Episode 4 The Country Midwives

Midwives.

They have to be there when they're needed.

Being mother to the mothers.

Your waters have not gone, have they?

Support to the fathers.

-All right, Sam?

-Yes, 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, heck!

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 tree house, actually.

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 smiles.

Very au naturel!

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.

Negotiating the maze of roads to Llansawel

is community midwife Nan Duncan.

After 34 years as a midwife, Nan has seen many changes.

The weather's still the same though.

It's absolutely throwing it down.

We're going to see this lovely couple now.

It's their first baby. A long awaited baby.

They've just told me where they're living,

so I'm just hoping I can find where it is.

At any one time, Nan could be visiting up to 20 mums-to-be.

Remembering how to get to each and every home can be quite a test.

I think I'm right in saying... Postbox, bungalow.

I think I'm right.

She is the first bungalow on the left, I believe she said.

That's not a bungalow.

The older you get, you don't remember so well, do you?

Sometimes, becoming parents can be an exceptionally long journey.

This is Cerys. She was born last Tuesday. 20 minutes to two.

She's a lump because she's eight pounds, two and a half ounces.

Doting dad John is 70 years old

and proud Karen is a 48-year-old first-time mother.

They're a little bit older and it's a second family for John.

But, you know, it's absolutely normal.

Everything is right with them

and how they've gone on about having this lovely baby

to make their family complete.

We did decide to have them earlier,

but when things don't happen, you just have to get on with life.

Better late than never! Definitely better late than never.

-Come in.

-Hello.

Karen and John are well-informed parents.

But, although they've got all the books, they know that the

best source of help for Karen's recovery is Nan's experience.

These stockings are like an extra muscle layer

and the extra muscle layer is pumping the blood back up to your heart.

So while they're on, it's not for the swelling,

it's to stop you having blood clots.

Often, the advice is as everyday as nappy changing.

A lot of people change the bum and then feed the baby

when it's bottle feeding.

But when it's breast feeding, they breast feed first,

then they change the bum and then they continue breast feeding.

They wake the baby up in the middle of it to make sure they get the most.

Right, OK.

Don't you start crying with me because I won't have any of it.

-She's got a fine pair of lungs, I know that!

-She is beautiful.

And so, today, Nan's journey with this family ends.

She's a natural and so helpful. So, so helpful.

They're a very well-read couple.

They know what they're doing and I can't do anything more

than congratulate them on doing such a wonderful job

of a perfect little baby and what a family.

It's good to be part of it. Lovely.

Looking after older mums is one change midwives are coping with.

Another is the technology that's on offer.

Chris Davies and partner Simon have gone to a private clinic

to see remarkable pictures of their unborn baby.

We have come to do our 4D scan to see our little baby's face

and to make sure she's all well and cwtched up nicely in there

and we can't wait.

4D scanning is like having a camera inside the womb.

It makes technician Ruth McJennett's work look quite easy.

You can see the baby's expressions, facial features,

who the baby's going to look like,

and it's just a lovely bonding experience for the parents and the child.

Oh, my gosh!

That's really weird. All the shadow suddenly comes up.

The unborn baby is just 26 weeks old,

but the new technology allows the parents, and us, a sneak preview.

It's cheating, isn't it? Like doing this is cheating.

You're not meant to see the baby's face or know the sex until she comes out.

-So...

-We've got a head start.

A lot of bonding and things that can happen as a result of that.

It's lovely.

Just another 13 weeks to go!

The Teifi valley, particularly around Llanybydder,

is predominantly Welsh-speaking.

But in the town, a new language is being heard.

One in eight workers at the local lamb processing plant

are first-language Polish speakers.

Midwife Anwen Evans tries her second language, English,

as a bridge, with limited success.

Me, OK? Anwen. OK?

And my phone number. So any problems, you phone.

I find it's difficult with somebody who doesn't understand your language

for you to be able to tell them appropriately, this is what's going to happen.

And when you speak to somebody on Language Line,

even though you tell them, you don't know what they portray back to the woman herself.

