Wednesday, 27 October 2010

Attitude and Stereotypes

Today we had a lecture about attitude and stereotypes and it really made me think about myself and the kind of person I am. I tend to think I don't conform to the norm and like to be a bit different. However as a female who is more than "cuddly" I certainly think I conform to the traditional image of a midwife. When my eldest daughter was born, I did tend to dress her in pink clothing; though it has to be said, I partially did that so that people would know she was a girl and this continued as she hadn't much hair until she was 2 years old.

In personality I think I am fairly atypical of female traits. I am sensitive, cry easily and wear my heart on my sleeve. I have a tendency to react first and think later - this can be both a benefit and a fault of course. In general I think I have a "good attitude". I mostly look on the positive side of life and am an optimist. However at other times I have a definite tendency towards a negative, pessimistic attitude. My self-confidence is not great and people don't always know this about me as I put on a face to hide it so I would say that is the more negative side of my personality. However when it comes to situations and life in general I am fairly optimistic. I also tend to try and turn situations around and find the positives in them where I can. I also like to think that I always try to see the best in everyone. This is probably because I don't believe that anyone is all bad and that circumstance, upbringing, finances etc. all contribute to who we are; not to forget that everyone is entitled to a bad day.

When I consider my home life I think I am a little less stereotypical. I have a house husband for example - that's definitely not stereotypical. My husband is responsible for the majority of the childcare, the cooking, the washing, and  the housework. My husband is not the type of man to be concerned with how people view him though.  I had however been a stay at home Mum for 4 years before I started the course. I don't think that is unusual, although it's not unusual for women to return to work either. Perhaps slightly more unusual is the fact that I used cloth nappies and a sling which which to carry them. Whilst these are growing in popularity, they are still the more unusual option.

When I was at school Take That were around for the first time and many of my friends were really into them. Me - nope I didn't like them at all! I was into Guns n' Roses and Pink Floyd. I liked to wear Doctor Martens and a leather jacket. So although I wasn't the stereotypical teenager in some ways, I was still conforming to an image of what a Guns n' Roses fan should look like. Not quite so much of an individual after all. These days I listen to what I like and if it's in the charts then great because they'll be playing it on the radio.

So what benefit is this to me in my training as a midwife? I don't fit into a "box". I am not stereotypical because no-one really is. Everyone is unique and an individual and as such the care provided to them needs to be tailored individually as well. As a midwife being able to see the good in everyone should only advantage me I think? Understanding that attitude can be affected by others is essential as well. If I am positive with a woman, in both my language and demeanour, then that can transfer to her and help her to be more positive too. It's important not to be judgemental as a midwife but we all make snap judgements on a daily basis. We make assumptions about what people are like based on their clothes, their appearance, their job. This shouldn't impact on how I look after women. I am most definitely not a saint or an angel, as midwives are sometimes portrayed,  but I do try my best to treat people equally already.

Sunday, 24 October 2010

A week at Uni

I began the week feeling very nervous about my exam. I was glad to have no lectures on the Monday so I could spend the whole day studying. My husband dropped me off at the library straight after we dropped our eldest off at school and I got straight down to work. The first thing I decided to do was my drugs calculation test; as I wasn't concerned about it, I thought I'd get it out of the way. I was more nervous doing it, than  I expected to be so I made sure to take my time, read every question twice and double checked each answer. Thankfully I passed it first time so I could then forget about it.

Tuesday we had a full day of lectures and meetings which none of us really wanted, as we'd rather have been preparing for the exam. In fact there were quite a few empty chairs. We began the day with a cohort meeting although it was meant to be a skills lecture, we ended up switching the two around. The cohort meeting gave us an opportunity to raise any issues that had come up over placement, problems we'd come up against and also to celebrate our successes. It seems that the difficulties were things that had come up time and time before. There were quite a few girls that had had problems having their books signed off - that their mentors would repeatedly put it off, and then it would be too late. There also seemed to be a huge variation in the marks we'd been given. There is a mark guide and we'd been advised to explain that the mark scheme was based on us as first years and therefore we'd possibly need to push for higher marks if we felt we deserved it. Unfortunately some mentors would mark us as first years assuming the marking criteria would remain the same over the three years and wouldn't listen to any opinion given by the student. It certainly made me realise how lucky I had been with my mentor and how I'd been marked for my placement.

