Make Me a Midwife The Midwives

Hi, it's the midwife!

That's it! That's it!

You're doing it! You're doing it!

Little pushes, then. Little pushes.

Oh, my gosh!

When we're at our most vulnerable,

we all need someone who isn't afraid.

I'm your midwife, and I'm going to be looking after you.

Midwives are responsible

for bringing our children safely into the world.

Hello, world!

You have to make a very, very intimate relationship with somebody

you've never met before in your life.

I apologise.

You've not done anything wrong!

-OK.

-You're having a baby.

You've not killed someone!

But now they're facing the highest birth rate in 40 years.

Too many women having babies. That's the problem.

Parents are more demanding.

I don't feel she's been getting answers.

And pregnancy is more complicated.

We're worried.

Do you know we're worried?

When you see your baby come out like he did,

you just think, "Oh, no."

Yeah, yeah, I'm fine. I just delivered my first baby.

Oh, that was the best feeling in the world!

This is what it's really like to be a midwife in Britain today.

SHE SCREAMS

Chloe and Rhian are first year student midwives.

This is well nerve-wracking, isn't it?

Today is their first shift

on the high-risk delivery unit at St Mary's Hospital, Manchester.

-Do you know where to go?

-Erm...

-..I think it's down here.

-Is it this way?

'I wanted to be a teacher at first,'

and I remember I did a work experience placement and I hated it.

But I always wanted to be in a job that was caring,

because I enjoy caring for other people and, you know,

I'm fascinated by pregnancy, birth, and everything.

Because it's such an amazing thing.

And, you know, the fact that a person comes from one egg and one sperm.

To think that it started from that.

Every time, it still gets to me.

It's just magical.

-Ooh, which ones are the midwives?

-There's the lady on the phone.

-Or just ask any of the people in scrubs.

-Excuse me?

Hiya, we're here for our first shift...

Erm, do we come here, or is it reception?

-Yeah, here. On the late shift?

-Yeah.

Take a seat. It starts at half one. You're a bit early.

-OK.

-OK. Thank you.

-Grab a drink.

-I don't want a drink.

Should we stand outside?

Walking into the office was quite daunting,

because obviously, I'd never been to Delivery before.

I didn't know what to expect.

Kind of looking around

and seeing if you can read people's name badges to find out who they are,

and going, "I'm the student midwife,"

because you don't know how it works up there.

And you kind of don't want to look like you're not doing anything.

-Chlo!

-Yeah?

There's a baby next to the tea stand!

BABY GURGLES

-SHE WHISPERS

-Do you think we could go and look?

I really want to ask.

Oh!

It's one of the nice jobs about being a student midwife!

You get to cuddle babies!

Hello!

-It's the tiniest baby I've ever seen!

-Oh, my God!

Chloe will train here for three years

before she is qualified to deliver a baby on her own.

Is everyone here? Yeah?

Right, then. Room one, is a para 1.

She's 38 plus six, and this lady's been induced

for hindwater SROM and a raised PCR,

but normal blood pressure.

At 18, she is one of the youngest students and has just left home.

From today onwards, she'll rely on an experienced midwife

to mentor her so she can practise on mums.

Have you come straight from college?

Yeah, I did my A-levels and I've come straight here.

On her first shift, she's working with Lesley.

The idea, really, is just really observation.

You'll see equipment, you'll see different types of births,

but you need to really concentrate on your women.

What are your women doing? And learn about your women.

-That's the key thing.

-Yeah.

'Often, the girls do look quite lost on that first day.'

That student in that crisp, brand-new, white,

fresh, looking-great uniform, excited to get going.

But they have a really tough time, student midwives. Very tough.

Unlike other students, going to uni, they have lots of holidays.

Midwifery students don't.

And they're working shifts, and they've got exams.

It's incredibly difficult.

It's probably the most difficult thing I've ever done in my life.

Apart from give birth.

One of the biggest challenges

is getting the hands-on experience they need to qualify.

So, I need 40 births in three years.

And you have to take care of 40 women in labour,

and then you have to have carried out 100 antenatal examinations

and 100 postnatal examinations.

'So the 40 births is the one everyone thinks about.'

Ready?

Chloe's first mother is Emma.

She is expecting her first baby

and is 12 days overdue.

Beautiful bump!

OK, Chloe,

so we wash our hands. Yeah?

So we always clean our hands before we start anything.

Before delivering a baby,

Chloe needs to learn how to examine one that's still in the womb.

-OK, so Chloe's just going to have a feel of your tummy.

-Okey-doke.

-If it's OK with you, Emma.

-Yeah.

-Are you feeling these tightenings?

-Yeah.

Yeah? The one important thing to learn about your woman

is what's happening.

Have a feel of them, see if you can pick them up with your hand.

-Because you need to learn about her contractions, any woman.

-OK.

Have a good feel around.

See if you can find any pulls.

And obviously, it's good to press across....

-Yeah, and then...

-..have a good feel around.

'At first when you feel the woman's stomach,'

it is just lumps and bumps, and it's...

I found it very difficult to tell,

you know, which way the baby's lying.

I couldn't tell whether I was feeling a bum or a head, leg, or what.

I had not a clue.

But you could feel it move,

and I thought, "Oh, my goodness!

"There's a baby in there! There's a real baby in there!"

