Baby Loss Awareness Week

Today is the beginning of Baby Loss Awareness Week and tonight many women all over the world will be lighting candles to join in the Wave of Light, myself included. Will you join in?

Some time ago my friend Marie offered to write a guest post for me about baby loss and I didn't hesitate to accept. As often happens, life got busy and in the way, so it took some time to organise. However, both of us agreed that this week was the perfect timing and I think you'll agree that Marie offers some valuable advice to both students and qualified midwives alike. Thank you Marie x

How has this past week been for you? Has it been a normal week? Perhaps you were working long shifts in your local hospital, or you were on placement in the community. Maybe you were studying, or if you’re lucky you’ve been having a well-earned break.

I don’t know what all of you were doing, but I do know that about 120 of you last week were supporting someone who had lost a child to stillbirth or neonatal loss. And I know that 120 of you will be faced with doing this next week.

And then the same the week after.

And then the one after that.

Because as you may or may not already know, on average 17 babies older than 24 weeks’ gestation die every day in the UK, before or shortly after birth. As a midwife you absolutely will be dealing with these situations one day, repeatedly in most cases.

This week wasn’t a particularly out of the ordinary week, although you may well have seen more publicity about baby loss awareness recently. The campaign, for which I’m not a spokesperson may I say, brings together four UK charities that if you’re not aware of you could do worse than to have a read about: The Miscarriage Association, The Ectopic Pregnancy Trust, Antenatal Results and Choices, and Sands, the Stillbirth and neonatal death association.

Each of them publish guidelines and leaflets for health professionals as well as for those who are affected directly and indirectly by pregnancy and neonatal loss. Each of them offer support both for those affected and for you as healthcare professionals. I’ll even make it easy for you and link to some here, here and here.

Why do I care? Why should you care? And who am I anyway?

I’m Marie. I’m a 30-something mum from Essex, who wears either a personnel or photographer job hat depending on what day you find me – I’m certainly not in healthcare. I like cats and chocolate, but I try not to mix the two. I drive a little too fast sometimes, I bite my nails when I’m tired or bored, and I wish that Gok Wan made clothes for the shorter fatter people in society. My son died two years ago, before birth. I’m one of the women you might have met, or will meet one day.

So, when it’s ‘your’ week, what kind of midwife will you be for any of those 120 women, just like me?

Will you be the midwife who told me to ‘know my place’ in my first lost pregnancy, when I sat on the bed before she’d asked me to? Will you be the midwife who, in an open reception full of other pregnant women, asked me what SANDs did and what had happened, and didn’t know what the SANDs sticker on my notes meant? Will you be the midwife who assured me I would not be placed next to a labouring woman after my son died, but then couldn’t understand why I was traumatised when they did exactly that? Will you be the midwife who drew the curtains around my bed in HDU rather than have to watch me cry? Will you be the midwife who, after the scan to confirm my son had died, told me all about her children and large family? Will you be the midwife who dismissed my tears and told me off for raising my blood pressure without offering support to me?

And if you’re not a midwife, but you’re another healthcare professional, will you be the one who ignored my requests for pain medication and told me to keep the noise down so I didn’t upset others when I was labouring with my late miscarriage? Will you be the one who chatted about Christmas at the end of my bed instead of getting me the bedpan I had asked for? Will you be the one who refused to admit me, bleeding heavily and screaming, to ER until my husband had filled out forms?

Will you be the amazing midwife sonographer who supported me through multiple pregnancy losses and successful pregnancies, made time to talk in the waiting room, minimised the delay and wait for scans, and provided tissues when it was all too much? Will you be the comforting midwife who always made time to listen and explain when I didn’t understand the printout from the DAU during my exhausting last pregnancy and just COULDN’T leave the hospital before I knew whether my son was okay? Will you be the caring midwife who understood why I was distraught that I had been assigned to be seen by a junior instead of my consultant at a key stage in my subsequent pregnancy, and arranged a better appointment for me? Will you be the home-visit midwife who held me while I cried when she visited me to check my blood pressure after my son died, and made special trips to come and see me, taking her time to sign me off until she was sure that I could get through a day? Will you be the labour midwife who stayed by my side during my entire 7 hour labour with the boy who would never cry, open his eyes, or smile, helped my husband dress him, and took his precious pictures and handprints? Will you be one of the midwives who visited my other son in NICU when he arrived early and I was in recovery, taking personal delight in sharing a happy end to my story?

This week, as a midwife or a healthcare professional looking after pregnant women you cannot choose not to deal with these situations, in the same way that I and my fellow women have no choice but to endure them. You can, however, choose how to deal with them, and how you are remembered afterwards. What will you choose?

For some stats on Baby Loss watch this.

For more information click here.

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!

Family matters...

This post is not so much about me as a student midwife but about me as a person, about my family. I've already told you all about losing my brother after all. I know I've mentioned my sister but I don't expect I've told you much about her and her family. This is all heading somewhere but I just feel that the background is vital....there is no point me telling you the ending without you knowing what came first and I believe that the whole story plays a part in where we are today. It's a part of what makes me who I am. It's a part of what makes up the relationship that my sister and I have today.

