No longer a student, not yet a midwife

So here I am - stuck in that place in between being a student and being a midwife. I have a job but I can't start until my pin comes through, my CRB check is complete and my references are done. Yet I am also no longer a student. 

It's an odd feeling to be truthful. Everything feels a little surreal - I am waiting for someone to tell me it's all a joke, of course I can't be a midwife, I don't know anywhere near enough yet. I know more than I think I do of course, and yet at the same time far less than I will need to know. I am aware that the coming months will be hard work...as hard as it was when I first started my training, if not harder. When I first commenced my training, I used to finish each day of placement with a horrendous headache because of the high level of concentration needed. As I will no longer have that safety net of a mentor, I will return to that high level of concentration, in an effort to ensure that I remember to do all that I need to do. I will probably check and check again, feel unsure and uncertain, unused to being able to make my own decisions despite the fact that I have been doing just that for months. I am predicting exhaustion, tears, headaches but at the same time I am expecting shifts where I come home and realise that I did a good job, that I got it right, that I was an advocate for women, that it's all starting to make sense. Gradually I hope that my confidence and experience will grow and the good shifts outweigh the bad. 

I am naturally nervous. Being a midwife isn't like starting a new job somewhere else. You really do hold lives in your hands. You want to provide a good service to the families in your care, and ensure that their experience is a positive one whether it is on the labour ward, in clinic or on the ward. What a midwife does matters, it really matters. It matters to me anyway and I have no doubt it matters to the women and families. 

I am now trying to enjoy this time out...spending time with family and friends; having a real break before the next step on my journey to truly becoming a midwife. I am almost able to say "I am a midwife"....and yet that still feels just round the corner.......

I did it!

Last week I was given the classification for my degree and I am very proud to tell you that I achieved a 2:1. We're now into the final pieces of paperwork and sometime next month (hopefully) I'll get my pin and be a fully qualified midwife. This month I shall attend an interview for a job and I know I've got my fingers and toes crossed that I'll get it.

It's an odd feeling right now. I'm exhilarated and slightly scared. I am scared of no longer having that mentor looking over me and ensuring that I'm doing things correctly. Yet at the same time I am looking forward to working independently, taking all that I have learnt from my various mentors over the past three years and developing my own practice.

I am proud to be able to say that I've made it. I have managed the demands of academic life, placement and family life. Once a long time ago, I began a journey to be a teacher and over half way through the course, I failed a major assignment and dropped out. At that point I thought I had given up the chance of ever getting a degree. I had no idea what I'd do with my life and didn't really think I'd ever make anything of myself. However I feel that I have also never really given up. I have always forged forward with the belief that there is something better out there for me; that I could do more.

I am not the greatest student, I wouldn't consider myself particularly academic. When I was doing my teaching course, I averaged very low marks, scraping through each assignment. My assignments as a student midwife, have been varied....some I've got it right and others I've not done so well at. I have taken something from each experience. I have literally taken it one day at a time, one challenge at a time...never daring to think beyond being a student and simply doing my best. I also could not have done it without the amazing support of my husband who always believed in me and my family's never ending support.

At the moment I am making the most of a little time off.....spending time with my children, seeing friends that I've woefully neglected over the past three years, spending time with family, catching up on my knitting and spending time preparing for Twirling Nationals with my daughters' twirling group (if you are interested you can follow them here http://distinctiontwirlersofmedway.blogspot.co.uk/2013/04/happy-easter.html ).

It's been a long journey and in so many ways, this is just the first step on the next part of the trip. I shall aim to continue to tell you all what it is like to be a newly qualified midwife. I am looking forward to taking that step but for now I shall enjoy spending time being me.

Do you have a mental health problem?

This week at Uni we've been talking about post natal depression and mental health issues. It was unfortunate timing that the news about Felicia Boots hit the headlines. Or was it? I do think that post natal depression is not talked about enough. Depression is a stigma and not discussed as much as it should be. Allegedly Felicia did not take the medication that she needed because she was so frightened that the medication would affect her babies through her breast milk. This is not an uncommon event, although fortunately most women do not kill their children. Do you know which drugs are safe in pregnancy or to breastfeed with? No? Neither do I. However I do know where I can access the information to find out and I also know that in some situations, whilst one drug may not be suitable, there may be an alternative. Simply stopping a drug is not the best course of action. 

Felicia's case is truly tragic but there are so many others that need more support. Mental Health issues affect 1 in 4 people every year....so that could easily be you right? I know it was me. I've told you about when my brother died and naturally bereavement can be a large precursor to mental health problems. Personally I also was dealing with a variety of other difficulties in my personal life...as mentioned before, my sister's family life wasn't easy, but at the same time my husband had lost his job, we were struggling financially and at the time, it just felt like everything was going wrong. Usually an optimistic person, I became consumed with the thought that some people were just unlucky and no matter how hard they tried, their lives would always be miserable, and who was to say that wasn't me. I had thoughts of leaving my family....not of suicide, just of driving away and living somewhere far away from them. I decided I was bad luck and I would bring nothing good to them. Luckily I have a wonderfully supportive family and friends, and I sought help from the GP. I was immediately referred for counselling and given regular appointments with my doctor. Initially my GP was reluctant to prescribe anti-depressants because I was breastfeeding and he was unsure if they were safe. Encouraged my friends, I returned to my GP armed with information from the Breastfeeding Network http://www.breastfeedingnetwork.org.uk/drugs-in-breastmilk-information-and-factsheets.html and I was given the medication that I needed. Fortunately for me, the medication and counselling I had, helped me. I recovered without any major side effects. I was lucky. I am no longer in counselling, and I am no longer on medication. However it's also not something I shout about.