There was also some discussion about the attitude towards students from some of the midwives. It's very obvious those that are happy to work with students and those that aren't. Simply put it is an essential part of their job but like any job I guess, everyone has parts they don't want to do....doesn't make it easy for us as students however. We talked quite a lot about the different ways we had handled it and hopefully it will help us for our future placements.

We then had our skills lecture, personal tutor group meeting and finally a psycho-social lecture. It would have been far better to have had the psycho-social lecture at the beginning of the day as many people left by the end of the day, and I found it hard to concentrate by that point. Once we'd finished for the day I went straight to the library to squeeze in some final study for the exam. I must confess it wasn't very successful as I was very tired by then.

So Wednesday came and the nerves were fluttering. We were due to have a lecture for Values at 9 but I confess I skipped it in favour of some more last minute study. At 12 I made my way over to the room along with some of my colleagues. The exam was two hours long and afterwards there was the typical postmortem. I found it much harder than I'd expected in some parts and other parts were ok. I simply hope I have done enough to pass it!

The next couple of days were far nicer without the exam hanging over us, though we'll all be grateful in about 6 weeks when we get the results. We're already thinking ahead to our next assignment and also our next placement. And we're also beginning to think about our transition time when we can choose what we'd like to do for 3 weeks; well 100 hours. I've got a few ideas and it's a case of deciding which one to go for. Next year I think I would like to go and learn about fertility treatment and then potentially use that experience to follow through with my final dissertation.

Sunday, 17 October 2010

Placement One - Done!

Tomorrow the first assignment is due in - thankfully I've already done mine and submitted it. I've since fretted over whether or not I've missed anything, whether or not I've submitted it correctly and so on. However all I can do now is wait and see so I am trying to put it out of my mind and concentrate on the other assessments I have coming up. I have begun on my next assignment already as it's a bit more challenging. I am grateful that I have until January to complete it.

The other thing I can do tomorrow is my online Drugs calculation test. The practice test has been open for a couple of weeks and I've done fine with it so I must confess to not being too worried. It is compulsory to get 100%  because in the real world when it comes to drugs, there can't be any errors. We get three attempts at the test, we can log in over the next two weeks to make our attempt and we get the result immediately....I think this is my kind of test!

However on Wednesday I have my first exam. I've been studying hard but I feel like each time I leave the library I know less than when I went in. I just keep hoping that some of it sticks. This is fortunately the only exam we'll sit this year and it's on Biology - probably my weakest area. The paper is split into two parts - the first part is 25 multiple choice questions; and the second part is the Midwifery specific question with a diagram to label and 4 long answer questions worth 10 points each. In order to pass we have to get 40% but obviously I'd like to get a better mark than that. This week I have been studying the pelvis - when I am in the car, I'm reciting the names of the bones and picturing the diagram in my head trying to match up the names with the image. I've also been studying fetal circulation before and after birth and the changes that occur. I've been looking at all the hormones and their effects during pregnancy. Tomorrow I am glad that I have no lectures so I can spend the day in the library studying hard although I worry that I don't have time to read up on everything that I want to. It's definitely a learning experience for the future....start earlier - yet I thought I started fairly early already.

I really enjoyed placement but I must confess to looking forward to going back into Uni now. I am looking forward to catching up with my cohort and hearing about their placement. I am particularly looking forward to talking with those who worked in the same area as me and with some of the same people. I am almost certain now that I am the only one in my cohort that hasn't made a "catch" of my own. I am trying hard to concentrate on the fact that it doesn't matter at this stage and next placement I will certainly do it, and plenty of times I am sure. Also I have had no problems in the end with getting my book signed off and I am thrilled with the result and feedback I have been given. However I cannot deny being slightly envious that everyone else has had their first delivery.