So it's really difficult.

Any disabilities? Physical or learning?

Interpreting is never easy.

The Language Line service translates Anwen's question into Polish

and the answer back into English.

For midwives, it does the job. Just.

Hello?

No, OK.

It's so difficult when the person on the other side of the phone

is purely a translator and she hasn't got any medical knowledge.

It's quite hard to get across the right message, I feel.

Hello?

No. We need to check her full blood count.

It's hard work when people don't understand you.

Adelle Roberts is the Health Board's Senior Clinical Midwife.

That role now includes adapting the midwives' practice to meet the

new multilingual and multicultural reality of Carmarthenshire.

In one of the local towns, they have seen quite a large influx.

Out of a population of about 40,000,

they saw about 2,000 people from the Polish community move into that area.

We are developing some literature to support the communication with the Polish mothers.

Sometimes it's very difficult.

In the middle of the night, you're trying to communicate in any possible way you can.

I see midwives using all kinds of gesturing, pointing, talking.

The non-verbal communication is huge!

They do their best to try and get the points they're trying to interpret across.

Language is just one of the differences to be taken into account.

Expectations can also be quite different.

Some of the women in Poland would go and see a gynaecologist on a private basis.

Their expectations of what happens in an antenatal examination would be very different.

They would expect a doctor to be there at the birth

and not for the midwife within a normal paradigm to be facilitating that.

Some Polish families have also settled in the west of the county,

between Carmarthen and Whitland, Caren Thomas' work area.

My baby is 16 tomorrow. Can you believe that?

16 years ago today, I was going into labour now tonight.

I feel that it helped me as a midwife

being able to look back on my own experiences.

I've certainly got a lot of experiences now that I've got four!

Caren is calling on Alicia Lesiak.

Morning. Are you OK?

Alicia is a mother-to-be who comes originally from Krakow.

As she can speak a little English,

Caren means to learn a little Polish.

-What's the Polish word for pain?

-Bol.

-Bol.

-Very bol!

-Very bol!

-What's the Polish word for push?

-Pchniecie.

-What?

-Pchniecie.

-Pchniecie. OK. Fine.

They are my two important ones. Pain and push.

A lot of it is just working out between you

that we're getting the same words and getting the story right.

It is a challenge sometimes.

So labour last time, did you have pain relief?

-Yes. Pain.

-OK. No, pain relief.

Not pain. Pain relief. So when you were having the contractions...

Midwives have always adapted to changing circumstances

and their ability to get on with people is just as important as ever.

-I'm waiting for a wee sample now.

-A pee.

-OK, you can tell me. What's pee in...

-Pee?

-Yes.

-Siusiac.

Siusiac. I'm waiting for a siusiac sample, which sounds a bit bad.

A siusiac sample. Lovely.

Near Llandeilo, there are plenty of places that aren't easy to reach.

Don't fall now, will you?

But one community is particularly remote.

Right, we need to go...

I'm not quite sure where we're going to go.

Today, Nan is on her way to Tipi Valley.

Founded exactly 40 years ago, today it's home to some 80 people.

Careful you don't slip by here.

Years ago, doing a home visit here

was an intrepid experience for the young Nan.

20 years on, the Tipi Valley women are old friends.

Hello.

In fact, it's Nan who's delivered many of them into the world.

In Wales, just 3% of mothers give birth at home.

Here, the home birth rate, so far, is 100%.

It was always more like a party atmosphere, to be honest,

having Nan at your birth.

I was in a hot tub.

You were in a hot tub and I think I said something like,

have you got any peas and carrots?

Cilla gave me a dressing down!

If it was just some stranger rocking up on the day,

that would have kind of freaked me out.

But knowing that it was Nan and Fiona and the team was just lovely.

It was very easy from the word go.

Even if I was phoning them at six in the morning,

it was just fine, yes.

Traditional Welsh communities are about sharing things

and looking after each other.

At heart, perhaps this alternative community

is not so different after all.

My three-year-old can walk out of the front door and he's safe. There are no cars racing past.

