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If you’ve found me here, I’ve moved to a new blog, for my new job as a self-employed community midwife:

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Becoming a self-employed community midwife!

For fans of my blog, sorry for the gap in posts, I have been very busy with an international move, I have now settled in Ireland with my family. In the meantime I have worked in a busy UK maternity hospital in the postnatal ward, labour ward and midwifery-led unit. I will be telling you more about those experiences now that I have some more time on my hands. Since arriving in Ireland I have been working on a busy postnatal ward, which has been a wonderful teamwork experience.

But my big news is that I have now finished working in the hospital, and am developing my career in a new direction. I have signed a Memorandum of Understanding (MOU) with the Health Service Executive (HSE – that’s the Irish version of the NHS), and I am now a self-employed community midwife!

This is very similar to being an independent midwife in the UK, but with a few differences. By signing the MOU, I agree to carry out a risk assessment when I book a woman in early pregnancy, and if there are any issues which would make her high risk, I will refer her for a consultant review. This risk assessment is evidence-based, with the aim of providing the best care to each woman in her pregnancy. The main exclusions for home birth are women who have had previous cesarean sections, body mass index over 35 and any serious medical or obstetric problems.

In return for signing up to these guidelines, the HSE provides me with full insurance cover, as if I were working in the maternity hospital as a midwife. This means that I am really part of the HSE team, and if a woman I am caring for transfers to the hospital but remains low risk, I can still catch her baby. The continuity of care that I can provide in this scenario is very important to me.

I feel that my new experiences in this role might be interesting to some people, but they are really beyond the scope of this blog, I am well past the student midwife experience now! So I am starting a new blog, and hope you will follow me there as well.

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What’s it like being qualified?

Just realised the other day, that in the humdrum of everyday life, I have completely forgotten about my blog! Time to update on how things are going, now that I am a qualified midwife, and what to expect in the first few months.

My first rotation placement was on the Maternity Ward of a busy urban hospital. There are 36 beds on the ward, for both ante- and post-natal women. There are also transitional care babies on the ward, who may be underweight, or premature, or on IV antibiotics. The ward is almost always very busy, and sometimes completely full, and the pressure is on to empty beds for women coming down from Delivery Suite. The community we serve is very multi-ethnic, and it’s always interesting to find out where women come from, and hear their stories.

I started out with a full week of induction, including training on manual handling, blood transfusions, pumps and other equipment etc. In the next 3 weeks, I was supernumerary on the ward, which meant I wasn’t counted in the numbers of midwives officially counted as working that day, I was only given a few women to be responsible for, and a ‘mentor’ was available to me if I had any questions. I took full advantage of all the midwives I was working with, bouncing things off them, getting second opinions on CTGs, and asking about Trust protocol in so many different areas. I was nervous to start with, but caring for 4/5 women at a time was similar to what I had been doing as a third-year student, and once I had found out where everything was stored, I felt a bit more at home.

BUT, then I became a proper midwife, no more supernumerary shifts, and that first few weeks was really tough…

It was a busy time on the ward, and I was caring for up to 11 women on a 12-hour shift. The problem was that I was really slow at everything! Getting a woman discharged took me an hour, and when 5 or 6 needed discharging in a day, there just weren’t enough hours. The ones who were staying in were probably the ones who needed care the most, as their babies were unwell, jaundiced, pre-term etc, or they themselves had had very difficult births, or had other medical problems, such as hypertension, obesity, or infection

I  felt like I was constantly firefighting, answering callbells, providing pain relief, checking blood pressure and temperature, giving emergency breastfeeding support, to women who were crying because it wasn’t working. It was overwhelming. My worst days came when I was also preparing women for caesarean section as soon as handover was finished, doctors were milling around asking if they were ready, delivery suite were phoning for them to be sent up immediately. I had a list that I needed to follow, get them in a gown, and into TEDS stockings, check their obs, fill in the pre-op checklist, prepare a blank treatment sheet for drugs, enter them as an admission on the electronic system, and make sure we had a valid group and save on the system so that we would be able to request bloods for a transfusion rapidly if it were needed.

