In my thirty years as a midwife many events, people, places, patients, colleagues, doctors, midwives and mothers – not to mention the babies themselves – have enriched and shaped my career.
I grew up surrounded by my mother’s friends, who were all nurses and midwives, and I am still learning from midwives and mothers today. We chat about our experiences and continue to share our knowledge. But looking back, I am aware of how we go through different phases of learning that affect how we practice.
When I trained as a midwife, I loved the work more than anything I’d previously done in nursing. I was fascinated by every aspect of how a baby develops month by month and the whole journey through labour. At that time, in the 1980s, the experience of having a baby was usually a happy outcome for couples, though of course there was sadness for some. The focus at the time was very much on the medical side. The business of having a baby was highly medicalised and the health of the mother and baby was seen primarily in terms of new technologies that were available for monitoring both pregnancy and labour. For many of us involved with pregnant women, thoughts were limited to getting a baby through a pregnancy and delivered safely. There have been many more developments since I qualified that might make pregnancy even more hi-tech, but I have learnt that really being with a person on every level – mind, body and spirit – is what is most important.This means listening to the woman, meeting her emotional needs, reassuring and guiding her and giving her the confidence that she can get pregnant in the first instance, carry a baby and, finally, give birth to him or her safely.
Today women have access to so much more information that, if anything, their fears have increased. Attitudes to being pregnant are changing, too, with more attention on the whole experience: what your baby experiences in the womb, how you can have a healthy baby and how you can influence his or her development physically, mentally and emotionally. Much work has been done recently on the influence that conditions in the womb can have on the future health of your baby – nutritionally, physically and emotionally – such responsibility adding another layer to parents’ anxieties! But I would like parents to see this as a positive change.You, as a future mother, have control over the environment your baby is growing in through your thoughts and emotions, in the way you react and deal with circumstances, in the food you eat for your baby’s nutrition and through bonding with him or her. Mindset plays a huge role here.
The first phase of my learning was on a highly medicalised labour ward as a student midwife.Women were encouraged to endure their labour lying on their backs, so that they could be monitored throughout. After the birth, bottlefeeding was promoted – many mothers chose not to breast-feed at all. Babies were taken into the nursery, away from their mums, where as student midwives on night duty, we woke them every four hours for feeding.
Men were allowed to stay with their partners in labour, though as an aside, I don’t think that it suits all men to be present at the birth. Some don’t want to or are squeamish, and I have seen many couples with subsequent sexual problems as a result of the man’s experience at the birth, when he felt obliged to be present, but would much rather not have been. Initially when men were first permitted in the labour ward they had to leave when examinations were being done. After that we went through a phase of them being encouraged to be highly involved. Other practices, such as artificially rupturing membranes, made birth a very difficult process for many women. All in all, what I learnt during this time was that I did not want to practice as a midwife in this way.
I was glad to take up a post as a midwife in Oman – an opportunity that arose because of my husband’s work. It was an amazing experience, which shaped my practice as a midwife and taught me skills for life. I really began to understand how to be with a woman in labour, away from a technical environment.Yes, there were monitors, but most of the time they were away being repaired! We had to monitor the babies using old-fashioned listening devices and came to understand the behaviour of women as they laboured and how their breathing patterns let us assess how labour was going. It was acceptable for the baby to sleep with the mother from the moment of birth and most breastfed very easily. I gave birth to my daughter, Sofie, there in a very simple local hospital. I had to work as a midwife right up to my waters breaking at 39 weeks and I gave birth to her with the help of life-long friends Serena and Jan Wilson. I laboured with a dozen other women in the same room, some of whom I had delivered the day before!
Returning to the UK, I was very rusty technically. I was not used to setting up epidurals and I had only done one episiotomy in three years. I worked on a labour ward to get back into the swing of things, but decided that I really wanted to be a community midwife. I loved looking after mothers and babies in their homes and doing home births. I was also pregnant with my son, Jack. Sadly I suffered postnatal depression, so the condition is something I empathise strongly with.Working as a community midwife was hard at this stage as Jack was awake a lot at night, things were tough with my husband’s work and we had a lot of worries. My doctor was fantastic, but all he could offer was anti-depressants, which I didn’t want to take, so I started to seek alternative therapies.The area of complementary medicine was not as developed as it is today and I saw some good people, but also some who were not. I eventually stumbled on acupuncture and this had a huge impact on me.The therapist was excellent – I felt listened to, nurtured and more energetic than before and I decided to train in five-element acupuncture.