So now I am looking forward to Thursday - the exam over, the drugs calculation test hopefully passed. Of course we'll be back into the thick of lectures and seminars but with the next deadline a while away, it feels a little less pressured. Wish me luck for Wednesday - I have no doubt I shall post to let you know how I felt it went.

Wednesday, 13 October 2010

The miracle of birth

Love is...., originally uploaded by stephalie1977.

When I was in my late teens and early twenties I was terrified of falling pregnant. It wasn't that I was scared of pregnancy but I certainly wasn't ready to be a Mum. The other thing that terrified me was the thought of having to tell my Mum that I was pregnant, knowing I wasn't ready nor old enough.

When I was 28, married and felt very ready to have a baby; it was still a nerve wracking experience telling my Mum that I was pregnant. She was of course thrilled to hear she was going to be a Grandma again (she already had three (and a half) grandchildren at that time). For me it was quite a scary experience....I almost felt like I was saying "Hey Mum, I've been having sex". The second time I fell pregnant was a far more enjoyable experience.

I've already told you about my friends sad experiences of loss but I've not mentioned the friends I have that struggle to fall pregnant in the first place. Couples with no fertility problems at all can find it hard to fall pregnant. Why? There are a variety of reasons.

One egg is released each month and sperm have only a limited life span. Also a woman's uterus is not very welcoming to fact it downright does all it can to make the sperm fail. Also when a man ejaculates, some of the sperm he releases are defective and the number of "good" sperm varies from man to man.

So the very first barrier is timing intercourse correctly for the release of the egg; then there is the hurdle for the sperm to reach the egg; then there has to be a good quality sperm able to infiltrate the egg and fertilize it and then just when you think you are on the home have to hope that the egg then implants and not only that but that it implants in the right place.

So you can see that pregnancy truly is a miracle even when everything is working correctly. As young girls you prevent against pregnancy but then one day we hope, dream, live for new life. It becomes an all consuming thought and you are hyper aware where you see babies and pregnant women everywhere. At the base of it all you hope that your body won't fail you. Of course not every woman feels such strong urges about becoming a mother but I certainly know plenty of women that do and it is how I felt.

Of course there are women who seem to fall pregnant at the drop of a hat, that only have to look at their partner and they are pregnant....if you've had fertility problems, you'll have heard these phrases before. And then there are the anecdotes "ooh I knew someone who'd been trying for a baby for 5 years, was just about to start IVF and she fell pregnant naturally". Or the useful advice "you just need to relax and stop thinking about it". Of course this follows the "so when are you going to start a family then?" from the second you get married. The thing is people mean well but it hurts. So if you ever find yourself in the situation that you might say something like this.....don't! Bite your tongue and don't.

I confess I don't know much about infertility treatment but it is an area I am interested in and I hope to spend some time at a fertility clinic during my transition period in University.

To all those friends that I have that do have fertility difficulties, I hope that someday soon your dreams come true and the miracle of pregnancy blesses you.

Sunday, 10 October 2010

Towards the end of placement now

I shall soon be going back into Uni, sitting my first exam, submitting my first assignment and doing a drugs calculation test. It already feels like I've come a long way since May and whilst I still have a long way to go, I am pleased with what I have already learnt. I've really enjoyed being able to apply some of the things we learnt in University to placement and I can definitely say some things were a lot easier to understand when we applied them to real women.

So what have I learnt so far? I've learnt about the importance of using the correct professional terminology in the notes....apparently writing "sore boobs" is not professional and yes I did do that. When pointed out to me, I was actually quite embarrassed but hey I'm here to learn after all. The other errors I made were a lot less embarrassing - thrombocytopaenia instead of low platelets is not obvious after all.

