I have spoken many times about the support I was incredibly privileged to receive from our midwife Michelle. Her unwavering commitment to us through Orla’s pregnancy and birth, our fraught and anxiety ridden journey through pregnancy after loss and the hugely reparative birth of Esme was incredible and we will be forever grateful. Throughout this time, I did wonder about the impact that this had on her; did she lose sleep too, wondering if our baby would make it into our arms safely? Was she counting down the days until our planned early induction? Was it actually her who breathed the biggest sign of relief when our baby came out screaming?
As a healthcare professional myself, I know first-hand how there are times when you can’t help but take your work home with you. When you wake in the middle of the night with a particular client on your mind. When you desperately await their call so that you can reassure yourself that they are okay. But it wasn’t until I head Michelle speak at a workshop for midwives that the true emotional impact of the work of loss and bereavement really hit home. Maybe it was only then that I could even allow myself to go there and recognise it before then, but it really floored me. We are all in this together and it is important that everyone who comes into contact with loss is cared for, because this is the only way in which to create sustainable and compassionate systems in which to practice.
In this moving letter to other midwives, Michelle shares her own experiences.
Michelle is a midwife of 21 years. She manages a case loading team of midwives and is experienced in supporting women with many complex needs through pregnancy, birth and postnatally. Michelle was a regional winner for the RCM Midwife of the Year Award in 2017 and most importantly for me, was the person to deliver both of my girls. I will forever be grateful for what she did for me and my family.
Dear Midwives young and old,
It’s hard to know where to start this letter, I suppose the beginning is always best. I can remember being very young when I knew I wanted to be a midwife, maybe 9 years old, when I could not have known the extent of the role. The view was always that being a midwife must be a wonderful job….and it is for the most part.
When you think about being a midwife you see moments of joy and happiness. Great job satisfaction, sense of achievement and wonder at being part of such an amazing process as well as being part of such a special time in women’s lives. You don’t really think about the times when this is not the case. When pregnancy ends in loss, in sadness, in disbelief. We don’t talk about it. The focus is always on the mother and family…which is absolutely as it should be, but we are not immune to the impact on us both professionally and personally.
You always remember the first time you experience pregnancy loss as a midwife and in truth every time that it happens. I know I do. These experiences leave a lasting impact and one that ultimately shapes you as a professional and as a person I think.
The first thing that hits you is the pain you feel internally on behalf of the family. Knowing what they have yet to endure. Its real and physically and emotionally a shock. The shock they feel is shared. It’s a hard concept to understand at times, with all these high standards of care, babies still don’t make it. What more can we do?
My first experience of term loss will always stay with me. I knew from the phone call that I answered on labour ward that the baby was gone……I don’t how I knew this. It may have been the way the mother spoke or just something in her voice. I could hear her fear and it was real.
Listening for a heartbeat is….. heartbreaking. You fervently hope that you can pick it up and offer reassurance, yet you often know very quickly that it is no longer there. Your throat closes up as you try to find a way to communicate anything. Your body language probably speaks for you, confirming their fears. Your own heart is racing as if this will somehow compensate for the one that is not there. I remember their absolute disbelief. The husband was more shocked than the mother, who I suspect had already understood that her baby was lost. How do you even start with helping them?
There seems nothing you can do and it is easy to revert to “professional doing mode” to cope yourself. But that family need you. They need you to just be there, hold their hand, stay silently by their sides, talk if they need to talk, answer questions openly and honestly. I was lucky (not exactly the right word) but I knew personal sudden, unexpected, devastating, life changing loss. I used what I knew to start supporting them. I was definitely lucky that I was able to be with them through the birth experience and help them bring their sleeping Son into the world.
It’s the silence in this type of labour that seems the hardest at times. We are so used to hearing a heartbeat during labour, monitoring it, that you often find yourselves suddenly looking round for a monitor or sonicaid to only realise that you don’t need it here.
I did not stop the flow of my own tears as he was born…I could not have done so even if I had tried. This was a shared grief, for them and their son and they understood and appreciated the knowledge that this was not just a job. I shared this experience with them and the birth of their next two children born alive and safely. This is the one thing I do know, every couple who experiences loss that I have ever met have gone on thorough their grief to have live children…..never forgetting the one that they did not get to take home.
As a case load midwife the joys of our job are even greater. You get to know a woman and her family over 9 months and see them transition into the scary world of parenting. Supporting them and sharing their journey. So, when loss is experienced in this context it is doubly devastating. You question everything, just as the mother questions every aspect of her pregnancy, you do the same. You feel responsible. Did you miss something? Was there something more you could have or should have done? It is a futile search for everyone. It is rare that an absolute reason is found…but you do it nonetheless. The tears shed are personal, private but professional tears too. The pain is intense and leaves you full of sorrow for this job that we do.
I only know this: do what you can to just be there. Speak honestly and openly when asked the difficult questions. Be the rock that the couple can tether themselves to during the worst journey they may ever have to endure. Don’t be afraid to show emotion with them or with your colleagues. You need support too if you are to maintain “rock like” qualities. Grieve too. Allow yourself time to come to terms with the outcome we all dread. Try to help them navigate this devastating scenario in the best way that you can. Create memories for them and with them. I am always amazed at the resilience of human nature, the fact that we have often still managed to smile and even laugh a little. Be compassionate to them but also to yourself.
How you help a couple navigate this path is probably the most important aspect of our job. Yet we don’t talk about it in this way, or in truth in any way. It can set them on the road to recovery, even though it is a long one, it has to start somewhere. This is the most valuable skill a midwife can have, don’t shy away from it, embrace it. Each time I am in this role I feel a small part of my soul stay with them. This may seem an extreme statement, but for me it is true. I know I will heal more quickly than they do so I can afford to give them a small part of myself to help them on their way. I will get it back, when I am lucky enough to meet them again and reach a happier outcome.