A change of address

Give me a bicycle and call me a travelling midwife, because my blog has just arrived over at blogs.gre.ac.uk/studentlife, alongside all of your other favourite student bloggers.

Click here to view all my posts, old and new.

Second year is FINISHED! DONE! NO MORE!

The 2^nd year of my Midwifery training is officially complete. How on EARTH did I manage that?!

I have recently received my letter from the university, confirming my progression into the third and final year of my studies. My second year will account for 25% of my overall classification, so it is nice to have a small chunk of it out of the way. I am not entirely sure how my grade for this year is calculated, but I have done a few sums and I have achieved either a first or a high 2:1. I’ll take that!

Over the course of the last few weeks I have received around 10 results, all of varying significance. My nerves are shot, however I passed everything- so no resits needed!

The results I feel most proud of, I would say, are for my exams. My cohort sat a written exam which was probably one of the scariest things that I have ever had to do. Students two cohorts ahead retaking the paper with us didn’t help with the panic. This was for our complications course, and any 2 out of 30 possible obstetric emergencies/complications could have featured. What made it scary was that we had to write at least a thousand words on the management of each of the two topics. It was a hefty exam- definitely not one that anyone could blag.

I was hoping for Post Partum Haemorrhage- (as the management has been drilled in to me so much now despite having never managed one following a vaginal delivery), or shoulder dystocia, which I do have experience of in practice. I turned over the page to reveal my questions and the words ‘UTERINE INVERSION’ jumped out at me- I immediately freaked out. I knew the basics- but I didn’t know enough to write 3 pages about it! I was starting to feel all shaky when I told myself to keep it together, and I calmly read the other two questions (we pick two questions out of three to answer). Maternal and Fetal complications following shoulder dystocia- phew. The second question that I answered was the role of the midwife in the care of a woman experiencing a stillbirth. I left the exam feeling a bit uneasy, but secretly confident. When I learnt that I had not only passed- but passed well, I was ecstatic.

My second exam was the dreaded OSCE. This is a practical exam; again, centred on the management of obstetric emergencies. Whilst this particular format of examination is daunting- the topics were narrowed down to 5, which helped a great deal with revision. The possible scenarios included Cord Prolapse, Post Partum Haemorrhage, Vaginal Breech Delivery (not necessarily an emergency but OK), Shoulder Dystocia and Occipito-Posterior Birth (again, certainly not a stand-alone emergency).

For the entire month of June, my PROMPT (Practical Obstetric Multi-Professional Training) manual went with me wherever I went. Evening in? Prompt. 5 minute tea break on labour ward? Prompt. Bathroom? Prompt prompt prompt. With the help of the PROMPT manual I memorised and felt confident with 4/5 emergencies. However; malpresention (Occipito-posterior) doesn’t really have a set management protocol, so I REALLY didn’t want that one coming up. I’ve delivered OP babies before- many a time in fact, I just didn’t quite understand how I would structure an entire OSCE exam around it.

To my huge relief, the scenario I picked out of the hat was shoulder dystocia! I had learnt so much about this, I could feel myself going bright red with joy. I had safely facilitated the birth of the dummy baby and quoted additional evidence and medical definitions when the clock struck 13 minutes- with seven minutes to spare! I achieved a high first for that OSCE which I am over the moon about.

The results for my numerous essays were varied to say the least. I achieved both my highest ever mark and my lowest. That’s second year for you- a complete rollercoaster! I was disappointed when I received my lowest grade, however it was still a pass and I have made a point of taking on the feedback I received. Hopefully my academic writing will improve during my final year- although it will have to- it’s dissertation time!

I have a number of ideas in my head for my literature review, at the moment I am leaning towards breech birth outcomes. (Watch this space!)

For now, I can relax with second year as just a memory. The feeling of relief is immense, especially as I now have no more exams to undertake for the remainder of my degree. The OSCE had been looming over me since day one of my training- I have always felt like if I could pass that, I could truly make it and achieve my goal of becoming a registered midwife.

Now for the final chapter of my midwifery education, year 3!

Bloggie Blog

Hello! It has been a stupid amount of time since my last blog so I do apologise! I have been so busy with 2^nd year placements and assignments that this blog, along with my social life, have sadly been neglected.

I will begin with my placement on Fetal Assessment Unit (FAU). It was probably one of my favourite placements so far. It is essentially an assessment centre where women can attend if there are concerns over maternal and/or fetal wellbeing. They can self-refer or be sent up to the unit by community midwives if observations detect a deviation from normality. Cases that I came across mainly consisted of reduced fetal movements, abdominal pain, itching and high blood pressure, but you can be presented with anything and everything.