My sister is 5 years older than me. As a child I idolised her, I wanted to be just like her. I don't really know why...she wasn't very nice to me - I was her nuisance baby sister. Our mum used to occasionally dress us the same - not a problem for me but I am sure it was pretty embarrassing for her. She wasn't really mean to me but she'd want to sit and read her books and I wanted her to play with me so she'd often tell me to go away and leave her alone. If she wanted to play however, she'd make out she was doing me a big favour and sit and play with my flower fairies and my little ponies with me. We used to share a room until I was 10 and she was 15, and we moved house. We had bunk beds and we both wanted to sleep on the top bunk so she'd tell me to stay awake and maybe she'd let me sleep on the top bunk. I am sure I was often asleep when she came up but I can certainly remember the occasions when I managed to stay awake and she wouldn't swap.

However for me, her halo slipped when she was 17. She had a new boyfriend and we didn't see much of her. When she was at home she'd be in her room, when she wasn't in her room, she was a typical teen and all you'd get was hormones. Then all of a sudden she left home. My parents were out one day and my sister was "in charge" of me and my brother. She left a note for my mum with me and she left. As it turned out, the note was to tell my parents that she was off to live with her boyfriend and she wasn't coming back. My parents were devastated as you can imagine. I was only 12 but I can remember a lot of hushed conversations at home. One day at school, one of the girls asked me if my sister was pregnant which I denied. When I told my mum however, it turned out to be true. There followed discussions with my sister and her boyfriend and his parents and eventually it was decided that they were going to get married, and they were both going to move back in with us. My sister's halo didn't slip because she left home, it didn't slip because she was pregnant, it slipped because she upset my parents so badly.

I recall it being around this time that I was allowed to get my ears pierced whereas my sister wasn't allowed until she was 16. My sister moaned for years about this fact - she didn't realise that in part it was because of her I was allowed mine done early. I don't know what I did, but my mum told me I was a big help to her at that time. Anyway my sister married her boyfriend and shortly before she turned 18 she became a mum. I have loved being an Auntie ever since and I was honoured to become her baby girls godmother. My sister and her husband moved into their own place and a couple of years later had a little boy. Life got better and they managed to buy their own house and 5 years later had another baby girl. I was so proud of them. They hadn't made the best choices but they'd pulled their socks up, worked hard and made a life and a home for themselves. I used to visit my sister weekly at that time, her youngest daughter just a baby. We used to go shopping a lot.  Life went on....there were ups and downs but generally life was good, life was "normal", life was uneventful - oh wasn't that nice! Then followed a catalogue of events that sometimes blurs in which order it all happened. It's the part of our lives that we sometimes think people wouldn't believe. However I am going to focus on the events directly involving my sister and her family, although it was around the same time as my brother falling ill and me getting married.

My eldest niece was 13. My sister and her husband had separated and although we were all initially shocked, it certainly seemed to be the best decision. Then came the bombshell. My niece confided in a friend at school. Her father had been sexually abusing her. Our lives changed in an instant, although of course, hers had changed some time before when it had all begun.

There is so much more to say that it is simply too much for one post alone so I shall tell the next part of the tale next time....

Time off and Paris!

Firstly apologies for the lack of posts recently but well I've been enjoying my time off from Uni and studying. I'm now preparing for 2nd year and expecting the coming year to be a lot tougher. During my time off I've enjoyed seeing friends who I've not seen for a while and just catching up. I've been to visit a school friend, whom I hadn't seen since before the birth of my three year old and who now has a baby of her own. And I spent a weekend in Paris with some of my photography group friends.

I am lucky because I have amazing friends who not only 100% believe in me and support me but also appreciate that sometimes they might not see me for ages - partly due to the course but also sometimes the family things that I have going on. It never really seems to matter, whenever we meet up it's like we only saw each other the week before. Isn't that the beauty of true friendship though!

Anyway my weekend in Paris....well first I ought to explain our group I guess. Some time ago a member of a forum I belong to, decided to begin a Photo A Day project and invited anyone who wanted to join her to a group on Flickr. The aim was to have a record of their year by taking a photo, of whatever they wanted, every day and uploading it to the group to share. Every year new members join, from all around the world, and the level of ability doesn't matter because it's a record for you not for anyone else. That said, most people find they just get better at taking photos because we learn from each other. There are various photo a day groups on Flickr but none so supportive as ours I think.

Two years ago some of us took a trip to London, stayed up all night to take pictures of our capital at night time. I learnt a lot about my camera that night and quite a lot about London too. I now have a framed photo of London Bridge at night on my wall and I would never have thought I could have taken that good a photo before.

I repeated the experience with some different members the following year and it was following this trip that the idea of Paris was first suggested, by a fellow member of the group, Marie, that we organise a trip to Paris to take photos and get together. Along the way the idea was also suggested that we not only get together in Paris but that we also Rock The Frock...if this is a phrase you are not familiar with then let me explain. Have you ever had a gorgeous dress that you would just love to have some photos of you in? Perhaps a wedding or prom dress that you don't think you'll get the chance to wear again....and now imagine having those photos taken on the steps of the Montmartre! Some of the girls on the trip to Paris well and truly rocked their frocks!

Of course you don't have to go all the way to Paris but it was definitely an amazing experience and one I would love to repeat somewhere else, perhaps Rome, perhaps Glasgow, perhaps Australia...oh how I dream. 

I am fully aware that this post is nothing to do with Midwifery and being a student....but one thing I will say, you need to have time out. Something you can dip in and out of, that doesn't add any extra pressure to your already burdened shoulders...find a nice balance. 

