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!

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!

Passion and fear

This week I have witnessed two ventouse deliveries - this is where a suction cap is attached to the baby's head and as the woman pushes, the doctor pulls which helps the baby to be delivered. There are various reasons why a ventouse delivery might be deemed necessary - maternal exhaustion, prolonged 2nd stage (the pushing stage), fetal distress, amongst others.

Of the two ventouse births I witnessed, one was due to slow progress in the 2nd stage and the other was due to fetal distress. I can't really share too much information about the deliveries themselves due to confidentiality but in the event of the fetal distress, my heart was in my mouth and I felt very emotional when the baby was safely delivered. I'd helped to care for the couple all shift and learnt quite a lot about their journey so far, and therefore I found it mattered a lot to me, my part in their story. I was really pleased to be able to see them again the next day. 

I now have 5 deliveries to my name, three of which you already know about in my last post Not one but three. I've been lucky to work with a brilliant team and I feel like I have learnt loads in just the last week. Four out of my five deliveries were in the semi-recumbent position but the fifth (actually fourth but this could get confusing) was on all fours.....it was brilliant to get my head round exactly where I was putting my hands, and to have a different perspective - however I have got to say....it's far messier. My final delivery of the week was lovely and controlled and as a first baby, my mentor had loads of time to point things out to me as the baby progressed. 

This week I am onto day shift and I think I will experience very different shifts to the night ones - there will be far more postnatal checks that need to be done than there are in the night time but there are also generally more staff. It will be really interesting to see the difference though of course I am hoping for a couple more deliveries and moving towards becoming more autonomous. I shall be investing in a book where I can keep a record of all my own deliveries as I am sure I will want to look back on them all one day. 

One thing that has struck me this week is the value of good support. I have been told how lucky I am to be able to witness birth and I agree I am lucky. However I am also lucky to witness the amazing roller coaster of emotions during labour and the special bond between the woman and her birth partner.  I have seen the love, the fear, the hope and the excitement all in the eyes of the birth partner as well as the woman. With the couple whose baby was in fetal distress, I witnessed the pure joy on the face of the mother, that the time had arrived to meet her baby, which was contradicted by the absolute fear in her partner's face as he could see the slowing heart beat and the number of people suddenly in the room. Not for one moment did he let his wife know just how worried we all were, but he continued to support her, to encourage her and be by her side the whole time. And then once the baby was born, I continued to watch that amazing bond between them, the continued joy and amazement on her face, and the relief and joy on his. You tell me I am lucky - I wholeheartedly agree and  no matter how lucky you think I am, I know I am 20 times more lucky than that. 

Not one but three!

I made my way to the hospital last night feeling quite excited about the prospect of getting my first catch. I met with mentor and she asked where I was at with my training and I was quick to tell her that I'd made all my witnesses and was itching to get my first delivery. Funnily enough she also wanted to know about what else I'd done. 

We began the shift with a very quiet ward. We made sure the rooms were equipped, checked equipment, tidied up....found things to do. We soon had a couple come in from triage, whom we settled into a room and did the necessary checks that needed to be done, before encouraging the woman to mobilise. She was very comfortable so other than the regular checks on baby's heartbeat and how Mum was coping, we left them to it. When she was next checked, she'd not really progressed so my mentor broke her waters and her contractions soon became more intense so I began to spend longer with her to help her cope.  The next couple of  hours passed fairly quickly and my lady was having some early urges to push, so I spent a long time helping her to breathe through the pains instead. After a short while, it was apparent that she was really struggling not to push, so we encouraged her to use some pain relief, so she opted to use the entonox

At 5.00 my mentor returned from her break early, and told me to go to another room quickly. So I dashed off guessing that it meant a delivery was imminent. Sure enough, I entered the room and could already see the head beginning to appear. I quickly gloved up and put an apron on. Supported by the midwife, I caught my first ever delivery of a baby boy at 5.05.  I checked over the placenta with the midwife, cleaned myself up and then returned to my lady who following a dose a pethidine, was dozing between contractions. After a short while, she was still pushing with the contractions, so I popped out to see if my mentor had returned, as I knew she was due another examination shortly. At which point I was hurried into another delivery room, to quickly glove up and catch my second delivery. The lady was very controlled and very quickly delivered a baby girl at 5.25. Again I checked over the placenta with the midwife, and got cleaned up before returning to my lady. 

