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!

Into delivery suite I go...

So here I am, a second year student and I've just started placement on Delivery Suite. On Sunday night I had butterflies in my tummy, and I was really nervous about starting placement this time. In part I think it's because wearing my second year badge, means I am meant to know stuff. Of course I do know a lot more than I did this time last year but there is still that feeling that you are faking it and soon someone will discover you don't know anything. It's a bit like the feeling that you are playing at being a grown up when you have children...I am sure some of you know what I mean.

Anyway I had my first shift on Monday and I felt like my head was full of cotton wool at the beginning of the day. It's been quite a while since we were last on placement and I had to get myself back into mindset and remember how things were done....mainly the documentation. Also this is the first time I've worked on Delivery Suite, having worked in the Midwife Led Unit before so I'm learning how things are different. The main difference is that there are far more high risk women being cared for which means that the CTG machines are used for monitoring, in some cases continuously throughout labour. Then there are the women who are on drips for inducing labour, women with epidurals, women with pre-existing conditions that need to be monitored, women carrying twins (or more), women who have had bleeding during pregnancy, women with high blood pressure, and anything else you can think of really.

In comparison with the midwifery led unit, delivery suite is more fast paced, and busier. There is always something going on. The doctors are also far more involved with care and decision making. One of the things I have learnt this week, is how quickly things can change, and how quickly the staff can move when they need to. For low risk women, the constant monitoring is not needed, but once you begin to intervene and various drugs are used, there can be a reaction to that drug, and it can be very sudden. However with the monitoring that is used, the response to any reaction is swift.

I've watched One Born Every Minute and how the midwives are portrayed - sat in the office drinking tea and eating cake whilst women labour on their own. I have to say this is definitely not my experience. Where I am the midwives spend the majority of the time in with their women. They may grab a cup of tea at some point, but often they don't get the chance, and I don't like to think how many midwives miss getting a lunch break because it's just too busy. Would you not agree that it would be a safer and happier environment for all if there were enough staff to ensure they got a break? It's not that I think it's unsafe where I am fortunately but I can definitely see that there would be a huge benefit to all, if there were more staff.  You can't predict who will walk the door, with what "problems" so you always have to be prepared for anything. Delivery suite needs midwives who work as a team, supporting each other, alongside the doctors, anaesthetists, maternity support workers, cleaners etc... Everyone has a vital role in delivery suite and communication is essential.

What do women want?

I've talked quite a lot about the kind of midwife that I want to be but the other day I was considering the kind of midwife that women want? I am in the unique position of knowing a variety of women, who have all had very different labours and experiences, positive and negative, so I took the opportunity to ask them just how they felt about their births and how they felt about the midwives involved in their care. The response was very mixed, as you'd expect but there were some common answers that seemed to run through their replies. The responses made for very interesting reading, and sometimes very emotional reading.

It came as no surprise that the women wanted to feel listened to; that they were more than just a number and treated as an individual. It's a well researched fact that women in labour have better outcomes when they receive one to one care and yet this doesn't appear to be happening for all women. Their are midwifery shortages throughout the UK which places a huge impact on the services that midwives are able to provide and the subsequent experience that women will get. Although it cannot be denied that staff shortages are not the sole reason that some women do not receive one to one care and despite listening skills being highlighted as an essential requirement for any midwifery student candidate, it appears that some midwives have lost the ability.

The vast majority of positive experiences were during labour and planned caesarean births and the women spoke of calm, reassuring midwives who kept them informed. There was disappointment spoken of, if a midwife who had been present for their care, had come to the end of her shift and a different midwife had taken over. Again I was reminded of the importance of one to one care and how much of a difference it made to women.

I was particularly sad to read that for most women the postnatal care, and in particular the breastfeeding support was declared to be awful. This is where there was frequent mention of a lack of staff, the staff that were there being in a rush because of the number of women they were caring for, coming across as uncaring and uninterested. It also seemed that whilst midwives had the knowledge about breastfeeding and support, they didn't have the time to spend with women supporting them.

Another factor in whether or not women had a positive birth experience, appeared to be their expectations of how things would be. I have heard it said many times that for the woman with the explicit birth plan, strict dos and don'ts of what they want, is a straight to theatre kind of woman. Whilst this is said very tongue in cheek, there can be a bit of truth in that statement - in particular for the first time mother. If you've not experienced it before, then how can you truly know what you'll need? If you aren't expecting labour to be hard work, then it's unlikely that a choice of no pain relief is going to work out. If you are expecting to jump straight back to normal following a Caesarean section, then you will get a bit of a shock.

There are no gold medals given out for childbirth and whether or not you use pain relief, whether you "manage" without an epidural, whether or not you give birth vaginally or your baby takes the sun roof! Yet I have heard many women speaking of feeling like a failure because things didn't go to plan.

My advice to women would be to be as open minded as you can be about pain relief, and positions and what you might need. It's good to know roughly what to expect but don't get fixed on a plan.

My advice to myself and any other aspiring midwives would be to always listen to women; to always remember the value of time and try wherever possible to provide one to one care, to keep women informed, be honest with them and let them know what is happening. When you can't spend time with someone, explain why not but try to organise something so that they do get some time with someone who can help. I know this won't solve the problems of staff shortages but we can all do our best.

And finally I just want to say a huge thank you to all of you that contributed answers to my questions about your experiences. I think I have learnt far more than I have put into this post, and I value each and every reply.