Tagged!

I've been tagged on Twitter by @naomiwinters_  to answer a few questions! I do like a challenge so here we go! I have been tagged to complete the sentences below and to tag 5 fellow bloggers who I would like to see do the same.

I am.....thinking about my brother today. Today should be his birthday....he would have been 37 and that feels very strange. In case you haven't read some of my other posts but I lost my brother almost 5 years ago to a brain tumour. When I meet new people and they ask if I have brothers or sisters, I hesitate. I don't want to not mention him, but I know the reaction I'll get when I say I have a brother that died. Anyway today I spent the day with my Mum, Dad and sister - we had lunch and enjoyed spending the time together. We certainly didn't sit around and cry or get sad, he wouldn't have wanted that, he didn't like a fuss.

The bravest thing I have ever done is.... taken antidepressants. Or potentially I guess it was the first trip to the doctors to admit I was struggling with life. Depression is a very lonely experience and for me it felt ridiculous that I could be depressed. I was a coper, I was an optimist, things didn't get me down so how could it be that I was depressed. However the reality was that I thought my family would be better off without me - not that I was suicidal, but that I shouldn't be in their lives as I was clearly bad luck and they'd be better off with someone else. Looking back I can see how ridiculous that was, but at the time I completely believed it. I was lucky that I had good friends who helped me to see that I needed some help; they encouraged me to approach my doctors for advice which thankfully I did. It takes a far braver person to admit they need help, than to do something on your own, in my humble opinion.

I feel prettiest when.... well now I don't have great self confidence in my looks. I don't think I'm pretty. However I guess I felt at my prettiest on my wedding day and my husband always tells me I look beautiful; whilst I don't believe him, I appreciate he believes it and that means far more than anything to me.

Something that keeps me up at night is.....well it doesn't take much to keep me up at night because I am a night owl and a bit of an insomniac. It's far harder to get me up in the morning. Whenever I am worried I do tend to suffer more with the insomnia.

My favourite meal is.....my Mum's roast lamb with all the trimmings followed by rhubarb or apple crumble with custard....and that has to be runny custard not the thick stuff you can stand a spoon up in.

The way to my heart is....through being a genuine, honest, kind and big hearted person.

I would like to be.....a Midwife but I guess you knew that.

So five bloggers I'd like to see join in are
https://copperhobnob.wordpress.com/

http://generationwhynot-stupidgirl.blogspot.com/

http://www.totallylaurasummers.com/

http://snipsnaphappy.blogspot.com/

http://www.bushbb.com/

I look forward to reading yours!

Oh and here is a link to Naomi's
http://www.naomiwinters.com/?p=34

Nightmares

One more week on placement, one more assignment result to come in and almost one year's training completed. The last year certainly seems to have flown by all of a sudden, although it didn't feel that fast whilst it was happening.....definitely felt slow when I was writing assignments.

This past week I have been spending my time with a Health Visitor and some of the other staff that work in the Children's Centre. The staff are lovely and have tried hard to fill my week with a number of different activities so that I get to see plenty. However it has been an unusually quiet week and I haven't seen much at all. It's also quite unusual for me to have nothing to do, as it's an observational placement. I've found it really difficult to sit back and not do anything and well I'm not very good at keeping my mouth shut.

Over my time at various groups with my own children, and time spent on parenting forums, I had heard a variety of stories, both good and bad, about Health Visitors. Stories of poor advice, outdated advice, fantastic support, reassurance, pushiness, unrealistic advice amongst other things. I could probably write a book of stories I have heard about health visitors. Personally I have only had the misfortune of one poor experience with a Health Visitor, all the rest have been fantastic. So whilst this doesn't really relate to my Midwifery training, I thought I'd share my experience. I'd been to see her about my daughter's nightmares, desperate for any advice I could get and she told me it was a bad habit. My jaw literally dropped and I was almost speechless. My husband "encouraged" me out of the room fairly quickly as he could sense my temper was rising. My daughter is now 5 and still suffers from nightmares, although she is far better than she was. At the time I approached the Health Visitor, she was having 3-4 nightmares a night and it would take 30-50 minutes to calm her down each time. She'd wake shaking with fear, sweating and her eyes would dart around the room looking for whatever horror it was that had scared her. Yet this was a "habit"? A year later, some educational psychologists happened to visit the school and I took the opportunity to ask their opinion on nightmares. They were very reassuring and calm, and explained how it was quite normal at her age, and that I should expect it to pass within a couple of months. They then asked me how long she'd suffered with them? My reply was "at least 2 years" and it was their turn to have their jaws drop.

I've always been fairly confident of the reason behind her nightmares - she has a very active imagination. She could make up stories and worlds of her own from a very young age. She would carry around her imaginary friends of spiders and monsters....and it was my feeling that in actual fact, it was spiders and monsters that she was afraid of.  At 5, she still has one nightmare a night most nights....very occasionally she'll sleep through the whole night. We've tried keeping a diary, reducing her cheese intake, giving her a nightlight and a variety of other things suggested to us. She's always had a good bedtime routine of bath or quiet time, story and then bed. Nothing has really made any difference to whether or not she has a nightmare. These days I may not be able to completely stop the nightmares but when she does wake from the one that she has, I "give" to her a good dream, which somehow seems to work. I live in hope that one day she will outgrow them but for now I will just be there for her to comfort her, and never will I consider it a habit she has to break.