The next stage of my life was three years’ training to become an acupuncturist while working in a special care baby unit.This was a wonderful experience. I loved the ancient arts of five-element acupuncture and Traditional Chinese Medicine (TCM), particularly the notion of living within natural laws to stay healthy.This was a completely different model of medicine, based on the art of listening to and understanding the patient as a complete human being, not just a body to be fixed. It introduced some very different ideas: such as the treatment of disharmony in the body, palpating to see how heat is distributed, looking at the tongue and taking pulses. Underlying all was the concept of ‘qi’ energy and the five elements, providing a unified theory of a person’s health in mind, body and spirit.
While all this might have seemed strange in terms of mainstream medicine, it made such sense to me that I began to think about how I could combine acupuncture with midwifery. So many women experience common ailments in pregnancy that are considered ‘par for the course’, such as morning sickness, and I was aware that pregnant women are reluctant to take medication – and I was also interested in using acupuncture during labour. It was obvious that there was a gap in the range of treatments available that acupuncture could fill.
Once qualified in acupuncture, I had to persuade consultants to allow me to use it and I was delighted when I got the go-ahead to start up a service giving acupuncture alongside mainstream midwifery in the National Health Service (NHS). At that time the only other unit using acupuncture was in Plymouth, run by Sarah Budd and SharonYelland, and I am very grateful to them for letting me observe them at work. I learnt a huge amount working in the NHS because I treated so many women and I was able to use acupuncture for all sorts of pregnancy-related conditions. Acupuncture took me in a different direction and I still use it today.
I developed a great interest in nutrition and micro-nutrients, both pre-conceptionally and during pregnancy, and this is now an important part of my practice. I became very interested in this area 20 years ago, through the work of Professor Barker on how the future health of a child can be influenced in utero. His concept is that the baby’s growing organs have a critical window of development, when key nutrients need to be in place for optimum development of that organ. I also followed the work of Professor Michael Crawford in the importance of essential fatty acids. I developed a range of supplements and have been spreading the word about the benefits of omega-3 for 12 years. At my clinic, as well as all the usual medical tests, we test for essential fatty acid status, micro-nutrients and antioxidant deficiencies and we have done much work on vitamin-D deficiency, testing over 1,000 patients.
The influence of mind and body on your baby, and what you can do to have a healthy pregnancy and baby, is where I am very much focussed now. Understanding what your baby is aware of in utero and what you can do to influence his or her development, will form the next chapter of my working life. I suppose my career has been spent looking at how to improve on what we already know about care and treatment in fertility and pregnancy.The final phase is to put it all together to help couples become pregnant and then to have the best possible pregnancy, using the knowledge colleagues and I have gathered. Often that means looking where there is little evidence. Our skill is pulling the strands together, offering a holistic approach to include the mental and emotional aspects of pregnancy. The integration of current scientific thinking with therapies that offer women better well-being for themselves and their babies is the way forward.
The final phase has included setting up my own clinic. I established it a decade ago and until then worked as a sole practitioner offering acupuncture, nutritional advice, fertility awareness and counselling. The approach has always been: working with couples to formulate a plan of action for conception and pregnancy. Based on a medically-led approach we use acupuncture, nutrition, fertility awareness and counselling as well to bring together a programme tailored to the individual’s needs. My vision was a midwife-led clinic combining all I have learnt and offering the best advice available. I now have a fantastic team of therapists, and in 2011 we set up Zita West Assisted Fertility, offering IVF treatment within a holistic practice.The first Zita West IVF baby is due in June 2012.
Like any venture into new territory, you can’t do it on your own. I am eternally grateful to my wonderful and expert team.