St Mary's Hospital delivers nearly 8,000 babies a year

and deals with many of the high-risk births in the region.

This makes it a particularly challenging place

for students to train.

There's fantastic days where it's low-risk.

You deliver a baby and everything went wonderful.

But in reality, on this unit,

we're dealing with a lot of high-risk, and that rarely happens.

And I think some of the students come in thinking,

"It's going to be amazing. I'm going to deliver babies

"and cuddle the baby, and aren't they cute?"

And in reality, that's not what we do.

That's the parents' job, to cuddle the baby after the event.

We're there to mop up the sick, the blood,

to get them through labour,

to nurse them through pain for many, many hours.

And I think they suddenly realise

this is quite physically and mentally draining, this job.

Aurelie is 20,

and a second-year student.

'This is all I've ever wanted to do.'

There's never been a backup, or a hobby,

or, "If it doesn't work out, I'm going to do this."

It's always been, "Right, midwifery." And that's it.

If you don't do midwifery, then you're just...

-SHE LAUGHS

-..going to be not working!

I'll just have a feel of your tummy.

See where baby's lying this time.

Well, where he won't be staying for long!

She's been struggling with her training.

Well, this is my third year as a student midwife.

But I am currently still remaining a second year.

Because in my first year,

I became really stressed,

and didn't know how to manage my stress well.

Because it's a really demanding course.

She's just failed her placement on the delivery unit.

This week is her last chance to pass.

She's in real danger of failing the whole course.

It's great to nurture them and support them,

and be kind to them,

but at the end of the day, you also need the results from them.

And I would not want to sign any student off

as fit and competent to practice, if I wasn't 100% sure.

-All right, my love.

-Thank you very much.

-See you later.

-See you.

Erm, we're going to do a sit-down with Aurelie, really.

Just have a quick catch up,

because we have our final interview

at the end of this week,

which is a huge thing for Aurelie.

-Right, so the things that you've been referred on...

-Mmm-hmm.

-..how do you think you're doing?

-Erm, I think I'm doing OK.

I think I'm doing OK.

But I think there is areas where I can improve.

-Like where?

-My confidence.

-Right.

I think, like, I don't value my own opinion. If that makes sense?

Like...I think, "Oh, I'm only a student."

-But you're going towards a qualified midwife.

-OK.

So you have to...you have to step up a gear.

Yeah.

You need to demonstrate some skills for me in the next couple of days.

I want to see you taking the lead. OK?

SHE EXHALES

-THEY LAUGH

-Aw, you'll be all right!

I hope you will, anyway.

THEY LAUGH

'I can't imagine how she feels.'

Having a year out, then being referred,

and then, this is the make or break for her.

And it's not over yet.

She's having to prove herself in every area that she goes to.

The first mother today is 17-year-old Detrice.

She's expecting her first baby.

She's got 13 pairs of shoes.

No, 14. You bought her a pair yesterday.

Yeah, she's got 14 pairs of shoes.

She's known for some time that her baby has a serious heart problem.

'When we come to delivery,'

they'll take the baby,

and she is aware that it may need to go out to Alder Hey for surgery.

But none of us will know the outcome until it's born.

As you know, Detrice, you've come over from triage

because the baby's heart rate is dropping.

So we have to be cautious

-and even more vigilant than ever.

-Yeah.

So I think the best thing would be to break your waters

and make sure the baby is not distressed in there.

-We wouldn't break somebody's waters if the trace was lovely.

-Right.

We wouldn't intervene.

But this trace is abnormal, so we're not going to sit and do nothing.

Detrice has agreed to let Aurelie break her waters.

What things are we thinking about?

-Cord.

-Cord.

-The head...

If it's possible, you don't.

-OK?

-OK.

-You feel confident?

-Yes.

-Sure?

-Yes.

-OK.

Use your gas, Detrice.

You don't need to have a...

listen, you don't need to have pain for this procedure.

Use your gas.

Because it will help to relax you.

We're going to do an examination to see where the head is. OK, my love?

All right. Relax yourself. Relax.

Cold jelly.

-SHE MOANS

-Keep breathing your gas, Detrice.

That's it. OK.

You're doing fantastic.

This is the hard part. Once this is done.

SHE MOANS

Detrice, they're just a little bit difficult for Aurelie,

so I'm just going to do them, OK?

You did very well, OK?

Are you going to use that gas?

OK, darling.

All right, those waters have gone now. OK?

All right, I'll go and find you some cushions, OK?

'When you're working with a mentor,'

sometimes you can still feel them in the back, looking.

For some people that might be OK,

but for me, under pressure, it's like...

it's like this burden on your shoulder

you're just carrying constantly.

And it's like, "Right, I need to make sure I'm doing it right,

"because the mentor's watching."

Then you get, I need to make sure you do things right,

and make sure whenever your mentor is looking, you don't look worried.

Make sure you're smiling.

So you have all this continuous tick list that you have to do!

'You have to be certain that no harm

'comes to these women and their babies.'

That is my priority, and my student comes secondary to that.

I need to know the woman is safe, the care is safe,

and that is what this job is all about.

And it's sucked back in.

22-year-old Jess has clocked up her 40 births,

and has just completed her training as a midwife.

I'd press the buzzer to let someone know what was going on.

Put the back of the bed down, and then elevate her legs.

