As I sat on a busy tube shuttling across London on my way to a regional meeting, I used the time to reflect upon my career. I had spent all my life aspiring to be a clinical midwife, guiding women through the most extraordinary time of their lives; mopping brows and holding hands. I became a midwife to make a difference, to ensure that women had the best birthing experience ever. Now as a midwifery manager however, had I lost all my clinical links? Was I so far detached from clinical midwifery that I had no idea what was going on? As the tube pulled into the station, I heard the speakers blare out, ‘Please mind the gap’. These words resonated with me and I was transported back to the last couple of deliveries I had been involved with.
I was called in the early hours of the morning and asked to attend a home birth. I had offered to do an on-call to help the community midwifery staff as there was sickness in the team. As the midwife gave me the details of the woman, I immediately recognised the name and address. I walked into the candle-lit living room with gentle music playing in the background and saw the labouring woman, who looked up at me from the birth pool. Our eyes locked onto each other and I could sense that we both instantly relaxed—I knew her and she knew me. What are the chances of this? I had met this lady about 9 years earlier when I had booked her first pregnancy. This beautiful, strong woman puffed and panted through her labour, not breaking her concentration. I know that because she knew and trusted me, she could completely relax in my close presence. As the labour raced on and she began to push, her husband joined her in the pool. Soon after, her baby was delivered into my waiting hands. The three of us, with our heads almost touching, cried together as we discovered the sex.
Not long after, I met a brave woman and her partner when she was 16-weeks pregnant. She had recently been diagnosed with stage four metastatic breast cancer and was being cared by lots of different specialists. When we first met, she looked lost. She had to explain her complex medical treatment to every new professional she met. None of them focussed on her pregnancy and they would constantly recommend termination of pregnancy as it would make her treatment easier. I made a promise that I would look after her with one of my colleagues and we would concentrate solely on this pregnancy. This surprise, miracle baby was her only chance to be a mother and we made a commitment to her: we would be with her every step of the way. The day of her planned caesarean section arrived; thankfully, I was able to be with her as she got ready for theatre. I could see the terror in her eyes; she was convinced that something would happen to the baby because of all the chemotherapy she had received. Once we were alone, I gave her a hug and whispered in her ear, ‘I am here for you, and will keep you and baby safe’. She squeezed me even tighter. As she lay on the table, she kept eye contact with me—we had truly built such an amazing bond. Once the baby was born, he immediately let out a scream; I felt an overwhelming sense of relief. All the months of worry were over and he was given a clean bill of health.
What linked these two memories is continuity of care. Following the publication of Better Births (NHS England, 2016) in 2016, I have worked tirelessly with an incredible team to implement continuity of care. It has been a struggle, at times, and I feel as though we are trying to introduce the perfect, gold standard maternity care into an imperfect NHS structure. Every time I question why I am working on this often thankless project, I am reminded of the faces of the women I have cared for throughout my career who received continuity of care and the impact upon them and their families. I also remind myself how I felt giving this care; it was rewarding and humbling to be part of their journey.
Although I don't often practice clinical midwifery, I don't think that is important. I offer care to women with a different hat on; I am developing our service and working collaboratively with women, midwives and obstetricians to ensure women and their families receive the best care available. Is continuity of care the panacea of maternity care in the 21st century? Research would suggest that it is however, my role as a midwifery manager to ensure that women and staff feel valued and are listened too. My career aspirations were to support women at the most important and extraordinary time in their lives. Today, I know that I am working hard to do this, just as I did as a newly qualified, band five midwife. The gap between frontline staff and management is often discussed. However, I feel confident that we are all working toward the same goal. Yes, maybe on different levels and at different paces but that does not matter. What is important is our common vision to improve maternity care as set out in Better Births, and to continue to take pride in what we do as midwives.