How to Become a Midwife

Sam Norman: The process of giving birth is extraordinary, exciting, tiring, painful and can often take a lot longer than the mother might have hoped. Nobody knows more about the agony and the ecstasy of giving birth than a midwife. So how do you become a midwife? With me, is Sue MacDonald, Education and Research Manager at the Royal College of Midwives to answer the questions on this amazing career. Welcome Sue. Sue MacDonald: Thanks Sam. Sam Norman: Sue, what makes for a good midwife, first of all? Sue MacDonald: I think the biggest thing and what all women say is about kindness and being able to empathize with the women. That doesn't necessarily mean you have to have babies and children of your own, although it obviously helps you to have to tune into women. But the kindness is a huge thing and it's difficult because you don't get O levels or A levels in kindness -- Sam Norman: Well, exactly. So if I am a kind person and I am desperate to become midwife, how do I apply? Sue MacDonald: There is a lot depending on your age, your academic profile and sort of your other things in your life really, because you will be required to have academic qualifications of some sort. Sam Norman: Like what? Sue MacDonald: Most universities ask for the minimum of five O levels and the two A levels and some universities will ask for more and some universities will accept something called the DC test, which is like a kind of supercharged IQ test that you can do which is equal to about five O levels, but it doesn't take as much time, you are sitting at that test for about two hours. Sam Norman: However it needs to be more practical than necessarily academically gifted to be a midwife? Sue MacDonald: Well, we expect a lot about midwives, and we expect them to be practical. We also need them to be academic because they do need to understand quite a lot of in-depth information such as physiology which is quite difficult, if you don't have an academic background. So the applicants that ask us about becoming midwife, we usually advice them, if they haven't done any academic study to either do some night school study or apply for the DC test to get it to university. Some universities will accept access courses which is another route that you can get into. Sam Norman: So once you've got these qualifications, how easy is it to get on to a training skill in to university. Sue MacDonald: Well, there are two routes to becoming a midwife. One route is you become a nurse first and that takes three year training and then you do a shortened midwifery course of eighteen months. That's basically a four-and-a-half year program from start to finish. Sam Norman: Long time. Sue MacDonald: It is a long time. The other route which is now much more common is a direct entry, three year program and what you need to do is think about where you want to be, and I mean geographically is there any universities locally because many women who come into midwifery have got children, have got family responsibilities. The profile of midwives tends to be that is not necessarily their first career move. So they are often settled and don't necessarily want to travel around, so then you need to look locally of what your universities have to offer, where they have a program and what their requirements are. There are probably depending on where you're applying, you might have sixty people applying for one place -- there are -- the competition is very -- Sam Norman: But then you have a shortage of midwives, as I understand? Sue MacDonald: Well, it comes down to every program of midwifery, student midwifery. You have half theory, half practice and all your practice has to be overseen, supervised by qualified midwife. Therefore, you can't have hundreds and hundreds of students in one maternity unit, if they are not supervised each one by a midwife. And also you can't have too many students because they won't get the amount of experience they need in order to qualify, so it's balancing that is quite problematic. Sam Norman: Yes, I can see. Sue MacDonald: But we have increased the student numbers in UK, hugely over the last five years. Sam Norman: Is there an age limit? Sue MacDonald: The age limit tends to be in courses that you are able to complete the course and give at least ten years service back. So some courses will say forty five, forty eight -- you need to be Sam Norman: Wow! That's quite young. That would be the sort of time a lot of people think possibly about the second career. Sue MacDonald: It is. It is. This is at the age where women tends to be older, we do have a few younger midwives who enter at eighteen, nineteen and then we have the majority are in their late twenties, early thirties and then we have a small number who are the older midwives or older student midwives, so it's quite a nice mixture of people and expertise that we have in the student profile. Sam Norman: What made you want to become midwife? Sue MacDonald: I didn't realize, I wanted to be a midwife, but the time I came in to it through being a nurse, and at that time you had to have two qualifications in order to really progress, and everyone said, you have to do midwifery. And I had to start and I didn't enjoy my midwifery course at all. It was very hard, very tiring, a lot of studying and it was quite difficult. When I qualified and I suddenly started enjoying it and I went back to nursing for a short while and I had to come back because I missed the mothers and babies so much and the intensity of the experience you get is not just about the birth, but is about caring for women in pregnancy and caring for them afterwards, helping them get used to being new moms and coping with this new - rather scary, new baby. You just don't get that in any other field of work. Everyday is different. I mean this is a fantastic job. Sam Norman: But there's a lot of responsibilities, isn't there? But you have to be prepared to shoulder that. Sue MacDonald: There is. You have two people that you're responsible for, mother and baby. Sam Norman: Exactly. And if something goes disastrously wrong, how do you deal with that? Sue MacDonald: You have a very good support mechanism because when things go wrong, you have your midwife colleagues around you to support you, you will obviously have to able to support the mother and her family, depend on what's gone wrong really. Sam Norman: Exactly. Sue MacDonald: You have also got a supervisory midwives who is your kind of experienced guide and mentor and she -- in every maternity service you'll have a number of supervisory midwives who are midwives. You might be a supervisory midwife doing the same thing for someone else, but that person will sit with you and go through what happened, what went wrong, why it went wrong, were there things that you did wrong that you need to look at and improve. Obviously it's just something that happened that couldn't have been helped and you can work through it in that way because what's really important is that you come to grips at what happened in order to give that support to the mother and baby, or the mother if it's a case where the baby has been lost. Sam Norman: Can you work part time? Sue MacDonald: Certainly after you are qualified as a midwife, just under half of midwives are part time now in UK, so, yes