There was a time in first year

when we were learning about women's parts

and I had diagrams on my bedroom wall

in first year of, obviously,

the vagina and the penis and everything like that.

And, obviously, whoever came into my room was like, "What is that?!"

And then you pull down.

To deliver the shoulders. So the shoulders are not delivering.

-Yeah.

-So you've confirmed you've got shoulder dystocia.

I remember a lecture we had

and it was about how your body changes during pregnancy,

and that scared me. I thought, "I'm never going to get pregnant."

I texted my mum and said,

"You're never going to get grandchildren out of me!"

Put your two fingers at the bottom

of the anterior part of the posterior shoulder

and try and dislodge. That's the Wood's screw.

And then the baby will come out.

-Yeah.

-Whee!

And hand to the paediatrician.

It's Jess's first shift as a qualified midwife.

Helen! Look!

-Ooh! You're a real midwife! Congratulations!

-Scary!

-It's my first shift.

-Oh, is this your first day? Oh!

Oh, I'm shaking now!

-Why?!

-I don't know!

It is very different going from a white uniform to a blue uniform.

Not just because of the colour, obviously,

but just because your responsibilities completely change.

The buck sort of stops with you, really,

and you have to live up to everything you've trained to be.

And everything that you've learned at university.

Everything you've come across in that three years of training,

it's now all on your shoulders.

And that's really where it starts, on your first day.

Her first day is on the antenatal ward.

SHE KNOCKS ON DOOR

Stacey? Hiya!

I'm Jess. I'm the midwife.

I'm just going to pop you on the monitor. Is that all right?

Stacey has been admitted with high blood pressure.

How many weeks are you now, Stacey?

-37 tomorrow.

-37? Oh, that's nice.

-Do you know what you're having?

-A girl.

Girl. Aw! Has she got a name yet?

-Perry.

-Perry? Oh, that's original!

I haven't heard that.

'Especially as a newly qualified,

'you feel completely thrown out of your comfort zone into the deep end.

'Even though people are around to say, "Am I doing this right?"

'You feel like you can't ask,

'because everyone's got as much work

'and everyone's as stressed as each other.'

-So, yeah, this is my first shift today as a midwife.

-OK.

-Oh, right, OK.

-But I trained here.

So I know all the bits and bobs and the people and everything,

-so it's quite nice.

-OK.

It's just scary being in a different colour!

-SHE LAUGHS Yeah!

-But, yeah.

-Are you excited?

-Yeah.

-Will you be doing deliveries and that?

-Yeah.

But I'm not in the delivery unit yet.

-OK. A quick feel of your tummy.

-Ooh, your hands are cold!

-Sorry!

-Oh, God!

-Sorry.

-Have you been having any tightenings or anything?

-Yeah.

It's tightening up now, actually.

-Yeah.

-Can you feel that?

OK. Buzz if you need me, all right?

The midwife course is so tough that across the country,

one in ten drop out.

Hospital shifts mean students work weekends and nights.

I soon learned that I couldn't go out as much as I wanted to,

if I wanted to give fully.

You can't come into clinic tired, or having gone on a night out,

because it doesn't work out.

Getting up early in the morning,

and your flatmates are still in bed at 10, 11,

go in for an hour of lectures and come back,

and you've been and done a whole day at university

and a whole day of clinic.

Today, Chloe is being mentored by Jenna,

who qualified just 15 months ago herself.

So honestly, I remember my first two handovers.

It's like, literally, like someone speaking a different language.

-Oh, no! OK.

-It really is.

And you will pick up on it,

and you'll notice that people say things that you don't even...

you don't question it, because they say it

as if you should know what it is,

and you feel silly sometimes questioning it.

Yeah, OK.

The difficult thing is you're meant to focus on normal midwifery.

Normal deliveries, normal antenatal.

Everything is meant to be normal.

Now, obviously, especially in a high-risk hospital like this,

normal is quite rare.

It's lovely, but it's rare!

SHE KNOCKS ON DOOR

Jenna is taking Chloe to see Emma.

Hello!

She's now been on the delivery unit for three days,

but there's still no sign of the baby.

'I think they've just had a really long, hard time,

'and they're both shattered, and they've both had enough.'

She's been actively having contractions since 8:30 last night.

So...thank God for an epidural in this case!

SHE LAUGHS

-Are you happy getting the bed ready whilst I...?

-What do I do?

-So you want the legs up first.

-Right, OK.

And then the back down, so she's not quite flat,

-but she's almost flat.

-OK.

-OK?

-Yeah.

BED RUMBLES

-JENNA LAUGHS

-They go with a bit of a jerk!

Gosh!

-Are you all right?

-No. Put it back.

-Up a little?

-Yeah.

And then, Emma, do you want to move your pillow?

Yeah, I need to.

I'll pop you back up. Sorry!

Emma's been asking for a Caesarean.

Jenna wants to find out whether she's any closer to giving birth.

Moment of truth!

-You happy for me to go ahead?

-Mmm-hmm.

-OK.

The head's come down a little bit.

Erm, but it has now got a bit of swelling on it.

-FATHER: The head has?

-The head. It's fine.

It's completely normal.

But when your cervix isn't opening any more,

what we don't want is to keep on going, keep on going,

keep on going, and it just gets bigger and bigger and bigger.