I have learnt that feeling for the top of the uterus is harder than it seems and that muscle can confuse me. Also it's important not to assume that just because the measurement doesn't appear to fit with gestation length, doesn't mean I have measured wrong. You can also move the uterus to fit what you want it to and it's obviously important not to do this. Holding the measuring tape quite tight can also affect the measurement and it seemed that I did that frequently. Women's pubic bones are at different heights and it's important to make sure you do measure from it and some women's are harder to feel than others. It's also quite surprising how many women go commando.

I feel I have also learnt how to manage my time better when talking to women. My first booking appointments I'd  let women and their partners talk away but my more recent booking appointments I have been more confident to take control and move the appointment along when needed. It's important to recognised when women need to talk but it's also important to recognise when it's not necessary so to speak. Goodness knows I have the gift of the gab and can talk all day long....just ask anyone who knows me; but a community midwife has to manage her time effectively in order to fit all the appointments in.

That some days I feel quite confident and that I know what I am doing and other days I feel like my brain fell out overnight and I haven't got a clue. So on the Thursday, I "ran" the clinic. I was confidently palpating, writing notes, checking urine and blood pressures and then on Monday at clinic, I felt like I fumbled my way through, guessing rather than knowing and being very grateful that my mentor was there to confirm or correct my findings. I was assured it is quite normal to have days like this though.

I have found that many women are interested in me as a student and are very happy to be a part of their care. Before I started I wondered whether I would have anyone who would object to me being there but so far that hasn't been the case. The feedback I have been given from women and their partners has been very positive and  I have been wished luck for my future from many of them. As part of my Placement Assessment Document I have to get feedback from two women and I found it quite hard to ask but both were really happy to do it for me, and gave me lovely feedback.

I have learnt the value of continuity and how much of a difference it can make to my learning and my confidence. I always knew that I'd work with a lot people when I came out on placement, I planned to make myself as useful and as amenable as possible but I completely underestimated how much it would affect me. I never thought I would get upset so early on in my training. In some ways, I think it's been an important learning curve for me and I hope that with my future placements I will know how to manage whilst working with a variety of mentors. On the other hand, I do believe that it's a common issue for student midwives and can make it harder to learn how to do things. It's certainly feedback I will take back to university but I am sure it's something they have heard time and time before.

I have also learnt how much pressure I put on myself and that my own high standards can serve to upset me if I don't reach them. When I think how embarrassed I was about writing "sore boobs" instead of breast tenderness, I also need to remember how much I have learnt. After all if my mentor is happy to come and go from the room whilst I do bookings, then she must be happy with how I am doing and confident in my abilities and therefore I shouldn't beat myself  up quite so much when I make a mistake. Certainly none of the mistakes I've made have been life threatening after all.

And alongside all of this I have improved upon my clinical skills. I am now confident at taking women's blood pressures. I am no longer at a complete loss when I palpate a woman and am currently working out the baby's position correctly. I have even begun to feel for level of engagement and starting to feel that I can tell the difference. I am able to read the urine dipsticks confidently now, whereas initially I was sometimes unsure whether there was a green tinge on some of the squares or not. I am much more confident on how to locate the heartbeat and tell the difference to maternal heartbeat, and whether or not it is through the cord I can hear it.

So I have just one more week in placement and as I will be working with a different community midwife this week, my mentor completed my summative assessments and as a result gave me my final grade for the placement. I am thrilled to have passed my first placement and to now be able to enjoy my final week, seeing how another midwife works, without the pressure of getting my book signed.

Tuesday, 5 October 2010

Running the clinic

On Thursday of last week we had a bit of time before the clinic began so my mentor and I sat and went through my book that I have to get signed off during my time on placement. We sat and talked about what we'd already covered and what I already knew and looked at what I didn't know. It really made me think about what we do and why and made me feel good about the things I had learnt along the way.