He knows everybody and everybody knows him. Everyone is looking out for each other.

That, to me, is what community should be.

It's not a million miles from the ordinary person.

They just want the best experience they can possibly get.

It's the way to go.

So they've taught me over the years

and it's a mutual respect, I think, from both ends.

Nan used to come when you were in my tummy.

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

I think I've got a tickle here. There's a tickle coming.

Newborn babies have never been scarce in Tipi Valley.

So the last piece of news Nan hears on leaving is not a huge surprise.

It was so nice to catch up with them.

I'm really chuffed to know I'll be back up here now in the new year,

so it's all good news up here.

During Nan's working life, midwives have seen the growth of doulas,

a new development on an age-old practice.

Doulas are female helpers, such as Rhiannon Marston and Mel Kelly,

who work before, during and after birth, alongside the midwife.

A lot of people think doulas are a new thing but actually,

women have been helping women for ever.

The word doula comes from the ancient Greek, meaning female care giver.

You don't have to be a particular kind of person to be a doula.

You just have to have an interest in families, babies

and supporting mothers to have the birth that they want.

That's basically what we do.

Doulas don't have to undergo formal training

and many of them favour a hands-off approach to birthing.

But Rhiannon and Mel don't see their role as challenging that of the midwife.

We don't work instead of midwives or health visitors.

We work alongside them.

We support home births, hospital births, caesarean sections.

We're not medically trained. We don't carry out clinical tasks.

But we give support in a practical way, an emotional way.

My last client before I had Eve

had actually been referred by the midwife.

So that's always really nice.

-Brilliant.

-Yes.

-Absolutely.

We'll support any kind of birth. We support what Mum wants.

So we mother the mother. That's a well known doula saying.

As with midwives, new technology is also extending

the range of services offered by doulas such as Rhiannon.

One that is growing in popularity is placenta encapsulation.

Placenta encapsulation is the process

of putting the placenta into capsules

so that it's an easy and convenient and more pleasant way of consuming the placenta

so the woman can have the benefits after childbirth.

Once the placenta has been washed, a print of it is made as a keepsake.

Rhiannon uses an ancient Chinese recipe.

First, steam the placenta with lemon, ginger and chilli.

Then, cut it up and thoroughly dehydrate it.

Next, form the umbilical cord into a heart-shaped memento.

Lastly, finely grind the dried placenta pieces

and pour into digestible capsules.

The benefits are prevention of anaemia, increased energy.

It'll give you a better milk supply

and it's really important in helping to prevent post-natal depression.

A new mother who's opted for Rhiannon's placenta service

is Lorraine Hardwick.

Little Rico is just six days old.

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

I've grown it. It's my organ.

So I'm giving it back to myself in order to recover

and just feel more normal after having a baby

because it's such a huge thing.

In nature, most mammals would consume their placenta,

so it's a very natural process and as we've become more civilised,

people think it's a bit disgusting.

When you tell people, they think, oh, my God, that's terrible.

But they think you have it with chips and gravy and onions and that.

But it's not. It's just in capsules.

It will hopefully benefit her health.

Husband Terry is all for it,

despite the fact that meat is never on their menu.

I'm a vegetarian. So is Lorraine.

You probably don't class it as eating meat, do you?

It's actually part of your own body.

Hopefully it's going to do her good.

I won't be having any! I'll leave it all to her!

Perhaps I'll have loads of babies

and I'll get loads of placenta encapsulation done

and I'll live off placentas, I don't know!

So I'll do that!

On the estuary of the River Tywi

lies the picturesque village of Ferryside.

It's three months now since Chris had a 4D image taken of the baby she's carrying.

Another week and the image is due to become a newborn reality.

Lynne's coming today. Last visit before the birth. Just to check everything's fine.

I think everything is and everything's going to plan. It'll be nice to see her.

Are you going to help Lynne check Mummy's blood pressure?

I'm starting to feel a bit anxious about the birth

and it's a time when you're just wondering when.

Two years have gone by since Lynne was here bringing Mali into the world.