So, obviously, I'll go and let the doctors know.

With no progress, or very slow progress,

I would say that now is the time to say,

-"Enough's enough."

-Yeah, get it on.

Yeah? Are you happy with that?

-Yeah.

-Yeah. Okey-doke.

Right, well, we'll go and speak to everyone. Get things sorted.

Make a plan. See what they're all up to.

-OK.

-And then we'll get going.

-Yeah, that's fine.

-Yeah? OK.

-Feels all right?

-Yeah.

Good.

I've never seen a C-section before, so it'll be the first time.

INTERVIEWER: Is that a bit nerve-wracking?

Yeah. It's quite exciting as well! SHE GIGGLES

20 minutes later, the doctor's been to see Emma,

and there's a change of plan.

'You know, I've just gone and spoken to the doctor,'

who said ultimately, we're going to make her wait another four hours,

because the baby's fine, and she's fine.

Now my job is to SOFTLY explain that her.

Why do they want to wait for four hours?

Erm, right, don't take this word directly from me.

Because that registrar examined Emma,

and her physical progression...

physically, she's OK... the doctor thinks

it's worth now waiting the three hours

to examine her again, to see if she's got herself into active labour.

OK? So in three hours, if they examine her again

and she hasn't progressed, they'll go to section.

But the doctor don't think he wants to put her through

a major operation if she's going to progress, if you see how I mean?

But just wait for her to come in and see what she says,

because that's only the information I've heard, OK?

I don't want to say the wrong thing in case it was wrong.

So I tried to give them the answer the best I could,

hoping in my mind that I was telling them the right thing.

Which I think I did.

'The problem is, examinations can be subjective.'

So from my point of view, I feel awful that I've told her,

"Well, I don't think you have progressed,

"which means we're probably going to a section."

And then the doctor's come in and said,

"Well, I think you have progressed."

As a professional, the decision that they're making is completely right.

And that's the difficulty.

So from my point of view...

an apology, and just going from there.

The reason everything has changed is because my examination

and the doctor's examination didn't match up.

Now, I'm not saying he's wrong, and he's not saying I'm wrong,

-but one of us is wrong.

-I just don't understand it.

They ask you what you want and you tell them,

they come back and tell you you're having something else.

I don't see the point of them

even giving you the option, to be honest with you.

Yeah.

They've told us twice that we might be going for this operation,

and now we're not. So it's just...

it's just confusing.

All I can do is apologise for the inconsistency of our examinations.

Of mine and the doctor's examinations.

The fact that they don't match up.

It's not our choice, is it?

-Knock her out.

-THEY LAUGH

'It was really interesting, seeing Jenna saying one thing,'

and the doctor saying another.

And how the doctor said, "We're not going to section her yet,"

and Jenna thinking, as a professional in her own right, something else.

As a midwife, you're going to have doctors,

and everyone's going to disagree at some point.

Everyone does things differently,

and I think you've got to accept that, working in a unit like this.

Jess has just started her shift.

OK, now, I just need to listen to baby,

-then finish the checklist, and then we can walk over.

-OK.

You all right to leave your bags here?

Because you'll be coming back to this bed.

-Yeah, yeah.

-Yeah? OK.

29-year-old Natalie has been admitted for a Caesarean section.

Jess has been assigned as her midwife.

'Yeah, since I've been qualified,'

this is the first Caesarean I've had to do.

I just hope it goes well.

I've done loads of Caesareans when I was a student,

but obviously, you've always got that support of your mentor there.

But, yeah, it should be OK today.

There's enough midwives on the delivery unit

if something were to happen.

There's always numbers to ring. There's always people to ask.

So it'll be fine.

OK, one question. If it's breach, do we need a Paed at delivery?

No, not necessarily. But you will need...

Yeah, yeah, yeah.

-OK. That's fine.

-OK, good luck!

-Thank you!

-See you later! Bye!

I don't know who they're saying good luck for, you or me!

THEY LAUGH They're making me scared!

It'll be fine!

Everybody says good luck!

-You think, "Why are they saying that?!"

-Hmmm!

-Yeah, so this is the delivery unit.

-Yeah.

And the theatres are right at the back.

'No matter how nervous you are, and no matter how anxious you are,'

in yourself, you have to go into that room and be all happy, smiley.

Pretend you've done them for years as a qualified midwife,

even though it's my first one.

-Are we ready?

-No.

Oh! I got a phone call saying we were! Hmmm...

-Hmmm, not ready yet.

-That's all right, don't worry!

-Just take a seat.

INTERVIEWER: Is this where you're going to come?

Yeah, this is where I'll bring the baby, straight afterwards.

And then we'll take it back in to Dad, obviously.

And Dad can hold it.

There's always that thought of, "I'm the only one in this room,

"if that baby comes out not crying, not breathing."

It's going to be my responsibility to resuscitate that baby.

I really hope it comes out crying!

'That's when you feel like a newly-qualified midwife.

'You feel like you're completely on your own in that room,

'even though it's full of people.

'You're the only one with that particular skill who could do that.'

He's a good size!

BABY CRIES

Thank you.

Thank you very much. Come on, baby.

I'm just going to take him over there and dry him off, OK?

He's perfect!

Thank you very much for crying straight away!

Yes!

Oh, that was the best feeling in the world!

