Michelle Tant

(September 2018) Feeling honoured this evening to see my article on the benefits of continuity of mentor in The Practising Midwife Journal ♡ (September 2018 issue)

(July 2018) The criteria for inducing the onset of labour in pregnancy seems to be widening, with the term ‘high risk’ having an increasingly broad net. However one term which has remained steadfastly clinically contraindicated and yet still widely practised, is ‘induction for large for dates (LFD)’. NICE guidance is clear on the issue (NICE CG70 July 2008) : 1.2.10 Suspected fetal macrosomia 1.2.10.1 In the absence of any other indications, induction of labour should not be carried out simply because a healthcare professional suspects a baby is large for gestational age (macrosomic). So first of all, what is large for dates? Clinically speaking it is a baby born with a birth weight of equal to or more than 4kg. This occurs in 2-10% of births in the UK, however, and this is a significant ‘however’, as the diagnosis of macrosomic babies is notoriously variable in sonographic accuracy with a range of 15% to 79%. Furthermore a systematic review of RCTs concluded that there

(June 2018) Last year I cared for a woman who experienced a stillbirth at term. As a result I suffered symptoms of PTSD and required counselling in order to move forward. I came to realise that much of my recovery was tied up in the worry that I was not meant to ‘feel’ in this way. The grief belonged to the mother so why did I feel so bereft. Through the help of a skilled counsellor and a huge amount of reflection, then ultimately through writing this article I was able to untangle some of those feelings. My hope is that in reading this, others will be helped through a recognition that the midwifes grief is a valid, albeit complex process. If this is you, then please do reach out and get the support you need. The article was published as a blog post on my most favourite midwifery journal website The Practising Midwife / All4Maternity, a fantastic comprehensive resource for all birthy types. I recently discovered that the wonderfully brave and courageous woman I supported last

(February 2018) As a breastfeeding counsellor with experience in facilitating breastfeeding antenatal sessions with over 500 partners of potentially breastfeeding mothers I have shifted my focus over the years from simply helping partners to understand the way feeding works, to helping them to visualise what life will be like as a fully involved parent, enabling their partner to have a positive breastfeeding experience as well as helping their babies to receive the optimum nutrition he or she requires. Becoming a midwife however has really opened my eyes to the realities of integrating partners in the early neonatal period. There have been improvements in the involvement of partners throughout labour and birth and many NHS Trusts do allow partners to stay for the first night following the birth of their baby in response to mothers saying they want this to happen. However as midwives, what is our expectation of the level of involvement and why do we think they are staying? It is

(July 2017) I held him for a while Your pain too great to bear his weight But still You wished him held close and so I did His body kept warm against my own and touched his fingers, told you he is beautiful as you looked at me bleakly I held him for a while watching his small face and rosebud mouth so still Willing him to move and stir to life But my will wasn’t strong enough and neither was yours I held him for a while felt your eyes on mine as I looked at his Held him just long enough to remember his face now etched in my mind and still you watched I held you both for a while as the emptiness washed over the three of us And I placed him in your arms while his warmth lingered Watched you breathe him in Sweet fragile boy, too still for life

 (June 2017) As I slowly began to take more triage calls as a student midwife, I learnt the early standard ‘advice’ we would routinely give to women calling in early labour… “Have you had a bath and a couple of paracetamol?” being the primary line of defence in encouraging women to cope at home, away from the intervention and interference of the labour ward. The intention is of course pure, when everything is normal and if that is where she feels safe, then the best place for a woman to be in early labour is at home. So what if the very thing that is intended to help women to cope with the latent phase of labour, is actually causing the latent phase to last longer? I read a fascinating blog post by Midwife Undercover  who had noticed an apparent increase in the length of the latent phase of labour and had consequently looked into the possibility that paracetamol was the culprit. As I read, I felt like I was experiencing an ‘eureka’ moment – paracetamol works by inhibiting p

(March 2017) On supporting a woman in labour who subsequently sustained a third degree tear, and the experience of significant feelings of guilt and hand-wringing, I have been reflecting on my role in the possible prevention of such a degree of trauma and then the support given to women following repair as well as the outlook for morbidity. According to the Royal College of Obstetricians and Gynaecologists (RCOG), a third degree tear can be defined as “a tear that involves the muscle that controls the anus (the anal sphincter)” and affects on average 3% of women giving birth; broken down this equates to approximately 6% of primiparous women and 2% of multiparous women although the risk increases to 5-7% if they have sustained a previous third degree tear (2015). Clements (2001) takes a more conservative stance, estimating third and fourth degree tears to be more in the region of 1-2%. Regardless of the percentile incidence, the reality is that the long term implications of su

