Episode 3 The Country Midwives

Midwives.

-They have to be there when they're needed...

-Oh, my baby!

-..being mother to the mothers...

-Your waters are not gone, are they?

..support to the fathers...

-Right, Sam?

-Yeah, fine.

..and trusted colleagues to each other.

All dressed, ready to go.

But in this part of the world, their journey is never easy.

Oh, 'eck!

It's full of great ups and difficult downs...

It's through gates, it's over fences.

-..of twists and turns...

-The most bizarre place is up a treehouse.

..of never quite knowing what's round the corner.

A total bag of emotions.

-Welcome to the world of safe hands...

-You've got a lovely belly!

My office is my car, you know?

-..all seeing eyes...

-Absolutely perfect.

-..and big, big smiles.

-Very au naturale!

I think a lot of the women are quite strong characters.

Welcome to the real life drama of the Country Midwives.

Carmarthenshire is one of Wales' largest counties.

Here, expectant mums are looked after by a team of midwives,

travelling and working in these rural communities.

The county's northern team serve most of the Teifi Valley,

including the small town of Llanybydder.

Team leader Sian Maynard normally enjoys driving in this

beautiful countryside, but the extra call of duty of the last few days

means that today, she's struggling a bit.

I was OK last night. The night before, I was on call.

I ended up getting called in at about 2:30am to help on the ward

and I finished about 2:00pm yesterday.

I was a bit tired then and it's hard to get to sleep,

to know how much to sleep, so you can still sleep in the night.

So your body clock is round the right way.

So, yeah, today will be hard going, probably,

to keep awake.

Her first call today is on Meinir Thomas

and her two-week-old son Tomos.

-Nice to be home?

-Yes, lovely.

Some three-quarters of women in Wales start breastfeeding,

but within six weeks, the number's down to less than half.

Meinir has tried, before deciding that the bottle is best for her

and Tomos bach.

For the first few days, it was fine,

but we had two nights that were quite sleepless, so I tried him on

the bottle and he was more content, so you could get on and do

something else then instead of feeding all the time, to be honest.

-You just felt that you were tied.

-When did he have his last feed?

-About half past nine.

-'I'd seen her on the postnatal ward,

'I'd helped her with the breastfeeding,'

so I already had a little bit of an idea when it came today as to

whether she would be continuing to breastfeed or bottle feed.

You felt a bit guilty then that you'd gone to the bottle,

but as far as I'm concerned, the baby's got a better

quality of life cos at the moment, he just feeds and sleeps.

Now you're not feeding, hands off the boobs,

hike them up with your bra now, under your chin!

Don't keep doing that, you'll keep producing milk!

You'll be feeding the whole of Llanybydder!

'You can't make people feel guilty cos it's their choice'

and at the end of the day,

Tomos has had almost a week of breast milk,

he's had all the colostrum, and that's fantastic,

that's what she wanted to do and she's as happy as Larry there.

Sian's particularly familiar with Meinir because of her history

of high blood pressure, which meant she needed extra attention.

They used to come and visit me at work and everything,

to check the blood pressure, so it's quite nice to get close to them.

You feel as if you're getting to know them

as a friend type of thing, you know? No, it's nice.

On top of that, a blood test taken around the 17th week of pregnancy

showed that Meinir's baby carried a high risk of having a birth defect.

-130/78.

-Oh, my God!

'We've monitored her closely. She was referred then, she's had'

an amnio and that amnio showed

that the baby was fine, and as you can see, Tomos is absolutely lovely.

Both Tomos' weight and vocal cords confirm his healthy progress.

TOMOS CRIES

Now, what could possibly quieten him?

There we are.

Instant!

Duw!

-I wish teenagers were like that!

-I know!

Despite the risks they faced, Meinir and Tomos are a success story,

thanks, in no small part, to the care

and attention of our community midwives.

-Take care now. Give us a ring, any problems.

-OK.

-Ta-ra.

-Bye.

'It's really nice to have a case like that cos it'

restores your sort of faith in what the human body can do, really.

Community midwives are at the front line of maternity care,

but they're just part of a larger system of care within

the local health board.

Meinir's blood samples were analysed in the

blood sciences department at Glangwili Hospital, Carmarthen.

