Miscarriage & Midwifing

Before continuing to read this please note it may be triggering for those who have experience of baby loss…..please bear this in mind and take care of yourselves before reading further. This is an incredibly personal post so please note all experiences are based on my experience of miscarriage.

I recognize I am a person who processes life events by writing about them. I realized quite soon after my miscarriage that I would need to write about it to help me grieve but now the time has come I don’t really know where to start. I do know I want to reflect on my experience as a student midwife grieving over my lost baby and how I felt/feel.

I started this blog post by doing a quick search for research and other blogs written by midwives who had experienced baby loss but the area is quite sparse. I was surprised by this as midwifery is dominated by women and as miscarriage effects 200,000 couples each year and 1 in 4 pregnancies end in miscarriage (Tommys.org.uk) the chances are a lot of midwives are touched by miscarriage.

I feel like midwives losing babies is a subject not really talked about. Maybe it is discussed among colleagues, friends and peers but my experience is it all feels a little taboo…..like if I talk about it I may be judged as not being able to do my job or might fall apart when taking care of pregnant women….I can’t really verbalise my feelings regarding this other than this was my personal experience of miscarriage as a student midwife. I felt like I needed to just carry on as taking time off may be perceived as a sign of weakness (this is not something I was told by anybody but it was how I felt). This degree is relentless…if I took time off I may never go back so I felt I needed to be ok…to show resilience, put my head down and ‘power through’.

I started my midwifery degree with 3 school age children and felt my family was complete. Both my lovely husband and I were both told, for various reasons, our individual fertility was irreparably damaged so as a couple our chances of conceiving were zilch….which was fine! After a particularly gruelling schedule of placement, exams, essay deadlines, family pressures etc I felt ill…..really ill. More than tired ill and more than stressed ill…I felt dreadful. I have been pregnant 3 times so I recognise the signs. I returned home after my first exam and did a pregnancy test……which was positive!!! I was stunned! Being a StMw (Student Midwife) the first thing I did was calculate my EDD (estimated due date)……our baby was due on our 13th wedding anniversary…..surely this was a sign that the little miracle bean growing inside me was meant to be?

After the shock settled for both me and my husband we started to get excited….this was a door that was firmly closed, bolted, locked and double padlocked! We had been given a chance! I knew the stats….I am 41 for goodness sake! I recited the stats to my husband to try to keep us grounded in the reality that this pregnancy was unlikely to continue but we had got pregnant against the odds so surely I would be ok?!

I went through a whole array of emotions and my thoughts were racing:

I wouldn’t graduate with my cohort which was gutting BUT I would have a much wanted baby…. which was wonderful!

We had no money…..no answer to that really except we would manage!

We are OLD – our youngest is 7 so we would be starting again when all our friends had similar aged children to ours….we didn’t care, we love babies and children!

….and many many more random thoughts…but most of all we were thrilled and, as all couples who are pregnant with a longed for child do, we made plans. We planned when we would tell people, when I would leave uni, when I would return, how I would cope with the pressures of a full on degree when pregnant in my 40’s, who would do my booking as I know all the community midwives in my area? Would people judge us as irresponsible and foolish? The odds of having a healthy baby were not in our favour so would family/ friends/ fellow midwives judge us for getting pregnant especially given all my husband’s health issues and my ever depressing age?! Do you know what?….we didn’t care! We felt so happy and blessed!

I grew our baby for 10 days….10 remarkable, wonderful days when I felt fertile and hopeful and excited. 10 days of hope and dreams and of improving stats (I found an app that showed the likelihood of me miscarrying reducing by the day)…I fell in love.

We were going away for a few days to end my 3 sons’ fortnight holiday from school. I had 2 exams and an essay deadline during this fortnight so the boys had been bribed to tolerate my emotional absence and grumpiness with promises of having 100% mummy for 4 days at the end of their holiday. On the Friday morning we were going away I started to bleed. By Sunday night it was pretty much all over. The hcg line on the pregnancy test had gone from a strong line to a faded line only visible when held up to the light. I was inconsolable and angry….why let me get pregnant for this to happen? I felt my body had let me down. I felt foolish for hoping….this was an incredibly early miscarriage and in a cold, clinical light I could accept that my very efficient body had dealt with a non-viable pregnancy quickly and with little fuss; but this knowledge did little to stop my heart from breaking.

I called my local EPU (early pregnancy unit) on the Monday morning we were leaving our mini break to confirm what I already knew. The very lovely, kind sounding nurse confirmed I was likely miscarrying and informed me to repeat the pregnancy test a week later to ensure all the ‘products of conception’ had gone and to ring immediately if I started to haemorrhage, have severe pain or pass large clots. My pregnancy was all but over. When we returned home I found the pregnancy test with the strong hcg positive line and I sobbed; that proved our baby had been real, albeit momentarily.