Eh? You're beautiful!

That was... I was very scared!

I'm shaking now!

Oh, I'm shaking!

That was something else! Come on.

Aw! Aw!

Say hello to the world!

-There you go!

-Oh!

-Oh!

-Did you weigh him?

-Oh, no, I haven't weighed him. I'll pop him back in.

-Let me see?

-I'll take him back in a minute and weigh him

-and put his bands on and things, OK?

-Let me see you!

Oh!

-Congratulations! He's beautiful!

-Thank you!

-BABY CRIES

-All right!

I can't believe I was at the delivery!

-Put it that way!

-SHE LAUGHS

What's this one going to be called?

-Vincent.

-Vincent? That's a cool name!

-I only qualified in September.

-Yeah.

And that was my first Caesarean without another midwife there.

I'm telling you now! So thank you!

It's all right! Well done! You did really well!

No, YOU did really well!

Do you feel better now you've done it, though?

-I feel better now I've done it, yeah.

-Was you really scared?

I was a bit nervous when I looked round

and realised I was the only midwife in there.

Well, it was good! Well done!

But then he came out crying, so he's made my day!

How's that? OK?

-That's OK.

-OK.

But this baby is quite compensated with its gases.

-OK.

-You see here and here?

So what does that mean?

-It means it was probably on the perineum a little bit too long.

-OK.

And it's...

Don't you find it, like...how a baby comes from one egg and one sperm?

-Yeah, it's amazing.

-And a baby comes out.

And then when you palpate a woman...

-You can't imagine, that surreal...

-No, you can't. And it kicks you.

I thought one day, "Oh, my God!

"One moment of passion leads to extreme pain for the woman

"at the other end!" SHE GIGGLES

-True.

-Yeah! SHE GIGGLES

She's a good girl, isn't she?

It's early Friday morning,

and Aurelie has come to visit Detrice,

who gave birth to a baby daughter last night.

The baby is in a critical condition

and needs heart surgery as soon as she's strong enough.

Does she look like Daddy, or you?

-Dad.

-Dad.

The doctor I saw this morning was like,

"Well, I can't give you a percentage

"on if she'll survive or not."

But hopefully, touch wood, she'll be fine,

and I'll be allowed to take her home.

All right! I know you don't like it!

-AURELIE LAUGHS

-She's called Darcy May Kelly Marie.

Being on the Intensive Neo-Natal Unit was a challenge.

Just to hear all the machines and just these...

..babies so vulnerable...

it sort of shook me a bit.

I was pretty scared.

It's a very emotional side of midwifery,

and if you're not quite emotionally...

stable, I could say, you could find yourself crying

at the end of every shift, to be honest.

Just worried about what's going to happen, really.

-But hopefully, she should be OK.

-Yeah.

And we know they're doing their best.

-So at least we know, you know what I mean?

-Yeah.

She's going to the best places

and the proper people are looking after her.

Aurelie has experienced trauma before.

In the Congo, where she grew up.

One of my friends' mums died after giving birth.

It was hard.

I struggled a lot.

It's quite emotional.

Even thinking about it right now, I can picture the corpse

and it's quite...yeah.

It's a shock.

Back home, we don't have such a thing as the NHS.

So if you don't have health insurance, basically,

or if you don't have the money to pay for your care,

you basically will be left untreated.

It's been her dream to one day return to the Congo as a midwife.

I would love to go home and work with women.

Especially for those ones who can't attend hospital,

because they may not be able to afford it.

I would love to just have a little village

or community antenatal class,

where women may come for free.

If it prevents the death rate of mothers, maternal deaths,

and neonatal deaths, then that would make me happy.

That would be my reward.

That I've passed on what I've learnt.

That's the plan for the future.

But at the moment,

she knows she's in danger of failing her second year.

That was just your mucus plug, OK?

So what happens is in the neck of the womb...

Kamika is 37 weeks pregnant.

She's worried her baby is not moving.

-Is it your first baby?

-Yes.

Are you excited?

HE LAUGHS No!

No?!

Bet you are, really!

He's not as active as he normally is.

-Not as active?

-Yeah.

All right. When you say, "Not as active as before..."

Kamika's notes show there have been concerns about the baby's size.

Aurelie needs to assess whether she's safe to go home

or needs further medical attention.

No pressure!

AURELIE LAUGHS

'Aurelie's really got exceptionally good skills with the women.

'She's a calming person, which you pass on to the women.

'If you're a lovely, calm person,'

you can calm a woman in the throes of labour.

And those are skills that you want your student to have.

But obviously, things that I do worry about with Aurelie

is when we're under pressure.

Something might be wrong with the baby's heart rate, trace,

or the woman, and then that pressure increases.

As a student, you're trying to learn to deal with learning the skill,

applying the skill, and dealing with stress all at once.

And that takes time.

'When you've got somebody who's scared,'

they don't care if you have to pass something or not.

They just want you to deliver the care and be nice to them.

So that's why even if I have to pass it, I'm like,

"Yes, I have to pass it." I acknowledge that.

But I make sure that I don't put that in front of the woman.

It's the last day of her assessment.

Yeah, sounds fine.

-So, give us your plan of action, please.

-Plan of action...

Her body is just progressing by itself,

so there would be no need of keeping her in hospital.

We would just end up medicalising her.