I guess my experience with this particular Health Visitor has taught me,  to always think about what I am saying, that if I don't know the answer to something, that it is ok to say so and that making assumptions is bad enough without voicing them as well.

Life in clinic

Since last week I have been working in antenatal clinic. It's a completely different experience in so many ways to what I have already done. Every day there are clinics run by the consultants, who may or may not be in attendance. I am well aware that it doesn't sound right that someone can be booked for a consultants appointment and for the consultant to not actually be there....so let me explain.

I had heard of the terms SHO, Registrar and Consultant but had absolutely no idea how it related to seniority....although I assumed that the Consultant was the most senior position. I assume that I am not the only person to have found it a little confusing as to who is who.

So an SHO is a Senior House Officer. This is a junior doctor who is undergoing training within a specialised area, supervised by the consultants and the registrars.

A Registrar is commonly called the Reg for short, and is a doctor who is undergoing advanced training in a specialised area in order to become a Consultant.

And finally the Consultant is the senior doctor who has completed all training in a specialist field and is deemed to be an expert in their area.

So if you are booked into the antenatal clinic for a Consultant appointment, it may very well be that it's not the consultant you will see. However rest assured, for if the SHO or Reg decide that the Consultant needs to be involved in any decision making, then they will not hesitate to bring him into the room.

So anyway being in clinic is very different from my community placement where we'd run clinics. The midwife there is autonomous and makes decisions regarding care herself, though of course, if she has any concerns, she would send the woman in to the hospital - whether it would be to see a consultant, or fetal assessment unit, or maternity assessment unit, or triage - it is the midwife that makes the decision. In antenatal clinic, it is very much the doctor that makes the decisions. Mostly I have been taking blood pressures and testing urine, and on some days I have also been palpating to check the position of the baby, and measuring the fundal height (the height of the uterus which gives an indication to the growth of the baby when compared with previous measurements) and listening in to the baby's heartbeat.  This has given me the opportunity to practise my basic skills and improve on them.

However I have also had the opportunity to listen and learn about care of more high risk women. The women coming into clinic are all coming for very different reasons - previous Caesarean Sections, bleeding in pregnancy, thyroid problems, sickle cell trait in the family, previous stillbirth, high blood pressure, recurrent urine infections and the list could go on and on. As you can imagine there are varying degrees of severity, which is why for some women, seeing the SHO is perfectly suitable and for others, seeing the Consultant is essential. It's not a case of special treatment, it's merely a case of medical requirement. You have to remember that in order to become a doctor, the SHO has already undertaken years of training. So if it turns out that when you thought you were seeing a Consultant, and you actually saw a Junior Doctor, it doesn't mean you are any less special, it just means that your care for the moment, is not as high risk as it may be for some others. And just to flip the coin, if you did see the Consultant, it may not be that you are extremely high risk, merely that he had already seen his highest risk patients and was now seeing anyone else waiting for their appointment. Confused? Yep I was too......after nearly two weeks there, I think I am just about getting to grips with it all.

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. 

I am brave

Today I had a conversation with a fellow blogger StupidGirl about how brave it is to follow your dreams, prompted by her latest blog post. Many people I know think I am brave to enter the world of Midwifery but I don't think I am brave as I am just following my dreams of what I have always wanted to do.

However it took quite a lot of courage to tell people that I wanted to be a midwife. I worried a lot about what others would think and expected a negative reaction. As a result when I was younger and still at school, I didn't actually tell anyone it was what I wanted to do and I certainly didn't have the courage to actually apply. Then as an adult, it still took a bit of courage and a long time thinking about it before I would even voice the thought aloud. I can remember not long after my second daughter was born, talking to my Mum and voicing the thought aloud for the first time. I was worried that people would think it was post-birth euphoria speaking rather than anything else so if I dared to mention it I'd automatically declare I was waiting at least a year before acting on my hopes.

Every time I spoke to someone else about hoping to be a midwife, I'd wait for that negative reaction and it never did come. I got lots of positive responses in fact, and still do. Many friends and family have said to me that I will make a fantastic midwife. It would take more courage for me to say "I am going to be a fantastic midwife" than for me to take blood, or help to deliver a baby.

What was a brave step, was actually thinking to myself 'it's my life and I'm going to make the most of it, I'm going to follow my dreams'. And that is a brave step for anyone, whatever they are looking to do. For most of us, following our dreams, means some kind of sacrifice somewhere else in our lives. For me I am sacrificing my time with my daughters. I once said, I wouldn't work where I had to struggle to organise childcare in the school holidays or if my children were ill. So instead I have chosen a profession with possibly the most antisocial hours you can get. Why? What changed? Is it that my children are no longer my priority? Well it helps that they are no longer babies and require less of me now; but I have the belief that if I have to go to work and leave my girls, then I don't want to be resentful that I am having to work somewhere I hate, rather than be with them. I want to be working somewhere I enjoy the work, that gives me purpose. For me, that is Midwifery. I will be giving my daughters less time yes, but a much more fulfilled Mum. I believe in this way I will actually give them more, than I would by staying at home with them.

