Hello! I’m Sarah and I am a specialist midwife for pregnancy loss, more commonly known as a bereavement midwife. I have worked as a qualified midwife in a busy London NHS Hospital for 15 years and wouldn’t dream of doing anything else. During my career I have worked in all midwifery settings including the busy wards, labour ward, a high risk midwifery community team providing continuity of care, as a midwifery sister on the antenatal and postnatal ward, and behind the scenes undertook a large audit project. I am now working in a job that I absolutely love – caring and advocating for families who have sadly lost a baby at any stage of pregnancy or in the first 28 days of life, walking this devastating journey with them and supporting them as best as I can!
There are a small (but still too many) number of families that will meet a bereavement midwife in their lives. It is not until you have to walk the baby loss journey that you even know about our existence and then you get to know your bereavement midwife very quickly and they become an essential companion in what often feels like an impossible journey. The road is bumpy, has cracks and often you will walk down a different path to your family, but once you lose a baby it is a journey that must taken, and having at trusted professional at hand when you need them, not make things better, but to prevent things from becoming worse.
It feels impossible to put into words what it is like to be a bereavement midwife. While it comes with much sadness and it is comes with much pride. I feel proud of what we do and find it humbling to help families in the journey through pregnancy loss, but many people still don’t really know what we do. Our work, like most of midwifery, is unpredictable. I work with another bereavement midwife in the unit I work in and we have a colleague who works in our sister unit. I hope that by sharing our day to day work with you all that it will give you and important insight into what we do and help other units in investing in their bereavement services.
8am-10am – My colleague starts her day. It’s vitally important to spend this first part of morning establishing which families need to be seen/contacted, if there have been any new cases overnight/ over the weekend. It is also the time to turn on the team mobile phone, and check the landline phone for messages (there are always messages!), and begin to plan the day.
On a typical day we have inpatients to see, families to visit at home, families coming to see their babies after discharge if they have decided not to take them home, and attending appointments with families as their advocate. We have memories to make, speciality teams to work with, psychology referrals to make, funerals to arrange, post mortem to take consent for, items to give and retrieve from babies and families. Behind the scenes we have notifications of pregnancy loss to send, data to collect, reviews of care to do, and service development.
My colleague begins her day with finalising some paperwork for families who have asked us to arrange a hospital funeral for them, whether that be burial or cremation. We offer all families a simple but dignified individual service for their baby’s funeral and they can chose whether or not to attend. Families can also arrange their own funerals free of charge with a funeral director but for some families it is just too overwhelming to do this and so it is important that they have a safety net of a hospital funeral. It is vital to get things right when organising a funeral, such as correct name spellings of the baby and family requests for the service such as particular readings or songs as you only have one chance to get this service right and it is an important part of a family’s journey through pregnancy loss.
She dashes down to the mortuary with all of the paperwork needed to release the babies for their funerals as the funeral directors are coming in the next couple of day.
On the way back she goes to labour ward to see a family who have just the night before have experienced a stillbirth at term. Our labour ward colleagues have already done a great job of starting the process of creating memories for this family by giving them a memory box, taking handprints and footprints and most importantly giving them the important time they need to spend with their baby as a family.
It is important that the parents wishes are respected when it comes to how much time they spend with their babies and that they are in control of this. For some parents this may be for a few hours after they are born, or perhaps they spend a couple of days in hospital with their baby. Some may take their babies home with them and others won’t want to see their baby at all. We work in a hospital where we have families from a vast variety of backgrounds and faiths and so whatever their wish it will be respected. We always tell them that they have the right to change their mind about anything they decided they always be supported. Making decisions that you never dreamed you would ever need to make, and to have so many decisions presented to you in one go can be confusing and overwhelming when intertwined with grief, but they are equally important decisions that have to be made.Giving families time and space to think these through is essential.
10am – I arrive at work meet my colleague in the office and we talk about what have planned for the day. We have a family to see at home, a family coming back to see their baby, phone calls to make and a mother coming back to the hospital to have some blood taken for further investigations as to why her baby died. We have follow up appointments to book, memorial service invites to send, baby loss awareness week to plan and answering phone calls, texts and emails from patients as and when they come in. As the team leader I also have a meeting to prepare for whereby we review the care given to patients in the lead up to their baby’s death and following their loss to see if we could do anything differently. We decide that my colleague will go out to do the home visit and take the bloods from the mother coming in later today. I will go with the family to see their baby and prepare for the meeting, get the invites sorted and make enquiries about our baby loss awareness week plans. The calls, texts, and emails will answered as and when they come. My colleague leaves to do the home visit, she probably won’t be back until after lunch, and I begin work on organising follow up appointments.
11am – Follow up appointments arranged. These appointments are made with the families named consultant between 8-10 weeks after their baby’s birth and gives the parents the opportunity to go over events leading up to the loss, how they are recovering, results of tests and investigations, and if we have been able to find an answer to why their baby died to give this answer sensitively to the family. Finding an answer is incredibly important to families but can also be coupled with stress if the answer means further testing or perhaps procedures before they should embark on a new pregnancy. If the families are ready we also use this time to talk about the future and recommendations for a future pregnancy. It goes without saying that this is a full on appointment and for this reason we do not ever formally discharge families from our care as they will often need to ask more questions about what was discussed, and following weeks of practical things to do and focus on the subsequent silence can be frightening. This is often the stage when we are asked by families refer them for extra psychological support.