On my return to her, I felt that she was now really struggling to breathe through the pains and she just sounded like birth might be imminent. So I popped out to check on the whereabouts of my mentor, who'd got caught on the phone and reported what I'd observed. She returned to the room with me, ready to perform a vaginal examination to check how she was doing. At which point, we discovered there was no need to perform an examination, as we could see the head beginning to appear. Unlike the other two deliveries, this was a first baby so we could expect the second stage to take a bit longer. The lady was very well controlled and pushed really well, so that in actual fact, the baby was delivered within 10 minutes of us being able to see the head. So at 6.15 I had my third delivery, this time another baby boy. As with before, we checked over the placenta but this time I didn't need to rush off anywhere else. 

Of the three, the one that obviously meant the most, was the couple I'd been supporting throughout my shift. I got a much better experience of the progress, signs to watch out for and how to encourage and support women. When I finally sat down, I had a complete head rush and needed 5 minutes just to gather my thoughts a bit. It was a complete adrenaline rush and with three more nights to go...I am feeling slightly tired at the thought if they are to be like last night. However I loved it! I am hoping tonight that I get to have the journey of support through labour, as well as the delivery again. And perhaps slightly less running from room to room....and maybe even a break at some point. 

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.

A week at Uni

I began the week feeling very nervous about my exam. I was glad to have no lectures on the Monday so I could spend the whole day studying. My husband dropped me off at the library straight after we dropped our eldest off at school and I got straight down to work. The first thing I decided to do was my drugs calculation test; as I wasn't concerned about it, I thought I'd get it out of the way. I was more nervous doing it, than  I expected to be so I made sure to take my time, read every question twice and double checked each answer. Thankfully I passed it first time so I could then forget about it.

Tuesday we had a full day of lectures and meetings which none of us really wanted, as we'd rather have been preparing for the exam. In fact there were quite a few empty chairs. We began the day with a cohort meeting although it was meant to be a skills lecture, we ended up switching the two around. The cohort meeting gave us an opportunity to raise any issues that had come up over placement, problems we'd come up against and also to celebrate our successes. It seems that the difficulties were things that had come up time and time before. There were quite a few girls that had had problems having their books signed off - that their mentors would repeatedly put it off, and then it would be too late. There also seemed to be a huge variation in the marks we'd been given. There is a mark guide and we'd been advised to explain that the mark scheme was based on us as first years and therefore we'd possibly need to push for higher marks if we felt we deserved it. Unfortunately some mentors would mark us as first years assuming the marking criteria would remain the same over the three years and wouldn't listen to any opinion given by the student. It certainly made me realise how lucky I had been with my mentor and how I'd been marked for my placement.

There was also some discussion about the attitude towards students from some of the midwives. It's very obvious those that are happy to work with students and those that aren't. Simply put it is an essential part of their job but like any job I guess, everyone has parts they don't want to do....doesn't make it easy for us as students however. We talked quite a lot about the different ways we had handled it and hopefully it will help us for our future placements.

We then had our skills lecture, personal tutor group meeting and finally a psycho-social lecture. It would have been far better to have had the psycho-social lecture at the beginning of the day as many people left by the end of the day, and I found it hard to concentrate by that point. Once we'd finished for the day I went straight to the library to squeeze in some final study for the exam. I must confess it wasn't very successful as I was very tired by then.

So Wednesday came and the nerves were fluttering. We were due to have a lecture for Values at 9 but I confess I skipped it in favour of some more last minute study. At 12 I made my way over to the room along with some of my colleagues. The exam was two hours long and afterwards there was the typical postmortem. I found it much harder than I'd expected in some parts and other parts were ok. I simply hope I have done enough to pass it!