This is absolutely not a dig at any stay at home Mum's before anyone thinks it is. I was a stay at home Mum for 4 years and it's hard work. If my husband hadn't lost his job, I wouldn't have applied to Midwifery until both the girls were at school. My eldest is at school now and it won't be long until the youngest starts Nursery but it's meant a lot to me that my husband has been the stay at home parent for them. He has been a constant for them, in a time when a lot has changed in their lives. I know I would have wobbled far more about applying without his presence at home. (and that's not a judgement on working mother's either)

If you've dreamt about working in a particular area, then just think about it a little more. We only get one life and our working lives are long - far too long to spend doing something you hate. Just take a look at what you'd need to do to follow your dreams? Do you need to do a course? Can you study in the evenings? Just see if it's possible...even if you do nothing about it for now. Be brave and take a step....dip your toe....dare to dream...

What kind of midwife do I want to be?

All of the posts about breastfeeding, discussions with friends about breastfeeding and then listening to qualified midwives talk about breastfeeding got me to thinking about what kind of midwife I want to be. I don't have these grand illusions that I can get every woman breastfeeding their babies. I don't think I can change the world after all. So what can I do? What kind of difference can I make?

Well this is my dream....I want to support those women that do want to breastfeed. I want to help them have skin to skin with their babies, to breastfeed as soon as possible after the birth of their babies. I want to make sure that women know where and how to access support should they want and/or need it. I want to provide women with accurate information, without ramming it down their throats. Then following this, I hope that gradually more and more woman have a positive breastfeeding experience, and that this drip feeds to more and more women, that breastfeeding can be easy and enjoyable. That breastfeeding becomes commonplace to be seen everywhere and that women can learn by example, just like women used to do.

I also want to ensure women know about their choices for birth - whether that is where to give birth, what position to give birth in or whether it is how to still feel in control should they need a Caesarean delivery. I want to be able to support women in their choices without cynicism. Of course, I also want to be able to know what to do in the event of an emergency, or when things don't go to plan. And when things don't go to plan, I still want to be able to support women in their choices. I want to be able to help women know what their choices are. I want them to still be able to have a positive birth experience knowing everything possible was done.

I have no doubt that some people think my dreams are daft, that I am aiming too high. But if I can support one woman, help one woman to feel that I made a difference, then it's a start. I am writing this in the hope that I don't forget my dreams; that I remember what is in important to me and that I try and keep to it as much as I can. I'll aim for making a tiny difference and hope that I succeed.

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.

Assessment, Assignments and Exams

I have now had half of my results for the year, thankfully all passed, and it's got me thinking about the different ways in which we are tested. Before even getting into University we all had to pass a Maths and English test and it has felt a bit like we've been constantly tested since then. So I thought I'd tell you all a bit more about the tests that we've had to do and how I have "survived" them.

Academic Skills - 2000 word assignment.
I enjoyed this assignment in some ways and in other ways it frustrated me. The assignment was, depending on our prior experience, teaching/reminding us how to write an essay and how to source references. We also had sessions on how to do Harvard Referencing  and four activities designed to help us so that by the time we came to actually write our assignment we'd done most of the work already. For the assignment itself we had to summarise our chosen article and then write about how we it links to our future role. Finally we had to talk about the academic skills we had learnt in the process. I enjoyed it from the perspective that I actually enjoy writing essays and I enjoy doing further reading. I felt frustrated because I was limited by it in so many ways. I would have enjoyed exploring the focal point of my article some more but it wasn't what the assignment was for. That said I am thoroughly enjoying researching my psycho-social assignment which is my next one due in.

Practice Assessment Document (PAD)
I have made reference to this book before. This is the book we carry everywhere with us on placement. For each placement that we do we have key areas that we have to achieve e.g. supporting women to breastfeed in challenging circumstances, recognise the onset of labour, be the initial port of contact for pregnant women, competently provide information regarding screening etc... You'll have to excuse me a little here as my book is currently with my personal tutor so I have had to rely on my memory and I couldn't recall exactly how they were written. When I first got my book and I looked through everything that we had to get signed off, it felt so overwhelming. Once on placement it almost felt even more overwhelming. The opportunity to get anything looked at let alone signed off, felt very remote. However I soon learnt you had to find the right balance of forceful, respectful and keen. However it is important to note that the balance can be different for everyone that you work with. I certainly found it far easier to get my book signed once I was into the Community part of my placement. Anyway for each section of our PAD we have to have at least one formative assessment before the summative assessment is done and a mark awarded. The mark given definitely depends on who you are working with, not just your ability and it seems that our mentors were every bit as confused as us; however in their defence it is a fairly new way of doing it so they are still learning too.

Exam - Biological Basis of Health.
A 2 hour exam consisting of 25 multiple choice questions, a midwifery specific diagram and 4 midwifery specific short answer questions. Now I am the first to admit that Biology is not my strong point. When I was at school and was choosing my options (is that showing my age or do they still call it that?) I could choose whatever I wanted. I wanted to do a science but knew it wasn't my strong point so I went to my teachers in turn to ask their advice. They each advised me not to take their subject......and this was a grammar school. looking back I think that says more about the teachers than it does me but hey that was then and this is now. So having said that I do sometimes wonder whether I was really that bad or more that I wasn't good enough. Either way it has left me with this feeling that I am no good at science. Having said that I think I have a good enough understanding of where things are in my body, and how the reproductive system works, and there are certain parts of our lectures I have found easier than others. Anyway to cut a long story short, I studied hard for my exam. Of all my assessments, exams are what I dread the most.