If doctors are afraid to prescribe the medication that people need then it's really no surprise that women are afraid to take it, in pregnancy or whilst breastfeeding. But where does this leave the women that so desperately need help. What about those women who have serious mental health issues such as bipolar disorder, schizophrenia, obsessive compulsive disorder, psychosis etc... The medication that they take can be essential to them being able to live a "normal" life. There are only 13 mother and baby units in the UK. This means that any mother requiring inpatient care for a mental health issue is more likely to be separated from her baby due to the lack of this vital resource. 

The NHS offers this page as advice for anyone worried about postnatal depression.

http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/feeling-depressed-after-birth.aspx#close

I don't have the answers to the problem but I hope that I do remember to talk to women...to take that time and listen and ensure that they are getting the support they so desperately need. I will do my absolute best to ensure that women aren't stopping medication unnecessarily. I will encourage women to speak up if they are feeling down and I will encourage family members to watch out for the signs of postnatal depression. But this is something you can look out for too....with friends, family members, colleagues, neighbours. Not necessarily postnatal depression but any form of mental health issue. Let's break down this stigma and offer people the help they really need. 

Passion and Inspiration

Sometimes I find myself bogged down in the workload. For example, at the moment we are working on two assignments, about to return to placement and in January we have a presentation and a biology exam. In the midst of this, I am also attending meetings in my capacity as set rep and trying to plan for Christmas, spend time with my family and friends and there just isn't enough hours in the week. Consequently I'm a little rundown at the moment, with cold after cold and a constant feeling of tiredness. So it's easy to wonder how I maintain my passion for midwifery, and to keep that light at the end of the tunnel to aim for.

I try to maintain my passion for midwifery through reading - I'm always interested in the use of techniques I've never seen in practice and that we're unlikely to be taught. For example, the use of water blisters to help with the pain in a back to back labour. If you've not heard of them before then have a read, it's really interesting. Something else I was reading about recently was a technique for dealing with shoulder dystocia where the mother is aided into a running start position which is explained here.

I also recently attended a water birth study day which re-ignited my passion for water birth and home birth. Prior to beginning the course, it was of course my own home water birth that inspired me to become a midwife and yet I am still to attend one myself. The study day reminded me of how to trust in women to be able to birth their babies without any intervention. It also highlighted to me the amount of fear there is surrounding home birth - from the health professionals as well as the women. Fortunately this isn't true of everyone but clearly a significant enough number for the percentage of women having a home birth to be extremely low. According to Birth Choice UK, just 2.39% of births in the UK were home births and in the area where I work just 2.2%, a figure which hasn't changed much in the past 10 years.

This week I was fortunate to be able to attend the RCM student midwives conference in Brighton. As well as the superb amount of freebies from all the stands that were there, I also had the opportunity to listen to some inspirational speakers. I was able to hear from other students, newly qualified midwives and midwives who had been working in the profession for a long time. If you ever get the chance to attend then I thoroughly recommend it. It's hard for me to sum up exactly how much you can gain from the experience. I'd also recommend any other conferences you can attend, such as the ARM conference or any other event where you might have the opportunity to hear such inspirational speakers.

So when I'm feeling the pressure of my workload and all I'm really doing is worrying about how I am going to get it all done, to the best of my ability, sometimes I just take some time out to remind myself why I am doing it and I then find I can focus better on my work. Alternatively I also have times when I just have to push on, push past the point where I feel everything I am writing is rubbish, to the point where it begins to make sense. Trust me, it does happen sometimes.

If you haven't done so already, can you please sign the petition for more midwives!
http://www.rcm.org.uk/college/campaigns-events/protect-maternity-services/

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. 

11 births and farewell MLU.

I've now finished my time on the MLU and next week I am off to the antenatal clinic where the experience will be extremely different. It's hard to believe that before this placement, I hadn't "caught" my first baby and now I've caught eleven. Eleven very different woman, who coped in very different ways with their labours. Eleven different birthing partners who supported their wives/girlfriends/daughters in a variety of ways. So many of the birth partners say how useless they feel whilst the woman is labouring. They simply don't have any idea of how valuable just being there can be.  And lets not forget the eleven very different babies. Six boys and five girls.

I'm not sure I can put into words just how much I feel I have learnt in such a short space of time. I've worked with different people and they all have their own ways of how to deliver and no doubt over time, I will choose my own preferred way. I like to think at the moment that I will work with whatever is appropriate at that time but ideally, maybe even idealistically, I'd like to be fairly hands off in my approach....allowing women to be in charge of their own bodies and deliveries. I think back to the births of my children and how I feel that my eldest was delivered by the midwife, and how my second was delivered by me....I know which experience I'd rather women have.

However one thing I have learnt is that no matter what I think, the woman has the right to make her own decisions. Whilst for me, being continuously monitored or unable to feel the contractions would be awful, for another woman, this is very important to them and part of being a midwife is taking a holistic approach and recognising what is important and why; ensuring that women have all the information they need to make an informed decision so that after the baby is born, they have felt a part of the decision making process and supported in their choices. What I would do is actually irrelevant in so many ways. So as well as all the clinical skills I am learning, I am also learning how to listen to women and support their choices.

Today I am feeling on top of the world, so pleased with all I have learnt and achieved. I'd love to bottle it - I could make a fortune! Or just have a little sip at those times when I am wondering if it is all still possible. For now I shall bathe in this happy feeling, enjoy a few days off and look forward to another new experience on Monday!

