From Issue No.96, Spring 2003
Marianne Tellier
I WAS THE MOTHER of three children when I started training to be a midwife. The birth of Joe, my third child gave me the desire to be a midwife, though the spark had been there since I had my first. It was then that I gained my experience of midwives and the difference they could make. I was so high after Joe was born at home. I knew midwifery was what I wanted to do.
We were the first group of direct entrants in Sheffield; we qualified in the autumn of 1994. It seemed difficult for the lecturers to see us as different from the nurses they were used to. We were a special set. For the younger ones it was more of a career choice. The older ones were highly motivated, for us it was a special vocation though I don't like to use that word because it's so immodest. To be in hospital was a massive culture shock. There was room for debate in the classroom but no room for debate in the hospital. People were annoyed that you didn't know that the green stuff was sterile.
I was up and down the whole way through the course. At qualification I felt reasonably OK because I'd dealt with some things well. The tutors understood how difficult it would be to be qualified. They emphasised the added responsibility.
Apart from short courses on health and safety and so on, we were pretty much ordinary midwives once we qualified. A dayshift meant being on a ward with six to eight mothers and four to eight babies. We had the same worries as any midwife: looking after two women on labour ward if you are lucky, or it's three and "take that APH" as well. You feel that you are putting people's lives at risk. A recent news story related how a midwife sent a newly delivered woman across London on a train; the midwife was newly qualified and the whole NHS descended on her.
I kept on with a view to getting out. At first, I wanted to be a good soldier, I thought I should look after more women and stay in the hospital. I couldn't countenance working privately, it didn't feel right. But I've changed my views and views in general have changed. I wanted to stay in there and do my best but I didn't feel I was good enough. I wanted to look after working class women. I wanted to work in the community but the only route was via the hospital and I didn't 'fit in' in the hospital. It felt as if I kept banging my head. Some people do 'fit in' in the hospital and they are invaluable if women are poorly. I know one who is wonderful with diabetic women and one who works vast hours of her own time with women on drugs. I wanted to be an ordinary midwife with ordinary women, but I didn't feel that hospital was the place for ordinary women and babies. It may sound as if I am putting my attitudes about birth on to women, it should be their choice, but there are no options except hospital for them in the same way that there was no other option for me.
So, I was stuck in a hospital where my face didn't fit. I felt I wouldn't get a community job unless I'd been there a decade. There were other problems: my partner was alienated with his NHS job and we had problems with the teenagers. Life was grim. After I had been qualified for two years and had done one year of my masters course, I used to walk to work fantasising about throwing myself under a car. I pictured being hurt badly enough to be unable to work but not to leave my children.
One night the baby of a woman on my ward became hypoglycaemic less than 24 hours post section. I didn't pick it up. I was directly responsible for that baby needing to go to special care. That night is imprinted on my mind. The ward was full. There were 21 women; I could usually cope with this number. There was myself and two support workers. There were antenatal women with high blood pressure, a woman with SROM and several newly post-section women. Several of the babies had problems. I never stopped all night. The baby in question fed well in the night. The day staff found it was floppy and the baby was rushed to special care. I was carpeted and told off for not observing the baby more closely. I did look at the baby, I helped the woman to breastfeed and she fed well. The baby wasn't floppy when I last saw it. There was a need to blame someone. Although the baby recovered, it haunted me. I never found out what was wrong with the baby, it left special care without a diagnosis. It wasn't something I got into big trouble for but I felt I'd let the woman down. I felt I got into trouble for something that wouldn't have happened if I'd had a proper midwife's relationship with that woman, if she'd been part of my caseload.
I spoke with an independent midwife who might have let me work with her but I didn't have the confidence to ask her by then.
I went off sick two months later. My sick note said depression. I just sat in the attic and played strange music. I went back to work after several months but my heart wasn't in it. They put me in antenatal clinic because it was easier, but it didn't address the problem of the endless conveyor belt of women I would never see again. If only they could have given me a small caseload, women I could know. After three or four months, I went off sick again. Both management and I had come to the end by then. It was the end of my tether not the end of my sick leave.
It's not just me. Midwife friends come and see me and burst into tears. It makes me feel weaker than other midwives, but that is what depression is. I let myself believe that my depression was caused by factors other than work. In retrospect, I see that working in the hospital was the main cause of my depression.
The Future
I recently made the decision not to re-register and I gave up the masters course. But I don't feel it has to be the end of the line. I could return, when my two year old is older. I would have to find a way to do a refresher course. I'd have to grit my teeth and do it in hospital. I have a weird fantasy that I could do independent midwifery and not charge for it - so I could look after women who are like I was when I had my first baby at 18; women round here. I want to look after a few women properly. It feels like a pipe dream: being a traditional midwife working in her own community. Why should only rich women have one-to-one care?
If you work in a big establishment, you can't take responsibility for everything. Yet if a woman stopped breastfeeding on my shift I took it personally. I blamed myself; I deprived that baby of its mother's milk. But feeling this sense of responsibility is not possible on that scale.
I'm not trying to avoid the problems, women do get ill. But if you know the women, the problems shouldn't creep up on you so easily. I would be happy to go into the hospital with women I knew.
Twelve women a year would suit me, while Jules is small. It's just a dream but that's how I could look after women well.
LW updated February 4, 2005