A Student Midwife’s Experience of Post Traumatic Stress & The Healing Power of Caseload Midwifery

This article was written for The Practising Midwife and featured in their January 2018 edition. If you’ve not signed up already to receive the journal you can do so here https://www.all4maternity.com/ it’s a fantastic resource and is now also available in online format. What is also fantastic is that for every person that subscribes, a subscription is provided free of charge to a midwife in more deprived areas of the world, providing access to invaluable resources and education.

My story of post traumatic stress triggered after a difficult day on placement, the subsequent difficulty of accessing the right help and diagnosis and finally the profound impact of the continuity of support received as a student from a team of caseload midwives. How love, support and encouragement from likeminded midwives aided my healing and made me the midwife I am today.

I can still feel the emotions churning inside me when I think about that day on placement as a student midwife. The day that sent me to the pits of despair, resulting in months of illness before eventually receiving a diagnosis of post-traumatic stress. The experience I went through and the support I had has had such a profound impact on who I am today, it made me realise how powerful it is to have someone to support and inspire you through tough times, to hold space for you. This was my experience of finding a new midwife in me, or perhaps just finding the midwife I was always meant to be, thanks to the support of my personal tutor and an amazing caseload team whom I worked with as I began recovering from PTSD.

Born perfect; not still, just too soon

I can still picture the little face of the baby, born perfect, just too soon to survive, but for a few moments life was very much seen in this little fighter, seeming to momentarily be gasping for air. This image was one that my own imagination wrongly turned into something horrifying over the following days, weeks and months. An image that became etched on the backs of my eyelids; appearing in widescreen every time I closed my eyes. I became too frightened to sleep, too afraid of the reoccurring nightmares that became a part of my life for what felt like an eternity.

Silenced, isolated and broken

The glimmers of support in the early days were overpowered by those that made me feel I had no right to be so upset. I felt like a fraud. Perhaps they had been through worse so I should just get a damn grip, right? I remember one person I confided in challenged what I told them I had seen, I said the words that were torturing me through breath taking sobs, I needed so bad to talk and it was so hard to say what I did… but all I got was corrected that it simply couldn’t of happened. I have no doubt the intentions were well meaning, they were just trying to find an excuse or an answer for me thinking it would take away the pain. It didn’t, it made it worse because I felt silenced.

I became isolated, I hated the thought of university but thankfully I had the perfect excuse to not see anyone, annual leave. I used this opportunity to hide away. I shut everyone out. I shut the world out and I drank. I drank to erase the horror in my mind. I drank to sleep. I drank to blur the pictures etched on the backs of my eyelids. Nothing worked. Images of dead babies and babies screaming and gasping for air filled my head every night, every blink. I was the star in my own horror film.

The strain on relationships

Friendships were broken and any relationships with cracks were shattered because the strain was just too much. I was mentally, physically and emotionally exhausted, so any burden of expectations put on me was too much to bear and I offloaded it without a second thought, I was in survival mode. It took all my effort to survive, how people couldn’t see that was beyond me. But the worst, the worst feeling was that maybe I just can’t be a midwife, maybe I just wasn’t strong enough. I was miserable.

The darkest of days

3 months on, with my world falling apart, the suicidal thoughts began. Sat at the train station, watching trains pull into the station and out again, I thought how easily this could be over. Just another person standing between the busy commuters and their 9am meeting. An inconvenience, but one forgotten about by 10am. Stood at the traffic lights, feeling the powerful gusts of wind hit my body from the buses speeding past, I considered how easily I could just step forward. ‘Yes’ I thought, ‘That’s genius’, people would think it was an accident and my family won’t feel the extra heart break and confusion that comes when someone commits suicide. They were only thoughts and I know I would never have acted on them, but the thoughts alone were scary enough.

Accessing the right support and diagnosis

I desperately needed to make sense of the horrifying, intricate details in my head, to translate them from thoughts to words. I tried, turning to my personal tutor, who validated my feelings and helped me help myself, she was wonderful. She would sit patiently, kindly, waiting for me to finish spilling out words. It felt like, if I could just get the words out, just say them all, even if they were within incoherent sentences, then the right ones might find each other and form a sentence. But just the thought of the descriptive words associated with the images in my head were enough to break me every time I tried, causing a breath-taking sob that went on and on and on, shaking my body to the core. I have never cried so hard or so much. Not even after my own loss. I knew I didn’t want to die and  I knew I wouldn’t, because I knew that I was unwell and I needed help.

By the time I even tried to see a GP, months had passed. Then I tried for weeks to get an appointment. One particularly desperate day after 5 nights of no sleep at all I stood, crying, in front of a packed waiting room, whilst the receptionist repeated ‘No appointments today, just keep trying’. I felt I was being failed by the very system I was training to work in. It was 3 weeks of trying before the suicidal thoughts prompted me to go to an emergency walk in centre; after all, I couldn’t be a midwife if I was dead. I was diagnosed with post-traumatic stress 3 months after that, after trying different forms of therapy that failed because they were treating me for depression, I wasn’t depressed.

Midwifery; not just a job, but a part of who I am

Then I started on the long road to recovery and healing. Midwifery means so much to me, it’s not a job, it’s built into me on a cellular level, it’s part of my heart and soul. With this in mind I decided that rather than coming off of the course for a year and having to re-join the cohort after me, I opted to just have a month off where I could really focus on the planned talking therapy I had, along with lots of self care. It was definitely the right thing for me to do, because despite how hard it was, it still felt that it would be even worse to fall behind and have to wait even longer to qualify and finally be the person I wanted to be. Midwifery was part of my healing.

