Because you obviously are the first woman in the world ever to be pregnant, aren’t you? At least, that’s what it feels like. If you have a very nice GP she or he may show some shared pleasure at the amazing, earth-changing news.
Slowly, however, it will dawn on you that there are an annoyingly large number of people out there in the same situation. And there is going to be a long succession of health professionals, displaying varying degrees of empathy and grumpiness, whom you have to go and see at regular intervals – along with all the other pregnant people. Yes, it does feel a bit like an assembly line.
After you first unleash your Big News on the world, you will have to make a booking appointment with a midwife. At the booking appointment you are given your maternity notes. (For heaven’s sake, don’t lose them. You are meant to have them with you at all times. Yes, at all times – even in the swimming pool changing room.)
A lot of things get discussed at the booking appointment, and you can find out more about what should be discussed at this point on the NICE website https://www.nice.org.uk/guidance/CG62/ifp/chapter/Antenatal-care
And in addition, you should be offered a choice of places to give birth – a consultant-led maternity unit, a midwife-led birth centre or unit, or at home attended by NHS midwives. The latter two might be discouraged if there are complications, but for most women they are an option.
If this is your first baby, and you have an uncomplicated pregnancy, you can expect ten appointments through the 40 weeks of your pregnancy, seven if it’s a subsequent baby. They will be either at an antenatal clinic, a GP surgery or even in a midwife group practice – depending on your local care arrangements.
I am not going to make a prediction as to how long those appointments will be, but the chances are that you will spend longer waiting outside in the waiting room than you do inside talking to the midwife or GP. Lately I’ve heard complaints from mums that the appointments feel rushed, and that they find topics ticked off as “discussed” on their notes which they don’t even remember mentioning.
It can be immensely frustrating.
So here are seven sure-fire, tried and tested ways to get the MOST out of those appointments.
- Have with you a list of topics you want to discuss. And be proactive with your list.
I don’t mean walk in, sit down and say “Right, this is what I want you to tell me. Point one…” I mean, for a start, that’s a bit rude.
The midwife will have an agenda get through, and it is important for you that she gets through it…but it’s ok to say politely: “Before we start, can I just mention some queries I have? I’m sure we’ll be covering them in the appointment but I’d like you to know first of all what’s on my mind.”
- Make sure you understand what you are told! Well, duh! But seriously, allow something to sink in and ask the midwife or doctor to repeat things if you didn’t get it first time. Ask if there is a leaflet you can take away with you, or a website that you can check up. Get them to write down technical words. Make notes.
- Smile! Midwifes are very strongly encouraged in their training to build rapport with their clients. But you can meet her halfway! Rapport works in two directions, and you can make things easier for her by being friendly back. Get her on your side. You may have already read that the love hormone, oxytocin, is key in pregnancy and birth. Well, midwifes need oxytocin too! Raise hers by being friendly and appreciating what she does. If there is time, ask her how long she’s been a midwife? What does she like best about it? How many babies has she delivered? (This best question as the answer is short).
- If you aren’t sure what a suggested procedure is meant to achieve, ask why it’s being done. Don’t just sit there like a pudding having things done to you. You could learn a lot if you ask lots of questions and listen to the answers. And by showing a real interest you are building rapport as well.
- 4. If the birth professional tells you a fact that sounds a bit general, ask her where the information comes from. For example, if a midwife says “your baby might die if you aren’t induced at 41 weeks” ask what the evidence is for this generalised statement. If a GP says “home birth isn’t safe” ask what their source is. And ask for details.
- Use your BRAINS! This is an old National Childbirth Trust antenatal class mnemonic which we use as a pathway to getting good information when any procedure or intervention is suggested in pregnancy or childbirth.
B is for Benefits. “What are the benefits of this suggestion? What’s it going to do for me?”
R is for Repercussions. “OK so I’ve heard the benefits. But does this procedure you are suggesting, kindly health professional, have any possible repercussions? Do you have any evidence of either?”
A is for Alternatives. “Anything else we can do which might have the same outcome?”
I is for Intuition and Individual. “What does your intuition tell you is best?” This digs down into your health professional’s experience…also their prejudices. “What would be best for me as an individual?” In other words, am I one of the women at risk here?
N is for Nothing. “That’s an interesting idea. And what if we don’t do anything? What happens then?”
S is for…Smile! Also for Speak Out.
- 6. Communication. Keep in touch and, if necessary, push a little harder for better communication. Ask if it is possible to have an email address or a mobile number. Or if you can get reminders of future appointments by text. Or if you can ask to be seen by a specific midwife who you like.
- You make the decisions. Remember – this is your baby, your body, your birth. If you don’t feel comfortable with one health professional’s opinion ask for a second view from another. For example, it is very normal for two doctors in the same hospital to have very different views about whether a particular woman should have an induction of labour. You make the decisions means there is no place for language such as “the doctor will do this or that” either during your antenatal appointments or when you are having your baby. Instead you should be hearing, “How would you feel about us doing…I’d like to suggest that we…would you like to think about…”
Enjoy your time sitting in the waiting room…don’t forget to bring something to read, or some work to get on with!
Above all work on building a relationship with all the health professionals you meet. They are people too. And they are very busy. Relationships have been called the hidden threads in the tapestery of maternity care” holding everything together . Your health professional will be trying to build a relationship with you but she or he might find it difficult because of all the other things they have to think about.