Published Thu, 2010-10-21 16:06; updated 2 years ago.

The word ‘midwife’ means ‘with woman’.

Midwives are specialists in normal pregnancy and birth, and are qualified to look after a pregnant woman and her baby throughout the antenatal period, during labour and birth, and for up to 28 days after the baby has been born.

Contacting a midwife

You can go directly to a midwife for antenatal care. If you don’t know how to contact your midwife, ask your health centre, or write to the Supervisor of Midwives at the local hospital. You do not need to see an obstetrician (a doctor who specialises in childbirth) while you are pregnant or giving birth.

What does a midwife do?

As long as everything is normal, a midwife can provide all your care. If complications arise, a midwife will refer you to a doctor who is trained to deal with special situations.

Within the NHS there are hospital and community midwives. There are also private midwives who work independently of the NHS. See 'Choosing an independent midwife' for more information.

Hospital midwives

These are midwives who are based in a hospital obstetric, or consultant, unit, and they staff the antenatal clinic, labour ward, and postnatal wards.

Community midwives

These midwives often work in teams and provide a degree of continuity of care. They see you antenatally either at home or at a clinic. When you go into labour they are available for a home birth, or they may come into the labour ward in the hospital to be with you. Once your baby is born, they’ll visit you at home for about ten to 28 days after birth. Community midwives also provide postnatal care for women who have been looked after during labour by hospital midwives.

Your relationship with a midwife

It is important that you and your midwife have a good relationship. You need to work together and she needs to support you in all your choices. In order to help you give birth, your midwife needs to be respectful, responsive, unintrusive, and accepting. This will help to make you feel safe and enable you to relax, which in turn allows the labour hormones to work.

Childbirth may be the most powerful life experience you undergo. With a midwife’s full support, you can tap into enormous reserves of strength during the birth process and learn that you are capable of so much more than you realised – a valuable discovery as you become a mother.

What training has my midwife had?

Some midwives have trained as nurses before becoming midwives, but it’s now possible to qualify as a midwife without qualifying as a nurse first. Student midwives are based at university, and are studying for either a diploma or a degree in midwifery. The course contains a mixture of theory and practice. Courses vary across the country, but are designed to prepare a student for the responsibilities of being a midwife.

Once qualified, a midwife must be able to care for women throughout pregnancy, birth, and during the postnatal period too, as well as care for newborn babies. She must be able to detect problems and summon medical help if needed, and be trained in emergency procedures herself. She also has a role in health education and preparation for parenthood, such as teaching antenatal classes.

Midwives also have to stay up to date in order to keep their registration, which is reviewed every three years. This includes having to work a minimum number of hours as a midwife and attend study events.

Your care in pregnancy

You will see a midwife regularly throughout your pregnancy and she will let you know how to contact her, if you need to. Your first visit will be at around eight to ten weeks or pregnancy. This is known as your ‘pregnancy welcome visit’ or, more often, your ‘booking appointment’. Your midwife will spend quite a long time finding out all about you and your pregnancy. She will ask you questions about your medical history, any previous pregnancies and also about your current pregnancy. If she is a midwife you will be seeing regularly, this is an opportunity for you to get to know each other and for her to find out about your hopes for the pregnancy and birth. She will answer all your questions and should also be able to help you with any concerns.

Your midwife can also advise on diet, exercise, and dealing with minor discomforts of pregnancy. See ‘Pregnancy niggles and discomforts’ for more information. She will outline what your options are for antenatal tests and screening and explain the purpose of each test. See ‘Screening and testing’ for more information. You will be provided with information about the various tests which you can take away and consider, so that you and your partner can decide whether you wish to have any of them.

At every antenatal appointment your midwife will, with your consent, routinely take your blood pressure, test your urine for glucose and protein, and feel your abdomen to see how your baby is growing. She will write everything down in your maternity notes. You’ll be given a copy of your own maternity notes to look at, keep, and to bring to appointments.

When the baby has grown enough, your midwife may listen to the baby’s heart rate with a hand-held device that uses ultrasound waves (if you are happy to have ultrasound). Later in pregnancy the baby’s heart rate may be heard using a Pinard stethoscope. Once your baby is big enough for you to feel movements, your midwife will ask if the baby is active. Toward the end of pregnancy it will become more important for your midwife to establish which way the baby is lying in your uterus. At certain points further blood tests will be done with your consent. See ‘Screening and testing’ for more information. These checks form the basis of every antenatal appointment a woman will have and they become more frequent as pregnancy progresses.

