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Midwifery

Julie Woodman - Midwife

Is a midwife like no other – she commutes on a motorbike for starters! And that is just for starters…this woman is a machine!

Following a nine-to-five career as a recruitment consultant, 23-year-old Julie decided that she needed a job where she truly made a difference to someone’s life – and not just their bank balance! As a mother to three children it was the labour of Julie’s third child that gave her that light bulb moment which led to leaving the corporate world of recruitment, and enter the clinical world of midwifery.

‘I wasn’t too happy with certain aspects of my third labour and it just made me think - I could do this job better!’ says Julie.

The timing wasn’t perfect for Julie; especially as she went on to have another child during her training so was juggling four children and a new career, but it was a decision that proved right.

‘Training was a juggling act, but the risk paid off as I’ve had a wonderful career and have achieved what I wanted in making a difference to people’s lives.’

Julie has been a midwife for 11 years, delivering over 1,000 babies, one of which was her hairdresser Rachel Baker. ‘I had been Julie’s hairdresser for over three years before she delivered my baby,’ says Rachel.

‘I was overdue and went into QA Hospital to be induced. The lady on the reception desk directed me to a bed and said that “Julie” would be with me shortly. I was absolutely mortified when I realised who it was – the thought that a customer would see me giving birth,’ laughs Rachel. ‘Julie was fantastic though in reassuring me and keeping me calm, making my embarrassment quickly diminish. The labour went on all night then 30 minutes before Julie’s shift was coming to an end little Eadi graced us with her presence,’ laughs Rachel.

‘I’m so glad that Julie delivered Eadi for lots of reasons. She was so fantastic in keeping me calm and it made the experience so much better. We now have an inside joke and it’s lovely that five-year-old Eadi now knows Julie personally.’

Julie is nine-months into a teaching role at Portsmouth Hospitals, which means as well as practicing midwifery she now delivers training to trainee midwifes both practically and classroom-based. ‘The change of role was because I identified several areas that I thought needed improvement and I wanted to make a difference to both midwives and patients.’

Julie says it can be a real challenge when a midwife is confronted with a patient that is high-risk and they’re trained in low-risk midwifery care. ‘High-risk could mean that the lady has diabetes or they could be suffering with something that the midwife hasn’t come across before like malaria. I wanted to introduce more high-risk scenarios into low-risk midwifery training in order for the midwife to feel more prepared and the patient to have the best possible care when they come into QA.’

It wasn’t hard to track down students that Julie has taught; many flocked with stories of Julie, giving high-praise for one reason or another.

Trainee midwife Rebecca Batten is in her final year of training and Julie has been one of her mentors since she started her degree in 2011.

‘Last year I had to sit an emergency scenario exam and I phoned Julie and said I was worried about the exam so could she give me some tips or advice. She asked me to pull together a group of trainee midwives, and along with some of her colleagues hosted a three-hour practise session for us, recapping all sorts of emergency situations such as a baby needing resuscitation and a pregnant lady collapsing. It was so nice of her to go out of her way and put on a class in her own time, in which everyone that attended passed!’

Midwife Lisa Storey qualified as a midwife in 2009 and says she completed all of her practice-based training alongside Julie. ‘One thing that struck me with Julie was her calmness in an emergency situation. She always seemed to handle them fantastically which I really admired. When I was pregnant, four-years into qualifying, I decided that I wanted a home birth. It was my second child but first home birth. I asked Julie if she could deliver my baby as I knew how good she was and had faith that should the worst happen, she could deal with it. Julie was on shift when my waters broke and the nurse in charge let her leave to be by my side. After a painful 10-hour labour I had a beautiful baby girl?

Julie now works alongside Maggie, the midwife that delivered her first-born Bryani 21-years-ago.

‘Bryani is currently 33-weeks pregnant and alongside myself, Maggie is going to help support Bryani throughout her labour,’ says Julie with a big smile across her face. ‘It’s funny how things come around,’ she chuckles.

Julie is as bright as a silver dollar with a very British sense of humour, a lady with endless talents and plaudits, it seems. Not only is she a motorbike-commuting-teaching midwife, but she’s also an adventurous runner, she tells me.

‘I run for Stubbington Green Runners and I’m qualified as a leader in running fitness. I love extreme cross country and adventure runs, and I’m known for getting a muddy as possible! I have completed the Tough Guy challenge in Wolverhampton, which involves underwater tunnels, overhead ropes and running through bales of fire,’ she chuckles.

When I ask Julie if she has ever done a marathon she laughs and says ‘I have run six marathons and an ultra-marathon which is 33 miles. I have also done a half iron- man triathlon which involved a 2km lake swim, 56 mile road bike and 13.1 mile run, and several Olympic length triathlons, many of which have been to raise money for charities.’  And with that she pads off to the labour ward leaving me to marvel in the distance at her shadow as it fades, firing my imagination and giving me an appetite for the future…. What an inspirational lady and a great role model for International Day of the Midwife.