Other students have often asked how I revise and I can only tell you what I do and say that it works for me. During lectures I take extensive notes even if they tell me it's going to be put up on our portal system. Following the lectures, I head to the library and type up my notes (not always immediately before anyone thinks I am a complete geek, I actually tend to do big chunks at a time) and when I reach a part that I've written that I don't understand I can reach for a book and read up some more so that I do understand it. I may include flow charts so that I can see that x leads to y and so on and so forth. I won't say it leads to me remembering it all but it does help and it does mean I understand it better.

Drugs Calculation Test
We had two weeks in which we had to log in and answer 20 drugs calculation questions. We were allowed to use a calculator and perform the test wherever we liked, although they did request that we did it on our own. In the two weeks preceding we could access practice tests so that we could get used to the format and the kinds of questions we'd be asked. We did have to get 100% to pass but in all honesty, would you want me to be correct with drugs calculations anything less than 100%? I wasn't nervous about the test; I hadn't had any problems with the practice questions after all. I guess the only thing I was worried about was making a silly mistake or misreading the question. It would be too difficult to misread mg as mcg or similar. Thankfully I passed first time but I was surprised by how nervous I was when I was doing it.

So what's left for this year? My next task is my Psycho-Social assignment, then my Values assignment and then my PAD for my second placement this year. Oh and I almost forgot, we have a poster presentation as part of our Psycho-Social this Friday; although it's not graded.

My advice to current students and future students is plan early! For us, we were given all our assignment details early, so I started to think about them early. I have had to plan my study time around my children and family commitments. When we had only one lecture in a day, I didn't go home, I went to the library. This gave me time to rewrite parts I wasn't happy with. It also gave me time to look through the assessment criteria and see if I had covered all I needed to. With my revision notes for the Biology exam, starting early meant I was re-covering things rather than learning things for the first time.

Attitude and Stereotypes

Today we had a lecture about attitude and stereotypes and it really made me think about myself and the kind of person I am. I tend to think I don't conform to the norm and like to be a bit different. However as a female who is more than "cuddly" I certainly think I conform to the traditional image of a midwife. When my eldest daughter was born, I did tend to dress her in pink clothing; though it has to be said, I partially did that so that people would know she was a girl and this continued as she hadn't much hair until she was 2 years old.

In personality I think I am fairly atypical of female traits. I am sensitive, cry easily and wear my heart on my sleeve. I have a tendency to react first and think later - this can be both a benefit and a fault of course. In general I think I have a "good attitude". I mostly look on the positive side of life and am an optimist. However at other times I have a definite tendency towards a negative, pessimistic attitude. My self-confidence is not great and people don't always know this about me as I put on a face to hide it so I would say that is the more negative side of my personality. However when it comes to situations and life in general I am fairly optimistic. I also tend to try and turn situations around and find the positives in them where I can. I also like to think that I always try to see the best in everyone. This is probably because I don't believe that anyone is all bad and that circumstance, upbringing, finances etc. all contribute to who we are; not to forget that everyone is entitled to a bad day.

When I consider my home life I think I am a little less stereotypical. I have a house husband for example - that's definitely not stereotypical. My husband is responsible for the majority of the childcare, the cooking, the washing, and  the housework. My husband is not the type of man to be concerned with how people view him though.  I had however been a stay at home Mum for 4 years before I started the course. I don't think that is unusual, although it's not unusual for women to return to work either. Perhaps slightly more unusual is the fact that I used cloth nappies and a sling which which to carry them. Whilst these are growing in popularity, they are still the more unusual option.

When I was at school Take That were around for the first time and many of my friends were really into them. Me - nope I didn't like them at all! I was into Guns n' Roses and Pink Floyd. I liked to wear Doctor Martens and a leather jacket. So although I wasn't the stereotypical teenager in some ways, I was still conforming to an image of what a Guns n' Roses fan should look like. Not quite so much of an individual after all. These days I listen to what I like and if it's in the charts then great because they'll be playing it on the radio.

So what benefit is this to me in my training as a midwife? I don't fit into a "box". I am not stereotypical because no-one really is. Everyone is unique and an individual and as such the care provided to them needs to be tailored individually as well. As a midwife being able to see the good in everyone should only advantage me I think? Understanding that attitude can be affected by others is essential as well. If I am positive with a woman, in both my language and demeanour, then that can transfer to her and help her to be more positive too. It's important not to be judgemental as a midwife but we all make snap judgements on a daily basis. We make assumptions about what people are like based on their clothes, their appearance, their job. This shouldn't impact on how I look after women. I am most definitely not a saint or an angel, as midwives are sometimes portrayed,  but I do try my best to treat people equally already.

The miracle of birth

Love is...., originally uploaded by stephalie1977.

When I was in my late teens and early twenties I was terrified of falling pregnant. It wasn't that I was scared of pregnancy but I certainly wasn't ready to be a Mum. The other thing that terrified me was the thought of having to tell my Mum that I was pregnant, knowing I wasn't ready nor old enough.

When I was 28, married and felt very ready to have a baby; it was still a nerve wracking experience telling my Mum that I was pregnant. She was of course thrilled to hear she was going to be a Grandma again (she already had three (and a half) grandchildren at that time). For me it was quite a scary experience....I almost felt like I was saying "Hey Mum, I've been having sex". The second time I fell pregnant was a far more enjoyable experience.