The baby's not moving the same tonight as it usually does.

That's...

-not normal, is it?

-No.

Normally, if she was low-risk,

and we've listened in, we might be happy with that.

-But this lady's got some risk factors, hasn't she?

-Yes.

Because she's having growth scans for small for gestational age.

So I wouldn't be happy for her to go home until...what?

She'd been reviewed by the doctor.

Well, first of all, let's get her checked out.

Because if we send her home, and anything were to happen,

we wouldn't feel good about that, would we?

So there's nothing wrong, don't want you to panic.

I don't want you to worry,

because we do this routinely for all women in similar situations to you.

If it's OK with you, we'll get a room free

where we've got the comfy bed

and we'll pop you on the proper monitor, you know?

But again, check it. All right?

So if you just have a seat in the waiting room

till we've got a room free for you.

Yeah? And you can carry on eating your little snack bag there!

You've got to stock up! You're going to be a dad, eh?!

All right. We'll get you a nice, comfy room.

Oh, God!

That's it. I've actually just pretty much ruined my chance.

-Look at her risk!

-I know!

'You do have to get tough, I'm afraid.'

Because you can't afford mistakes.

You can't afford to make error here.

These are people's lives. These are people's babies.

And if somebody comes into that department bleeding,

or reduced baby movements,

she could be in serious need of attention,

and if you fail to recognise...

that's somebody's life.

That's somebody's baby.

Just take deep breaths.

Just breathe through it, Gemma. That's it.

Just got a lot of pressure?

Chloe has been on the delivery unit for three weeks.

-It's a good sign.

-'Chloe's doing really well.'

And obviously, the more she does things,

the more confident she'll become.

SHE GROANS That's it, Gemma.

Keep breathing that gas.

-That's it.

-Shit, shit, shit!

Gemma is nine days overdue, and expecting her first baby.

She's now been in labour for 30 hours.

Oh, God!

That's it.

-SHE LAUGHS

-What?!

Diamorphine, it doesn't actually get rid of the pain, does it?

It just knocks the edge off them.

-I don't believe that.

-CHLOE LAUGHS

'I think that sometimes,

'it's nice to leave a student in the room with the woman.'

So I just tend to sort of bob out for 10-15 minutes,

and just let them have a bit of time.

SHE KNOCKS ON DOOR

Hi! It's only Faith. Are you OK?

We're just going to have a feel of your tummy, Gemma. All right?

And just make sure that baby's in a good position.

Straighten your legs out, yeah.

Midwifery is a very hands-on thing, and it's about developing skills.

And the only way you can develop those is by actually doing it.

Chloe's about to face one of the big milestones for a student midwife.

An internal examination.

-Have you done many of these, Chloe?

-I haven't done any.

It's really about trying to encourage somebody to do it.

Because they're scared. It's a very intimate procedure,

and if it's something they've never done before,

it's about just trying to reassure them,

and saying, "No, you have to have a go.

"Don't worry if you don't know what you're feeling.

"It doesn't matter. It's just the fact that you're having a go."

It just comes with practise.

Is it OK if Chloe just examines you first?

Just so she can see?

-What size gloves do you wear? Small?

-Small.

Right, you pop these ones on, then.

Everybody's got to learn, yeah.

So this is this hand. Yeah.

GEMMA: Do you want my feet together?

In a minute, yeah.

That's it. And then your other hand.

Now, the first time you do an examination,

you probably won't feel very much, but it's just experience.

So don't worry about it, OK?

Take some nice, deep breaths, and just try and relax, OK?

-So, like this?

-Yeah.

-All right? Go on.

-Like this?

Yeah, don't be frightened.

-You won't hurt her!

-CHLOE LAUGHS

-And if you do...

-Don't worry.

Students are always really gentle,

whereas the midwives are not so gentle!

-I can feel the baby's head.

-OK.

Keep going, up a bit higher and round the back.

If you can feel the baby's head.

-Yeah, I can definitely feel the baby's head.

-Can you feel any water?

Any membrane there?

Any bulging membrane or anything?

It's difficult, so don't...

It feels like...

-spongy, kind of.

-OK.

If you think about...like, feeling your top lip, almost.

You know that feeling? Like a ridge?

-Can you feel anything?

-Yeah.

Can you feel any, like, cervix bit?

-It feels a bit...it's so hard to describe.

-It just feels hard.

Just hard like the head?

And then on the side of baby's head,

is the cervix, from twelve o'clock...

-Oh, yeah!

-..it's on one side.

-Oh, yeah!

-Can you feel it?

-Yeah.

So she's still got a bit of the cervix left,

so that's why I'm saying she's nine.

-OK.

-Because if she was ten, there wouldn't be any.

-OK.

-Yeah?

-Yeah.

-All right? Well done.

-Thank you.

-Yeah?

-Yeah.

Right, fine. Well done.

Gemma's almost ready to start pushing.

This could be one of the 40 births Chloe needs to qualify as a midwife.

If she's pushing at half three, I'm SO going to ask to stay.

I can just add it onto my hours. It won't matter.

I don't think, anyway.

What I tend to do with students that haven't had a delivery yet

is do something called hands on hands.

So she will put her hands on,

and then I will put my hands over the top,

and help to deliver the baby, really.

Oh, my God!