Director of Midwifery, Gill Walton, says: ‘In well-developed maternity services such as PHT, International Day of the Midwife. helps us to remember that in some countries maternity care is sadly very poor and inconsistent. There are many midwives working tirelessly to improve this and prevent mothers and babies from dying needlessly. This is our opportunity to celebrate the important role of the midwife in safely caring for women, babies and families and share good practice so that every year lives can be saved.’


Christine Hall - Diabetes Midwife


Christine is a midwife of 21 years and specialises in diabetes. Woman that have diabetes are five times more likely to have a still birth, three times more likely to have a neonatal death in the first month of their baby’s life and five times more likely to deliver pre-term.

Pre-eclampsia, pre-term labour, stillbirths and birth injuries are more common in babies to women with diabetes. With this in mind QA houses a team of two diabetes-trained specialist midwifes, diabetes specialist nurses, dietitician, obstetrician and diabotologist to not only look after woman with diabetes that are expecting, but also those that are considering pregnancy.

‘Pre-existing diabetes occurs in one in every 250 pregnancies across the UK,’ says Christine.

‘Woman that have diabetes are five times more likely to have a still birth, three times more likely to have a neonatal death in the first month of their baby’s life, five times more likely to deliver pre-term and two times more likely to have congenital abnormalities or a large baby; and studies have shown that attending a pre-pregnancy clinic such as ours and getting your body healthy before pregnancy and planning your diabetes care pre-pregnancy can greatly reduce the risks to the woman and her child.’

The diabetes midwifery team have a big job. Not only do they deliver babies daily, but also they screen ladies who do not have diabetes but have certain risk factors and have been referred from their community midwife. ‘Risk factors can include anything from a raised BMI, family history or if they previously had a baby over 9lb,’ says Christine.

The team monitor pregnant woman with type 1, type 2 and gestational diabetes fortnightly throughout their pregnancies, monitoring their blood sugars, commencing and adjusting insulin if needed and from 26 weeks of pregnancy, monthly scans to keep an eye on a baby’s growth.

The team hold weekly clinics for those at various stages of pregnancy to give continuous advice on blood sugar levels and dietary needs.

‘We are continuing to see an increase in admissions year-on-year,’ says Christine. ‘This is because over the years we have got better at screening, and equally, over the years more of the population are becoming more over-weight, resulting in more woman with type 2 diabetes.’

From April 2012 to May 2013 QA had 318 diabetic deliveries, which is a 30 per cent increase to the previous year, which had 244.

‘There is a lot to think about when you are pregnant with diabetes,’ says Christine. ‘We are aware of potential risks of going overdue such as shoulder dystocia, trauma to mother and baby delivering a larger baby, increased risk of a instrumental delivery or caesarean section and a very small risk of still birth, so we offer induction between 38-40 weeks.’

Christine says that when a baby to a mother with diabetes is born, typically the baby can be overweight at birth and throughout their childhood, which leads on to more work the team do in educating parents in how to deal with this. ‘When the baby is delivered they may have low blood sugars as the baby will may be over-producing insulin for the first 24hrs, so we need to monitor them closely,’ says Christine.

‘We had 23 woman with type1 diabetes deliver last year and 27 with type 2.

QA undertook 163 caesareans to woman with diabetes last year, 88 were elective and 75 emergency. ‘This figure is higher than the national average for woman without diabetes but is comparable nationally for woman with diabetes as they’re a higher risk group,’ says Christine.

Postnatally, the team organise a fasting blood sugar at 6 weeks for the woman who had gestational diabetes, this is to screen for type 2 diabetes. An annual test for life is recommended and lifestyle and dietary advice is given to reduce the risks of developing type 2 diabetes.

Woman with type 1 and type 2 diabetes are reviewed at 6 weeks postnatal in the diabetes centre.

The joint service is provided by Professor Mike Cummings, DSNs Sarah Moutter and Anita Thynne with dietary support from Jeanette Head.

Mr Marwan Salloum, Mr Sengupta and Diabetes Link Midwives, Ann Going and Christine Hall provide the obstetric component of this service together with a team of Link Midwives in the community.

The joint clinic is provided on a weekly basis (Wednesdays 2-5 pm) in Maternity Out Patients at QA Hospital and aims to see all pregnant ladies with pre-existing or gestational diabetes within one week of referral. The service also aims to provide a full pre-pregnancy counselling service to optimise maternal and fetal well being.

All mothers and babies attend the Post-Natal Pregnancy Service for management of pre-existing diabetes control as well as optimising health to reduce subsequent risk of diabetes in those patients with a gestational presentation.


Hayley Nelson - Infant Feeding Specialist

Scientific research widely supports that breast-milk provides the best nutritional start for babies, which is why Portsmouth Hospitals employs Hayley as an Infant Feeding Specialist for its maternity services.

Hayley says PHTs Maternity Department now offers a Tongue Tie division service for babies under 28 days who are having feeding difficulties. “A tongue tie is when a baby is born with a shorter and tight frenulum making it more difficult for the baby to move their tongue freely.