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. 

Breastfeeding - my experience

Those that know me know that I am still feeding my almost three year old daughter and those that don't know this about me, may be surprised to know this. I feel passionate about breastfeeding and I know a lot about breastfeeding, positive and negative. Anyway I felt it was time to talk a little bit about my experiences, my opinions and my expectations; and I will say now that some of what I say may surprise you.

My Experience

When I fell pregnant with my first daughter and thought about how I planned to feed her, I merely thought "well I'll give breastfeeding a go but if it doesn't work out then I'm not going to beat myself up over it"....and I don't think that's a rare way to feel at all. I went to my antenatal class about feeding and noticed that there was a distinct drop in numbers attending. I listened dutifully to all the benefits to me and the baby and felt no real difference, and certainly no more prepared. I don't recall them discussing problems at all, though it is possible they did.

When my daughter was born, we did have skin-to-skin but in the immediate time following the birth there was no mention of feeding her. I certainly didn't have a clue what to do, or whether I should be trying to feed her or not. Anyway eventually someone did come to try and help me to breastfeed, I have no idea whether or not she was a midwife or maternity support worker. She certainly did her best, but my boobs would challenge most I think, as they are on the large side. Anyway she did manage to get her latched on but she didn't feed for long, and just wanted to sleep. Overnight she was very unsettled and I did my best to feed her but had no idea whether or not I was doing it right and come the morning I asked the midwives for some support. They did their best but she just didn't want to feed at the time they were able to help me, and when she did feed it was only for about 5 minutes. The midwives in the morning wanted me to stay a bit longer and get some more support with feeding, the afternoon midwives discharged me home. Did I feel confident? No, but having said that, I wanted to go home because I didn't feel that I was getting the support I needed whilst I was there anyway.

Over the next few days I gradually got sorer and my nipples cracked and were bleeding. I dreaded every single feed. However if someone suggested I switch to formula, I was like a stubborn child, I dug my heels in and was determined that it wasn't going to beat me. It was at this time, I actually discovered how much being able to breastfeed, mattered to me. I couldn't tell you why it mattered all I know is that it did. At that moment I certainly didn't give a monkey's about the health benefits, and I certainly wasn't thinking that formula was evil; I just knew that I wanted to breastfeed. Even now I can remember how determined I was whilst at the same time, I sobbed through every feed, and curled my toes.

Before I scare anyone who hasn't had children off breastfeeding for life....I would like to add that it changed very quickly - once I got the right support. I've actually already mentioned the inspirational midwife Annie who corrected my positioning and helped me on the road to pain free feeding. I saw Annie at home on day 5, and attended the breastfeeding group the same day. By the time I returned to the group a week later, the pain was gone. With my eldest daughter I went on to be pain free for the remainder of our breastfeeding journey which was ended by her when she was 13 months 1 week old. I attended the breastfeeding support group every week.....ok I wasn't experiencing pain but I did feel like I needed support. I made a lot of friends at that group, some of whom I consider amongst my closest friends now, one of which is in fact my second daughter's godmother. Having friends that had experienced the growth spurts, the distracted nursing child, the sleepless nights was essential.  Of course some of things are nothing to do with breastfeeding, but neither were the conversations about our husbands or families! The point was, someone had always had the same or similar experience and it meant you didn't feel quite as alone. At the time I was grieving the loss of my brother, who had died when my eldest was 10 weeks old; and whilst many of them may not have known that, they helped me more than they could ever know.


With my second daughter, I didn't anticipate any problems - after all, I had attended the group for well over a year, I'd already breastfed one child, I knew about all the problems to look out for...what could go wrong? Well...my daughter hadn't done all those things and she needed to learn how to feed, even if I didn't. There were no major problems, but boy did she have a strong suck on her and I experienced a couple of days of soreness as a result. When she was weighed on day 5, she'd already gained 13 ounces, so there was nothing wrong with her latch.

Over the coming months we experienced reflux , breast refusal, biting, mastitis and even a fairly long period of time where she would only feed from one side. I still have no idea why she only fed from one side; there seemed to be no real reason to it. She'd refuse to feed completely when she was teething but we invested in an amber teething necklace which seemed to do the trick. I was once a sceptic when it came to these alternative methods but the one and only other time she refused to feed, my husband had forgotten to put her necklace back on after her bath. The group helped support me, in that I knew it was quite common for babies to refuse to feed when they were teething, and that it was normal for different babies to react in different ways. With my first daughter, we'd never known she was teething, we'd just suddenly realise she had a new tooth.

When people found out that I had breastfed babies with teeth, they would always ask me about biting and doesn't it hurt. I have been bitten, and in all honesty, my second daughter once bit me so hard it drew blood. Not once did it occur to me, to stop breastfeeding because of it. I dealt with it in the same way I dealt with it any time she did something naughty. I told her very firmly no, and put her on the floor. She'd yell and cry, and I'd pick her up, tell her firmly not to bite and we'd continue. I'd like to say I only had to tell her once but it wouldn't be true. However I also learnt the signals for when she was considering biting, and the continued consistent reaction from me, ensured that it was soon a thing of the past; and she certainly never once bit me as hard again.


The couple of times I had mastitis, I was lucky in that I knew the signals and I was able to beat it becoming a more serious issue by feeding, feeding and feeding some more. I'd use a variety of positions to ensure that all the ducts were emptied properly. Again I am grateful to my attendance at the group, for knowing just how to handle it.

