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!
Tampilkan postingan dengan label booking appointment. Tampilkan semua postingan
Tampilkan postingan dengan label booking appointment. Tampilkan semua postingan
Selasa, 04 Oktober 2011
Selasa, 28 September 2010
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!
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!
Rabu, 08 September 2010
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!
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!
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