Working in the community

Before Christmas I was working in Community which I do love. I particularly like it when I see women before and after the birth of their baby, or to see women on their first day home and then to see them when they are being discharged. In both situations, I have witnessed many changes in the women. I have witnessed the nervous woman become a confident mother, and I have witnessed the confident professional become very unsure and lost when faced with a tiny helpless baby. Babies are certainly unpredictable and it doesn't matter how many books you read before they are born, you simply can't be fully prepared.

One of the most common questions to be asked as a Midwife is "is this normal?" - this might be during pregnancy or after the birth but it gets asked a lot. 99% of the time (a guess, I haven't sat and worked out a statistic)  I would say yes, that it is perfectly normal. Babies are born with their own personalities and all we can do is respond to their needs to the best of our abilities. In the early days this often means trying to guess at what they need...mentally going through the checklist - hungry? nappy needs changing? too hot or too cold? tired? It's all guess work really until you can begin to learn your baby's cues.

Frequently new mothers ask about how to get their baby to sleep in the moses basket/crib/cot...anywhere rather than lying on Mum. Don't worry I did the same myself, in fact I think I spent the first 2 years of my eldest's life wondering and worrying about how to get her to sleep anywhere but near or on me - she had to be in contact in some way, whether lying on me or just having a hand on me. Generally I advise new mothers to cuddle their babies...shocking I know...but the baby has spent 9 months inside Mum, able to hear her heart beating as a constant sound, and never before having experienced hunger, temperature, gravity and yet we expect babies to suddenly sleep by themselves. Birth is a shock to them and they need reassurance and comfort. I also advise trying putting something that smells of Mum in the crib, warming the crib with a hot water bottle (ensuring to remove it before baby goes in) so it's not suddenly cold on their back, giving baby to Dad to settle for sleep, a slumber bear if they can afford one but what works for one baby won't work for another, and sometimes what works one night won't work the next, and sometimes it feels that nothing works at all. It can simply be a case of give it time...it certainly was the case with my eldest daughter. My younger daughter was far easier - she'd sleep anywhere! I certainly don't believe it was anything I did that made her more likely to sleep, just that she was born with that kind of personality. So give it time, cuddle your baby, try these things by all means but I promise that at some point, your baby will be able to go to sleep by themselves. I have been on the receiving end of such advice and at the time it felt like useless advice, the tiredness was relentless, and that even one more night was one night too many but I hope it brings comfort to know that yes this is normal for many babies.


I seem to have wandered into the realms of sleepless nights and generic advice but it is something that new mums ask about so often that I feel it's worth discussion. Certainly I feel that the lack of sleep I endured when my children were younger has prepared me well for night shifts as a midwife. As a breastfeeding mother helper, helping to run the group, the women that came along would frequently ask for help with sleep and their babies. We live in a society where "sleeping through the night" appears to be main focus, the ultimate goal, particularly in the early days and then with some desperation as time goes by. However if were simply to accept that babies wake in the night for an indefinite period of time, is it not easier to cope with? That actually the norm is not for babies to sleep through the night, but for them to wake regularly to feed and that at times they will sleep for longer and other times they will wake more frequently, such as during growth spurts which again are normal. I know that I found it far easier to deal with my second child's nightly wakings because I was prepared for it. I was still exhausted at times, and I still complained about it but I didn't waste energy trying to fight it or find an answer to it. I tried things to see if it helped but I didn't worry if it didn't, I just recognised that she wasn't ready yet. However I did have the advantage of not working at that time, I wasn't yet a student either. My eldest spent mornings at nursery so I used that time to catch up a bit and rest.  I think we have a tendancy in this country to try and push ourselves back to normal as soon as possible and actually we'd do well to stop and learn about our babies, spend time with them, allow time to recover from the birth properly...focus on what's important...not on having a show home, or getting out and about as quickly as possible, make use of friends and family to help out if you can. This is of course all very idealistic and I do realise that but I can dream, at least when I'm allowed to sleep that is. At the very least I think this is useful advice for those very early days....stop, rest, recover and cuddle your baby.

Photos courtesy of Marie Donn Photography

Another placement finished

Two more assignments submitted and suddenly I'm halfway through the course. Everyone told me that the time would fly past and they were right, it really has flown. I'm looking back at all I've done and learnt and feeling quite proud of myself and yet I can still look at all there is to learn and feel overwhelmed by it all. Over the past 18 months I have seen a variety of women with very different needs,and a variety of different midwives with different ways of working. I've seen normal births and I've seen births that needed high levels of expertise in order for mother and baby to survive - all of which I have learnt from. Sometimes it can feel like what we do at Uni, is a distant cry from what we do on placement. After all our first 18 months of training has been focused on normality but of course what we see on placement can be very different. One thing I have learnt is that remaining focused on what is normal, helps to identify when something isn't within the realms of normality.