If you've learnt anything from this blog post, you should have worked out just how much I value the breastfeeding support group; it should therefore come as no surprise that I went on to become a breastfeeding mother helper and along with a friend, facilitated the group. I was awaiting training to become a peer supporter but I actually got my place at University before that happened. I did however attend the monthly training meetings with other mother helpers and peer supporters so I gained a wealth of knowledge about how to support women.

You might think from this blog post that I believe every woman should breastfeed...well you'd be wrong but I shall save telling you all about my opinion for my next blog post......

Coping with negativity

I am now 6 months into my first year, have completed my first placement, my first assignment and my first exam and already in this time I have experienced a large degree of negativity.

There can be negativity before you even begin the course, from professionals, from family and friends, from complete strangers....those who wonder why you want to be a midwife as they couldn't imagine anything worse as well as those who know how difficult it is to get a place and wonder why you want to put yourself through it. In all honesty, I partially feel this is like the first test of how much you really want it. If someone can put you off so easily, before you've even tried, then maybe you don't want it enough.  That said, I have been lucky in that the response from my friends and family has been incredibly supportive and I know that I will need them when things are tough, when perhaps I do doubt if I am doing the right thing.

I have talked before about reading on forums about poor placement experiences some students have had at the beginning of my "What Makes a Good Mentor?" post, and I don't want to repeat myself, so you can just go back and re-read it. However in a nutshell, I guess I am talking about the negative attitudes of others towards students. I know that I have said to my fellow students that as first years, we truly are the lowest of the low, and I have heard tales of being treated as a completely different person once qualified. Is it right? No of course it isn't but is it going to stop happening? Not any time soon, I am sorry to say. The only thing I would like to be sure of, is that I won't treat students that way or anyone in fact.

The other kind of negativity you can come across, is the negativity of qualified midwives towards the job, and sadly the women. As a first year, I am at a stage where I feel passionate about childbirth, choice, breastfeeding and supporting women in their choices. I don't want to change how midwifery is practised (I'm not wanting to change the design of the wheel after all), I have no urge to change the world, but I do want to support women to the best of my ability. I don't want to lose that passion that I arrived with, through working with midwives that are jaded about childbirth through the experiences they have had. I certainly don't want to criticise anyone I have worked with; I am hardly in any position to do so with the limited experience and knowledge that I have. So instead I thought I'd write a little bit about how I hope to deal with it and maintain positivity.

By keeping a record of my passion in this blog, I hope that I can always read back on it and remember why I wanted to become a midwife in the first place. That after a difficult shift, or when I am in the midst of assignments and feeling stressed, I can come here and read this and just remind myself why. That I can read about the people that inspired me, the stories that saddened me, the women who I wished had had better experiences to remind me how I don't want to be.

I also have an excellent support network of friends and family who I know will always lend me an ear, and encourage me when I most need it. They are also there to help me take a break, and give me some time out from the pressure. My husband is wonderful and will take the children out so I can have some space, and not only to study, sometimes so I can just have a bath and watch the TV in peace. I think it's valuable to know when to stop and take some time for yourself as this helps you to keep going.

I am also a member of forums where I can share opinions and ideas, gain support and have debates over all sorts of topics. I can also speak with my fellow students, in particular those that are based with the same trust as me, as they know the same people as me. It is going to be interesting to see how we all change and grow along our journey to be midwives. I think we will all learn just as much from each other, as we do from our own experiences.

I've recommended to friends who are pregnant, to listen to all the advice, take what you want and leave the rest behind. I hope I can apply this to my learning too, whilst of course maintaining my knowledge for safe practice.

Inspirational Midwives

I have heard it said that along the way in my training it is likely I will see some bad practice, some ways of practising that I won't want to use and hopefully a lot of good practise. So it got me to thinking about putting down in writing what it was about the two midwives that I know, that inspired me so much, so that when I am suffering from a lack of confidence I can look back and read it. Of course it will be hard to convey exactly why they are so inspiring in writing but I shall do my very best. Those that know me and are local to me will know exactly who I am talking about but obviously I need to keep this confidential so I shan't be mentioning their names - I shall call them Jo and Annie for the purpose of this post.

I first met Annie when my eldest daughter was about 5 days old. She visited me at home to perform her heel prick test and she unfortunately had to come back and repeat it when she was 9 days old as she just hadn't bled well enough. I opened the door to her and cried with relief at seeing her. Now I shall talk in more detail about breastfeeding later but on day 9, I was at the end of my tether with breastfeeding. I was sore, my nipples were cracked and bleeding, I was incredibly engorged and I had a baby that wanted to be constantly feeding. Annie helped me to get her latched properly, and encouraged me to attend the breastfeeding support group later on that day. So later on that day I managed, somehow, to get myself out the door and down to the group. I shan't bang on about the group now, as I will cover it in more detail when I talk about breastfeeding, but Annie ran this group so amazingly well. She'd manage to balance supporting women, without ever judging them or pressuring them. She knew when it would help for someone to have a peer supporter provide one on one support and when someone needed more. When Annie ran the group we had a thriving membership, sometimes there weren't enough chairs; yet when government funding was pulled back, it meant she was only able to drop in on the group when she could, and the running of the group fell to the peer supporters themselves. Whilst the peer supporters did a fantastic job, the membership dwindled considerably. It was down to Annie and that group that led me to breastfeed as long as I did, as well as myself of course.

I can't remember when exactly I first met Jo as she'd sometimes come along to the breastfeeding group, though that was more Annie's domain, or whether or not it was at the  Baby Massage class that she ran. Jo has a wealth of knowledge on many many subjects not just midwifery related and I believe she has recently completed her Masters.