(February 2017) Something a little different today. There is a scenario which many midwives may be familiar with. It is constructed from my imagination/experience and so no fears about confidentiality though I suspect you may feel you recognise it. Have a read and then consider my questions at the end. A woman has a normal vaginal birth of her first baby around mid afternoon. She is absolutely over the moon and desperate to breastfeed; it was in her plan and she really feels it is the best thing for her baby having been to antenatal classes and done a bit of reading. She is thrilled when her little boy latches on first time and assures you that it doesn’t hurt. You can see that baby has a good latch, he stays on for a good 20 minutes before dozing off and she is transferred to the postnatal ward. You hand over to the midwife that the baby has fed well and they are both for routine postnatal care including feeding support. The following day you are assigned to the postnatal wa

(December 2016) Mary paused again as the back ache which had been plaguing her for the last few hours gripped her, causing her to grasp onto the donkey’s pack as she walked alongside. She looked up as the sensation passed and saw the outline of the town up ahead and sighed inwardly in relief, careful not to let Joseph hear her. He had been so kind and gentle with her since this whole thing had started and though she felt sure that he would continue to stand by her, she worried that it wouldn’t take much for him to take the advice of all their friends and family and reject her completely. He didn’t talk about it but she knew that the community was confused by his determination to stand by his pregnant bride to be. Many of his family could barely look him in the face and business had fallen recently, he was a skilled carpenter, taking pride in carrying on the family business, but he didn’t seem to waver. There were the faithful few though who seemed to trust his judgement however

 (November 2016c) As a breastfeeding counsellor I am frequently asked about antenatal hand expressing from a gestation of 37 weeks, regarding both the rationale and technique. Colostrum is the first milk produced and is present during pregnancy and until the mature milk comes through at around 2-3 days. Colostrum is particularly important in the protection of the newborn as it transitions from being inside the uterus in a sterile environment to being on the outside, exposed to the bacteria present in our environment. Colostrum is high in protein, carbohydrates, vitamins, bacteria- fighting leukocytes as well as a high concentration of the secretory immunoglobulin A (IGA) which acts as a sort of 100% organic vaccine, protecting the vulnerable membranes in the lungs and gastrointestinal system. Furthermore colostrum acts as an antibacterial paint, sealing off the naturally permeable newborn gut. Speaking of the gastrointestinal system, colostrum acts as a laxative to one of the

(November 2016b) Recently I was introduced to the concept of ‘Hygge’, or rather I was recently introduced to the word to describe a principle I realise I already aim to live by. On reflecting on the topic further I made the connection also to my midwifery practice – I often receive feedback from women that I help them to feel ‘safe’ and for me safety in my personal life is wrapped up in the safeguards of my close-knit family life and community of friends. Hygge is a Danish word and is virtually impossible to pronounce in English but you will recognise the feeling of cosiness, intimacy, woolly socks and hot chocolate around an open-fire-ness even if you haven’t been to Denmark, apparently the happiest country in the world. It occurred to me that Hygge and Midwifery were a duo demanding a little extra attention. Photo credit: http://www.chatelaine.com/living/hygge-danish-concept-could-make-winter-more-bearable/   After a busy couple of shifts, I am simultaneously overwhelmed w

(November 2016) This is a re-post from my previous blog. Events and encounters recently have drawn me to revisit it for a number of reasons. I wrote this in May of 2014, a little under a year before I qualified as a midwife. This experience and my subsequent experiences relating to it have played their part in defining my practice as a midwife. For me it is one of the most important events I have written about. In memory of Baby X and the other angel babies… May 5th 2014 Earlier this year I observed an autopsy of an infant girl. This is my response to the encounter. There are no identifying comments in the text. My assumption is of cot death though of course this is not diagnosable at point of autopsy. I lost my own brother to cot death when I was 5 years old. I remember him vividly and I remember his absence in our home just as clearly. Our lives were never the same again; his loss is still felt now nearly 30 years later. Seeing Baby X brought so much of the pain back in

(October 2016) When you complete your midwifery training you might be under the illusion that you can purchase a smaller bag for work. That is all it is, an illusion. On starting your brand new job you will be presented with your ‘Band 5 Book’. And it looks remarkably like your student PAD but without the page of signatures. In the UK a vast majority (I would hope all?) of newly qualified midwives benefit from a preceptorship program of some sort to help them gain extra skills and experience. Generally speaking this will include skills such as perineal suturing and cannulation, additional skills to help you to provide continuity of care for the women you look after. So on handing in my precious ‘book’, I am now a Band 6 midwife and I thought it might be a good point in time to reflect. Achieving the skills required to for Band 6 has at times felt very task oriented, having to do something a certain amount of times to be considered competent (and more importantly, feel confide