A simple example of this is when we first palpate the uterus to see what position the baby is in, in a woman who is 40 weeks pregnant. Focusing on normality, we would expect the baby to be in a head down position so if the baby is not in that position, we can identify this and then act appropriately. At the beginning of my training I didn't really have a clue what position the baby was in but with practice I soon began to be able to tell. I even managed to identify a baby in the breech position. As I've continued in my training, I've become more and more confident and even at an earlier stage of pregnancy, can often identify the position. That said, I am not afraid to say when I'm not sure and to ask the midwife I am working with to have a feel and see what she thinks. It's essential to be comfortable enough to say "I don't know". There is no shame in not knowing something, there is shame in pretending that you do.

It's not unknown for a doctor to request a second opinion and I've witnessed qualified midwives ask for another midwife's opinion. Yet I know it can be difficult to say 'I don't know'. I'd say it's probably more difficult at the beginning of your training because you don't know yet whether or not you should know the answer and whether you'll look foolish if you don't know. I still maintain that you look far more foolish if you pretend to know the answer....you will get caught out. These days when I come across a term I don't know - usually when booking someone, they mention a medical condition I've never heard of - I'll ask the midwife I'm working with, or I'll look it up. We can't know everything after all.

So if you are about to start your first placement then there is your first bit of advice - don't be afraid to say you don't know something. BUT don't wait for someone else to find out for you - look it up - google is your friend!

Fear

Becoming a parent can, for some, be the most frightening experience in the world. You can ask about others experiences, you can read all the books, you can look on the internet but nothing can really tell you what it's going to be like. It is quite normal for first time mums to focus on the labour that is ahead of them and read all you can on the subject or alternatively, completely stick their heads in the sand and not think about it at all. I was someone who had to read everything I could. For me, as a future midwife, as someone who has been through labour twice, as a mum who wonders what parenthood will bring that day, I wonder if I can help alleviate some fear? I certainly hope that I can, for women that I work with and with friends who are to become parents in the future.

Labour is certainly something that holds a lot of fear and it's understandable that it does because anything that involves pain, is something to worry about. Instinctively, as humans, if there is pain then there is something wrong. However labour is unique in that, it is the only time that pain is actually a good thing. If you are someone that has had a tough pregnancy, or you go overdue, or you've just had enough of waiting, you may even find yourself wishing for the pains to start. The one time in your life, you will wish for pain?

Television doesn't help of course...it gives the impression that when you go into labour your waters will break and you are instantly in agony. I'd hope that most people realise that labour generally takes longer than how it is usually portrayed on the tele. For most women, labour begins with mild, irregular pains. Many women liken them to period pains. You can breathe through them, you can walk through them, you can easily talk through them...not like they'd have you believe in Albert Square. They can be 10-15 minutes apart, they can stop for a few hours and then start up again. This is the main reason women are recommended to wait before rushing up to the hospital. Yes they hurt, some are stronger than others but as it's not a constant pain it's something women can cope easily with. The fear that can accompany those pains however, is what some women find difficult to handle. The not knowing how long it will last for, can be difficult to handle. And sometimes whilst the pain isn't that strong yet, it can still prevent women from sleeping or getting comfortable, and this can have an impact on how well women cope.

I believe that fear surrounding labour and birth should be handled at the antenatal stage, or perhaps pre-conception would ideal. I wholeheartedly believe, that in the delivery suite is not the place though. It's much more difficult to maintain normality when someone is terrified. It's not impossible and I have witnessed some amazing midwives who can calm the most frightened of women, and ground them, manage their fear, soothe them and make them feel safe. I hope to be this kind of midwife. I believe that the overwhelming fear that some women experience does sometimes lead them to choosing an epidural for pain relief. They don't know what to expect and how long it might take. Providing women with accurate information, and helping them to make an informed decision is vital. Being able to alleviate their fear is also vital. I have witnessed frightened women "choosing" an epidural and as someone pointed out to me, how can it be an informed choice when it is a fear based decision. Women should not reach this level of fear.