So my mentor then told me she was going to let me "run" the clinic. Of course she wasn't going anywhere but whereas previously she'd do the writing and most of the talking, whilst I did the urinalysis, blood pressure and we both did the palpation, this time I was going to do the lot and she'd check my palpations intermittently...particularly those that were worried about the size of their baby or had babies in awkward positions previously.

We saw around 20 women and had barely a break in between. I find I work better when it is like this - it seems to solidify my learning so much more. I think I got almost every palpation correct and I felt like I was getting to grips with measuring the height of the bump too. It really made a difference as to how I came across to the women as well I think as I am sure they can pick up when I am more uncertain about things.
For more information about what happens at antenatal clinic, you might find it useful to look at my previous post Antenatal Clinic.

Another part of being a Community Midwife is the postnatal visits to new Mums in their homes. There are three guaranteed visits that all women get. The first visit is the day after the woman and baby get home from the hospital. Around day five we visit to perform the heel prick test on the newborn and if the baby is breastfed we also weigh the baby. The final visit is usually on day ten where we discharge the woman to the Health Visitors care. Women are covered by maternity care until day twenty eight but most women won't require this. It may also be that women get more than the three visits during those first ten days but it does depend on what their needs are. For example, a lady who has just had a third baby and is comfortable with all she is doing, recovering well may well not need anymore visits. Whereas a first time Mum who is getting to grips with breastfeeding and recovering from a section would benefit from more visits. And it's not as simple as saying well she's a third time Mum she won't need us, because she might, so it's looked at from an individual basis.

We ask the woman about her bleeding and how she is feeling in general. The reason for this is because sometimes after giving birth there can be retained products - parts of placenta or membranes. The uterus may expel them naturally but the last thing we want is for the woman to get an infection. If the Mum has increased bleeding combined with a temperature then we'd be palpating the uterus to check it's contracting down as expected. If the uterus is "spongy" then it's an indication that something could be going on and we'd send the Mum and baby back into the hospital to be checked over. Sometimes women have heavier bleeding if they've been more active, or just after they have been breastfeeding or also when she gets up after a long period of lying still so heavier bleeding on it's own is not an indication of anything to worry about. Similarly it's quite normal to have a temperature when the milk comes in so it's vital to look at the whole picture.

We also ask the women about their toilet habits....yes Midwives are obsessed with wee and poo! The reason for asking is quite simple. The bladder, uterus and bowel are all very close together and the bladder can be damaged and lead to urine retention. It is common for many women not to have a bowel movement until day 4 or 5 but we ask about it because women can be very nervous about it, particularly if they have stitches. So it provides the opportunity to reassure them. Also we want to avoid women becoming constipated and so we can talk about ways to avoid this.

We also ask whether or not their breasts are comfortable whether or not they are breastfeeding. This is because almost every woman will have milk come in regardless of whether they choose to breastfeed or not. This gives breastfeeding mothers to talk about any concerns they may have about position and latch, frequency of feeding and so on. We can also talk to bottle feeding mothers about how to cope with the pain and the engorgement as quickly as possible. We also like to ensure that women are eating, drinking and sleeping  - well sleeping as well as they can considering they have a newborn. The body needs food, water and rest in order to produce milk but also the women need the opportunity to recover from the birth.

We ask about how the women are feeling emotionally. We can reassure women that it's normal for emotions to be all over the place after giving birth but we also want to be aware of any women who might be at risk of postnatal depression. Postnatal women are at risk of deep vein thrombosis so we ask if they have any pains in their legs and this is particularly important with women who have had a Cesarean section. We also make sure that women are aware of their postnatal exercises.

Of course we also check the baby over. We look at their temperature, frequency of feeding, whether or not the cord has come off yet, how their nappies are and how frequently they are needing changing, and we also look at their skin. Newborn babies often have very dry skin which is normal but we can advise women on what to do to prevent it becoming sore, cracked and potentially infected. We recommend olive oil as it's a natural substance and won't harm a baby's delicate skin. The other thing we have to look out for is any bruising or fingertip marks. I am thankful that this is not something I have seen.