(July 2016) In my antenatal breastfeeding sessions one of the most common subjects brought up independently is that of safe sleeping and the avoidance of cot death, also known as sudden infant death syndrome (SIDS). There is invariably thinly disguised fear evident in the room combined with, in my experience, a desire to talk about it but avoid it at the same time. After all, talking about the potential death of a child makes for uncomfortable discussion. Currently in the UK there are approximately 288 unexplained infant deaths per year. This includes babies 0-12 months though a small percentage of the total (6.6%) were between 12 and 24 months. Since the launch of a safety campaign (Back to Sleep) in 1991, the incidence of cot death has reduced by 65%. Recommendations include primarily putting the baby to sleep on their back, in the same room as the parents for the first 6 months of life with their feet to the bottom of the bed. Further research has added to the recommendation

(May 2016) I have sat down to write this at least 3 times now and each time deleted every last word. Like Goldilocks trying out the three bears armchairs I ended up with too hard, too soft or broken. It seemed important today however that I make some sense of my thoughts so today I am doing that most valuable of writing traditions… typing until something takes form and makes sense, I hope you’ll bear with me. Let me start by saying just how much I love this profession. Today is International Day of the Midwife and my Facebook and Twitter feed are filled to overflowing with evidence of the passion that midwifery inspires not only in midwives ourselves, but in the families we touch. I work in an obstetric unit and I am going to go out on a limb and say I am proud to do so. I soaked up ROAR and see so many opportunities to provide women centred care, kindness and compassion in the hospital environment, helped along with a generous dollop of newly acquired assertiveness it has to

(March 2016b) I read the Better Births National Maternity Review (NHS England 2016) with interest and not a little trepidation having spotted a few media headlines before reading the real thing. Many could be forgiven for imagining that the focus of the review would be the personal budget which has receiving so much attention and while I have reservations about this particular aspect, it is short sighted to think this is the beginning and the end of it. Pic credit ( https://www.rcm.org.uk/news-vie ws-and-analysis/news/national-maternity-review-published) My overall impression of the report was its focus on choice and safety and that the two are not mutually exclusive. My feeling and my experience is that the kind of care the review discusses is largely the kind of care that midwives would like to provide. Certainly it would seem that there are incidents where this has not happened and if we have learnt one thing from Morecambe Bay and Mid Staffs, it is that no one is immune

 (March 2016) I have long considered myself to be a non-superstitious person, though being a woman of faith (Christian) some might say I am given to believing in things I cannot see but that is another story. Since joining the midwifery profession however I have found myself drawn into ‘playing along with’ if you like, the common superstitions of life as a midwife. I am not just talking about that sinking feeling you get when you see on the calendar that it is a full moon AND a high tide on the night you are booked for a night shift on an already busy obstetric ward. I love to crochet and will take any small opportunity to whip my hook, ball and current project out of my bag. The first time I did this as a qualified midwife though, one of my colleagues mock gasped and asked if I was trying to jinx them all? I was understandably confused and she went onto explain that if you brought something to do such as knitting or crochet then you consign us all to a manic shift with barely

 (February 2016) On January 30, 2016, an article was published in the Lancet reporting the conclusions of a review of 28 systematic reviews and meta-analyses of studies related to the outcomes and statistics of breastfeeding. The key findings were remarkable in their significance to both infant’s and women’s health as well as the global state of health and economy. I was particularly interested to see what was said about the UK because in my experience a common defence of a trend away from breastfeeding in high income country is that the risks from formula feeding are not applicable to regions with safe water supply. In practice and when formula milk is made up appropriately this is probably correct however I don’t feel this view adequately addresses the risks of not breastfeeding. I was saddened to read that with rates of less than 1%, the UK has the lowest breastfeeding rates at 12 months in the world. This is just part of the story though. I decided then to identify the

 (January 2016) It take three years of fulltime study, combining theory with practice, (and a whole heap of blood, sweat and tears)  to become a qualified and registered midwife. The question I have repeatedly asked myself, since donning my navy blue ‘Midwife’ polo shirt for the first time, is whether those three years adequately prepare you for the emotional and physical onslaught that being a newly qualified midwife is. Two months in and my answer to this is yes and no. My “yes” has me visiting some basic truths – I qualified as a midwife and as such I feel able to competently support a woman through her pregnancy, birth and postnatal period. I know what is normal and I know who to speak to when it becomes… not normal. I know I am not alone and that senior midwives come out of the woodwork when I ask for help. I know these things in my head… and occasionally in my heart. In my heart I love midwifery and this is what keeps me pressing through my “no”. My “no” is what has