As before, the new baby will be delivered in a birthing pool

and Chris will practise hypnotherapy to manage her pain.

It's basically self hypnosis.

It's focusing on being relaxed rather than scared.

So when the contractions come, it's just to breathe into it

rather than fight against it.

It was all really quiet, it was gorgeous,

and was really difficult for me to be so quiet!

So we get to do it all over again with the same person.

For me personally I feel much more comfortable at home

and having somebody like Lynne as a midwife, who respects what you want, is perfect.

I think everybody should have that experience. It's such a shame that people don't.

Keep an eye on the movements and give us a ring if there are any concerns or anything.

Near the town of Carmarthen itself, although it's getting dark,

Caren's been waiting eagerly for the call she's just received.

She's on her way to help Jen, whose second child will be Caren's

very first home delivery as part of the community team.

Had the phone call to say she's in labour. Mega excited.

I've been waiting for this now for a few weeks,

so I'm going to examine her now and see how we're doing.

Sounding great.

Keep going, keep going, keep going.

Keep going, keep going, all the way through.

Good girl. Good girl. Keep going.

I've been encouraging her to rock through the contractions and she seems to find that quite supportive.

It'll get that baby into a good position as well.

I've just examined her now and 6cm.

Lovely thin cervix, bulging membranes.

When those waters go, we're going to need an ark to get out of here!

-You're all right.

-I feel my legs are going to go.

Let's get down on the sofa then.

Caren is right.

The waters break with such force

that Jen believes it's the birth itself.

Oh, God, the head's coming. All right.

All right. It's OK, it's OK. That's water. That's water.

OK. Well done. Well done.

It is just the water. But Caren's concerned.

The baby's heartbeat has slowed right down.

If you need to push, you push.

I'm going to get a 999, just in case we need it.

In the hospital, I just have to pull a buzzer

and I've got a whole team there behind me.

At a home birth, we've only got basic resuscitation equipment.

We don't take any chances. If we need backup, we'll get them here straight away.

Fluctuations in a baby's heartbeat are not uncommon in childbirth.

Do they carry on here or do they call an ambulance?

They'll have to make a decision...soon.

Nan Duncan has been a midwife since 1980.

During that time, she's also raised three children

and done her bit on the family's small-holding.

Have you been out and about today, then, Mum?

LAUGHTER

As well as caring for young mothers, she's now also looking after

her own mother, Lena.

This is my mother. My wonderful mother.

And she's only 81.

Lena has fond memories of caring for young Nan.

I could do nothing wrong.

She was a perfect baby.

Honestly. I know she was my second baby, mind.

And my first baby was a bit cross, you know. But I don't think...

First babies, they do get it hard, mind. Because...

they are busy training the mothers, aren't they?

Second baby, mother's already trained.

I can come in here and tell Mum all my woes.

Well, she is a sitting duck. I think everybody comes in and tells her.

And we can get up and walk away,

and poor old Mum is less mithering what to do about things.

I do have my grumbles, don't I? We take it in turns.

We take it in turns to grumble.

Nan is as fond of her mother as Lena is proud of her daughter.

It's not an easy job, is it, midwife?

I'm pleased that she's made a life for herself. It's nice. It's nice, yes.

And she enjoys it. You just carry on, don't you?

I think it's the Welsh way, do you?

Truly, that is it, isn't it? Do your best.

-Yes. Live with your own conscience, isn't it?

-Yeah.

Well, I'm really fortunate to have my mum.

At Caren's landmark home birth, they didn't call the ambulance.

The baby's heartbeat is healthy once more.

In fact, it's all systems go!

Her waters went. I think the head came down with a bump,

then her heart rate dropped then as a result.

But as soon as we got her into a good position,

got to have a good listen in, she was absolutely fine.

-That's how they react, see?

-That's better.

Yes, she's coming, you're doing fantastic, go for it. That's it.

And again, if it's there. That's it, go on, keep her coming. And again for me.

Good girl. Go on, keep it coming. So the top of her head then.

She'll take a bit of time to do this bit now,

but that's perfectly normal, all right?