you can work part time. And that can be one session a week. It can be four days a week. It can be three days a week. It can be night duty. It's whatever the service will -- Sam Norman: And what's the money like? Sue MacDonald: The money for a student midwife is around 6,000 pounds per year. That's not a huge amount of money, and you obviously get the benefits of being a student midwife. When you have qualified, you're into a whole bracket of different benefits and you're into probably about 16,000 pounds outputs. If you're a consultant midwife, you might be earning in 40,000 bracket, 40,000 a year. Sam Norman: Can you be a private midwife? Sue MacDonald: Well, you can be private midwife or an independent midwife. There are a small number of midwives who are working outside the National Health Service as independent midwives and women will go to them direct and employ them to care for them during pregnancy, during the labor and afterwards and yes, you can practice in that way. It's obviously difficult, if you've been brought up in the NHS to get used to working at a contract with women to work with. The independent midwives -- Sam Norman: It's a different relationship then. Sue MacDonald: It is and but it's still -- though it's a way of -- there is a sort of contractual relationship in that way, the relationship of a midwife is the same unless you're using the same skills and the care that you have given. But of course women maybe feel happy about it because they know that you have been employed as their midwife and you're going to be the one all the way through, that's the benefit of having independent midwife service, but then of course you have to be used to being self employed, filling in your tax returns and all the things that you have. Sam Norman: If I was really keen on going into this, who would I go and talk to, where do I get more information? Sue MacDonald: Well, we have and we get a lot of the calls at the college, the Royal College of Midwives, and we do have a website which is rcm.org.uk. And on that web page, we have got information specifically to how to become a midwife and different web pages that you can go and find more information and we do answer questions when you want person to person discussion about becoming midwife. The other way of doing it, once you have decided on the university or universities, where you'd like to undertake training is to go along to their open days. Most universities will have an open evening and open day, you can go and meet real midwives, real student midwives and the teachers that you'll be meeting in your program, and you can get a real feel about whether you see yourself as being a student midwife, and that can be really helpful. And not failing as though if you decide not to become student midwife after you've done huge amount of research. That's not a failure. Again that's another choice. And also the other thing you can do is get to talk to midwives locally and you might meet in your maternity service if you're a mother yourself, you may have had the opportunity to talk to your midwife. Sam Norman: I suppose most women will be inspired by their own experience - that's what - is that the driving force behind it? Sue MacDonald: A lot of women well have been inspired on a very good experience. There are some women who might be inspired by not so good experience and think well, I need to become a midwife and change things, and that's good too. But if you have had a bad experience, you need to unpack that before you come into midwifery because it's a hard enough program without having a lot of baggage with you. Sam Norman: Well, exactly. Presumably, you need to have a great understanding of psychology, don't you? Sue MacDonald: Absolutely. The most important psychology is your own self psychology and understanding how you might be perceived by others, because when I was saying about being kind, you can think you are being kind or you can think you're a kind person and the people see you as kind, you need to make sure and checkout with people around you, do you give out kind messages? Are you always kind? How would you deal with stress and if things are difficult and you're dealing with someone who is very aggressive or nasty, as women in pain can sometimes be quite aggressive. You need to be able to cope with that and not take it personally. So knowing yourself is a critical part of becoming a midwife. Sam Norman: What happens if you get assigned a mother who you just don't like? What you do? That must happen. Sue MacDonald: It doesn't happen very often and because you have to work professionally and you may not get a choice. It's like being a mother, being allocated a midwife you may not like. You don't necessarily have the choice because there may not be enough people around at that time and generally midwives can get over that. And if you feel, you really can't work with the woman then you need to speak to supervisory midwives and arrange for someone else to take that care, but you can't leave the woman until you have got someone to take out the care, by law you will have to handover your care to somebody. Sam Norman: It must be pretty scaring, I was thinking about some -- once you're qualified and even supervised over time, doing your first birth and assisted over there by one supervisor must be terrifying, isn't it? Sue MacDonald: It is very scaring. It's a huge, daunting responsibility. And usually at the end of training though, in the last few weeks with your midwife who is supervising you, they will tend to get you to do much more, get you to do the talking through the delivery and get you to do everything and they kind of take a background seat, so they're still supervising you and obviously if you start doing something wrong, they will step forward and point it out with you. But you can't get that confidence in the last few weeks, you can't ever take away that step though into being an autonomous practitioner. But again there is a huge support network and when you become a midwife, you find that your midwife colleagues will really rally around. And there's a huge amount of talking that goes on in the coffee room, when you've had your first delivery because you feel fantastic, because you've done it with the woman together, and that's very important to celebrate, and I think where you can have that celebrating and you can really feel positively, then you step on to the next one and you find suddenly after few weeks, it's not scary anymore. Sam Norman: How long does it take to get over that sort of squeamish aspect, I mean there's a lot of blood and gore, isn't there -- what all you see surround a labor ward. How do you cater with that? Sue MacDonald: I think it depends on how squeamish you are to start with. I mean that doesn't help there -- Sam Norman: Squeamish need not apply. Sue MacDonald: No. There doesn't tend to be a lot of blood and gore. It's not as messy as people think. And I think if you think about programs that you see on the TV, it always looks very gruesome, if you are aware, it's not the same. If you're involved and you're caring for women, on a one to one, you are not necessarily seeing more unpleasant sides of things; you accept it as part of the experience. Sam Norman: Alright! Sue. Thank you very much. Sue MacDonald: My pleasure.