Midwife

I trained as a general nurse first and spent a rotation on a postnatal ward, and it was the continuity that pulled me in: the same women coming back for follow-up, the way a good relationship changed how confident they felt about breastfeeding or about their own recovery. I moved into direct entry midwifery training and did my final placement with a caseloading team, which meant following a small group of women from booking through to six weeks postnatal. That model showed me what the job can be at its best: you know someone's history, their fears, what happened last time, so you're not starting from zero at 3am when they ring in early labour. I chose midwifery over general nursing because I wanted that long arc with a family, not just an isolated clinical encounter, and because the physiology of a normal birth still interests me after years of watching it.

I start by finding out what she already knows and wants, because a woman in established labour with a doula and a written plan needs something different from someone arriving frightened and unprepared. Physically, I encourage movement and upright positions early, because they help labour progress and give the mother some sense of control, and I offer the full range of pain relief options without pushing any one of them. Emotionally, my job is often just steady presence: low voice, eye contact between contractions, narrating what's happening so nothing feels like it's happening to her rather than with her. I bring the birth partner in as an active participant, showing them how to apply counterpressure or just hold a hand, because they'll still be there after I've gone off shift. I also watch for the moments where reassurance isn't enough and she needs a real decision, like whether to accept augmentation, and I make sure that conversation happens clearly, not in the middle of a contraction.

I treat the birth plan as a starting conversation that can shift, and I say that clearly at booking so it isn't a shock later. When labour shifts away from what she wanted, I explain what's changing and why in plain language, give her a real choice where one exists, and avoid making her feel she's failed some test. I remember a woman who'd planned a birth centre delivery with no intervention and needed transfer for slow progress and a suspected infection; I walked her through exactly what an induction would involve before we left, so the ambulance transfer wasn't the first time she heard the word syntocinon. Afterwards I sat with her and her partner for the debrief she asked for at her six week check, because unmet expectations can sit heavily even when the outcome was healthy. Keeping her informed at each step, rather than presenting decisions as already made, is what keeps trust intact when the plan has to change.

I adjust the format to the person rather than running through a fixed script, because a first time mother needs more grounding in basics than someone on her third baby who mostly wants reassurance. For infant feeding, I use a teach-back approach: I show a positioning technique, then ask her to try it while I watch, rather than just talking through it, because that's where the real problems usually show up. I keep written material short and give it in her first language where possible, and I always involve a partner or support person if one is there, since they'll be doing the night feeds too. Postnatally, I check the practical things that get skipped when everyone's tired: wound healing, bleeding, mood, and whether she's actually eating and sleeping in any form. I also flag warning signs to watch for in plain terms, like what a normal versus concerning lochia looks like, so she isn't Googling it alone at 2am.

During a second stage that had been progressing normally, the baby's head delivered and then retracted back against the perineum, the classic turtle sign, and I recognised a shoulder dystocia immediately. I called for help using the emergency buzzer while staying with the mother, got her into McRoberts position with two people supporting her legs, and applied suprapubic pressure while giving clear, short instructions rather than narrating my own anxiety. The second midwife started the clock and documented timings as they happened, which matters afterwards for both clinical review and reassurance that we acted within safe limits. The shoulder released within about ninety seconds of applying the manoeuvre. Afterwards, the harder part was the debrief: I sat with the parents that evening, explained exactly what had happened and why, and made sure the obstetric team followed up given the risk of associated nerve injury. Staying calm in the room comes down to having the sequence so well rehearsed that your hands know what to do before your head catches up.

I looked after a woman in her second pregnancy who wanted a home birth after a previous caesarean, which sits outside typical low risk criteria and isn't something I'd have chosen for her myself given the small but real risk of uterine rupture. My job was to support her choice by making sure it was properly informed, so I went through the actual numbers with her rather than vague risk language, involved the consultant obstetrician for a joint conversation, and made sure an individualised care plan was written and shared with the ambulance service in case a transfer was needed quickly. I documented the discussion carefully, including that she'd declined the recommended hospital birth and understood why it was recommended. She went on to have a straightforward vaginal birth at home with no complications. Whatever the outcome had been, respecting her autonomy while being honest about the risks was the only defensible position, and it meant she trusted me enough to call early rather than labouring alone out of fear of judgement.

I was caring for a couple at thirty eight weeks when we couldn't find a heartbeat on the scan, and I had to be the one to confirm it after the sonographer stepped out. There's no good way to say those words, so I kept it simple and direct rather than softening it into something confusing, then stayed with them while it landed. Practically, that meant moving them to a quiet room away from other labouring women, giving them time before any decisions had to be made about induction, and offering memory making, like photographs and hand and footprints, without pressuring them to accept anything they weren't ready for. I made sure the bereavement midwife was looped in before I finished my shift, and I handed over clearly so the next person on wasn't asking them to repeat their story from scratch. Afterwards I used clinical supervision to process it myself, because pretending a loss like that doesn't affect you isn't sustainable over a career, and it isn't honest with your team either.

I rely on trends rather than single readings, so I use the modified early obstetric warning score to flag when observations are drifting even if no single number is alarming yet: a rising heart rate alongside a falling blood pressure matters more than either in isolation. For postpartum haemorrhage, I'm assessing blood loss continuously rather than waiting for an estimated total, and I escalate as soon as loss passes around five hundred millilitres with any ongoing bleeding, or sooner if the mother shows signs of compromise like tachycardia or dizziness. For pre-eclampsia, I take reported symptoms seriously even when blood pressure readings are borderline: a bad headache, visual disturbance, or epigastric pain gets a repeat blood pressure and urine protein check straight away, not a wait and see approach. When I escalate, I use SBAR so the obstetric registrar gets the full clinical picture in one call rather than a fragmented version, and I don't wait for permission to start basic interventions like fluids or oxytocics while help is on the way.

My role in a complex birth is to be the person who knows the mother's full picture, her history, her wishes, and how she's coping, while the obstetric and anaesthetic teams focus on the immediate procedure. I make sure everyone entering the room gets a quick verbal handover rather than having to read the notes cold, and I use closed loop communication for anything urgent, repeating back an instruction so there's no ambiguity about a drug dose or a plan. During an emergency caesarean under general anaesthetic, for instance, I'm the continuity for the mother once she's asleep and the link to her partner, who often needs someone to explain what's happening in plain terms while everyone else is focused on the clinical task. We do regular multidisciplinary simulation training on our unit, which matters because the first time you practise a team response to a crash section shouldn't be the real event. After a complex case, I push for a proper debrief with the whole team, not just the midwifery staff, because that's where practice actually improves.

I write contemporaneously wherever it's physically possible, even if that's a single line jotted down between tasks, because reconstructing a timeline from memory two hours later is where errors creep in. On a unit that still uses partograms alongside electronic notes, I make sure both are kept in step rather than letting the paper fall behind, since a partogram that isn't updated in real time loses the whole point of flagging slow progress early. When something urgent happens and writing has to wait, like during an emergency, I note timings mentally or ask a colleague to record them as they happen, then complete the full entry as soon as the immediate situation is safe, clearly marked as a retrospective entry with the time I'm writing it. I keep language factual and specific rather than vague, so 'declined vitamin K after discussion of risks' rather than just 'refused', because the record needs to hold up months later if there's ever a query. If I'm consistently too stretched to keep records current, I escalate the staffing concern rather than letting standards quietly slip.