Somewhere in there, I also needed to explain what the routine was when going into theatre, when the partner would be able to be there, and to reassure them that it wouldn’t be scary like operating theatres on the telly, that it is friendly and informal. I think the experienced midwives do the whole thing in 10 minutes, it was taking me 30 at least. The stress was massive. And once I’d finished all that, it was already 9.30, 2 hours into my shift, and I still had 9 women to look after who I hadn’t even seen yet.

I made mistakes, of course I did, (and still do!) We are only human, and it takes time to be familiar with new systems, new staff, and the increased level of responsibility. It felt like there was never enough time in the day, and I would get to the end of my shift with two women  who were still desperate to be discharged, but I somehow hadn’t managed to find the time. All of which was handed over to the night staff, who never complained about it (to my face). The midwives I was working with reassured me, reminding me that we provide a 24-hour service, and that the night staff would only be bored if we didn’t leave them something to do! Everyone was very kind, and the women especially were so understanding.

Over time, things got better. By the time I was 2 months in, I had figured out how to prioritise the tasks I had, and how to delegate to the HCAs who were lifesavers, removing catheters, helping with breastfeeding, answering callbells. I became more familiar with how the paperwork worked, and got faster at doing those jobs. It became more fun! I started to settle in, and after 10 months on the maternity ward I loved it so much I didn’t want  to leave for my next rotation onto delivery suite, but that’s another post😊

becoming a midwife….finally!

Well, I finally made it, I just finished all my made up time work (in the 3 weeks that was supposed to be holiday at the end of the course!) and tomorrow is officially the last day of my course. So I will be no longer a student midwife, but a midwife, which is a slightly scary thought! Up until now, I’ve had somebody looking over my shoulder the whole time, not literally, especially this year, I’ve been given quite a lot of independence, but there has always been a qualified midwife looking over my documentation and making sure that I know what I’m doing, and that I’m doing the right thing.

I start a new job as a registered midwife in a few weeks time, when my PIN number comes through from the NMC, and I’m quite excited to be given that responsibility, to be working with woman, it’s something I’ve wanted for over 10 years now, and to finally be here is quite overwhelming. When I hit send on the last email to my personal tutor to get work signed off, I went blank for a moment, and then realised I was crying and couldn’t stop. It’s been an emotional rollercoaster over the last 3 years, with doses of extreme anxiety, a high level of marital  debate, never enough time for anything, and rarely any time off. The constant lack of funds has been a major source of stress, and childcare has been difficult at times.

The bits I will remember fondly from my course, my student friends, we have kept each other sane, even when we were all losing the plot, and laughing hysterically at nothing at all! They have been my rock, and have always been there, even when things were really tough. And the women, the lovely women I have cared for, and watched over as they do the hardest job of their life, growing a baby, birthing a baby, and becoming a mum. It is a privilege to be part of their lives while they struggle, and grow and change. And while they are going through all this stuff, they have always been nothing but kind to me, and grateful for whatever support I manage to give them.

If you are starting your journey towards becoming a midwife, I would like to tell you that you are a unique individual, and what you bring to working with women is personal to you. During the course, you will discover reserves of strength you never knew you had, and be amazed at the skills you will gain, you will end up doing things you would never have believed yourself capable of. Being with woman is thrilling and challenging, it will be the work of a lifetime, and well worth it.

Good luck! xx

Second Year Blues

So… this blog kept me sane during my second year studying midwifery. It was really important for me to pass on some of my experiences, so that they weren’t in vain. With the benefit of hindsight, second year of the course was probably one of the toughest years of my life, only coming after the years each of my babies was born!