Over the course of the week I became much more confident in undertaking assessments. I needed some prompting at the start, and I was quite weary of getting anything wrong so I was always asking the midwives to check things! However, by mid-week I was starting to take more initiative. When women presented with symptoms, for the most part I could identify the associated conditions, risks and procedures. It was a lot of blood tests and CTGs! Even though I am probably the shakiest person you will ever meet, I’ve always had the knack of venepuncture. I had to take blood from most of the women I saw, so it was a great opportunity to increase my confidence. Some ladies required special measures to obtain a sample, so I learnt how to take blood using a butterfly needle and syringes which I had never done before. A definite highlight of the week was when I managed to take blood from a client who claimed no midwife had ever successfully obtained a sample, and apparently even the anaesthetists had struggled in the past! Probably a lucky shot, but I was happy all the same.

Although I was only there for a week, I developed great relationships with the midwives working there. They were friendly, approachable and extremely knowledgeable which is all you can ask for in a mentor. I was working alongside another student midwife from my cohort too, and we get along really well. It is always good to have another student on placement, you can help each other out! I even grew close with clients- some women experiencing more complex conditions attended the unit up to three times that week.

Now that I think about it, it was a week of firsts for me. I performed my first membranes sweeps, a procedure I’ve been asking mentors to let me do for ages. They can be really difficult, especially on primiparous women. Fortunately I have long fingers which certainly helps! Following one sweep, I asked a client to give me feedback and she wrote the loveliest things in my pad! I also tried my best at a couple of speculum examinations. I found it really fiddly but I’m starting to get the hang of it (especially now that I’ve had more practice in Triage placement).

I could go on for so long about how much I learnt on FAU but this blog would be 1000s of words! My next placement was on Neonatal Unit, which I had been looking forward to. It’s safe to say I’m glad I went down the path of midwifery instead of paediatrics- it just wasn’t for me. The nurses and doctors were lovely, and I am happy I was given the opportunity to see how the ‘other side’ works. However, as cute as those babies were- I prefer to be able to have a conversation with my clients!

I then had a week on triage- this was similar in ways to FAU. Many women attended reporting the same problems (aches, pains, movements) if it was the night shift as the fetal assessment unit closes in the evening. There were many women with query SROM (waters breaking) and contracting, so I got lots of vaginal examinations and speculums in. Surprisingly, I managed to get the majority of exams correct- which I was over the moon about. Except for one where I assessed someone as 4cm and they turned out to be 8. I have no idea what happened there.

Triage consisted of liasing with lots of different people- from paramedics to mental health services. A lot of the time we acted as a signpost, assessing clients and then transferring them to the appropriate ward. Women at various points in labour were often in the unit, and so much of the time my guesses of progress from outwards appearance were proved entirely wrong on internal examination. One was so close to delivering that I ended up facilitating the birth seconds after her admission to labour ward!

My latest placement was with a specialist community midwifery team who caseload clients in need of extra support. The midwives’ caseloads differed depending on their own specialism and interests, however the cases mostly comprised of women with mental health problems, teenage pregnancies, and those with social care involvement. I found this placement enlightening, and I was inspired by the commitment that the midwives had for their women. I was happy to see a model of community midwifery as it probably should be- continuous care, a named midwife, and no appointments. The specialist midwives each had their own weekly drop-in clinics, during which their clients could visit at any point in their pregnancy. They were so well supported, I know that I would love to have that standard of care for my pregnancy.

I am now very near to the end of my second year. I am in shock that I have made it this far. I am starting to see clients who I have cared for in their previous pregnancies which is so weird! I’ll find myself looking at their toddlers thinking ‘I felt you when you were in your mummy’s tummy!’

Just one week left of placement now on the ward. I have a lot of competencies to get signed off so I am feeling a bit stressed at the moment. At least I know that I will obtain a range of experiences caring for antenatal and postnatal clients on the ward, so hopefully I will be all signed off for year 2 practice in a matter of days. 

Sexual Health

I am very pleased to say that I am feeling much less stressed than I was when I wrote my last post!

The sun has come out, and Greenwich is looking absolutely beautiful with all the blossom trees blooming. I was at a wedding last weekend which was so much fun, and my student loan is finally in- it feels good to no longer be a pauper.

I am currently on my Sexual Health placement which I am LOVING. It is unbelievably interesting. I have been working with the nurses and doctors in a sexual health clinic. The team are all so friendly and they’ve taught me so much (and they give me cake which is always a bonus). I’ve witnessed check-ups, STI screens, counselling and treatment. I’m sure that this isn’t for everyone, but I love being in the lab looking at the specimens under a microscope! I now know how to find candida albicans (thrush) from a sample- lovely!