Continuity of support – Caseload Midwifery

The real turning point in my recovery was when I was placed with Juliet May and her caseload team, the amazing Valley Midwives based in London, a team of women who were the making of me as a midwife and who will always hold a very special place in my heart. I can’t actually recall if I told any of them the full story of what happened at that time, but I did talk about parts, they got the gist of it. When I did talk there was no attempt to try and make the events better, not ever, which was just a relief. I felt safe with them, all I got was love and encouragement and acceptance. I hadn’t realised at the time but I know this as ‘holding space’. But what I now see as so special about this is that I don’t think that was even something they consciously did, but rather just the type of people they are.  They held space for me, they made me feel protected and in a short space of time made me find my place in midwifery and start to finally come out the other side of the cloud that had been surrounding me for almost a year. At the same time as this I began to find the words, I began to pick apart what happened and most importantly I started to find peace with it, because I finally felt safe. Gradually it began to feel like the huge burden I had been carrying for almost a year was lifting. It was only then I realised just how heavy that had been.

Turning a corner

I started to sleep well; I would wake up excited and come home in an oxytocic buzz. It couldn’t have been further from the version of me that was merely existing just the month before. It was like just being in their presence and seeing them at work providing a level of care I didn’t think was possible on the NHS had some sort of healing power. I almost feel like there is kind of magic about true caseload care, how healing it can be for so many different people in different ways.

Being allowed to feel, without feeling weak

They were so kind and gentle with me, I felt so protected by them and for the first time in a very long time I felt happy. It made me see the value of this type of care not just for women and families, but also for midwives and student midwives. I felt so nurtured by them, I was allowed to feel and was told many times that being emotional did not make me weak. I felt like the same compassion, kindness, patience and nurturing they gave their women, they also gave me as their student.

I had begun to think that I just needed to grow a thicker skin to be a good midwife, that I was too emotional to be a midwife, that I needed to disconnect from these feelings. When actually, what I learnt was that I needed to do the exact opposite to be the midwife I wanted to be, but that I just need to learn my boundaries, to know when I need support and where to get it from. Recovering from PTSD isn’t about suppressing emotions and putting a traumatic experience into a box and locking it away. Recovering is about picking it apart, feeling the feelings, talking about them, being allowed to be angry or sad or confused without being questioned. When you find the people you feel safe to do this with in midwifery, you’ve found your tribe… don’t let them go!!

Finally a Midwife

Fast forward to now, a few years on, I’m happy to say I am a qualified midwife and I know that this experience has had a profound impact on who I am, the way I practice and the way I support my colleagues. When I look back on the darkest days it feels like I’m watching a film, it doesn’t feel like it was me at all and I feel strong for getting through it. Now there are no more frightening images relating to that day, just the real memory of a strong, inspirational woman, her perfect beautiful little human and a powerful group of women who helped nurture me into a Midwife that is strong minded, passionate and emotional but a fierce advocate for women and families. Having that person you KNOW and TRUST is not something that is vital for just women and families, but also vital for our midwifery workforce and future midwives. Continuity Matters!!

6 thoughts on “A Student Midwife’s Experience of Post Traumatic Stress & The Healing Power of Caseload Midwifery

  1. Donna x says:

    Beautifully written… and bloody hell, I’m so sorry I didn’t realise everything that was going on at that time. Love u lots and so proud of you for overcoming the many obstacles you have faced to realise your dream xx

    Like

  2. Annabel Bryant says:

    So so brave to write about your experience so eloquently and so pleased that you found the support and love you needed. What a terrible tragedy it would have been in the Valley Team had not been there for you. Our job can be so terribly hard and distressing, let’s stay close, hold space and support each other. Wow there are so many families who are going to be so blessed to have you as their midwife x

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    • Michala Marling says:

      Thank you Annabel, you were a part of me finding solace in midwifery! Had I never seen how great it could be or had inspiration from yourself I might never have known just how amazing midwifery could be! Thank you for always being there when I needed support or someone to rant to! Lots of love xxx

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  3. rysieblog says:

    So beautifully written. VERY relatable to me, as I struggled with some huge feelings/trauma after being involved in an extremely traumatic forceps birth, that resulted in a huge PPH and a neonatal resuscitation in one of my first shifts as a graduate. I found it really difficult to process until I was able to find a safe space to debrief, and thankfully for me, I could focus on the fact that in the end, both mum and bub had been ok. But in the weeks following the event, I found myself on the verge of panic driving into work, sleeping poorly, and constantly replaying the scene, especially the sounds. It’s so hard to justify why it affected me so much, but it took a hell of a lot support and debriefing to get there.
    I know it’s not on the same level as a foetal death, but I was actually shocked by my lack of self-perceived resilience. However, trying to tough it out did nothing but amplify my panic, and I’ve learned to always talk things out and get that support ASAP.

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    • Michala Marling says:

      Thank you, it’s written from the heart and I feel quite vulnerable it being out there for all to see! That must have been very tough to deal with, you don’t have to justify the reason it affected you the way it did, it’s tough and it’s ok to find it difficult! The turning point for me was it being recognised as post traumatic stress, I was initially treated for depression and it made me worse because I wasn’t depressed. If you need to talk please do get in touch my number is 07926 612850 talking to someone who just listened and didn’t try to make it better or challenge my feelings really helped me. xx

      Liked by 1 person

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