Sunday, 30 January 2011

Passion and fear

This week I have witnessed two ventouse deliveries - this is where a suction cap is attached to the baby's head and as the woman pushes, the doctor pulls which helps the baby to be delivered. There are various reasons why a ventouse delivery might be deemed necessary - maternal exhaustion, prolonged 2nd stage (the pushing stage), fetal distress, amongst others.

Of the two ventouse births I witnessed, one was due to slow progress in the 2nd stage and the other was due to fetal distress. I can't really share too much information about the deliveries themselves due to confidentiality but in the event of the fetal distress, my heart was in my mouth and I felt very emotional when the baby was safely delivered. I'd helped to care for the couple all shift and learnt quite a lot about their journey so far, and therefore I found it mattered a lot to me, my part in their story. I was really pleased to be able to see them again the next day. 

I now have 5 deliveries to my name, three of which you already know about in my last post Not one but three. I've been lucky to work with a brilliant team and I feel like I have learnt loads in just the last week. Four out of my five deliveries were in the semi-recumbent position but the fifth (actually fourth but this could get confusing) was on all was brilliant to get my head round exactly where I was putting my hands, and to have a different perspective - however I have got to's far messier. My final delivery of the week was lovely and controlled and as a first baby, my mentor had loads of time to point things out to me as the baby progressed. 

This week I am onto day shift and I think I will experience very different shifts to the night ones - there will be far more postnatal checks that need to be done than there are in the night time but there are also generally more staff. It will be really interesting to see the difference though of course I am hoping for a couple more deliveries and moving towards becoming more autonomous. I shall be investing in a book where I can keep a record of all my own deliveries as I am sure I will want to look back on them all one day. 

One thing that has struck me this week is the value of good support. I have been told how lucky I am to be able to witness birth and I agree I am lucky. However I am also lucky to witness the amazing roller coaster of emotions during labour and the special bond between the woman and her birth partner.  I have seen the love, the fear, the hope and the excitement all in the eyes of the birth partner as well as the woman. With the couple whose baby was in fetal distress, I witnessed the pure joy on the face of the mother, that the time had arrived to meet her baby, which was contradicted by the absolute fear in her partner's face as he could see the slowing heart beat and the number of people suddenly in the room. Not for one moment did he let his wife know just how worried we all were, but he continued to support her, to encourage her and be by her side the whole time. And then once the baby was born, I continued to watch that amazing bond between them, the continued joy and amazement on her face, and the relief and joy on his. You tell me I am lucky - I wholeheartedly agree and  no matter how lucky you think I am, I know I am 20 times more lucky than that. 

Monday, 24 January 2011

Not one but three!

I made my way to the hospital last night feeling quite excited about the prospect of getting my first catch. I met with mentor and she asked where I was at with my training and I was quick to tell her that I'd made all my witnesses and was itching to get my first delivery. Funnily enough she also wanted to know about what else I'd done. 

We began the shift with a very quiet ward. We made sure the rooms were equipped, checked equipment, tidied up....found things to do. We soon had a couple come in from triage, whom we settled into a room and did the necessary checks that needed to be done, before encouraging the woman to mobilise. She was very comfortable so other than the regular checks on baby's heartbeat and how Mum was coping, we left them to it. When she was next checked, she'd not really progressed so my mentor broke her waters and her contractions soon became more intense so I began to spend longer with her to help her cope.  The next couple of  hours passed fairly quickly and my lady was having some early urges to push, so I spent a long time helping her to breathe through the pains instead. After a short while, it was apparent that she was really struggling not to push, so we encouraged her to use some pain relief, so she opted to use the entonox

At 5.00 my mentor returned from her break early, and told me to go to another room quickly. So I dashed off guessing that it meant a delivery was imminent. Sure enough, I entered the room and could already see the head beginning to appear. I quickly gloved up and put an apron on. Supported by the midwife, I caught my first ever delivery of a baby boy at 5.05.  I checked over the placenta with the midwife, cleaned myself up and then returned to my lady who following a dose a pethidine, was dozing between contractions. After a short while, she was still pushing with the contractions, so I popped out to see if my mentor had returned, as I knew she was due another examination shortly. At which point I was hurried into another delivery room, to quickly glove up and catch my second delivery. The lady was very controlled and very quickly delivered a baby girl at 5.25. Again I checked over the placenta with the midwife, and got cleaned up before returning to my lady. 

On my return to her, I felt that she was now really struggling to breathe through the pains and she just sounded like birth might be imminent. So I popped out to check on the whereabouts of my mentor, who'd got caught on the phone and reported what I'd observed. She returned to the room with me, ready to perform a vaginal examination to check how she was doing. At which point, we discovered there was no need to perform an examination, as we could see the head beginning to appear. Unlike the other two deliveries, this was a first baby so we could expect the second stage to take a bit longer. The lady was very well controlled and pushed really well, so that in actual fact, the baby was delivered within 10 minutes of us being able to see the head. So at 6.15 I had my third delivery, this time another baby boy. As with before, we checked over the placenta but this time I didn't need to rush off anywhere else. 

