that I can feel better rested?” often there are policies and procedures in place that dictate a certain timeline for birth, but would you apply the same timeline to another physical process like going to the bathroom or having sex? No, because our bodies aren’t machines!
The importance of having someone that you trust with you at that time cannot be underestimated, so have a chat with your birth partners and make sure they know what your preferences are in labour and can help you feel safe during this time. Mark Harris’ “Men, Love & Birth” is an excellent book for male partners.
Jelly babies are a good energy boost for the final hurdle too!
6. Negative birthing experience. What can be done to avoid them and what help can be offered to women to overcome the trauma?
I find a negative birth experiences comes from when you feel your autonomy has been stripped away and you feel utterly powerless. This can be avoided by taking time to think through what each of your options are before making a decision. If you have had a negative experience, most NHS trusts have a service where you can de-brief with your hospital notes with a midwife from that trust. It is also something that I offer if your trust doesn’t do this, and you can ask for a copy of your notes from the trust to look through. Sometimes, it isn’t about the facts of the birth though, sometimes it is just a lasting feeling from the experience. This can be helped by talking to someone like a councillor, a peer support group or a birth worker who specialises in trauma. There are a few practitioners that use 3 step rewind to reprocess trauma into something more neutral or even positive.
7. Hospital birth has it’s pros and cons. To me the most significant problem lays in the lack of flexibility for individual cases and strict guidance set by hospital procedures. There’s only this much time given for the placenta to come out, or there may be restrictions for the active labour if certain rooms are unavailable. What are your views on this problem, please?
I think it is an inherent problem of birthing with an NHS trust in a hospital, there is an inflexible timeline that birth must stick to and deviation from this is seen as a failure of the hospital to ‘induce labour’ or ‘failure to progress’ both horrible concepts that often leave the woman feeling her body has failed her! Such a dangerous message to leave someone with about their body and its capabilities.
As a student I only saw active labour with no drugs when women came in the latest stages of labour. Usually the instant that a woman needed a rest or there was any fear, it was managed with drugs. I couldn’t understand why so many women were being dragged across the finish line with drugs in their first labour because things ‘slowed down’. This often resulted in an instrumental delivery after hours of forced pushing with an already exhausted body deprived of food and sleep. Or an emergency caesarean because the baby became too distressed! Then when they returned for their second birth often they required no intervention and our role was to simply catch their baby.
Being with women at home, I have noticed that often listening to intuition and looking at the big picture, the surges slowed down and become more uncomfortable as I am talking to her or there is a change of scenery, yet when she is quite and “zoned out” she copes well with surges and they are coming very powerfully. Oxytocin is the hormone that powers labour and it is also the hormone of love. You would never dream of going to hospital to conceive your baby in front of monitors keeping track of your heart rate and an audience, it would never happen! So why do we expect birth, a process that uses the same hormones and reproductive organ to be any different?
8. What in general should change in order for women to have more positive birthing experience. Not just in relation to the NHS care, but in general. What can be done and how can partners and other family members contribute as well?
In terms of partners for the birth, have a chat about what each of your hopes and fears for the birth are and how you would like to approach each aspect of this. Birth is a really exposing environment emotionally and talking through things that are on your mind will help you feel more confident that you understand each other and how you can work as a team to meet your baby.
After birth you will feel completely overwhelmed and experience every emotion you have, this is a great time for you to retreat to your safe space with your loved ones to do what they do best, smother you in love. Drop food round, do the dishes, make the bed, put some washing on and the leave again! There will be plenty of time for them to get to know your baby when you have figured out what noise means I want food, and what means I need my mum. You should not have a parade of visitors or go out and do the weekly shop when you haven’t slept all night. Your body and your mind will recover better if you snuggle down in bed next to your baby every opportunity that you get. This idea of having your body bounce back and having a sleep schedule is not being kind to yourself, let the older kids watch TV all day, pull all your friends in to help you out. We need to go back to having the community of support where a woman used to stay in hospital for rest after a baby, this could be a whole week! Help a new mother out by doing, don’t just ask to hold the baby, and forget what she needs.
In terms of what should systematically change, the ideal standard of care would be for every woman to have plenty of time with a care provider she trusts through each part of pregnancy, birth and the new baby phase. The reality of the NHS system is that we can access amazing quality emergency care when we needs it and there is no question that doctors and midwives in the NHS save multiple lives every day. However it is not the best system for encouraging normal physiological birth, as it can often feel like a conveyor belt, not just for the women but for the staff too. No sooner have you watched a baby being born into the world than do you have your team lead knocking on the door asking how long before you can take another patient who is having the urge to push on the antenatal ward.
The NHS needs more staff, and it needs to take better care of the staff it already has to that there are passionate midwives who have time to remain passionate about each and every woman and family they help to welcome their new baby.
Until that day, accessing extra services like an Independent Midwife is the best way of achieving an empowering and positive birth.
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