My colleague is out on her visit and so I get on with making the phone calls.
1pm – I’ve made and documented 4 phone calls as well as answering a further 3 and 2 emails from families. One of the calls was 45 minutes long, but thats OK, it is important that families do not feel rushed. Sometimes we talk to the mother, sometimes the partner, sometimes we are on speakerphone to them both. We spend a lot of time talking about grief and loss, reassuring families that it is OK and very normal experience the same feeling of loss as when you lose anyone who special to you. We often give them advice about managing caring for and supporting other children they may have that will be affected by losing a sibling. Losing a baby at any stage of pregnancy is no less painful and families need to know that while these feelings are unsettling to say the least they are still OK. We try to use the baby’s name (if chosen) and include them in the conversation as appropriate. We want our families to know that we respect and values their baby’s place in this world. A Couple of visits have been scheduled in for later in the week following these calls, plus I have some extra memories to take for a family who initially declined them but have now changed their minds. My colleague is on her way back from the visit so I dash off to accompany the family coming back to see their baby.
Both the mother and father have come today, the mother wants to spend time with their baby but the father does not. We are lucky that in the space we use for families to return to see their baby there are two areas, the space the baby is in and a space where family members can sit if they do not want to see the baby. I show the mother to where her baby is, a tiny but beautiful baby, and we spend some time cleaning and changing her, getting her ready for her funeral. I can see the comfort that this is bringing to the mother, she feels like a mother, singing and talking to her baby and this warms my heart my than words can say. I leave her with the baby as she would like some time alone and pop next door to spend some time with the father, he is finding it difficult to talk so I don’t press, but I remind him that if and when he is ready to talk we will bright here. After about 10 minutes the mother is ready to say goodbye for today and we have a long hug and a few gentle words before she leaves.
I go next door into the mortuary to get some footprints and hair for the family who called earlier and send a text to say I’ve done this. We arrange for them to come tomorrow to pick them up. I’ve missed 3 calls while I’ve been away.
2.30pm – I get back to the office and my colleague has returned! It’s good to see her. She tells me all about how the family she has seen will need some extra support and we refer them to our psychologist at their request. Home visits usually take couple of hours. Once families start talking we let them lead the conversation which can often understandably be meandering but always relevant. We may have to repeat information which has been lost in the wealth of information they have been processing but we always say it like it is the first time we’ve said it. We don’t mind. I update her on the calls made and the family that have just left. Its important that we each know what the other has said or done so that the families don’t have to tell us which can be upsetting. She grabs a quick lunch before the next mother arrives for her bloods and I eat while I return the missed calls and start doing some preparation for the care review meeting.
4pm – My colleague has taken to bloods and sent them, as well as spending time talking the mother. We usually arrange to see them in quiet room on the other side of the hospital away from maternity, assuming back to the maternity unit can be upsetting. She is just going back to check on the family who are now on the ward with their baby from this morning.
5pm – My colleague sits and documents everything she has done today before she goes home. She also answers another two phone calls during this time until we turn the phone off at 6pm. I’ve done as much preparation for the meeting as I can do for today as I still have so much to do! I send an email to all of the relevant departments to let them know about the family who had their baby last night so that nobody contacts them about missed appointments, baby hearing tests, or congratulates them on their new arrival because they didn’t know. Such a simple but effective action.
I’ve had an email from a mother who has just found out she is pregnant again. My heart does a leap of joy and both myself and my colleague squeal. This is the best news after a busy day. Rainbow babies are so precious and the part of our job that balances out the sorrow and joy. I calm myself before I respond, as while I am excited beyond words, the family will be apprehensive and anxious. I respond by confirming the plan from her follow up appointment with the consultant and we put into place the first steps in this pregnancy. I then refer her to one of our caseloading teams as continuity of care will probably be the most important factor in this pregnancy for managing the anxiety and fear that this family will no doubt feel during their pregnancy. This will be a long journey for them but they will be well supported.
I quickly send off a few emails to various people to make arrangements for baby loss awareness week that is coming soon and order some ribbons to make some pink and blue pins.
6pm – My colleague leaves to go home after checking that everything is stocked up should their be a new case overnight. We have a hug (most days end on a hug), and I stay on to print and post many invites to our baby memorial service in December. We invite everybody have cared for in the last couple of years, and I realise just how many families pregnancy loss hits, yet we hardly talk about it. I’m feeling thankful that we didn’t have any more new families today. Families are always commenting on how many people they know that have come forward to support them because they have had a pregnancy loss too, and it always astounds them just how people have experienced the loss of a baby. Thats why this year and every year we are working hard to make the most of what we can do to raise awareness during baby loss awareness week, we have to break the silence!