Here, a backroom staff of 40 check up to 1,500 blood samples a day.

Dwynwen Davies' blood would also have been tested in Glangwili.

She lives near Llanybydder with daughter Delyn Mair.

Dwynwen is 30 weeks into her pregnancy. She's carrying twins.

11 weeks pregnant when I found out. Jumping for joy.

And then to find out that I was pregnant with twins was

unbelievable and the joy, you know?

I own a day nursery and work obviously very closely with children

and I've picked up the parvovirus, which is linked to slapped-cheek.

Children with slapped-cheek syndrome,

that shows as a red rash on the face,

usually recover from the cold-like symptoms in a few days,

but what's quite harmless for children can be very serious

indeed for unborn babies.

At its worst, the virus can make the baby swell up with fluid,

with the potential of death by drowning.

At 17 weeks, on the weekly scan,

they'd seen fluid in one of the babies' bellies.

After three weeks, the fluid had gone

and the unborn baby was well again.

However, a month later, at 24 weeks, the virus struck again.

They said it had come back with such a vengeance that they didn't

think that the baby would survive.

For that month, I felt it was the longest time in my life because

I knew the baby was deteriorating but there was nothing I could do.

The baby was in my belly

and there was nothing I could do to help that baby,

so in effect, it was waiting for the baby to fill up with fluid,

drown if you like, and day in day out, there was nothing

I could do and I was 28 weeks pregnant when her heart stopped.

It's really hard.

You feel quite like you've failed, in a way,

because there was nothing you could do to stop it happening.

After careful consideration,

the medical team decided that removing the baby that had died

was not possible without risking the wellbeing of its remaining twin.

Dwynwen will have to carry both babies through to the

pregnancy's full term.

I'm going down every week to have scans,

just to check that there's no fluid in the healthy baby.

But they can't rule out that it won't come back,

so it's quite an anxious time

and you don't know at the end of it what will be the outcome.

The team working in the west of the county serve from

Carmarthen Town itself to Whitland and the border with Pembrokeshire.

Caren Thomas has just joined the team in this area.

For 13 years, she was a hospital midwife,

but six weeks ago, Caren swapped the familiarity of the ward

for the diversity and unpredictability of the community.

It is very different to my hospital work, but it's fantastic,

especially on a day like today when the sun is shining.

Out in the community, you've got more time to be with women

and to listen to their problems and people are pleased to see you

and it just seems...less stressful, I suppose, in a way.

Caren's been called to see an expectant mum who is suffering

from hyperemesis, a morning sickness that doesn't know when to stop.

She's been actually in hospital twice already to be rehydrated, then.

Bless her. It's not nice. Not nice at all.

They really suffer, these girls, with hyperemesis.

It's horrible.

Mary Pascal has the unfortunate experience of being amongst

the 1% of women who suffer from hyperemesis.

And how is the sickness now today?

-You were very sick overnight, were you?

-Yeah. Last night, I had 16.

And then today, six.

'She vomited 16 times overnight,'

six times already this morning,

unable to tolerate any fluids or any food.

So the oral tablets aren't working as well then.

Probably cos you're vomiting, you see?

You're sicking the tablets up then, you know?

What I was wanting to do was to just test your wee today.

-Are you able to do me a wee sample.

-Yeah, have you got a pot?

'She's 13 weeks now,'

we should be expecting the sickness to ease a bit, but unfortunately,

some women do get it a lot longer and all the way through their pregnancy.

Yeah, I can see straightaway that there's quite a lot of ketones

in this, which is a sign the body's quite dehydrated now.

I think probably our best bet would be to send you in again, Mary,

and get some IV fluids into you and get you feeling a bit better again.

What do you think?

I think that's all right,

but I'm more worried about the medication, if it's not working.

If it's not working. That's something they'll be able to sort out.

It's tough going for Mary

-and husband Joseph is naturally concerned.

-It's quite worrying.

They tell me the baby's going to be OK.

It's just I'm worried for Mary as well.

I mean, it's normal to be sick in pregnancy,

but this is extreme sickness.

I'm with a patient who is 13 weeks...

Caren arranges a short hospital stay for Mary.

Dehydration is not a matter to be treated lightly.

