When you start working in maternity care, whatever your job, people often think how happy it must be. Compared to other specialties, we are very privileged to have the joy of working with women who will normally have a good outcome. The majority of women who begin pregnancy fit and healthy will have a physiological pregnancy, deliver a healthy baby, and leave to start their life as a mother.
Some women won’t though. Some women enter pregnancy unfit, or with serious medical conditions that may stop their pregnancy early or potentially cause difficulties both for themselves and their babies. Others may be well when they become pregnant but develop conditions such as pre-eclampsia, gestational diabetes, or puerperal psychosis—all of which will have long term implications for their health. Still others will have a complication with high morbidity, such as a massive obstetric haemorrhage.
It’s for this reason that midwives do not work in a vacuum, but have the support of obstetricians, obstetric anaesthetists, and other medical specialists. “Hope for the best, prepare for the worst” could well be the mantra of maternity healthcare workers.
Over the years I have learnt a lot about the concept of partnership. Working with a team is crucial, with high quality clear communication at all levels the foundation of providing excellent care. We also have to develop partnerships with the women we care for as part of our ongoing learning on how to care for them and their babies. The value of working together with those who have experienced a loss, or an adverse event, or a complication is something that cannot be underestimated.
In this, I am thinking of the couples we cared for whose babies had died in utero, who came in for induction of labour. They gently pointed out that the single room we were using on the antenatal ward was not fit for purpose, so we redesigned it.
I’m thinking of the women and men who helped us to learn from their experiences and then share this learning with others. Our bereavement midwives wanted to better understand the lived experience of those having a second trimester miscarriage. Our lactation midwives wished to learn about the woman’s experience of milk suppression following a perinatal death. Those women (and men) who generously talked to us on these subjects have helped so much and allowed us to build on the body of evidence of what is best practice.
I’m thinking of those who came to talk at a meeting held recently on the subject of bereavement. I’m thinking of those who helped develop national guidelines on bereavement and of the many voluntary organisations that work with us to support women and their families.
I’m thinking about patient advocates who work tirelessly with us to change the system and reduce the chance of recurrence of adverse incidents. To all these people, and groups, and organisations—to those who advocate, and educate, and speak so honestly about their experiences—we are indebted. We all have a common purpose, and together, in partnership, we are making a difference.
Mary Higgins is an obstetrician at the National Maternity Hospital, University College Dublin.
Competing interests: None declared.