Your care during labour

If you have booked a home birth, your midwife will come to assess you at home when you go into labour. If you are having a hospital birth, some community midwives do home assessments before you go into hospital, but often you will have to make your own way to hospital at some point during your labour, before you get seen by a midwife.

During labour, your midwife’s job is to support and help you. She is also there to support any birth partners you have. Her role includes helping you to give birth in the way that you would like, and to monitor your health and that of the baby. She can help you to get into positions that are comfortable and will help labour progress, and she can suggest ways of coping with contactions. If your midwife feels concerned at any point that things are not progressing normally, she will liaise with medical staff.

If you are being looked after by a team of community midwives, you may already know the midwife who is with you during labour. To be cared for during birth by a midwife you have got to know beforehand is helpful. If your labour is long, you may experience a change of shifts; your midwife will go off duty and be replaced by one who is just starting her shift.

Immediately after your baby has been born, your midwife will help you, and your partner, if present, to get comfortable and feed the baby.

Your care after the birth

In the days and weeks following the birth, you will be visited at home by a midwife who will examine you and the baby to make sure that you are both adjusting well. In some areas, the midwife may stop visiting once your baby is ten days old, but in other areas she may carry on visiting for up to 28 days after the birth. She will ensure that the baby is feeding well and beginning to gain weight, and that you are recovering well from the birth.

How can I get continuity of care?

Research shows that to receive care from the same person throughout pregnancy, labour and the postnatal period provides a better birth experience for a woman than if she is looked after by lots of different people. One way of getting continuity is to book a home birth. Some women book one even if they are not sure that it what they want, and they make their final decision later on during their pregnancy or even in labour. You are also more likely to receive continuity of care if you give birth at a birth centre.

If you are planning to give birth in a hospital unit, it’s not always as easy to get to know your midwives. If you arrange to have ‘shared care’ with your GP and the hospital, the majority of your appointments will be at your GP’s surgery. While this can be very convenient, your GP will not attend the birth and it means you are unlikely to know the midwives at the hospital when you go in to give birth.

Some hospitals operate a team-midwifery system, usually run by community midwives. If you have only one local hospital, you can ask whether it is possible to have midwifery-led care, and to be looked after by a small team of midwives. If you have several maternity units to choose from in your area, you may need to ask several of them. Some hospitals have teams that operate only in certain areas, which may limit your choice. If you are in doubt, phone up your local community midwives and discuss it with them.

Making sense of your medical notes

Your baby’s position (or presentation and lie)

Recorded as Ceph or C or Vx (cephalic, vertex, or head down); Br (breech or bottom down); Long (longitudinal or vertical); Tr (transverse, or across your body); Obl (oblique or diagonally); OA = Occiput Anterior (head down, facing your back); OP = Occiput Posterior (head down, facing your front); OL = Occiput Lateral (head down, facing your side).

L or R written in front of these indicates which side of your body your baby is lying on. OA is the most favourable position for your baby to be in. 

How much of your baby’s head is in the pelvis

NE, NEng, Not Eng (not engaged) or ‘free’ means that baby’s head is above your pelvis. 1/5, 2/5, 3/5, 4/5 refer either to how much of the head can be felt above your pelvis or to how much of it is in your pelvis (ask your midwife which). Your baby is engaged once 3/5 of the head is in your pelvis. E or Eng = Engaged.

Your baby’s movements

FMF = Fetal Heart Movements Felt; F = Felt

FMNF = Fetal Movements Not Felt; NF = Not Felt

Your baby’s heartbeat

FHH = Fetal Heart Heard; H = Heard

FHNH = Fetal Heart Not Heard; NH = Not Heard

Urine test results

Prot or Alb (protein or albumin) and glucose are what are tested for.

NAD means Nothing Abnormal Detected; Nil means none found (normal); Tr (trace) means that a small amount of protein or glucose has been found; +, ++, +++ indicate that greater amounts have been found.

Your blood pressure

The average blood pressure for adult women is 110/70. Blood pressure above 130/90 is considered high but if the blood pressure was particularly low at the beginning of the pregnancy, lower levels may be considered to be excessive later on.

Swelling (or oedema)

Oed. Amount recorded as +, ++, +++

Content provided and copyright by NCT, the UK’s largest parenting charity. We support parents through pregnancy, birth and the early days of parenthood through our antenatal and postnatal courses, local support and reliable information.

www.nct.org.uk/info-centre  

NCT