OK, give me a ring if I can do anything else for you.

'The best thing for Mary now is to get into hospital and get treated.'

So no, it's not always rosy.

But there we are. She'll be better soon.

Glangwili Hospital in the county town of Carmarthen is

-the midwives' operating base.

-Hello.

Women who are diabetic carry a higher level of risk

to their health when they become pregnant.

Whilst modern advances have made such risks more manageable,

modern living is presenting mothers, doctors

and midwives with new challenges.

Hannah Roberts, expecting her second child,

is amongst the growing number being seen by Dr Lisa Forrest,

who've been diagnosed with gestational diabetes.

Gestational diabetes is a form of diabetes that tends to be

diagnosed during pregnancy and often disappears at the end of pregnancy.

-Still managing to check the blood sugars?

-Yeah.

'I've never had diabetes or any problems like that, but I did'

have gestational diabetes when I was pregnant with my daughter.

There's a lot of hormonal changes during pregnancy

and you screen women with certain risk factors,

women who are overweight at the start of pregnancy,

women who've got family history of diabetes, women who've had a

previous large baby or have previously had diabetes

in a pregnancy.

I have to monitor my blood sugars four times a day.

So many things contain sugar that you wouldn't even think of.

I have to avoid white bread,

I have to be careful what time I eat certain things.

Gestational diabetes is becoming more common and that's partly

because of the sort of increasing rise in overweight

and obesity in sort of young women.

And it's also because of the increasing maternal age,

becoming pregnant in their sort of 40s.

We estimate in Carmarthenshire around about sort of four in ever 100

pregnancies are complicated by diabetes.

We'll see you back here either clinic,

Hannah, in about two weeks' time.

Unchecked, the condition can cause abnormally big babies,

leading to a more difficult birth for the mother,

as well as long-term risks to her health.

I'm seeing the doctor every two weeks in clinic,

just to make sure all my blood sugars are OK,

that I don't have any problems with my tablets.

And that hopefully the baby's not too big.

It's a 20 mile journey from Carmarthen to the town of Llanybydder.

Dwynwen Davies lives nearby.

She has five weeks to go before the time will be right for her to

give birth to twins, one alive and one that has died.

For the sake of the surviving baby, her pregnancy must run its course,

which means she's having to travel regularly to Cardiff,

where specialist equipment checks for any sign that the deadly

parvovirus is back, threatening the healthy baby.

Hi. How are you?

From the start, Dwynwen has been under Anwen's care and guidance.

Giving birth to twins means that two midwives will be there,

so today, Sian is accompanying Anwen to start to get to know her.

-This is Sian, our team leader.

-So how... Ooh!

-LAUGHTER

-Yeah, nearly landed up on the floor!

The number of stillbirths in Wales is now very low indeed,

less than one in every 250.

Part of Anwen and Sian's work here today is to prepare

Dwynwen in any way they can for what lies ahead.

Obviously, we can dress the baby, whatever you want us to do,

or we can leave the baby just as it is for you to look at

and have some time with.

It's so nice to have the midwives that you've dealt with

for the last seven months,

that they're going to actually be there, that's really nice.

'Today's been a lovely opportunity to come round to see her.'

We're just trying to make a few plans as to who is going to

be with her because it would be really nice for her to have

a bit of continuity and a little bit of extra support from ourselves,

seeing as we'll be looking after her afterwards.

I need to start...

I know where the baby will be buried and things,

-but it's just not knowing what undertakers and bits.

-Yeah.

-We can look into that for you.

-Yes.

-Don't worry about that.

And little things like if you want something special to

go in with the baby, a blanket or...

-I've got them.

-You've got them already. Yeah.

'Things do happen.

'We don't always have the happy stories, as midwives, unfortunately.'

And in a case like this, it's so difficult because it's twins

and one is alive, one is dead,

the emotions that she's going through are just horrific.

You can't begin to imagine what she's going through.

West of Carmarthen lies the village of Bancyfelin.

-Midwife Caren is calling on Hannah Roberts.

-Are you all right?

-Yes.

-Good, thank you. Come on in.

-Thank you. There's me coming in anyway!

SHE LAUGHS

As in a growing number of women,

Hannah's pregnancy has brought on gestational diabetes.