Together Jo and Annie ran the antenatal group/drop in. They were much like the antenatal classes run by the hospitals in some ways but far far better. They would cover all the usual topics you'd expect at, such as pain relief, positions in labour, instrumental deliveries, episiotomies etc. However what made this group so fantastic is that there was no limit on how often you attended. When I fell pregnant with my second daughter, I attended early on following some bleeding I had and then more regularly from around 28 weeks. It meant that you got to know the others that attended, some would be further along than you, and some would be earlier in pregnancy. When I attended the hospital classes when I was pregnant with my first daughter, we had one of those awkward get to know each other games and everyone was uncomfortable. At drop-in, as I shall call it, we did always introduce ourselves and although it was always a little bit uncomfortable, it got it over and done with, not to mention once you'd been a few times you found it easy. It also gave you a chance to say what had been going on with you that week, to raise something that might be worrying you, to moan about work or relatives. And it always felt like someone else had been through the same or was currently experiencing the same and that made for a very reassuring environment. So Annie and Jo provided this opportunity to access the information we needed, time to speak to a midwife but also time to speak with our peers. Separately they are both brilliant but together they are the best!

When I fell pregnant with my second daughter it was only natural to me to book with Annie. I saw her every week at the breastfeeding group and I felt so comfortable with her. Throughout my pregnancy I saw either Annie or Jo and got to know them both so much more. They gave me the confidence and the information to choose a home water birth. It was the ultimate joy when it was Annie and Jo that were present for the birth of my 2nd born. My first daughter was delivered by the midwives, my second daughter was delivered by me. Annie and Jo helped that to happen and in the case of a normal birth, this is how it should happen. The best part of this is, it's not only me they have this effect on. Amongst my friends, I can see how many they have empowered in their births....whether they were home births, Cesarean sections, instrumental deliveries or inductions....Annie and Jo inspired them all.

If I can be half as good a midwife as either of them, I shall be proud. I feel honoured to have known them, and words can't describe how I lucky I feel to have had them at the birth of my second daughter.

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 sperm...in 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 straight....you 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.

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.

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.

So what does it all mean?

You get back from your appointment and glance through your notes and there are all these abbreviations that you have no idea what they mean. I'm going to now do my best to explain some of the most commonly used abbreviations or terms but if there is one that you've had that you want to know..just leave me a message and I'll do my best!

 
ANC - antenatal clinic - may be used to let you know where you next appointment is.
ARM - artificial rupture of membranes which is when they break your waters for you. Generally done to encourage/speed along progress in labour.
BBA - born before arrival. Those babies that don't want to wait for the midwife to arrive or the labour takes Mum completely off guard and end up being born in a car park (mentioning no names here). Anyway it means that no midwife was in attendance for the birth.
BMI - body mass index. Something that most of us don't like but it is your weight in kgs divided by height in metres squared. A healthy BMI is 20-25.
BP - blood pressure. We all know it's recorded but do you know what it actually tells us? The top figure, the larger number is the systolic measurement. This tells us the maximum amount of pressure during contraction of the ventricles. The lower figure is the diastolic measurement and this tells us the pressure in the ventricle at rest.
BPD - seen this on your scan reports? This is the biparietal diameter which is essentially a measurement of your baby's head. The parietal eminences are the two "points" (it may help to feel your own skull lol)  on the top of your head - one on the left and one on the right. The sonographer can use this measurement to estimate within about a week, the gestational age of the baby.
CRL - again seen on scan reports. This is the crown rump length....exactly as it sounds it is the measurement of the baby from the top of the baby's skull down to the bottom of the spine. Also used to asses the gestational age of the baby.
CTG - cardiotocograph. The machine that is used to monitor your baby. Either in the fetal assessment unit or during labour.
ECV - external cephalic version. This is the manoeuvre they use to try and turn a breech or transverse baby into the head down position.
Engagement - this can be very confusing as it depends on the midwife writing it as to which way they mean. Some will write 2/5ths and this will mean that they can feel 2/5ths of the baby's head, meaning the baby is 3/5ths engaged. Others will mean that they can feel 3/5ths and so is 2/5ths engaged. One thing I would say is, 2/5ths or 3/5ths it doesn't really matter. What matters is there is a degree of engagement. The baby's head may well not engage any further anyway if there is some of the waters in front of their head, blocking them from dropping further into the pelvis. 
FHHR - I am sure most of you have worked out that this means the baby's heart has been heard but can you work out exactly what it stands for? It means fetal heart (heard and regular).
FMF - fetal movements felt.
Gravida - either a primigravida or a multigravida. A primigravida is a woman who is pregnant for the first time and a multigravida is a woman who is pregnant for the second or more time.
GBS - group B streptococcus. This is a bacteria found in either the rectum or the vagina of approximately a quarter of all pregnant women. It can cause an infection in the baby, and in rare cases death of a baby so it is commonly treated with antibiotics during labour to reduce those risks.
GTT - glucose tolerance test. The test that checks for gestational diabetes. It is more commonly found in women who have a high BMI and/or a family history of diabetes.
IOL - induction of labour. 
IUGR - intrauterine growth restriction. This basically means that the baby is anticipated to be a small baby...where perhaps the baby has stopped growing, or is growing more slowly which can indicate that the placenta isn't working as well as it should be.
LMA (RMA) - left (right) mentoanterior . This would be in reference to the position your baby is in. So the mento refers to the baby's chin; so in this case the chin is to the left of the pelvis and facing towards the front of the woman's pelvis and the baby is going to be born face first. This would only be detected by a vaginal examination, as externally you cannot feel which position the baby's head is in.
LMP (RMP) - left (right) mentoposterior. As above but the chin is facing to the back of the woman's pelvis. Again would still be a case of the baby being born face first.
LOA (ROA) - left (right) occipitoanterior. This, whether left or right, is the more ideal position for the baby to be in. It means that the occiput, which is the bone on the very back of the baby's skull, is facing towards the front of the woman's pelvis. The baby has tucked it's head right down onto it's body and is therefore presenting the smallest diameter to be born. (Imagine you are putting on a jumper with a tight neck, you wouldn't try and push your face through, you tuck your head down onto your chest)
LOP (ROP)- left (right) occipitoposterior. As above but the baby's occiput
LSP (RSP)- left (right) sacroposterior. This means that the baby is in a breech position and facing to the back of the woman.
MSU - midstream specimen of urine
NAD - nothing abnormal detected....always good to see
NT - nuchal translucency. This is the part of the scan when they are screening for Downs Syndrome and other disorders. They measure the skin at the fold at the back of the neck. This is most commonly used alongside a blood test to give a more accurate risk factor.
PG - prostaglandin. The hormone that is used in induction of labour.
PPH - postpartum haemorrhage. Bleeding to excess following the delivery of the baby.
SFD - small for dates.
SOB - shortness of breath.
SPD - symphisis pubis diastasis.Causes moderate to severe pelvic pain during pregnancy due to the relaxin hormone.
SRM - spontaneous rupture of membranes.
SVD - spontaneous vaginal delivery.
Transverse - the baby instead of being head down or even breech, is instead lying across the abdomen. This can result in a more unusual shaped bump. Fairly obviously if the baby is in this position at term, and any attempts to turn the baby have failed, this would mean a Cesarean section as the baby simply won't fit into the pelvis. This can often happen in women who have an unusual shape to their uterus e.g some women have a heart shaped uterus.
UTI - urinary tract infection.