I was on placement in the community the next day and was also scheduled to attend a 20 week ultrasound anomaly scan with one of my caseholding couples.

Would I be ok?

Part of me felt silly for being so upset…this was very early (I was about 6 weeks) and people lose babies at all stages of pregnancy how dare I be so upset about such an early loss? But I was…it was the loss of hope and loss of a future we had dreamed of and imagined. The loss of us being parents to 4 children and being a family of 6 ….or more! We had joked it may be twins (my age and a family history of twins increased this possibility).

I was a counsellor before training as a midwife and during my 15 years as a practising counsellor I experienced major personal life traumas but, with increased support from my supervisor I maintained my practice throughout. I know I am able to acknowledge my own feelings whilst also allowing the space within myself to empathise and be present for others in a professional capacity. For this reason I felt I would be okay to attend placement but remain mindful and aware of my own emotions whilst staying grounded in my role as ‘student midwife’. I have always felt it is my role as a professional to empathise not identify. Allow an individual to experience their own situation without inflicting my personal feelings and experience on them.

I sat in the 20 week ultrasound scan with one of my caseholding couples and I was genuinely excited for them. Their baby looked healthy and they were told they were likely having a baby girl. I was thrilled for them and felt emotional and privileged at being able to experience such a lovely, personal moment. I went home after finishing the rest of my shift and felt ok but the poignancy of the situation was not lost on me as I could still feel my body dealing with the loss of my baby.

So what can we do as midwives?

…….Baby loss is a fact of life…the stats prove this. The stats don’t show the women and their partners behind that loss. The stats don’t show how many midwives experience baby loss. The stats don’t give you the tools to manage that loss. I have coping mechanisms thanks to my previous career but I am not made of stone…..what I found hard was not a 20 week ultrasound scan but an 8 week booking appointment when I would have been 8 weeks pregnant and it would have been around the time of my own booking appointment. I didn’t fall apart and I was (I believe) fully present for the couple during that booking appointment but did I go and have a cry on the toilet after it?…. Yes I did.

What needs to change?

……I am not sure……more talking amongst midwives of their own experiences of baby loss (hence this blog…..very few people knew I was pregnant so I feel quite exposed writing this but I am trying, in my own small way, to challenge the perceived taboo) and an acknowledgement that miscarriages, even very early ones like mine, leave a footprint. Our wedding anniversary will come and go and we will acknowledge our baby existed for however short that amount of time was.

Miscarriage is discussed in a very clinical way with terms like ‘products of conception’, ’tissue’ and ‘chemical pregnancy’ but I needed to talk about my ‘baby’ and ‘hope’. I needed to talk about how I felt about my 3 beautiful sons not having the chance to meet their baby brother or sister. I needed to sob & sob and not feel guilty for crying over somebody who only existed for a short space of time. I am not a Christian or a particularly spiritual person but our baby existed to me & my husband and we need time to be sad. My husband was quite pragmatic until we did the final (negative) pregnancy test …until that point he must have been carrying some hope (I was not; the test for me was a relief that my body had dealt with everything and I didn’t need to go to hospital and have any medical procedures) and he cried. I was shocked…..I am embarrassed that I was shocked as I feel like I should know better but I was genuinely surprised he was so upset. Fathers need acknowledgement within baby loss too and they tend to grieve differently. My experience as a counsellor is it seems to take longer for men to acknowledge loss and therefore grieve. This is worth bearing in mind when supporting families with loss.

If you are working with women and their partners following baby loss, please acknowledge the loss; acknowledge the sadness and grief. Being told “well it was very early” is unhelpful as it undermines a couple’s grief, we needed permission to be sad not platitudes in an aim to ‘cheer us up’.  Being told “well at least you can get pregnant” is also unhelpful as that does not acknowledge the loss of this pregnancy and this baby which is what we were experiencing. What helped me was my amazing trio of fellow Student Midwives who were my friends. They were not clinical or ‘midwifey’ they were my friends and gave me permission to grieve.

Thank you for reading.

 

 

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Maintaining Friendships Old And New

I moved into halls for the first year of university despite already living in Manchester (well, Greater Manchester). I felt ready to gain some independence by ‘flying the nest’ and wanted to be within walking distance of university. When I lived with my mum before university I was only less than twenty miles away from the main campus so my friends from home who I used to live super close to aren’t incredibly far from my accommodation. The nursing course can get pretty hectic at times; more often than not all you want to do when you get back from placement is have a good kip!