Of the three, the one that obviously meant the most, was the couple I'd been supporting throughout my shift. I got a much better experience of the progress, signs to watch out for and how to encourage and support women. When I finally sat down, I had a complete head rush and needed 5 minutes just to gather my thoughts a bit. It was a complete adrenaline rush and with three more nights to go...I am feeling slightly tired at the thought if they are to be like last night. However I loved it! I am hoping tonight that I get to have the journey of support through labour, as well as the delivery again. And perhaps slightly less running from room to room....and maybe even a break at some point. 

Thursday, 20 January 2011

I am brave

Today I had a conversation with a fellow blogger StupidGirl about how brave it is to follow your dreams, prompted by her latest blog post. Many people I know think I am brave to enter the world of Midwifery but I don't think I am brave as I am just following my dreams of what I have always wanted to do.

However it took quite a lot of courage to tell people that I wanted to be a midwife. I worried a lot about what others would think and expected a negative reaction. As a result when I was younger and still at school, I didn't actually tell anyone it was what I wanted to do and I certainly didn't have the courage to actually apply. Then as an adult, it still took a bit of courage and a long time thinking about it before I would even voice the thought aloud. I can remember not long after my second daughter was born, talking to my Mum and voicing the thought aloud for the first time. I was worried that people would think it was post-birth euphoria speaking rather than anything else so if I dared to mention it I'd automatically declare I was waiting at least a year before acting on my hopes.

Every time I spoke to someone else about hoping to be a midwife, I'd wait for that negative reaction and it never did come. I got lots of positive responses in fact, and still do. Many friends and family have said to me that I will make a fantastic midwife. It would take more courage for me to say "I am going to be a fantastic midwife" than for me to take blood, or help to deliver a baby.

What was a brave step, was actually thinking to myself 'it's my life and I'm going to make the most of it, I'm going to follow my dreams'. And that is a brave step for anyone, whatever they are looking to do. For most of us, following our dreams, means some kind of sacrifice somewhere else in our lives. For me I am sacrificing my time with my daughters. I once said, I wouldn't work where I had to struggle to organise childcare in the school holidays or if my children were ill. So instead I have chosen a profession with possibly the most antisocial hours you can get. Why? What changed? Is it that my children are no longer my priority? Well it helps that they are no longer babies and require less of me now; but I have the belief that if I have to go to work and leave my girls, then I don't want to be resentful that I am having to work somewhere I hate, rather than be with them. I want to be working somewhere I enjoy the work, that gives me purpose. For me, that is Midwifery. I will be giving my daughters less time yes, but a much more fulfilled Mum. I believe in this way I will actually give them more, than I would by staying at home with them.

This is absolutely not a dig at any stay at home Mum's before anyone thinks it is. I was a stay at home Mum for 4 years and it's hard work. If my husband hadn't lost his job, I wouldn't have applied to Midwifery until both the girls were at school. My eldest is at school now and it won't be long until the youngest starts Nursery but it's meant a lot to me that my husband has been the stay at home parent for them. He has been a constant for them, in a time when a lot has changed in their lives. I know I would have wobbled far more about applying without his presence at home. (and that's not a judgement on working mother's either)

If you've dreamt about working in a particular area, then just think about it a little more. We only get one life and our working lives are long - far too long to spend doing something you hate. Just take a look at what you'd need to do to follow your dreams? Do you need to do a course? Can you study in the evenings? Just see if it's possible...even if you do nothing about it for now. Be brave and take a step....dip your toe....dare to dream...

Tuesday, 18 January 2011

No more assignments!

For this academic year anyway. On Monday I submitted my final assignment for this year, providing I don't fail one anyway and have to re-do it. We only had three assignments to write this year and each one was harder than the last. I'd thought on reading the brief that the Values assignment would be quite enjoyable. However it was easily the assignment that challenged me the most. I work well with facts and being able to reference from research; but talking about my feelings about something was far harder. For those that know me well, this may come as a bit of a surprise. I wear my heart on my sleeve and don't generally have any problems talking about my feelings. However it's quite different when you have to reference your feelings somehow....once I was talking about theory I was far more comfortable. Anyway I am pleased it is finally submitted and shall now be obsessively checking for my results.