I have no doubt missed plenty out but please do shout and I will try and clear them up for you!

Antenatal Clinic

Every week the midwife I am working with runs an antenatal clinic. This is not a drop in clinic like you have with the Health Visitors but appointments made in advance. At the booking appointment, it is decided whether or not the woman will have consultant led care or midwife led care. It may well be that she only actually sees the consultant once during her pregnancy but the next appointment after the booking appointment is at the hospital so that she can see a consultant as well; this appointment is at approximately 16 weeks of pregnancy. If the woman is under midwife led care then the next appointment will be at the antenatal clinic run by the midwife at the children's centre.

So what is it that happens at these appointments and why? Well in part it's an opportunity for the woman to ask any questions she has - whether they are about labour, or something she has been experiencing in pregnancy. It's also a vital appointment for the midwife to make some important checks. So at each appointment the woman's urine is tested for glucose and protein; and depending on the dipsticks being used it may also be tested for leukocytes, blood and ketones. Glucose may show up in the urine if the woman has eaten a lot of sugar prior to providing the specimen but it can also be an indicator for gestational diabetes. Protein can be a side effect of discharge but can also be an early indication of pre-eclampsia. Leukocytes and blood can indicate a urine infection. Ketones in your urine indicate that you are burning fat which could just mean you're hungry and need to eat something; they are often present in women who are suffering from morning sickness or hyperemesis. The main thing to be careful of is dehydration in this case. However if the woman is diabetic then the presence of Ketones is an indication that glucose levels are too high and there is not enough insulin.

Blood pressure is also monitored - it is taken at the booking appointment and at every appointment thereafter. High blood pressure can be an indication of pre-eclampsia but it can also be a side effect of hot weather. In the 2nd trimester it is quite common for blood pressure to drop and for women to suffer low blood pressure. It's always important not to just look at blood pressure results on their own but to look at the whole picture - one high result with no other symptoms is not necessarily a concern. Whereas a result that may be within normal guidelines but is high for that woman who is also showing protein in her urine is a concern. In this
circumstance, the woman would be sent to the hospital for monitoring or a blood test or both.

The other part of the antenatal appointment is measuring the woman's bump, checking the baby's position and listening in to the heartbeat. The bump is measured after 16 weeks of pregnancy to ensure that the baby is growing and that the baby is, to the best you can tell, growing accordingly to gestation. The position can generally be ascertained from around 28 weeks. This can sometimes provide an answer for women experiencing a lot of back pain and confirm whether they can feel feet or a bottom. At around 34 weeks it is hoped that the baby will be in the ideal position for birth but prior to that the baby can be in any position it likes. Identifying the position of the baby also helps to find the best place to find the heartbeat. Hearing the heartbeat gives reassurance to the mother but also provides the midwife with an indication of how the baby is doing.

So this gives you just a glimpse into what may seem so routine but is actually so very important. For most pregnant women, all the checks are normal and are reassurance but a midwife is there for them too as well as those for whom it is most definitely not routine. Something that women often find after their appointment is that when they read through their notes they don't always understand what has been written so next time I'll cover those abbreviations and what they really mean.

The first meeting with a midwife

I think most people have an idea of what a midwife is but how many understand what a midwife actually does?

As I am working so closely with a community midwife at the moment, I thought it would be interesting to give you a glimpse of what they actually do day to day and why. I was going to show you a typical weeks work but felt that certain parts needed more description and therefore understanding, so I am going to start with the booking appointment for now.

