Jaki Lambert, Director for Scotland, Royal College of Midwives

Jaki Lambert is Director for Scotland at the Royal College of Midwives, and former Head of Midwifery in Argyll and Bute at NHS Highland. In this video, Jaki tells us what she feels is her greatest achievement as a midwife, but you can hear her tell her full story in the Here for Life podcast.

I would say my greatest achievement was to be able to see my grandson be born, 10 miles away from here, at home.

I wasn’t there as a midwife, but what was really wonderful was to see the impact it had on my daughter-in-law, on my son, and the lasting impact it had on their being parents and feeling that they had their complete choice respected.

Where did your midwifery journey start?

I didn't come into midwifery until I was in my late 20s, after I’d had my own child in what was, for me, a beautiful home birth. I was already interested in women’s health, and women having control over their own bodies and what happens to them.

Childbirth is an enabling and important part of your life, one that can be a wonderful or less than positive experience. To be a part of that for other women felt amazing.

What was your midwifery training like?

When I was training, it was hard to see how to apply the midwifery I was learning. Midwifery was either hospital-based or community-based. I didn’t see a place where I could practise all the skills I was learning and develop across all areas of midwifery.

Then I read an article about providing a different kind of care, where midwives got to know their caseload of women, and their families, and provided total care: before, during and after the birth. This was the way I wanted to work.

When we were developing services in Argyll and Bute, it was important to make connections so that we could keep developing the profession. Since then, I’ve learnt more about remote and rural education and training and presented on it over the years. It’s an amazing career path but it needs to link into other services.

What makes you passionate about working as a midwife?

I believe every woman should have that opportunity to feel in control of their choices and their experience and not doubt themselves. It's a very different space to the one you normally get an opportunity to see. Every midwife should understand what that relationship feels like.

A positive experience stays with you for life. It’s not about everything being normal or perfect, it’s about feeling in control and having a voice, rather than things happening to you. That’s why I do it.

The maternity services need to be set up that values midwives and provides the structures that support them to practise. That way midwives can ensure that those women have a positive experience that stays with them for the rest of their lives. Five minutes in a busy clinic is not the same as providing the all-round of care that someone needs, rather than pushing them from pillar to post.

What is your greatest career achievement?

My greatest achievement was seeing my grandson be born 10 miles away from here, at his home. I wasn't there as a midwife, but it was wonderful to see the impact it had on my daughter-in-law son, and the lasting impact it had on their being parents and feeling that they had their complete choice respected. I was also proud because this was a service that we have developed around here that let that happen.

It was such a pleasure to see my own grandchild being born, in the community that they lived in, but also that the way we work made that possible. There's something about being part of a community that makes you want to provide what the community needs.

Can you tell us about your role at Argyll and Bute?

You are a generalist, not a specialist, in a remote and rural service. There's no part of your skills that you want to give up, which actually makes you an expert generalist. You have to use every aspect of your training. Which also means you don’t have to sacrifice any part of the job, you get to do the whole lot.

This makes it interesting and exciting, but also unpredictable. One day you’re providing planned care, but you’re always ready to provide unplanned care, which is challenging. No two days are the same.

We can do it because we set up structures to make it possible. It's about setting up services that fit the local context, but also enable a midwife to work to every aspect of their profession. It has to be appropriate to the environment.

Every midwife in Argyll and Bute is linked together, so that if one connection breaks down, there are other ways that people are connected in. That means you know that there’s a consistent level of care, but care that’ is individual to the women receiving it.

We train together, we do clinical supervision, we review incidents, and we learn through feedback from women. It's opening up as many opportunities as possible for people to learn from different situations.

We have a model for practice that we developed with every midwife in Argyll and Bute. For example, women said that they wanted a local service for scanning, and that traveling to Glasgowwas difficult to organise and expensive. That gave us the impetus to train midwives and develop a local sonography service.

What are the most important aspects of being a rural midwife?

One of the most important things is that if there is a problem with a woman or her new-born baby, that we have really good systems set up for transferring and ensuring that the woman is in the right place for that baby to be born.

We have built up a relationship with air ambulance service ScotSTAR (Scottish Specialist Transport and Retrieval), who also provide training across the remote and rural units. That has helped because they are not expecting us to be neonatal consultants, they’re expecting us to be good midwives, with all the skills that entails. It has also given us the confidence to provide care in situations that we maybe would not have been able to do before.

What changes have you seen during your career as a midwife, especially with new technology?

Years ago, we ran a new-born resuscitation training session. We did the training and I said afterwards, ‘That's great. Now what do we do?’ The reality is that once you've resuscitated the baby, the nearest facility is still two-and-a-half hours down the road.

Technology has revolutionised the way we can provide care in a rural setting, particularly pre-transport care. With technology, it is as if the person is in the room with you, talking you through a procedure. This makes it possible for you to be confident that actually you can keep on providing care despite the situation. Technology means that there is a seamless transition of care from an island, or another rural part of the country, to a large hospital in the city.

Yet, in London, it often takes the same amount of time to travel from one side of the city to another as it does to go from a rural to an urban location in Scotland. If we apply the way that we work here to other settings, it increases the possibilities of how we can provide care close to home, but in a way that's safe, effective and professional.

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