(NICE 2005a)“In this instance if the baby is having feeding problems due to a suspected tongue tie I will do a thorough assessment and if the parents wish and there are no contra indications I will release the tight tongue tie,” says Hayley.

Hayley says a lot of her work is completed before a baby is even born, and that breastfeeding can be more successful if the parents have some knowledge of breastfeeding before the baby is born. “It is advisable for parents to attend an antenatal breastfeeding workshop. There are various ones available throughout our local area including one run by myself once a month.

Hayley tells me that she is also responsible for writing any policies related to infant feeding, neonatal weight loss and even a jaundice pathway. “My role is very varied which keeps it interesting,” says Hayley.

Hayley says she regularly links with breastfeeding network volunteers and co coordinators to support women breastfeeding in the hospital and community. “I co-ordinate the loan of free electric breast pumps for ladies, and I attend many different strategic and local steering groups. This work then supports local breastfeeding welcome schemes.

“It’s important for ladies to feel comfortable breastfeeding in public,” continues Hayley. “I fully support various breastfeeding welcome schemes where local businesses advertise that they are a breastfeeding friendly establishment by displaying a simple sticker in their window.”

As a mother of three children, Hayley breastfed in 1997 , 2001 and 2003 and says the culture of breastfeeding has dramatically changed since the 90s. “There are now so many support groups available to mothers that simply were not there back in the 90s when I breastfed my first-born,” says Hayley.

Hayley says education is key and ensuring that new mothers understand the health benefits of breastfeeding is one of her key priorities.

“We have always known that ‘breast is best’ but the importance of breastfeeding has become lost over recent decades due to the power of formula companies promoting their products to make large profits.

“More and more research is highlighting how breastfeeding has so many health benefits for the baby and mother, and how formula milk is being linked to obesity, gastro enteritis and diabetes.

“Babies that are bottle fed tend to be over-fed and in later years, research shows that more bottle-fed babies end up obese in childhood and later in life.

“Formula is also high in protein which can be linked to diabetes, whereas breast milk is specifically tailored to provide the exact nutrients needed to promote healthy growth and development.”

Hayley says the health of the nation is everyone’s responsibility and the key message of breastfeeding needs to be supported both upstream and downstream. “The midwife’s part in educating patients will include discussing the health benefits of breastfeeding during the antenatal period and signposting the pregnant lady and partner to a breastfeeding antenatal class. These classes are very beneficial and are not just for those women who know they want to breastfeed, but for anyone who is unsure of how they intend to feed their baby.

“These classes cover the benefits of breastfeeding for the mother, baby and family, how to know when their baby is hungry, different feeding positions, how the baby attaches to the breast, how to recognise the baby is getting enough milk from the breast, and what support is available.”

I ask Hayley what advice she would give any pregnant woman that reads this article. “If you have never considered breastfeeding then go along to a class to find out more. You don’t need to make any decisions until you have had your baby.

“For women who have had their baby I would say for most women breastfeeding is natural, but if they are experiencing problems then ask for help. The local Maternity Centres are open seven days a week, 12 hours a day to offer extra breastfeeding support in addition to the postnatal visits. There is also support from health visitors, Children Centres and voluntary breastfeeding agencies who all work together to help provide a web of excellent breastfeeding support.”


Gill Walton - Director of Midwifery

Is a qualified Midwife since 1987. Gill worked in clinical practice, education, parent education and operational management at the Princess Anne. She then became a Director of Midwifery, first in Reading in 1999, North East London and then Oxford where she was also General Manager for Women’s Services and Sexual Health. Gill joined Portsmouth Hospitals Trust in January 2011. All these roles have been challenging, but very enjoyable as the units, staff and the women and families are all different.

Gill is passionate about the difference midwives can make to women’s experience of childbirth and positive parenting. She strongly believes in involving women and their partners in decisions about their care. Gill's other passion is developing pathways to normalise birth, even for those women who have a high risk of complication.

Gill has previously been a member of the Royal College of Midwifery council and enjoys getting involved in national and local strategy development relating to maternity services, childbirth and women’s health. She is also very involved in the South Central SHA Maternity Programme and evolving network and chair the South Central Heads of Midwifery and Consultant Midwives Committee. Gill also really enjoys public speaking, especially if it’s about midwifery!

Gill is the professional lead for midwifery and manages maternity services. They look after over 6000 mothers and babies each year, across four sites: Queen Alexandra Hospital, The Grange, Blake and St Mary’s. Maternity services and the neonatal unit are now merging into one service and Gill is very much look forward to working more closely with the neonatal team.

Gill has spent a lot of her time working closely with Health Visitors, public health, children’s centres, GPs and the local authority, as the largest part of maternity services is delivered in the community.

Gill is currently leading a three-year programme developing family centred care, entitled “Nurture”. She is really encouraged by some very positive changes to outcomes for women including births in the midwifery led units at nearly 30%, an increasing normal birth rate and a reducing Caesarean section rate.

 

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