I've already told you about my friends sad experiences of loss but I've not mentioned the friends I have that struggle to fall pregnant in the first place. Couples with no fertility problems at all can find it hard to fall pregnant. Why? There are a variety of reasons.

One egg is released each month and sperm have only a limited life span. Also a woman's uterus is not very welcoming to sperm...in fact it downright does all it can to make the sperm fail. Also when a man ejaculates, some of the sperm he releases are defective and the number of "good" sperm varies from man to man.

So the very first barrier is timing intercourse correctly for the release of the egg; then there is the hurdle for the sperm to reach the egg; then there has to be a good quality sperm able to infiltrate the egg and fertilize it and then just when you think you are on the home straight....you have to hope that the egg then implants and not only that but that it implants in the right place.

So you can see that pregnancy truly is a miracle even when everything is working correctly. As young girls you prevent against pregnancy but then one day we hope, dream, live for new life. It becomes an all consuming thought and you are hyper aware where you see babies and pregnant women everywhere. At the base of it all you hope that your body won't fail you. Of course not every woman feels such strong urges about becoming a mother but I certainly know plenty of women that do and it is how I felt.

Of course there are women who seem to fall pregnant at the drop of a hat, that only have to look at their partner and they are pregnant....if you've had fertility problems, you'll have heard these phrases before. And then there are the anecdotes "ooh I knew someone who'd been trying for a baby for 5 years, was just about to start IVF and she fell pregnant naturally". Or the useful advice "you just need to relax and stop thinking about it". Of course this follows the "so when are you going to start a family then?" from the second you get married. The thing is people mean well but it hurts. So if you ever find yourself in the situation that you might say something like this.....don't! Bite your tongue and don't.

I confess I don't know much about infertility treatment but it is an area I am interested in and I hope to spend some time at a fertility clinic during my transition period in University.

To all those friends that I have that do have fertility difficulties, I hope that someday soon your dreams come true and the miracle of pregnancy blesses you.

Towards the end of placement now

I shall soon be going back into Uni, sitting my first exam, submitting my first assignment and doing a drugs calculation test. It already feels like I've come a long way since May and whilst I still have a long way to go, I am pleased with what I have already learnt. I've really enjoyed being able to apply some of the things we learnt in University to placement and I can definitely say some things were a lot easier to understand when we applied them to real women.

So what have I learnt so far? I've learnt about the importance of using the correct professional terminology in the notes....apparently writing "sore boobs" is not professional and yes I did do that. When pointed out to me, I was actually quite embarrassed but hey I'm here to learn after all. The other errors I made were a lot less embarrassing - thrombocytopaenia instead of low platelets is not obvious after all.

I have learnt that feeling for the top of the uterus is harder than it seems and that muscle can confuse me. Also it's important not to assume that just because the measurement doesn't appear to fit with gestation length, doesn't mean I have measured wrong. You can also move the uterus to fit what you want it to and it's obviously important not to do this. Holding the measuring tape quite tight can also affect the measurement and it seemed that I did that frequently. Women's pubic bones are at different heights and it's important to make sure you do measure from it and some women's are harder to feel than others. It's also quite surprising how many women go commando.

I feel I have also learnt how to manage my time better when talking to women. My first booking appointments I'd  let women and their partners talk away but my more recent booking appointments I have been more confident to take control and move the appointment along when needed. It's important to recognised when women need to talk but it's also important to recognise when it's not necessary so to speak. Goodness knows I have the gift of the gab and can talk all day long....just ask anyone who knows me; but a community midwife has to manage her time effectively in order to fit all the appointments in.

That some days I feel quite confident and that I know what I am doing and other days I feel like my brain fell out overnight and I haven't got a clue. So on the Thursday, I "ran" the clinic. I was confidently palpating, writing notes, checking urine and blood pressures and then on Monday at clinic, I felt like I fumbled my way through, guessing rather than knowing and being very grateful that my mentor was there to confirm or correct my findings. I was assured it is quite normal to have days like this though.

I have found that many women are interested in me as a student and are very happy to be a part of their care. Before I started I wondered whether I would have anyone who would object to me being there but so far that hasn't been the case. The feedback I have been given from women and their partners has been very positive and  I have been wished luck for my future from many of them. As part of my Placement Assessment Document I have to get feedback from two women and I found it quite hard to ask but both were really happy to do it for me, and gave me lovely feedback.

I have learnt the value of continuity and how much of a difference it can make to my learning and my confidence. I always knew that I'd work with a lot people when I came out on placement, I planned to make myself as useful and as amenable as possible but I completely underestimated how much it would affect me. I never thought I would get upset so early on in my training. In some ways, I think it's been an important learning curve for me and I hope that with my future placements I will know how to manage whilst working with a variety of mentors. On the other hand, I do believe that it's a common issue for student midwives and can make it harder to learn how to do things. It's certainly feedback I will take back to university but I am sure it's something they have heard time and time before.

I have also learnt how much pressure I put on myself and that my own high standards can serve to upset me if I don't reach them. When I think how embarrassed I was about writing "sore boobs" instead of breast tenderness, I also need to remember how much I have learnt. After all if my mentor is happy to come and go from the room whilst I do bookings, then she must be happy with how I am doing and confident in my abilities and therefore I shouldn't beat myself  up quite so much when I make a mistake. Certainly none of the mistakes I've made have been life threatening after all.

