So Being a Midwife Part 1 has established that midwives are not professional night nannies or nappy changers. I’m pretty sure most people do actually know that, so I can’t help but wonder so many women and partners seem to think this is a critical part of our job? A lovely lady who’d had a vaginal birth and was mixed feeding her baby (breast and bottle) buzzed the other night to direct a colleague towards the nappies and wipes, informing her that her baby’s nappy was dirty. She had given birth 4 days earlier. Now I know she had been feeding for hours and was exhausted, but she knew how to do it, had what she needed, but just thought we would have the time and could take care of that for her. Sadly no.
Another lady was 40 hours post Caesarean section when she buzzed for someone to change baby’s nappy. This new mama had been walking around, going to the toilet herself (indwelling catheter was long gone) and she was breastfeeding her baby. I had been looking after her all night, so I knew how well she was doing and was surprised she’d asked me this. She must have seen it on my face because she gestured vaguely towards her lower half from the bed and explained it was hard, because of the pain.
Alarm bells started ringing in my head. In 5 minutes I’d be handing over to the night staff and they would not be able to do this for her and I did not want my lady meeting with the wrath of any stressed-out staff. On the ward, midwives have a ratio of 1 midwife to 5 women- plus their babies. Outrageous isn’t it. That’s a hell of a lot. Fortunately there is a union-led campaign to ‘Count the Babies’ in the ratio- but we’re not there yet. Overnight, the ratio is even worse, often upwards of 8 women plus babies. We simply cannot do things like change nappies unless the woman is literally less than 24 hours post caesar, very unwell, or in severe, poorly managed pain.
This poor mum, tired and sore and missing her husband as she was, would not qualify. I had to get her up and explain all this to her in a way that she felt supported and not abandoned.
“But how do you know she’s not in severe pain?” I hear you ask. Pain management is a large part of what we do on the ward, and proactively keeping it under control is our goal. I knew pain wasn’t an issue because she had been citing 3/10 ‘manageable’ pain and declined extra pain relief throughout the shift. Also, I could see it in her face, and her movement. Finally, her ‘obs’ (observations, ie. vital signs and some extra physical assessment elements specific to midwifery) were normal. Of course it was difficult and slow to get up but as I gently explained to her, she would be going home in the morning, and if she could go to the toilet, she could change her baby’s nappy. She wasn’t thrilled, but she started getting up slowly, as I made sure she had everything close at hand.
I reminded her that we are happy to show her how to do things and learn new skills. Did she know how to change the nappy? After a moment’s hesitation she said yes she did. I observed her movement and felt reassured that she was indeed managing really well, and congratulated her for doing such a good job with everything. Next, I asked her to please ask for extra pain relief if pain was interfering with normal activities (self care, baby care, nappy changes included!). Finally, I shared with her again that we know that getting out of bed in the post partum period and doing the things women need to, as best they can, improves and shortens their recovery period after birth.
I hope she understood that I was absolutely helping her, but not necessarily in the way she expected or wanted in that moment. Midwives are here to help women by empowering women to help themselves, and better manage the challenges coming their way. I hope that maybe, the next morning, my lady was moving more easily and feeling stronger and more able to do all the things. I really do, because that is actually why I go to work. To be “with women” (the literal meaning of “midwife”)- not to change all their beautiful baby’s poo-namis.