Booking Appointments: This is the first time the midwife meets with the pregnant woman, usually when she is 8-10 weeks pregnant although there are still a number of women who book later in their pregnancy. But what exactly does a booking appointment involve? Most women are excited about going to their first midwife appointment but don't really know what it entails. Well essentially it's form filling...fun eh! There is a lot of information to gather - contact details, next of kin, medical history, family conditions that could be hereditary, details of any previous pregnancies which includes terminations and miscarriages, information about previous labours and births, information about any children they currently have, allergies, any social concerns, any previous serious accidents, any operations, nationality of both the woman and the baby's father, date of their last period, whether they usually have regular periods and how long they normally last, whether they were using any contraception or if it was planned, have they taken any medication, have they taken folic acid, how tall are they, what they currently weigh, what shoe size they are, and what ailments they've suffered in this pregnancy. Some questions give way to other questions whereas some the answer is one word and we can move on. From this long list I am sure you can begin to understand why the booking appointment needs to be a long one - it generally takes 30-45minutes.

But the important question is this - why do we need all this information? Some of it is obvious - we need to identify risk factors that could impact on the pregnancy. For example, if the woman had a serious car accident in the past and had to have surgery on her pelvis, we need to know about it, as it could be a factor in her ability to birth vaginally - of course it may not affect her at all. Or if there is a family history of high blood pressure during pregnancy then it's something we would be watching for as it often does run in the family. Something may not seem very important but it can have a huge impact on the care required. Something that might seem unimportant is asking whether or not they are rubella immune or if they have ever had chicken pox. Chicken pox can be quite dangerous in early pregnancy or in the last weeks of pregnancy but if you have had it as a child then your immunity will protect the baby unless you are one of those rare people who didn't maintain immunity. Rubella or German Measles is also very dangerous in pregnancy and this is why all teenage girls are offered the innoculation in school. It is advised that before anyone starts trying for a baby, they make sure that they are rubella immune.

History about previous pregnancies and labours is very significant. If a woman has come to us on her second pregnancy and had a previous Cesarean section then we need to know why that happened. It is not true that because she has had one c-section that she would automatically need or want another one. However in some circumstances it would be the recommendation as the safest way to have the baby. You can also get some information about pain relief used and what worked for them and from this you might get an idea as to the kind of labour they hope for this time. We also need to know whether they had any problems recovering from the birth - did they have a post-partum haemmorhage? If the answer to that is yes, then it impacts on the type of birth we'd recommend to them; a home birth would not be the safest option.

Just asking who the next of kin is, can open the door to details about the father of the baby and whether or not he is in contact or if they are still together. It also offers the opportunity to ask about racial background and nationality. In some cases this has an impact on risk factors - for example Sickle Cell Disease is generally only found in people of sub-Saharan African descent. It can also raise any social issues - are there any other children? Do they live with them or are they refused access to them? I am sure it is obvious why we need to know these things.

Knowing the date of their last period obviously helps us to work out the estimated due date of the baby but also information about the usual length of cycle can help too. It also is essential for working out what scans are needed and when as for things like the nuchal scan, there is a window of opportunity for the most accurate results.

Probably the thing that is asked that is less clear as to why we ask it is shoe size and height. Why on earth do we need to know them? Well give me your best suggestions and I'll tell you if you are right lol

If I have raised something and not fully answered why we ask it then please do ask and I will do my very best to answer you!

And into Community I go....

No not Community service before anyone makes the joke! I shall for the next 6 weeks be working alongside a Community midwife and getting a glimpse of the work that they do.

A week before I was due to go out I rang my Community mentor to arrange where I was going to meet her. Unfortunately her response was not what I expected "well you won't be meeting me, I'm on annual leave for two weeks, back in for two weeks and then off again for two weeks, I don't know why they gave me a student".....which left me with a goldfish look on my face and thinking "oh no here we go again". Though to her credit she did sort it out within a couple of hours, and a midwife in her team rang to arrange for me to go out with her instead. So already it was a big improvement as I hadn't had to sort it out myself.

So fast forward to Thursday and my first shift out with my new mentor and I was feeling quite nervous. She put me instantly at ease and chatted with me about what I thought a Community Midwife did. We then went out to some postnatal home visits where she got me just to observe; a few discharges and a heel prick later and I was done for the day. She had another visit to do but as a really sensitive one, she decided not to take me with her. So I took the opportunity to go to the library and get some work done on my assignment.

The next day I met her at the clinic where we booked in three women who were between 8-10 weeks pregnant. I observed the first two and then she let me book in the third lady. I was really pleased that she gave me the opportunity so quickly but also that she supported me in it. She was right on hand to help me should I need it, but she also wasn't looking over my shoulder and making me nervous. It meant I felt completely comfortable, knowing she wouldn't let me make a silly mistake, or miss something out and that she was there to provide the more detailed information about the blood tests that I don't know yet. After finishing at the clinic we had just one visit and again we were done for the day. Two half days....I could get used to this lol.

I opted to work the Saturday as well as my mentor wasn't working the Bank Holiday Monday and I'd end up short on my hours. We had 6 visits in total to do, which included one discharge and five heel pricks. I'd already been told that she'd be letting me do the heel pricks as it would be good experience to do so many at once. So we started off at the hospital to put the ladies we'd booked the day before onto the computer system. The first two went like clockwork and then on the third the computer did something strange and was trying to add an additional pregnancy that the lady had never had. So it took us a little while to sort that out and whilst doing that my mentor received a phone call about another lady that needed to be seen. We went to see her first and whilst we were there, my mentor could find no record of the baby having had her heel prick test done - she'd been back into the hospital and on antibiotics and on discussion with the hospital, it appeared not to have been done. So this resulted is us being in this lady's house for rather longer than anticipated. It also meant we didn't have enough heel prick kits with us so we'd need to go back to the hospital.

