The WRISK project regularly asks contributors to share their perspectives on a range of issues related to risk communication in pregnancy to further understanding of the challenges faced by scientists, clinicians, policy makers, and of course women themselves when trying to navigate risk messaging. These represent individual and personal viewpoints, and are aimed at encouraging reflection and discussion, rather than reaching conclusions.

In this blog, Nikki Lacey takes us to the front line of community midwifery and shares the art of respectfully communicating risk whilst under immense time pressure. Nikki trained as a nurse, qualifying as a midwife in 2000 and later undertaking a Masters degree. She currently works in the Vale Parenting Service as a Specialist Midwife for the under 19’s in the Vale of Glamorgan, Wales.



As a junior, inexperienced midwife I never really understood the pull of community midwifery, the ability of my community colleagues to know the names of every women on their caseload seemed a dark art and I found the somewhat territorial nature of them pronouncing the patients were “their women” quite strange. I preferred the immediacy of labour ward practice and the sometimes dramatic, lifesaving nature of a career in the delivery room.

Fast forward twenty years and I am now a community midwife! Maybe it is age, wisdom or just being time served but there is certainly a unique satisfaction in being a community midwife and building a relationship with the families in our care through the continuity we can provide.

No two days are the same, no two babies are the same, and no two women hear or interpret the information, advice and guidance that we give in the same way.


Delivering public health messages

Community midwives are at the front line of sharing information and giving public health messages. As a community midwife you may have given the same piece of information to a number of women already that day, but for the woman and her partner sat before you, it is the first time they have heard it and it needs to be given in a pertinent and meaningful way. Words need to be carefully chosen, non- biased and tailored for each woman because they will go home reflecting on your every word. This is made easier to some degree if you can provide continuity and know the families in your care, as you know their story, their background and their pregnancy so far. It can be made significantly more difficult if you are covering a colleague’s caseload or clinic, or don’t know the women sat before you as you are often surreptitiously leafing through her notes to learn about their pregnancy journey whilst attempting to engage in meaningful conversation.

Sometimes, being a community midwife feels like a being on Countdown. We cram our consultations full to the brim with information about vitamins, minerals, weight gain and a healthy diet, foods to include, foods to avoid, recommended immunisations in pregnancy, advice on responsive feeding, safe sleeping, not to mention smoking cessation and questions about mental health and domestic violence.

We are assured that each new piece of information we are asked to give to women “will only take a few minutes”, but lots of pieces of information take lots of minutes to impart. Our appointments become a balancing act, a juggle between the right amount of conversation, physical examination, and information giving with the countdown clock ticking away in the background!


The art of communicating effectively

It’s a real skill to weave this information giving in to a conversation so that women and their families feel they have had a meaningful, quality consultation instead of feeling ‘talked at’ and overwhelmed by the volume of information that they have been bombarded with! There is an art to communication- it requires you to give information and public health messages to women and families in a sensitive, non- judgemental, motivational way, using open questions and being responsive to them.

We must always give women and their families time to digest information and to ask questions pertinent to them; to do this in any other way means that the information we give is prescriptive, women feel they are given a list of ‘shoulds and cants’ rather than information they can weigh up and decide if they want to adopt.

Worse still, if our information giving technique is poor we can instil fear and present an unbalanced risk of complication because we haven’t had the opportunity to explore how the information we have given applies to individual women and their circumstances. Our aim as midwives and health practitioners is to empower women and their families to make healthy life choices that will benefit their families going forwards.