For the baby's sake and her own,

she has to be very careful of what she eats.

-Good. And are you good with your diet?

-I am now.

Yeah. I wasn't at all.

It's quite amazing, the difference, you know,

that you have to go through and you realise actually how much rubbish

you do put in your mouth when you're not actually thinking about it.

When you've got to actually think about everything that goes in.

I'm very good now.

My carb intake is huge.

Cake, biscuits, anything, you can grab on the go.

Amongst other matters, it is the size of the baby and the

resulting birthing problems that midwives are most concerned with.

-Can you tell whereabouts...?

-Yeah, I can feel a head down there.

A big fat bum there.

'Diabetes is becoming more common now.'

As midwives, we have to be a bit more on the ball about what it means

and what it means for them and their pregnancy and that it's more at risk.

The careful monitoring of Hannah's condition means that all is well.

-BABY'S HEARTBEAT

-Aw!

-Perfect.

That's lovely.

Although she's obviously doing her best to keep to the strict

dietary guidelines,

there's something worrying her that she needs to get off her chest.

Say, I may have had two mouthfuls of cheesecake at work...

But say for example I did, is it really going to affect things badly?

Has that happened? Have you had two mouthfuls of cheesecake?

-Is this a confession? Did somebody bring it in to work?

-Yeah.

-And do they know you're diabetic?

-They do now.

LAUGHTER 'That was brilliant though.'

I didn't know what she was going to come out with when she said,

"I do have something to ask you." She seemed quite serious. Bless her.

-You've confessed all now and all is well.

-I feel better.

I feel cleansed!

'Mums will tell us everything. You become close friends'

with lots of your clients

and they do tell you lost of things then.

She feels better now that she's confessed to Caren

the priest/midwife.

Back at Glangwili Hospital, Carmarthen,

fluid could be threatening Dwynwen's healthy baby.

Her pregnancy isn't quite full term,

but doctors have decided the day of birth and stillbirth has arrived.

'It's hard because as a human being, my emotions are everywhere as well.'

It would be easy for me to cry with Dwynwen,

as to be expected with the situation.

But I've just got to be strong with Dwynwen,

try and help her to come through the tears.

But, yeah...

It's nice to have a familiar face, you know. That's a lot of help.

The lost baby will have been dead for over seven weeks now.

What affect that will have on its appearance no-one can tell.

I've got the little crib to one side,

all dressed ready to put the baby in for her.

And I know Dwynwen has got some little clothes.

So we will be able to put them on and dress the baby afterwards.

Dwynwen's been so brave.

Now it's actually the moment, that's when it really hits you

and it's good that we're there to support one another as well.

Dwynwen's Caesarean section is scheduled for 2:00pm.

Can you get me the registrar...

Babies, however, have little regard for ward timetables.

Another mother, visiting the loo starts giving birth.

-Which means but one thing...

-Fantastic.

..all hands on deck.

There we are. Argh!

All of the hands on deck of course are experienced hands.

Well used to the "anything can happen-ness" of the maternity ward.

A lady had to be delivered quite quickly, but everything's fine

that's just being on the labour ward...it's normal.

Blinkin' heck, we were just going to have a cup of tea!

Dwynwen's time has come.

Her mother is by her side.

Nevertheless, her walk down to the theatre cannot be anything but lonely.

Dwynwen is going to be grieving and also...

Joyful that the other baby is fine and relieved at the same time, so it's...

It's just...a total bag of emotions, you just don't know what she's going through.

Not all that far from the town of Carmarthen, Caren's next call takes

her not to a street or a cul-de-sac, but to the top of a field.

I'm not sure how er...

how muddy it's going to be at Michelle's now, because we do have to walk across a field.

I'll have to put my wellies on.

It's less than two months since Caren swapped

the life of a hospital midwife for that of the open road.

I've seen more of West Wales in the last six weeks

than I think I have done in my whole life time.

This is why I haven't got a posh car, you see.

Because this is what the community is all about, potholes, mud...

Rough terrain.

DOGS BARKING

Eventually, Caren makes it to an alternative community that's

a far cry from the enclosed maternity ward she worked in for 13 years.