I wasn’t the only one who struggled, I’ve talked to other midwifery students who had similar anxiety levels on starting new placements, even ones I had already worked in the previous year. There were nights I couldn’t sleep, for worrying about the day to come, and woke up in the morning exhausted and dreading the day ahead. There wasn’t any particular reason for these feelings of anxiety that I could pin down, my mentors were great, I wasn’t getting negative feedback on my performance, I didn’t have any traumatic experiences. I think I have to put it down to just feeling overwhelmed by the need to step everything up a gear. There’s a huge difference between practicing as a first year and second year student midwife.

Once you’re in the second year, your mentors expect you to be able to, for example, manage a bay of 4 women on the antenatal or postnatal ward, for a shift. Obviously you spend quite a bit of time discussing your plans of care with the mentor to make sure you’re not missing anything or making mistakes, but some mentors will let you accept handover of care for those women in the morning, and hand care over to the next shift in the evening yourself, while under supervision. This is a huge step up in terms of responsibility, and even though you are well-supported through this, it’s stressful.

I’m thinking about this again at the moment because I’m half way through third year now, and starting to think about applying for jobs, and I’m realising that there’s going to be another seismic shift, when I become totally accountable for my own practice. Every time one of our tutors or midwives on placement reminds us “not long now, you’ll be in the navy blue soon…” we all groan in horror. It shouldn’t be so scary, but we’re all very aware that soon we will have the lives of women and children in our hands.

I don’t know how I got through second year, my home life suffered, my family walked every step of the way with me. I’m stronger now, without a doubt, but I do wonder about the cost. I hope that the experience of becoming a qualified Registered Midwife won’t be too traumatic, and am actively seeking a job in a Trust that prioritises induction and preceptorship, so that I can feel supported through this huge transition.

The death of Savita

You may have seen in the news recently the story about Savita Halappanavar, an Indian woman living in Galway, in Ireland, who died in Galway University Hospital after being admitted with back pain, in the middle of miscarrying her baby.

I’ve spoken to a few of my close Irish friends, and we are all angry. Furious. How can it be possible that a woman has been treated this way in a developed country? We all suspect that the Catholic Church still has more influence over our lives than we would like, we know that they have too much control over education, and over the legislation proposed by government. Now it appears that their influence penetrates much deeper into the health services than we knew. We assumed that doctors were acting with the best interests of the women they were caring for at heart.

However, it now seems that the iniquitous lies of the pro-life brigade have done their work, and undermined the ethical code of our doctors, who have put the life of a dying fetus ahead of the life of its mother. This illogical attitude is characteristic of the latest campaigns coming out of pro-life in the US, where the latest fallacy is that abortion is never medically necessary to save the life of the mother, that it is not a therapeutic treatment in any circumstance.

If this makes you angry, it should. Women shouldn’t be treated as second-class citizens, breeders, worthless containers for their valuable fetuses. Whatever your views on abortion, there should be have been no hesitation in this case, where the fetus could not have survived the cervix being fully dilated.

Our thoughts go out to Savita’s husband and family, and the huge loss they have suffered. May she rest in peace.

 

My Ghana Elective – soulsearching and culture shock…

After spending a month in Takoradi with Work the World, I wanted to share some personal reflections on my experience, in the hope of helping other student midwives considering a placement in Ghana. Before I do that, I would like to thank the Iolanthe Midwifery Trust, who made my journey possible, through a generous grant. The Trust is an amazing organisation that is committed to supporting student midwives who want to challenge and stretch themselves, worth a look at their website if you are considering an overseas elective: http://www.iolanthe.org

I spent two weeks in Effia-Nkwanta, a large regional hospital which was also a referral centre, and two weeks in Jemima Hospital, a smaller private maternity hospital, allowing me to see different aspects of healthcare provision in Ghana, and to explore both in quite a bit of detail.