Seeing my friends from home can be tricky to plan, to be honest, especially seeing as they have commitments like work and studying just like I do and it’s not just a ten minute journey involved in meeting up. I probably don’t tell them enough that I miss them, but I really do, and I really look forward to going home to meet up with my friends or having them stay over at my flat. Seeing my friends from home is so good for helping me stay grounded and true to my incredibly Mancunian roots and it reminds me of a big reason why I’m doing this course. I really hope I can make the people I care about and who care about me proud. If you don’t have the opportunity to meet up with your friends from home very often you’ll understand that the time you spend together is golden and you’ll appreciate it all the more. I’m so, so fortunate to have maintained friendships with such a brilliant bunch of people even after all these years.13151090_226356241076122_2131036156_nI enjoy spending time with the friends I’ve made on my course too, as I think we have a good balance between chatting about nursing as well as unrelated things. We’ll talk about what skills we’ve been learning on placement and helping each other stay motivated when writing assignments by offering suggestions of resources to look at and just offering a pep talk sprinkled with the essence of ‘as a fellow student nurse, I really know how you feel’ then five minutes later we’ll be having a conversation about something like make-up or food. I’m so, so fortunate to have made such a brilliant bunch of friends at uni.

My advice to anybody studying on a course that keeps you super busy (ring any bells?) would be to appreciate and make time for your friends from home whilst still being open to making new friendships at uni. Your friends from home will be glad that you’re enjoying yourself and have support for when they can’t physically come to see you. Believe me, you’ll have no idea how you would have made it through uni without your friends – old and new.

 

Mentoring-who has the power?

I am sat here just an hour away from heading out onto placement for a final shift on the ward I have been working on and am pondering the nightmare that is getting paperwork and skills signed off. Finding the time, apologising profusely for the massive amount of writing up of skills I do to justify that I am good enough, hoping the mentor feels the same and signs them…..will the anxiety ever stop?!

Part of my thought process has left me wondering about the power balance in the midwife mentor-student relationship. Ideally there would be no power imbalance and the mentor/student would be engaged in a mutual, respectful and supportive pairing but I feel this is unrealistic and ignores the fact that, as students, we are reliant on our mentors to provide good, honest feedback and ultimately grade us which can mean the passing or failing of our degree. Surely, even with my basic degree in psychology, this puts the power balance very firmly on the side of the mentor?

Students, generally, want to please our mentors and not just for the sake of a ‘good grade’ (I feel this is a little simplistic and patronising) but because we want to do well! As a second year I have not struggled and battled my way this far through a very difficult degree to be mediocre and just ‘ok’….I want to be GOOD and COMPETENT. This means when I am working with mentors I ask a million questions and watch, listen and then ask another million questions because I want to be the best I can be.

I wonder if mentors are trained and updated on the power they hold in the relationship? I am sure they are and every mentor I have been lucky enough to work with has been supportive and encouraging whilst providing excellent constructive feedback when needed. Have I been lucky though or is this standard? I am not so sure……

The issues of boundaries in the midwife mentor/student relationship is interesting. My previous career was in an appropriately, heavily ‘boundaried’ arena and I feel I am acutely aware of boundaries at all times but  there have been occasions when my mentor has been made aware of my personal circumstances when necessary as this will, of course, impact on my practice…..could this be perceived as over stepping a boundary? Or, for example, if I ask a mentor if she is ok because I know her child was ill and she left work early during our previous shift….is this overstepping a boundary?

Is this a little too ‘pally’?

What is ‘too friendly’?

What could be perceived as forging a ‘too close’ relationship with a mentor when you are together 8 hours a day/ 5 days week in a car and in clinic and you have your lunch together and you talk……most people come into this profession because we are compassionate so we reach out to each other as 2 women sharing information about our lives…..is this overstepping a boundary? What should we discuss? Should we limit ourselves to just discussing midwifery at all times? But this feels incongruent and, again, unrealistic.

Also, what of mentor-student relationships that are not nurturing but, dare I say it…..toxic and damaging? Where does that student go? Every student knows that we are reliant on the mentor for passing us therefore, dare we complain if we don’t feel happy? Dare we mention to our PEF, link lecturer, academic adviser, ward manager etc that we are not happy?

We SHOULD do but do we?

What if we are branded a trouble maker?

What if we are considered to not be resilient enough for this degree because we have struggled with a mentor?

What if we still have to work with that mentor and they know we have an issue with them?

What if we don’t have to work with that mentor but one of her colleagues and they know we have complained?

We absolutely MUST speak up if we are struggling as the damage of ‘carrying on regardless’ is insistent and could lead to further issues both psychologically and practically further down the line but I hope that midwife mentors are aware of the power they hold and that forging a good, strong, supportive relationship is tantamount to bringing out the best in a student and that the majority of students just want to be the best midwives we can be!

Thank you to every mentor who has treated me with kindness and compassion-you have modelled how to be an excellent midwife and excellent mentor.

To those students struggling with mentorship-please speak out.