-All right, Jim?

-Yeah.

-Yeah, we doing good, right? Fantastic.

It's encouragement, encouragement as the moment approaches.

-The head is right there.

-Yeah.

-Well done, Jen, well done.

I know, I know, it's stinging like mad now. Good girl, go on.

Right, do a little push for me. Breathe. Head is out, my darling.

-You're right in the crook, there.

-OK.

-Next contraction, you're going to push like mad for me, OK?

-OK.

Coming again?

Yeah. All right, pushed down. Here she comes again, look.

-Jen, look down.

-Oh, my God!

-"Hello, my Mummy! Hello, Mummy."

Look, she's beautiful, look at her.

And so, baby Scarlett is welcomed into the world.

20 to midnight.

Oh, you superstar, you.

Jen and Jamie are obviously delighted. And so is Caren.

You were amazing. Have we checked she's a girl?

Yes, she is! That would be a shock, wouldn't it?

Very emotional. This is my first birth for the team. So that is brilliant.

Nice to get that under the belt.

One more bit, look. Brilliant!

Jen was absolutely fantastic. She was brill. Waited weeks for that!

It was exactly what I wanted.

The village of Ferryside, six o'clock in the morning.

Somewhere in the dark, midwife Lynne is on her way.

Ten days overdue.

Chris started with contractions about one o'clock this morning.

It's been really, really tense the last couple of days.

There's been a surreal relief that things are starting to go.

Both of us are really excited and really pleased, so...it's fantastic.

There she is, the lady herself.

-Hi.

-I've never been so relieved... Thank bloody God.

Low lighting and mood music support Chris's

hypno-birthing technique while she lies in the birthing pool.

In one way, Lynne's job here is to do as little as possible.

-So seven o'clock it is now.

-OK.

With water, it's difficult to see what's going on anyway, you know.

It does make our job...

not more difficult, you just got to go with the sound of the woman.

-Think positive again.

-Ah...

-Just relax into it now.

And again, that comes with the years of experience as well.

You know that there are progressing well and things.

Indeed, things ARE progressing well. And quickly.

With Lynne's quiet encouragement, the full-vocal drama of birth

-reaches the final act.

-CHRIS GROANS

Just go with it now, Chris. CHRIS SCREAMS

Although partner Simon had the hypno-birthing script at hand,

in the adrenaline of the moment, there's no time...no need.

CHRIS SCREAMS

Don't panic, don't panic.

Well done!

7:35. Well done! Congratulations!

BABY CRIES Yes, oh.

Keep her head above water.

About 25 past, she was having urges to push.

And the baby is here now at 7:35. So she did really well.

Oh, I'm so glad to see you.

-We are!

-I know! Oh...

And Mali came in then, straight after the baby was delivered, so it was lovely.

Baby...a real one.

To complete the naturalness of her birth process,

Chris is waiting for the placenta to deliver in its own time.

As with the birth itself, it's not a long wait.

That's the best one I've ever had. Fab!

In the meantime,

Simon, in his own way, is bonding with his new baby daughter.

Simon was talking away through the contractions,

but I don't think he had much time to get through his script.

But he did really well. Fair play to him.

Much better now.

That she's out.

It was much quicker than Mali.

And we were home.

I'm so relieved we were home.

So relieved.

For Chris and Simon, it's the morning calm following the evening storm.

For Lynne, it's the start of another day's work.

I'm on call, so I'm hoping for a quiet afternoon now.

I'm going home to do my hair and put my make-up on, cos I haven't had time.

Have some breakfast and then go down the hospital, do some notes.

And then we'll take it from there what the day holds.

Happy now.

All the boxes ticked.

-We're very lucky, aren't we?

-Mm.

The Country Midwives. All roads.

-All weather.

-It's fun and games.

-All languages.

-THEY SPEAK POLISH

-All ages. Always there.

-Hello!

Always have been.

-Keep going, all the way through.

-And always will be.

Yes, there'll be always room for midwives.

They're not going to stop having babies, are they?