I've now got a few days off before returning to the MLU. My fingers are twitching to catch my first delivery. I've been watching One Born Every Minute and thoroughly enjoying it but it only serves to remind me what I want to be doing. I loved this weeks episode - no Caesarean's, just normal birth and not just that but a water birth! I felt quite emotional watching that one....and also quite lucky. In fact I feel lucky most days - midwifery is so competitive to get into, and getting to see new life enter the world - well that's special. I know it's not every one's cup of tea but I find it so amazing and special, and a privilege to be a witness to. It's not just the births though - it's the whole experience of caring for women at such an amazing time in their lives.

My most recent part of placement was spent on a postnatal ward. Unlike the MLU, on this ward can be all the high risk women, post-section women, post post-partum haemorrhage women, women with high blood pressures, diabetics, and the list goes on. Also on this ward are antenatal women, who are in for monitoring, are in early labour or have come in for induction of labour. It's a fast paced ward and a very high need ward. Some shifts I'd feel I was chasing my tail the whole time but I learnt so much.

One day I spent a long time helping a new Mum with breastfeeding amongst other things. She was quite an anxious new Mum so she had a lot of questions. She'd waited a long time for her baby and she was determined to get it right. As we weren't too busy that shift, I was able to spend quite a long time with her, providing one-to-one support and giving her confidence in herself. When she left to go home, she gave me a big hug and said thank you for my help. There aren't many jobs where you'd get that response from a client! I love my job!

Monday, 10 January 2011

Formula free hospitals

I've just completed my time on the postnatal ward and now have a study week before I return to the Midwife Led Unit for four weeks. So far on placement, if the mother has been formula feeding her baby, she merely requested a bottle and a teat and it was provided for her - as of today this is no longer happening and I can't deny that I'm pleased not to be there this week as the changeover happens. What will happen now is that mothers who plan to formula feed, will need to bring with them a tin of stage one formula and two bottles. A milk kitchen is provided where new mums will be shown how to sterilise and prepare the bottles safely, according to guidelines. 

One of the most common issues I have seen with supporting new mums to breastfeed is time. Midwives are already stretched by busy wards and a less than optimum number of staff; that I can only be concerned by how much more time the milk kitchen will require from them. Prior to beginning my training I would have been 100% percent behind the plan to remove formula from hospitals but whilst I am still in support of this happening, I have a more realistic view of the challenge it will pose to the staff. 

I am in support because I think it provides a more accurate view of how bottles are prepared and the time that it takes. I also hope that a midwife may be less inclined to encourage "trying" a bottle when it's not as easy to just grab one from the cupboard. Of course, this all falls in line with all midwives being trained in breastfeeding support and how best to support women, which I certainly know is happening in both my placement hospital and my local hospital. I hope with the growth of accurate information being provided, more women will feel supported rather than pushed. 

I am however concerned about the women who are post caesarean section, unable yet to get out of bed, possibly even finding it difficult to sit up for themselves. These are the women that already need a lot of support - how does the milk kitchen work for them? I can only assume that there will always be some formula milk in the hospital for the women who go into labour prematurely, or come in without their bags. Will there be milk provided for the women who need a high level of support? Or the women who plan to breastfeed but perhaps change their mind, maybe it just doesn't work out for one reason or another? What will happen then? I guess there are a lot of unanswered questions at the moment. 

Is this a cost-saving exercise for the NHS or a move towards a society where breastfeeding is the norm? Can it be both? I am certain that there will be teething problems but I am optimistic that it will work out. I am ever hopeful that the breastfeeding support will increase, the breastfeeding knowledge will increase and women will feel more confident in their abilities. 

Saturday, 1 January 2011

Happy New Year!

A new year is often synonymous with new beginnings and hope, happiness and celebration. I am looking forward to catching my first baby this year, hopefully soon and then becoming a second year student midwife in May. I have hopes of weight loss and being healthier. I have many celebrations to look forward to - two ruby weddings, two 65th birthdays, an 18th and a 21st birthday, two 40th birthdays and a wedding to go to.

However for many the new year can be tinged with sadness - for me it's the beginning of another year without my brother. Today I visited my brothers tree:

I love the cemetery where my brother's tree is. There are always people visiting, there are always fresh flowers and it's a lovely place to spend a contemplative moment. Whilst there I often wander to look at gravestones, or memorials, particular when there is a new one crop up. Today I wandered to spend a moment in the baby and children area - such sorrow and such pain and yet such beauty. The babies gone but not forgotten, still bought gifts though they are not here to enjoy them. The sadness of losing a child seems somehow greater than losing an adult and I'm not about to debate how true that is. Truth is loss of any kind is painful and times of celebration can highlight their absence.

Today I shall light a candle for my brother, but I shall also think of others who have lost loved ones and remember them too. Whilst we think of them, and talk about them, they are never forgotten. Don't ever be afraid to talk to someone about their lost loved helps to know someone else remembers and cares.

Happy new year to you all. I hope 2011 brings you all happiness and laughter, good health and maybe just a smidge of wealth too.