The next few visits were fine and I did the heel prick test on the babies whilst my mentor filled in the paperwork. In case you don't know what the heel prick test is, you can read more about it here
https://www.bbc.co.uk/health/physical_health/conditions/phenylketonuria1.shtml
The test itself is really simple....even more simple than when they did them on my own babies at 2 1/2 and 4 1/2 years ago - they use a little blade rather than a needle and it's very simple to use. It was a nice thing to check off my list as having done.

We completed all of our visits, including returning to the hospital to collect an extra heel prick kit and an extra visit that had been requested by someone in a bit of pain postnatally. So by the time we eventually finished for the day it was 4 pm, which for a Saturday was a long day. On the plus side I got lots of practice at doing the heel prick test, lots of time to chat with my mentor, some time in a mental health facility (not as an inmate!) where I waited in the office whilst my mentor carried out an antenatal - very sensitive situation so I won't be discussing it on my blog. I am getting on so well with my mentor that I asked her if it would be possible to stay with her for the remainder of my placement period this semester; it seems daft to switch to my original named mentor for just one week. She seems equally as happy with me and said she would ask her team leader if it was possible so I am keeping my fingers crossed. it would be brilliant to have some continuity.

Academics and assignments

A common question I have been asked is how I am coping with the academic side of my course, especially with two young children to distract me at home. I made some decisions before starting the course about how I would manage my time. At school I was the type of person to leave everything to the last minute and then not do it very well; but since I've grown up and now that I am doing things I am genuinely interested in, I find that I actually look forward to doing my work and the thought of leaving things just scares me. So I've been organising myself really well; starting my wider reading early, getting an early start on my assignments and typing up my notes from lectures. I'm not a swot, I just know I have to work hard if I want to be a midwife and that it's the academic side that will challenge me the most.

One of the best things I have done so far is to never attempt to study at home. I always go to the library. When we have a day at Uni where we finish at lunchtime, I stay for a few hours and study. If we have a long gap between lectures, I go to the library. If I didn't have children of my own, I have absolutely no doubt that I'd be doing things differently but you have to find what works for you. I am extremely lucky in that I have a husband who is extremely supportive and understands that I need time at the library even when he hasn't seen me much. I find at the library I instantly put myself in study mode, I can concentrate far more easily as there isn't anything to distract me. The Uni libraries are wonderful too; I can use the books whilst I am there, the Internet to look at journals and search the web for information. I have even found YouTube a great resource for studying some of the biology - there are some brilliant videos showing exactly how the blood flow works in the heart and around the body - this has really helped me a lot.

So the last three days were spent in Uni and I can tell you straight it was a complete shock to the system after three weeks holiday. We were in with back to back lectures from 9-6 every day apart from an hours break for lunch. And if that wasn't bad enough, for each lecture we were at opposite ends of the campus so it was a speedy walk between each lecture too. It was all very intense with lots of talk about our upcoming assignments and exams. And so the reality has hit for quite a few of my year group and lots of people are starting to worry about our first assignment which is due in October. Having already started mine I'm certainly not feeling too stressed yet but I am also fully aware that I will re-read and re-write it many many times so I need that head start.

It was wonderful to catch up with my fellow midwifery students and found out how they were all getting on in their placements. We've already had such a variety of experiences and it seems we are all enjoying the work we are getting to do; which is of course the most important part. So now I am off into the Community part of my placement and I'm really looking forward to it. I am hoping to get lots of experience at booking women in and doing their antenatal checks and of course if there is a home birth - well that would be fantastic but I won't be holding my breath!

25 weeks pregnant

Sam 25weeks, originally uploaded by stephalie1977.

I shared a photo of this beautiful bump a few weeks ago. The lovely lady it belongs to is a very special person who has also played a part in my journey to becoming a midwife.

I first met Sam at a breastfeeding support group that we both attended. I didn't know much about her other than she had a little girl who didn't seem too much younger than my own. Over time we got to know each other better and I discovered that her daughter was in fact her second child, and that she'd also had a son. Malachi should be 5 now but in very tragic circumstances, Sam lost her precious baby boy when he was just weeks old.

Sam now has two beautiful daughters and a fourth baby on the way. She is a passionate, loving mother with very strong beliefs. She's not afraid to speak her mind and knows exactly what is right for her and her children. She is hoping for a second boy this time, but I have no doubts at all, whether boy or girl, this baby is truly lucky to be blessed by Sam as a mother.

During Sam's third pregnancy, she attended the same antenatal group that I did, run by two midwives. And as with me, she was lucky to have these very same midwives present for the home birth of her third child. They'd known Sam since the birth of Malachi and it's hard to put into words exactly how much they mean to Sam. So for them to be there for that birth was truly magical.

When I listened to Sam talk about the support, encouragement and love from these two inspirational women; it again affirmed exactly what I wanted to do. To be able to comfort someone in the depths of so much pain is truly a gift and both Sam and I have been so lucky to not only know these women, but to also have had them empower our labour and birth experiences.

I shall devote a blog post to these two midwives soon, to try and give you an inkling of why they are so special....but for now you'll just have to take my word for it.

Also Sam has recently started her own blog to share with you her journey...please do read and follow...
http://mummyspam1985.blogspot.com/