And alongside all of this I have improved upon my clinical skills. I am now confident at taking women's blood pressures. I am no longer at a complete loss when I palpate a woman and am currently working out the baby's position correctly. I have even begun to feel for level of engagement and starting to feel that I can tell the difference. I am able to read the urine dipsticks confidently now, whereas initially I was sometimes unsure whether there was a green tinge on some of the squares or not. I am much more confident on how to locate the heartbeat and tell the difference to maternal heartbeat, and whether or not it is through the cord I can hear it.

So I have just one more week in placement and as I will be working with a different community midwife this week, my mentor completed my summative assessments and as a result gave me my final grade for the placement. I am thrilled to have passed my first placement and to now be able to enjoy my final week, seeing how another midwife works, without the pressure of getting my book signed.

Running the clinic

On Thursday of last week we had a bit of time before the clinic began so my mentor and I sat and went through my book that I have to get signed off during my time on placement. We sat and talked about what we'd already covered and what I already knew and looked at what I didn't know. It really made me think about what we do and why and made me feel good about the things I had learnt along the way.

So my mentor then told me she was going to let me "run" the clinic. Of course she wasn't going anywhere but whereas previously she'd do the writing and most of the talking, whilst I did the urinalysis, blood pressure and we both did the palpation, this time I was going to do the lot and she'd check my palpations intermittently...particularly those that were worried about the size of their baby or had babies in awkward positions previously.

We saw around 20 women and had barely a break in between. I find I work better when it is like this - it seems to solidify my learning so much more. I think I got almost every palpation correct and I felt like I was getting to grips with measuring the height of the bump too. It really made a difference as to how I came across to the women as well I think as I am sure they can pick up when I am more uncertain about things.
For more information about what happens at antenatal clinic, you might find it useful to look at my previous post Antenatal Clinic.

Another part of being a Community Midwife is the postnatal visits to new Mums in their homes. There are three guaranteed visits that all women get. The first visit is the day after the woman and baby get home from the hospital. Around day five we visit to perform the heel prick test on the newborn and if the baby is breastfed we also weigh the baby. The final visit is usually on day ten where we discharge the woman to the Health Visitors care. Women are covered by maternity care until day twenty eight but most women won't require this. It may also be that women get more than the three visits during those first ten days but it does depend on what their needs are. For example, a lady who has just had a third baby and is comfortable with all she is doing, recovering well may well not need anymore visits. Whereas a first time Mum who is getting to grips with breastfeeding and recovering from a section would benefit from more visits. And it's not as simple as saying well she's a third time Mum she won't need us, because she might, so it's looked at from an individual basis.

We ask the woman about her bleeding and how she is feeling in general. The reason for this is because sometimes after giving birth there can be retained products - parts of placenta or membranes. The uterus may expel them naturally but the last thing we want is for the woman to get an infection. If the Mum has increased bleeding combined with a temperature then we'd be palpating the uterus to check it's contracting down as expected. If the uterus is "spongy" then it's an indication that something could be going on and we'd send the Mum and baby back into the hospital to be checked over. Sometimes women have heavier bleeding if they've been more active, or just after they have been breastfeeding or also when she gets up after a long period of lying still so heavier bleeding on it's own is not an indication of anything to worry about. Similarly it's quite normal to have a temperature when the milk comes in so it's vital to look at the whole picture.

We also ask the women about their toilet habits....yes Midwives are obsessed with wee and poo! The reason for asking is quite simple. The bladder, uterus and bowel are all very close together and the bladder can be damaged and lead to urine retention. It is common for many women not to have a bowel movement until day 4 or 5 but we ask about it because women can be very nervous about it, particularly if they have stitches. So it provides the opportunity to reassure them. Also we want to avoid women becoming constipated and so we can talk about ways to avoid this.

We also ask whether or not their breasts are comfortable whether or not they are breastfeeding. This is because almost every woman will have milk come in regardless of whether they choose to breastfeed or not. This gives breastfeeding mothers to talk about any concerns they may have about position and latch, frequency of feeding and so on. We can also talk to bottle feeding mothers about how to cope with the pain and the engorgement as quickly as possible. We also like to ensure that women are eating, drinking and sleeping  - well sleeping as well as they can considering they have a newborn. The body needs food, water and rest in order to produce milk but also the women need the opportunity to recover from the birth.

We ask about how the women are feeling emotionally. We can reassure women that it's normal for emotions to be all over the place after giving birth but we also want to be aware of any women who might be at risk of postnatal depression. Postnatal women are at risk of deep vein thrombosis so we ask if they have any pains in their legs and this is particularly important with women who have had a Cesarean section. We also make sure that women are aware of their postnatal exercises.

Of course we also check the baby over. We look at their temperature, frequency of feeding, whether or not the cord has come off yet, how their nappies are and how frequently they are needing changing, and we also look at their skin. Newborn babies often have very dry skin which is normal but we can advise women on what to do to prevent it becoming sore, cracked and potentially infected. We recommend olive oil as it's a natural substance and won't harm a baby's delicate skin. The other thing we have to look out for is any bruising or fingertip marks. I am thankful that this is not something I have seen.

So what does it all mean?

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

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

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

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.

And into Community I go....

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

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

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

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

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

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

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