The first thing to emphasise, is that much of the midwifery practice you will see in Ghana will be very similar to that in the UK or any other developed country. The differences lie partly in cultural attitudes to birth, pain, bereavement, and death, and partly in the greatly reduced resources available, mainly translating into vastly reduced numbers of midwives. The other noticeable difference is the lack of evidence-based care, and adherence to models of care dating back to the ‘50s, familiar to fans of ‘Call the Midwife’.  Most of the commonly used midwifery drugs are available, along with clean needles/syringes and gloves, handwashing facilities and soap (but not towels). There is a decent theatre at the hospital for cesarean sections, and the doctors are extremely well-trained and up-to-date.

The antenatal care in Ghana is very similar to that provided in the UK, although there is much less time for each appointment. Similar infectious disease and blood group testing is done in early pregnancy, a very brief history is taken from the woman, malaria prophylaxis, ferrous sulphate, vitamin B complex, multivitamins and high-dose folic acid are routinely given all the way through pregnancy.  I would advise starting out on your first day in antenatal clinic, as this is a very familiar setting, and routine, except for the huge numbers of women being seen very fast! You may start out doing 40 or 50 blood pressures, and then graduate to SFH measurement, palpation and auscultation with Pinard. It’s great fun, and you can learn some basic Fante very quickly in this setting, due to the constant repetition.

Intrapartum care is a more challenging environment, as the practice varies more from the UK, and the cultural norms are completely removed from our comfort zone. I found that in my first week on labour ward I experienced culture shock, partly from seeing midwifery practices I considered outdated, but also from seeing the conditions in which the women labour and birth their babies, in an open ward with little or no privacy. The experience of culture shock is very personal, in my case, I had one shift where I felt completely dislocated, and unable to understand the attitudes of the Ghanaian midwives, or of the women they were caring for. It was an overwhelming experience, and I was so relieved when that shift ended. I spent the next couple of days wondering why on earth I had come to Ghana, and what I had hoped to learn! By my second week, I made it my mission to learn more about the whole maternity unit, and spent some time each on Antenatal Ward, Postnatal Ward, NICU and Antenatal Clinic. My way of coping if I don’t understand something is to research the hell out of it! I read the women’s histories, the ward record books, looked at maternal mortality statistics, and discussed midwifery practice with the senior obstetric consultant. During that period of reflection, I found myself asking: What does my practice need to be here? What do I do in this situation? Can I follow NICE guidelines in these working conditions? How do I prioritise, when there are 5 women on labour ward and only one midwife apart from myself?

When I returned to Labour Ward, after reflecting on and processing my experiences of the first week, it was with an increased understanding of the health system, renewed enthusiasm, and increased respect for the Ghanaian midwives and their ways of working in very difficult circumstances, with humour and efficiency. After much soulsearching, I came to understand better the dilemmas that the midwives were facing, and some of the reasons they were practicing in the way they were. I came up with answers that worked for me, and began to confidently discuss care plans with the midwives, often suggesting increased mobility for the women in first stage, and change of position in second stage. One of my priorities was to prevent routine episiotomy for primips, and I was successful in this regard in the 2 weeks I worked at Jemima Hospital. I delivered one primip on hands and knees, with an intact perineum, and the midwife who observed me declared herself to be so impressed she was going to try it herself!

I loved my time in Ghana, I felt that I both lost my way and then found it again, and in the meantime discovered myself as a midwife, completely reviewed every aspect of my practice and why it was important, and gained massively in confidence in my own midwifery skills and practice.  I am going into my third year with a completely different mindset, ready to take on the world! I would recommend Ghana as a midwifery placement to anybody who wants to be challenged and learn more about themselves, as well as have an opportunity to visit this amazing country.

 

International Day of the Midwife

Community Midwifery Education Program (Photo credit: Canada in Afghanistan / Canada en Afghanistan)

I couldn’t let today pass without posting to mark it. I spent some time today logged into the Virtual International Day of the Midwife Conference, it has been amazing, with an incredible variety of presenters, and subjects from all over the world.