Hi, Michelle, how are you?

Michelle gave birth to a little Aria just 15 days ago.

How much does she weigh now?

-She is 8.8 now.

-What was she born?

She was 8.4, but she went down to 8.

That's right and she's back up to 8.8.

See, you've got double cream in those boobs. That's excellent feeding.

So that's your sort of reassurance things are all going well with

-the feeding. So in yourself, you're feeling OK?

-Yeah.

It must be wearing you out a little bit? Tired.

I think we're getting the hang of it now,

it's just she's not really sleeping through the night very well.

She looks lovely, she doesn't look unwell or anything, does she?

So I'm not worried about her.

A healthy blood pressure means this will be Caren's last call on Michelle.

It's absolutely normal.

Looking after her pregnancy has been a central part of Caren's work

since she hit the community road.

And as often happens, they've become good friends.

Do you think it would be all right if I can quickly use your loo?

Of course, you do have to venture outside.

-Venture outside to go to the loo?

-Yeah.

An outside toilet may be nothing new to some, but how about this?

-Can you see the yellow bucket?

-That's fantastic.

-Until recently, this was Michelle's shower.

-I was out here in the snow.

Oh, my word you are far braver than I am.

So yes, this one is like luxury now.

-Oh!

-That's our shower now.

That's like an normal bathroom, it's fantastic.

And now it's here in a very snug bathroom.

I'll just leave you to it.

-Is it OK to wear my wellies in here?

-Yeah.

-OK.

Outside the hospital theatre where Dwynwen's C-section

is taking place, it's an anxious time for her mother.

NEWBORN BABY CRIES

But finally, she hears the sound that announces to the world that all has gone well.

The healthy baby has been delivered safely.

BABY CRIES

But also delivered is the baby that died of the parvovirus seven weeks ago.

It is Sian's responsibility to clean and clothe the lost child.

It will be treated with the same respect as the healthy baby

being looked after now by Anwen.

It's fantastic the relationship that I and Sian have got.

Because we've got a faith in your colleague knowing, OK,

she's doing that, you don't have to think about that bit, then.

By the time Dwynwen is returned to her room, her newborn little

girl, Cadi Aur, is ready to be cradled and cwtshed for the first time.

Aw...

Dwynwen has always said that she'd want to take

the stillborn baby also in her arms.

The loss of Martha Aur may seem tempered by the joy of Cadi Aur.

Actually it's no less a loss. Grieving is a necessary process.

She's not going to look like her sister, OK?

Now, you can't see her face, OK. But you can see her now.

Can you see her little hands there?

You can never prepare yourself for it and I think it's just...

You just feel a bit...

Pants, really. Yeah.

If you look closely, you can see her little fingernails.

It's just about supporting Dwynwen now through this

and making sure that she's stable

and that we've got facilities over on the ward for her now.

OK?

It's bittersweet.

You can't help but think, well, it's not how things should have been.

But, erm...

You know, it's just one of those things, isn't it?

Dwynwen will stay here now for as long as it takes for us to do the paperwork.

It'll take us a good couple of hours.

Probably three to four hours,

so nice, strong coffee now and get through that paperwork.

After such a day, everybody's quite drained.

But Dwynwen has one important and uplifting moment to come.

My daughter's going to be chuffed to bits. She wanted a girl

So...she's going to be chuffed to bits.

Hello!

Aw, Delyn, Wow!

Whilst Delyn Mair gets to know her little sister,

Anwen and Sian work through the awaiting forest of paperwork.

It's a part of the job,

but you know it doesn't happen this late every day, it's just...

And families understand as well you know,

they get used to it don't they?

I'll probably see Sean, but Stefan will be in bed.

Lisa's in Italy, so won't get to see her.

They started work over 12 hours ago. It's been a long day.

We were both supposed to clock off at five.

-So this is just a labour of love.

-Yeah.

Next time on the Country Midwives...

a midwife's home visit becomes a tepee visit.

Do you know what, I think I've got a tickle coming here. I think I've got a tickle here.

A pill that may be hard for some mothers to swallow.

I don't think it's anything unnatural about it.

And midwife, Caren, takes charge of her first homebirth.

I waited weeks for that. It's exactly what I wanted.