The next couple of days were far nicer without the exam hanging over us, though we'll all be grateful in about 6 weeks when we get the results. We're already thinking ahead to our next assignment and also our next placement. And we're also beginning to think about our transition time when we can choose what we'd like to do for 3 weeks; well 100 hours. I've got a few ideas and it's a case of deciding which one to go for. Next year I think I would like to go and learn about fertility treatment and then potentially use that experience to follow through with my final dissertation.

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.

So what is that makes a good mentor?

And why is it that you hear so many horror stories? This is something that is not unique to Midwifery but also occurs in Teaching, Nursing and no doubt many other careers.

Before beginning my training I had read on forums about students being bullied by mentors, being left to do things that they shouldn't be doing alone, not being allowed to do things, struggling to get things signed off in their books, and the list goes on. I had also read a lot about fantastic mentors and how supportive they could be. So going into placement I was apprehensive about who I would be working with and especially when I thought about Community as I would be with one Midwife all the time - can you imagine how hard that would be if you didn't get on? So now I am well into placement and really enjoying working with my Community Mentor, I have been thinking about what it is that makes a good mentor.

1. Consistency. Both in who you are working with and also in how they work. When you work with someone different each time, you soon discover that everyone has their own way of doing things. It can be really good experience of course to see the different methods but it certainly doesn't help when you try to do something, and the person you are working with says "oh no that's wrong, don't do it like that" or something similar. It is also nigh on impossible to learn, if the person you are working with does it differently each time with no apparent reason, and no explanation. Also if you consistently work with the same mentor, they can see how much you improve and learn along the way which just isn't possible when you only work one shift with each person.

2. Time. It is important as a student to have the opportunity to discuss things with your mentor. So you can understand why things happened the way they did, why certain decisions were made etc. Labour is generally quite a slow process, and the actual delivery of the baby can also be slow but once the baby is born, then things are generally a little busier - decisions can be made very quickly and there isn't always the opportunity to ask questions, and of course sometimes it isn't appropriate. So in an ideal world, there would be time later on to sit down and "debrief". For the student, it is also imperative to have a chance to look at the placement books and the essential learning outcomes that need to be signed off on. Left too late and this can be a real problem. I also believe it helps the mentors as well, as then they know where to focus the students learning.

3. Friendly, approachable and supportive. Yes I know this should go without saying, particularly in a caring profession such as Midwifery but unfortunately this isn't always the case. I mean to me it's common sense, if the mentor is approachable and friendly, then the student is far more willing to try, far more confident at having a go, knowing that the midwife is there to support as needed, and therefore much more likely to say when they don't know something. It's much easier as a student, to build confidence, with someone who is supporting you, letting you try, letting you make mistakes but at the same time ensuring you aren't putting anyone at risk. It's well proven that you learn better by doing something yourself than by simply watching.

4. Recognises the student as an adult learner. Again this seems obvious but I do think some people forget this. And I am not restricting this issue to the mentors, I believe that some students forget that they are responsible for their own learning too. The mentor should treat the student as an adult, not as a pupil. And the student should not act like a child but as an adult who wants to learn - I'd also like to see this in University but I'd take a guess that you'll always get those that thing it's funny to sit in lectures looking at magazines and laughing. A bit of mutual respect goes a long way I find. The student should speak up about the things that need doing - like the placement book. It's their responsibility to ensure it is done, not the mentors, and to not leave things till the last minute. On the other hand, it is the mentor's responsibility to give the student the time when reasonably able. (and yes I know this really belongs in my time section)


5. Showing an interest. Not all mentors choose to be mentors and in many ways I don't think it's fair on either the student or the mentor for this. But it most definitely helps if the mentor is interested in being a mentor as then they are far more likely to offer the time and support to the student. It also helps the mentor and the student if the mentor knows what kind of experience the student already has - can save on a lot of repetition.

All of this is what I believe makes a good mentor and at the moment I have a fantastic mentor. I hope I get to work with her again in the future but I am going to enjoy the coming weeks with her. On the flip side I'd like to think I am a good student and that I am fulfilling my side of the relationship by acting professionally, showing willingness to learn, asking when I don't know something, being honest when I'm not sure of something so she can be confident I'm not about to do something unsafe, being on time and being friendly. A good working relationship depends on both parties playing their part after all.