Three hours later, Faith discovers the baby is in a tricky,

back to back position, making a normal delivery much harder.

Oh, Mum!

Fucking...sorry!

The doctor will decide what happens next.

Hello? I've got Louise, the doctor, with me, OK?

She's just come in to have a look at you.

So what we need to do is think about what we're going to do next.

If this is going to happen vaginally or not.

It doesn't sound like it, but we just need to double check for you.

Is that all right? HEART MONITOR BEEPS LOUDLY

OK, I want you to just get it out now!

Listen, we just want to make sure.

Oh, bloody hell! Sorry!

Oh, just get it out!

OK, Gemma?

Just as Faith says, you're still only nine centimetres.

And that's because baby's facing back to your back.

You're telling me that you've had enough,

and so what we're going to do is

I'm going to have a word with our consultant,

and see if he's happy for us to do a Caesarean section.

-Is that what you want?

-Oh, just get it out, please!

Is that all right?

CHLOE: There's a tissue there if you want it.

GEMMA SOBS

Oh, I hate it!

This is the first time Chloe will be given

the responsibility of taking the baby once it's delivered.

-Yeah, get some gloves from there.

-OK, yeah.

But the key is, in theatre, don't touch anything blue.

-I'll tell you, but just stand away from the table.

-OK.

Don't touch any of the doctors that are in their gowns and stuff.

-Just try and stay away from them.

-OK.

-This is the one I should use, isn't it?

-Yeah.

Do I show Gemma the baby, or just take it straight through?

They're the waters?

Get ready.

Just bring your hands a bit closer together.

Oh, I hope not!

DOCTOR: I might need some help.

What, from down below?

The baby is so low in the birth canal that it needs a push.

Can you get my fingers now?

Hello, baby!

-So...

-Oh!

-You all right?

Just hold it down. Big enough!

BABY CRIES

DOCTOR: Hello, baby! All right?

-There we go.

-So go show her it, yeah?

-Yeah.

Here you are! Congratulations! OK?

-Oh, I did it!

-I know!

We'll just take her and give her a rub off, all right?

Congratulations!

Right. Oh, dear!

Look at all that hair!

-So what happened there was because she'd been in labour...

-Oh, my God!

..her head had got low, and it was a bit stuck.

So that's why I just had to go underneath and give Louise a hand.

Push baby back up for her.

Oh! Come on!

-Just pop a nappy on her.

-OK.

And we'll just take her straight to Mum and Dad.

-OK.

-Yeah?

So I hand her to Dad, yeah?

Yeah, give her to Daddy.

Here you are, Daddy!

Congratulations to you both.

Have you got her?

-Yeah, I've got her.

-OK. Sorry!

Hey, you! I know!

'Chloe was great. She was really, really good.'

At the end, she came up to me and she went, "Oh, my God!"

I said, "What?" She said,

"I've just seen your ovaries. They're amazing!"

-SHE LAUGHS

-I was like, "What?!"

And she said, "And your fallopian tubes, and your bladder,

"and everything! It looks great!"

I was like, "OK..."

We'll let you have a little cuddle,

and then we'll go dress her and everything, all right?

'I was so worried that I was just going to drop the baby'

straight through the towel! Or slip on something!

Because that's someone's baby, you know?

I think it's the worst fear you can have,

but, you know, you just grab hold of it and take it through.

You're careful with a baby.

There's something instinctive inside of you,

that you're careful with someone else's baby.

I don't think that'll ever happen.

Touch wood. It won't ever happen.

After a week on the delivery unit,

tonight Aurelie will learn if she's passed or failed.

It's not very professional,

I'm walking in with a brew!

Hello!

OK, so, let's go back to the beginning.

-Final interview, yeah?

-I know, yeah.

How do you feel you've done?

Erm, I think I've increased my confidence.

Yeah.

And the fact that I've been placed under a lot of pressure

has sort of moulded me to know

when I need to sort of step out of my comfort zone

and put on my midwife hat.

-And just be like, "Right, we have to do this."

-Yeah.

The problem we have is, the pressure is on me too,

because, we see, we've got lots of skills referred here

that we have to pass, or I have to fail you.

So it's massive, isn't it, today for you? OK.

So basically, I've put, Aurelie,

that I've found it a pleasure to work alongside you, OK?

Oh, thank you.

I think you're very kind and empathetic towards the women.

The women in your care have fed this back, and that speaks volumes.

When the women notice a student midwife being kind,

because often, they're in pain,

and they don't really want to give feedback,

because they're busy with other things.

I think you're learning from your experiences,

and when you have done things wrong and I've challenged you after it,

you've remembered, OK?

And that's reassuring. That's very reassuring to know.

So that's a real good positive, OK?

So this has been a really difficult time, and a difficult decision.

It's probably one of my most difficult decisions

to make as a mentor.

Erm...

but I am going to pass you, Aurelie.

-Oh!

-Erm...don't go soft on me now!

No, I won't!

I've been up all day with no sleep over this!

I am going to pass you.

When you can see potential in somebody,

you shouldn't just write it off.

I'm wishing you all the very best,

but I have put, you know,

year three is going to be very challenging.

Very challenging for you.

And you need to be honest, and you need to seek support.

And if you're not coping with the demands of the profession,

you need to seek support quickly.

Don't struggle.