When I was pregnant with my second daughter, I attended an antenatal group, as previously mentioned in my Inspirational Midwives post last year, where I was given all the information I could possibly need to make an informed choice about where I wanted to give birth, my pain relief options and what to expect if things didn't go to plan. I always wished I'd attended the group when I was pregnant for the first time. What I find incredibly sad, is that group had to stop running due to a lack of funding. Those midwives inspired a number of women to have a home birth, who in turn inspired others to also have home births, and that cycle is still continuing, their inspiration still continues on. They gave women a voice, because they provided the information, they probably saved the NHS a lot of money because a women who knows what to expect, needs far less interventions, would decline unnecessary interventions. In an ideal world, the community midwife would be able to handle all fears about labour and birth during an antenatal appointment. Sadly there just isn't time - too many women and not enough midwives. Midwives constantly thinking about the next woman they have to see....it's not that they don't want to, it's more that it's just not possible.

Fear is the biggest barrier for a woman facing labour and birth. Time is one the biggest barriers facing the midwife. My biggest fear about becoming a midwife, is not having the time to be able to give women the care that they need, that they deserve and becoming frustrated with time constraints. I hope to remember the midwives who managed to give the time without neglecting others, somehow found a way to manage it. 

Nightmares

One more week on placement, one more assignment result to come in and almost one year's training completed. The last year certainly seems to have flown by all of a sudden, although it didn't feel that fast whilst it was happening.....definitely felt slow when I was writing assignments.

This past week I have been spending my time with a Health Visitor and some of the other staff that work in the Children's Centre. The staff are lovely and have tried hard to fill my week with a number of different activities so that I get to see plenty. However it has been an unusually quiet week and I haven't seen much at all. It's also quite unusual for me to have nothing to do, as it's an observational placement. I've found it really difficult to sit back and not do anything and well I'm not very good at keeping my mouth shut.

Over my time at various groups with my own children, and time spent on parenting forums, I had heard a variety of stories, both good and bad, about Health Visitors. Stories of poor advice, outdated advice, fantastic support, reassurance, pushiness, unrealistic advice amongst other things. I could probably write a book of stories I have heard about health visitors. Personally I have only had the misfortune of one poor experience with a Health Visitor, all the rest have been fantastic. So whilst this doesn't really relate to my Midwifery training, I thought I'd share my experience. I'd been to see her about my daughter's nightmares, desperate for any advice I could get and she told me it was a bad habit. My jaw literally dropped and I was almost speechless. My husband "encouraged" me out of the room fairly quickly as he could sense my temper was rising. My daughter is now 5 and still suffers from nightmares, although she is far better than she was. At the time I approached the Health Visitor, she was having 3-4 nightmares a night and it would take 30-50 minutes to calm her down each time. She'd wake shaking with fear, sweating and her eyes would dart around the room looking for whatever horror it was that had scared her. Yet this was a "habit"? A year later, some educational psychologists happened to visit the school and I took the opportunity to ask their opinion on nightmares. They were very reassuring and calm, and explained how it was quite normal at her age, and that I should expect it to pass within a couple of months. They then asked me how long she'd suffered with them? My reply was "at least 2 years" and it was their turn to have their jaws drop.

I've always been fairly confident of the reason behind her nightmares - she has a very active imagination. She could make up stories and worlds of her own from a very young age. She would carry around her imaginary friends of spiders and monsters....and it was my feeling that in actual fact, it was spiders and monsters that she was afraid of.  At 5, she still has one nightmare a night most nights....very occasionally she'll sleep through the whole night. We've tried keeping a diary, reducing her cheese intake, giving her a nightlight and a variety of other things suggested to us. She's always had a good bedtime routine of bath or quiet time, story and then bed. Nothing has really made any difference to whether or not she has a nightmare. These days I may not be able to completely stop the nightmares but when she does wake from the one that she has, I "give" to her a good dream, which somehow seems to work. I live in hope that one day she will outgrow them but for now I will just be there for her to comfort her, and never will I consider it a habit she has to break.

I guess my experience with this particular Health Visitor has taught me,  to always think about what I am saying, that if I don't know the answer to something, that it is ok to say so and that making assumptions is bad enough without voicing them as well.

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 fours.....it 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 say....it'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. 

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. 

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!

Assessment, Assignments and Exams

I have now had half of my results for the year, thankfully all passed, and it's got me thinking about the different ways in which we are tested. Before even getting into University we all had to pass a Maths and English test and it has felt a bit like we've been constantly tested since then. So I thought I'd tell you all a bit more about the tests that we've had to do and how I have "survived" them.