What I have found the most challenging is sitting in with the nurse as they take a history- especially with the men as I’m sure you can imagine, it’s all a bit awkward. We have to ask some really, really personal questions so I’ve found myself trying my hardest not to blush! In order to witness these appointments I do need the patients’ permission first, which I was worried about as I thought no one would want me looking at their bits! But I found that as long as I introduced myself and struck up conversation quickly they didn’t have a problem. It’s important to let them know that all information they disclose is confidential and that we aren’t judging. A few of the men have questioned why me, a student midwife, is there. I try to make a joke out of it and explain that I need an understanding of both sides- as they are involved in the baby making too!

My week hasn’t all been light-hearted banter and precautionary check-ups. I had a really interesting discussion with a clinical psychologist, who cares for people with HIV. It made me realise how far we have advanced in medicine in recent years. Years ago, HIV was seen as a death sentence; however now, for many people diagnosed, their condition is managed with medication. The psycho-social aspects of contracting HIV are so complex, and the psychologist kindly took me through how she breaks ‘the news’ to those with a positive result, and the various care pathways and services that are then offered.

I am surprised at how hands on this placement was for me- where I thought it would be mainly observational, I have still been given the chance to develop my skills in venepuncture and speculum examinations which is great!

This week has been so enjoyable that I am seriously considering specialising in sexual health after I qualify. The university offers a post-graduate certificate in sexual health, so watch this space! 

I take back what I said...

I take back what I said. 2^nd year is HORRID. I think that the first semester lulled me into a false

sense of security, as I didn’t find it as challenging as I had expected. However now that I am well and truly in semester 4, I’m so stressed I’m getting regular nose bleeds!

What I have found with this course is that everything can seem plain sailing, you’re working hard, getting good grades, you think to yourself ‘Wow! This isn’t as hard as they say!’ and then bam, something happens and everything feels a bit out of control.

My Nan passed away a few weeks ago, and it’s been a hard blow. Instead of picking myself up after a nasty night shift, I will find myself in tears, again, on the bus back home. During the final moments of a birth I was facilitating, the parents decided to play a hymn on their phone, which happened to be the single song we sung at my Nan’s funeral. That hurt a lot. You come across such raw emotion every day in midwifery, and if you feel the slightest bit vulnerable it can leave you in pieces.

I remember being so desperate to get into Midwifery that I swore to myself I would never complain about it if I ever got in, so the last thing I want to do is be negative. I am still so thankful to be here and I am determined as ever to reach my full potential. Three essays, two exams and placement to pass- the prospect sounds incredibly daunting, but the fact it will be behind me in 2 months is so comforting!

I guess what I am trying to say is that if I can get to the summer, I am sure I can do it. It’s my final week on labour ward for the year, so I really really REALLY hope that I get more deliveries as I feel like 2^nd year has been a bit of a ‘dry spell’ for me.

But- swings and roundabouts, although my deliveries have slowed a bit this year, my clinical skills including vaginal examinations are really improving, and it is those skills that I will carry with me through my career.

So all in all I’m getting there! It’s been such a struggle but I am seeing the light at the end of the tunnel, and I’ll be super happy once I’ve finished my research essay tomorrow. One hurdle at a time!

More Lectures

I am well and truly into lectures now, and I am hoping to get started on my assignments soon to get them out of the way.

A few exciting prospects have surfaced- including the opportunity to write an article with one of the senior lecturers. To be published before I have even graduated would be such a huge honour- so I will be working hard over the next few weeks to write a really decent piece.

Next week I am attending a conference on FGC (Female genital cutting, often referred to as FGM). It is a topic I am particularly passionate about so I intend to learn how the NHS and department of health intend to implement services and safeguarding measures in my region, and I will hopefully expand my knowledge on the subject in the process.

I am also getting together with a group of women who have kindly agreed to meet with me through a local division of a national bereavement charity. They will share with me their personal experiences of miscarriage, stillbirth and infant loss, in the hope for me to develop my understanding as a student midwife. I am hoping this will equip me to provide a high standard of individualised, compassionate care to the families I come across who are going through these incredibly difficult times. This experience will hopefully complement the learning I have undertaken over the past week in lectures. I have benefitted from both a theoretical lecture and a workshop on bereavement in midwifery. Although I found the lectures hard-hitting and difficult; I am grateful we have had the opportunity to learn more, as it is important to be as prepared as possible for practice.

This week I received my results for the dreaded pathophysiology exam- and by some miracle I got a high 2:1! I am ecstatic with this result as I feel I struggle with the general science element of the course. We studied pathophysiology alongside the nursing students who are much more likely to come across anaphylaxis, pneumonia or other critical conditions. I am always more confident when I’m being examined on something I have already learned about or witnessed in practice. The clientele that midwives work with are generally young healthy women going through a natural physiological process.  However- I worked hard and with my result I feel more confident in identifying symptoms in a case where a deviation from normality may indicate a medical problem.

Until next time!