Don't wait to do something that could be, you know, bad.

So that's where we're at today.

It's a pass, but you've got so much work to do.

And I don't think I need to tell you that. I think you know.

Cos year three, you've got all your exams and revision.

-It's a very, very demanding course.

-OK, OK.

I think you need pushing a bit more.

It may well be that you're very laidback.

Ugh! Yeah...I passed!

There's still another 18 months of training

before Aurelie will get to wear a blue uniform.

I'm positive, in that I really do think she can do it,

but it's going to be the biggest challenge for Aurelie,

this third year.

So she needs to come out in third year, all guns blazing, ready to go.

And really demonstrate those skills.

'It saves lives. That's all that matters, to be honest.

'And when it comes to saving lives,'

it's not really about the midwife.

It's about the woman and the baby.

At the end of the day, if you're a midwife, it's not about you.

It's not about how you feel, or how tired you are.

It's about the woman. She is the most important thing.

That's what she will remember for the rest of her life.

Jess qualified four months ago.

Today it's her first shift on the delivery unit.

She hopes it's a chance to get her first normal delivery as a midwife.

I've had in the past, you know, "How old are you, 16?

"You look too young. You're not mature enough.

"Oh, you're only just newly qualified?

"We want somebody more senior."

And if that's the case, then you do have to take a step back and say,

"OK, I'll get you someone more senior."

Kimberley has been in labour for 36 hours with her first baby.

The baby's heart rate has been causing concern.

HEART MONITOR BEEPS

These things are so long by the end of it, it's ridiculous!

JESS LAUGHS

The baby's heart should be between 110-160, really.

So if it's lower than 110 for longer than three minutes,

we need to pull the emergency bell. But it just didn't get to that.

It was about a minute, a minute and a half. It felt like ten!

So I think he's a boy, because they all do that!

SHE LAUGHS

Do you want the gas and air for this, or are you OK?

OK. All right, just take some deep breaths if you need to, OK?

And the good news is, I can't feel any cervix.

So that means you're fully dilated, OK?

Great news!

Basically, we're going to try and get her pushing.

We need you to hold your breath, put your chin on your chest,

and then push right down into your bottom.

Like you've been constipated for about a month.

I can't do it for that long.

We'll be there, telling you to keep going, keep going.

And then you take a quick breath in,

and if the pain's still there, you push and push and push and push.

And if the pain's still there, you push even more. OK?

For Jess' first birth, this is not straightforward.

There are signs the baby is in distress.

That's it.

And push right into your bottom, right into your bottom. That's it!

That's it. Keep going, keep going, keep going, keep going!

A doctor and extra midwives are on standby, in case of an emergency.

That's it! That's it! That's it!

Well done! Well done! Well done!

Fantastic. And again. One more.

Last one. Last one.

Keep going, keep going, keep going, keep going!

-DOCTOR: Excellent!

-You're doing it!

It's going to burn in a minute, OK?

-I need you to breathe.

-SHE PANTS

Little pushes. Yeah. Little pushes.

Little pushes. That's it, that's it.

That's it. Well done! Well done!

That's it. That is amazing!

-You're so good!

-That's fab.

And have a rest, OK? Have a rest.

We've got the head.

OK.

DOCTOR: Have you got one?

OK, that's it. The baby's coming.

-Keep going.

-That's it.

-Oh, there we go!

-Hello!

There we go. Congratulations!

-You've done it!

-Hello!

There are concerns that the baby is not breathing properly.

MIDWIFE: We'll just go and give him a little wake up.

Can we have the cord gasses, please?

Can you do that, and I'll...?

I'll just give you an injection into your leg, OK?

So I'm giving 33.

No, he's OK. He's all right.

I'm Vicky. I'm one of the sisters off the neonatal unit. All right?

You can see him there.

The baby is breathing again.

But he's being sent to the neonatal unit to be monitored.

-You did so well!

-So did you!

All right? You were great.

I've done so many as a student, I've just never...

Well, that's the thing. This one means the world to you, doesn't it?

-Yeah.

-OK? You're a star!

-That baby will be fine as well.

-Of course he will.

He'll be fine. Thank you.

So we're going to take him over, and we'll let you know when he's ready.

JESS: That was amazing!

It all happened so fast. I didn't think I'd get it.

It came out in need of resuscitation and stuff.

I've never seen that before, so that was pretty scary.

But I was focusing more on her, really,

because I knew people were already focusing on the baby,

so...yeah, she'll do really well. She'll be fine.

And that baby will be fine.

It'll be back with her in a couple of days.

She was amazing!

She was amazing! Amazing!

It was fantastic. I'm so proud of her.

It was really good.

I don't want to go back into the office yet,

because I'll just cry again, so I'll wait a minute!

SHE LAUGHS

Oh! That's a better feeling than getting your 40th delivery.

Getting your 40th delivery as a student is nothing compared

to that feeling of doing it in a blue uniform.

First baby, done! Done!

-Yeah?

-Yeah! First baby!

I burst into tears! Burst into tears, yeah!

Burst into tears.

Oh, I just burst into tears!

-She's finished now?

-Yeah, I just burst into tears!

That was amazing! That was my first baby in blue!

-Oh, really?

-Yeah!

Oh, congratulations!

I'll see you later, girlies.

-Bye!

-Bye!

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