Gemma Albery always wanted to be a midwife, but she didn’t achieve her dream until she was in her thirties. When she accompanied a friend attending Bourn Hall’s Norwich clinic for a follicular tracking scan she was so impressed by what she saw that she applied for a job with us – and now loves her work as a Fertility Midwife Specialist. As part of our series celebrating the International Year of the Nurse and Midwife Gemma tells her story.
“I always wanted to be a midwife, even when I was at school. But when I saw the careers advisor she told me I would never be a midwife as I had been diagnosed with epilepsy when I was younger,” says Gemma. “I later found out that advice was wrong.”
When Gemma left school she initially worked as an administrator as well as looking after her dad whilst he was ill. “Caring for my dad made me realise that I really did want to go into the care profession,” says Gemma. “I applied to the Norfolk and Norwich Hospital to be a health care assistant, which I did for quite a while. Then I had a few other jobs around the hospital, just to gain a bit more experience. I worked in the pathology lab, on the Jenny Lind Children’s Hospital outpatients department and did a few jobs in the delivery suite as well.
“When I fell pregnant with my daughter, I revealed to my midwife my childhood dream and she encouraged me to go for it. So, I applied to the University of East Anglia, aged 31, and managed to get on the course!
“There was quite a mixture of ages there. Some younger and I wasn’t the oldest. It was a three-year course, which was quite difficult because by then I had two young children. It was like working full-time plus studying in the evenings as well.
“Luckily, I have a supportive family around me to help out with the children; I don’t think I would have been able to do it otherwise.”
Becoming a Fertility Midwife
Once Gemma had qualified she worked for six years at the Norfolk and Norwich in maternity services before a chance request from a friend for a lift to an appointment took her in a new direction.
“My best friend was coming to Bourn Hall Norwich for fertility treatment and asked me for a lift,” says Gemma. “So I came with her and was lucky enough to go into the scan with her; seeing what they did here at Bourn Hall was just amazing.
“I got talking to one of the staff there and I said it would be wonderful to work at Bourn Hall. She advised me to keep an eye on the website for any vacancies, so I did, and this role came up.”
Gemma joined the team at Bourn Hall Norwich in January 2018 and hasn’t looked back since.
“It’s fantastic seeing the other side of it, helping people at the beginning of their journey to parenthood,” says Gemma.
“I perform ultrasound scans, which I really love, it’s so rewarding, she says. “Prior to egg collection we do follicular monitoring scans to see how well the ovaries are responding to the stimulation medication and when its the optimum time for the patient’s egg collection. Then after embryo transfer if there has been a successful pregnancy test, the couple have their early pregnancy scan with us.”
Gemma says that the Norwich staff all work together seamlessly as a team. “We share the jobs amongst the team,” says Gemma. “We talk through patients’ treatments and their drugs. We all do some admin work, and I perform fertility monitoring scans, early pregnancy scans, help out in theatre, and in recovery. It’s quite a varied role. Where possible we try to support the same patients throughout, so they have a familiar face and we really get to know them.”
IUI less invasive than IVF with good success rates for many
Bourn Hall always tries to help patients to get pregnant at the earliest opportunity, with the least invasive treatment. In Norfolk GPs can refer patients directly to fertility specialists at Bourn Hall, so Gemma sees patients that have been trying to get pregnant for a year or more without success.
Where women have irregular periods, this may be an indication that ovulation (release of a mature egg) is not happening each month. For many women this can be treated with Ovulation Induction or Intrauterine induction (IUI) where medication such as Clomid is used to stimulate egg release and careful monitoring of the ovaries is used to advise the best time for natural conception.
Gemma gets involved in this type of scanning to help determine the timing of IUI.
“IUI is less invasive than IVF treatment and can be sufficient for those with irregular cycles,” says Gemma. “So, it is offered first if the doctors think it’s suitable and our results are good.”
New appreciation for the IVF journey
Gemma admits that when she was working as a maternity unit midwife that she didn’t fully appreciate the journey that IVF patients had been on. “I never realised, when I was working at the hospital how much they had been through to get to this point,” says Gemma. “Their notes would just say ‘conceived through IVF’ and you wouldn’t know anything about how many times they’ve been through IVF or if they’ve had any early pregnancy loss before that. Unless you ask all those questions.
“I didn’t understand the whole process and there are some differences between IVF and naturally conceived pregnancies. When you conceive naturally, midwives take the due date from the first day of the last period. However, with egg collection you need to add two weeks as that would be when you would have conceived naturally. When we do the first scan at Bourn Hall, we tell patients accurately when the baby is due, but that information doesn’t always go to the community midwife; it’s down to the patient to explain and it can cause confusion.”
Supporting patients at every step
Sadly there are times when patients lose a pregnancy – and there is specialist help available. “It is difficult when it’s not been a good outcome and the pregnancy isn’t progressing,” says Gemma. “We have counsellors that patients can access if they feel the need. Obviously, we are here if they want to talk and we are able to direct them to the counsellors if that’s appropriate .”
Secondary infertility – when a couple have been unable to conceive after both or one have previously had a child or children naturally – can be quite common in women over 35 Gemma observes. “I sometimes think that’s harder, if you’ve conceived quickly the first time and then you’re struggling the second time – it’s hard to get your head round,” says Gemma. “I do think it can be hard if you already have one child and people are always asking ‘when are you having the next one’. And if you do say you’re struggling they say, ‘you should be grateful for the one you’ve got’. So, it’s a Catch-22.”
Despite the setbacks which some people may experience Gemma offers the following advice: “Just don’t give up. Keep exploring your options, keep an open mind and a positive attitude – its important to know you did everything you could to achieve your dream of parenthood.”
Throughout her midwifery career it is the direct contact with patients which Gemma relishes. “I love being with the patients. I think during my time here it’s still midwifery based, providing one-to-one care for the patients. I remember the first woman who I followed through – she ended up with twins and brought them back to show us, which is always lovely.
“I’m so pleased I have been trained to do the early pregnancy scans, It’s just amazing. I still can’t believe seeing the embryo that will, hopefully, become a baby.”