Academic Skills - 2000 word assignment.
I enjoyed this assignment in some ways and in other ways it frustrated me. The assignment was, depending on our prior experience, teaching/reminding us how to write an essay and how to source references. We also had sessions on how to do Harvard Referencing  and four activities designed to help us so that by the time we came to actually write our assignment we'd done most of the work already. For the assignment itself we had to summarise our chosen article and then write about how we it links to our future role. Finally we had to talk about the academic skills we had learnt in the process. I enjoyed it from the perspective that I actually enjoy writing essays and I enjoy doing further reading. I felt frustrated because I was limited by it in so many ways. I would have enjoyed exploring the focal point of my article some more but it wasn't what the assignment was for. That said I am thoroughly enjoying researching my psycho-social assignment which is my next one due in.

Practice Assessment Document (PAD)
I have made reference to this book before. This is the book we carry everywhere with us on placement. For each placement that we do we have key areas that we have to achieve e.g. supporting women to breastfeed in challenging circumstances, recognise the onset of labour, be the initial port of contact for pregnant women, competently provide information regarding screening etc... You'll have to excuse me a little here as my book is currently with my personal tutor so I have had to rely on my memory and I couldn't recall exactly how they were written. When I first got my book and I looked through everything that we had to get signed off, it felt so overwhelming. Once on placement it almost felt even more overwhelming. The opportunity to get anything looked at let alone signed off, felt very remote. However I soon learnt you had to find the right balance of forceful, respectful and keen. However it is important to note that the balance can be different for everyone that you work with. I certainly found it far easier to get my book signed once I was into the Community part of my placement. Anyway for each section of our PAD we have to have at least one formative assessment before the summative assessment is done and a mark awarded. The mark given definitely depends on who you are working with, not just your ability and it seems that our mentors were every bit as confused as us; however in their defence it is a fairly new way of doing it so they are still learning too.

Exam - Biological Basis of Health.
A 2 hour exam consisting of 25 multiple choice questions, a midwifery specific diagram and 4 midwifery specific short answer questions. Now I am the first to admit that Biology is not my strong point. When I was at school and was choosing my options (is that showing my age or do they still call it that?) I could choose whatever I wanted. I wanted to do a science but knew it wasn't my strong point so I went to my teachers in turn to ask their advice. They each advised me not to take their subject......and this was a grammar school. looking back I think that says more about the teachers than it does me but hey that was then and this is now. So having said that I do sometimes wonder whether I was really that bad or more that I wasn't good enough. Either way it has left me with this feeling that I am no good at science. Having said that I think I have a good enough understanding of where things are in my body, and how the reproductive system works, and there are certain parts of our lectures I have found easier than others. Anyway to cut a long story short, I studied hard for my exam. Of all my assessments, exams are what I dread the most.

Other students have often asked how I revise and I can only tell you what I do and say that it works for me. During lectures I take extensive notes even if they tell me it's going to be put up on our portal system. Following the lectures, I head to the library and type up my notes (not always immediately before anyone thinks I am a complete geek, I actually tend to do big chunks at a time) and when I reach a part that I've written that I don't understand I can reach for a book and read up some more so that I do understand it. I may include flow charts so that I can see that x leads to y and so on and so forth. I won't say it leads to me remembering it all but it does help and it does mean I understand it better.

Drugs Calculation Test
We had two weeks in which we had to log in and answer 20 drugs calculation questions. We were allowed to use a calculator and perform the test wherever we liked, although they did request that we did it on our own. In the two weeks preceding we could access practice tests so that we could get used to the format and the kinds of questions we'd be asked. We did have to get 100% to pass but in all honesty, would you want me to be correct with drugs calculations anything less than 100%? I wasn't nervous about the test; I hadn't had any problems with the practice questions after all. I guess the only thing I was worried about was making a silly mistake or misreading the question. It would be too difficult to misread mg as mcg or similar. Thankfully I passed first time but I was surprised by how nervous I was when I was doing it.

So what's left for this year? My next task is my Psycho-Social assignment, then my Values assignment and then my PAD for my second placement this year. Oh and I almost forgot, we have a poster presentation as part of our Psycho-Social this Friday; although it's not graded.

My advice to current students and future students is plan early! For us, we were given all our assignment details early, so I started to think about them early. I have had to plan my study time around my children and family commitments. When we had only one lecture in a day, I didn't go home, I went to the library. This gave me time to rewrite parts I wasn't happy with. It also gave me time to look through the assessment criteria and see if I had covered all I needed to. With my revision notes for the Biology exam, starting early meant I was re-covering things rather than learning things for the first time.

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.