The midwife who left me lost for words was Leah Kavere Amadi, who works for UNFPA in South Sudan, on working in war-torn post-conflict societies. Her discussion of the difficulties faced when trying to look after birthing women in these environments was very moving. Imagine training a healthcare assistant for months, so she  can help you in dealing with an emergency, or assist labouring women while you are delivering, only to have her disappear one day, because of the continuing conflict. Her presentation was calm and focused on helping people to understand the role of the midwife in countries where there is not only unimaginable poverty, but also the destruction of much of the existing healthcare infrastructure, and ongoing conflict that moves from place to place.

Her priority in the middle of this was to transfer her skills to the local nurse/midwives who are still delivering the majority of women, with the aim of reducing morbidity and mortality.

Her total commitment to her cause was striking, and made me reflect on my own commitment to midwifery. I would love to follow in Leah’s footsteps one day, and work in Africa, providing mentorship and training to local midwives, in some ways it seems like the most important work any of us can do, ensuring that our midwifery skills survive, and that the women we are caring for now and in the future do too.

Iolanthe Midwifery Trust

I have just heard that I have been successful in my application to the Iolanthe Midwifery Trust for a grant of £1,000 to help in covering the costs of my elective placement in Ghana later this year! I was absolutely thrilled to get the news, and would like to thank the Trust for the support they are giving me, I will do my best to make the most out of my elective, and pass my learning on to my colleagues.

As part of the grant, I will be writing a piece, possibly for publication in MIDIRS or Essence, about maternal mortality in Ghana, reflecting on my time spent with woman in the country. This will be later on in the year, but I will keep you posted.

Midwifery books and equipment – what to buy?

You don’t need to buy lots of stuff before you start the course, I know it’s fun to prepare a bit, you need a minimum of stationery, don’t buy midwifery books unless you have lots of spare cash to throw around. All these books are in the library where you can take them out for free and renew them online or over the phone up to five times, before returning them and taking them out again. You can get a lot of midwifery books second-hand on Ebay, if you really want to buy them, it doesn’t matter if it’s not the latest edition, for something like Mayes or Myles, it’s really background reading.

The only possible exception to this is Anatomy and Physiology, it’s quite good to own at least one of these, maybe two. If you learn by highlighting and underlining, the library won’t like you doing it in their books!! My personal preference is for Ross and Wilson, which is an A&P book aimed at nurses, it has full colour diagrams, which really helps, (I’m a visual learner!) and it’s in just the right amount of detail for a degree. However, it doesn’t give you the detail you need on reproductive systems, menstrual cycle, pregnancy, labour and birth, for all of that, you need just one book, Stables and Rankin. (Links for the books are below). The only other book which is really essential (to read, not to own), is Johnson and Taylor, and it will be your bible for placement, as it contains all the details of all the practical skills you will be learning there, including abdominal palpation, testing urine, taking blood, vaginal exams, and countless others.

There will be lots of reading lists given to you by your lecturers, but they don’t expect you to read everything, never mind buy it all! As for midwifery equipment, the only thing I would try to get for free in your first week from the Royal College of Midwives is a Pinard. Don’t buy anything, you just won’t need it, when you are in hospital the equipment is all there, when you are on community, your midwife has a bag stuffed full of everything you will need.

I know it’s tempting to splurge, but save your hard-earned cash, you are probably going to need it down the line, it’s tough being a student!

http://www.amazon.co.uk/Wilson-Anatomy-Physiology-Health-Illness/dp/0443101019

http://www.amazon.co.uk/Physiology-Childbearing-Anatomy-Related-Biosciences/dp/0702044768/ref=sr_1_1?s=books&ie=UTF8&qid=1332705806&sr=1-1

http://www.amazon.co.uk/Skills-Midwifery-Practice-procedures-Self-assessment/dp/0702044806/ref=sr_1_1?s=books&ie=UTF8&qid=1332705834&sr=1-1