Back to lectures

It’s my first week back in lectures, which I am actually really happy about. (Not that I’m a geek or anything). It is such a relief to have the pressure of placement and juggling assignments behind me for the time being. It also makes a big difference having the weekends off. The 9-5 Monday to Friday regime is great for my social life, especially as I have a lot more energy after spending 8 hours sat in lectures as opposed to 12 hours (sometimes overnight) on my feet!

My cohort has an extra course to study this semester in addition to the usual three. Not only does this mean more contact hours in university; but more assignments! What makes the workload even more intense is that some of the courses will be assessed in multiple formats; so for example, our grade for the midwifery module this term is awarded based on our practical assessment on placement, a written exam, and an OSCE examination. That’s for only one out of the four courses we are undertaking!

However, the subject matter is becoming increasingly interesting as the course goes on. This term we are heavily focussing on complications- in childbearing and in the fetus and neonate. It helps having a year and a half of practical experience behind me as I have witnessed many of the conditions I’m now learning about in theory.

I’m nervously anticipating my results from my exam and essay to come through- I desperately hope that all the hard work paid off. My final placement for semester 3 on the community was hugely successful so my overall grade for practice was my highest ever! Also my placement planner for this semester finally came through today- I am beyond excited.

My first placement is three weeks on delivery suite. This will hopefully be an opportunity to get some births in as I’ve only delivered two babies so far this year! (We need 40 births by the end of the degree). Although I have delivered 21 babies I can only count 15 for my course- as four were in Africa and two deliveries were followed by complications with the delivery of the placenta- which unfortunately means we can’t count them!

I am also scheduled for a placement in triage which I’m excited about- this will help me gain confidence in determining the onset and progression of labour. The long-awaited sexual health placement is also just round the corner which I’m sure will be fascinating. My other practical experiences lined up include Fetal Assessment Unit, for which I’m not sure what to expect, Neonatal Unit, and Best Beginnings (a midwifery team who care for women in need of extra support).

I am now over half way through my degree and the pressure is really on. Sometimes I feel completely out of my depth and at other times I surprise myself with how much I have learnt. The reality is sinking in. It’s getting serious!

Busy Me! :)

It’s been a busy couple of months for me, with two placements to complete, two essays to write and a huge exam to prepare for!

However I can see the light at the end of the tunnel, with most of my academic work for the term behind me and my last week of placement for semester 3 finally here. Next week I will once again be a ‘normal’ university student, with lectures 9-5 and weekends off!

Today I received my grades for my placement on post-natal ward. I am over the moon with the feedback my mentor gave me, its’ given me a real confidence boost!

I wasn’t looking forward to ward prior to my placement, although I’m not too sure why. I have been there occasionally when transferring ladies from delivery suite once they have had their babies- and it always seemed so hectic. However my first day working there reminded me why I love what I do.  I had learnt a lot of what I was doing when providing post natal care on the community- this was the perfect opportunity to develop my confidence. My mentor and I worked well as a team, which I feel helped the women in our bays feel like they were being given enough time. This made for a positive experience for all involved- my client’s feedback was incredibly encouraging and my hope was to be more of a help than a hindrance to my mentor.

Some women were on the ward for over a week post natally, which gave me the opportunity to develop strong client-professional relationships. I was also blessed enough to provide care for women whom I booked and cared for antenatally- meeting their babies was a fantastic experience, especially as I had known some of these families for the best part of a year.

I grew in confidence in medicines management, administered my first injections, helped give a blood transfusion, and learnt loads about the various drugs under the ‘midwives exemptions’. My documentation improved a great deal (this is something that I can struggle with in practice) and I learnt how to discharge women from the ward back home. Once I became familiar with the ward, myself and my mentor would look after a bay each- and I started to take the lead in the care of the women and their babies. After a while I began to notice how much my clients appreciated my care. I received my first bouquet of flowers and was given lots of encouraging comments. My mentor was fantastic at teaching me new things, and I quickly grew comfortable with all of the midwives on the ward- everyone was so friendly and helpful.

I am now back on the community (I have already spent 12 weeks in this area during my 1^st year) and I’m finding all that I learnt on the ward has helped me become more competent in practice, especially with post natal home visits. I am now in the final week on the community, and this is the only time I have here for year 2. Next year I will be expected to lead ante natal clinics and visit women at home on my own, so I’m using this placement to learn as much as I can and polish my practice so that I am ready for the responsibility that third year brings.

Speaking of responsibility, this week I need to find a woman (or two) to form part of my caseload. In our 2^nd and 3^rd years we are required as part of our midwifery education to take on a small caseload. We are recommended to take on between 2-4 women- and these pregnancies can spread the span of the remainder of our degree.  Ideally we shall book these ladies, then accompany them to scans, doctors’ appointments and, if they are experiencing a ‘normal’ pregnancy, act as their lead carer throughout their care.  We are then expected to be on call 24/7 whilst these ladies are at term- so between 37-42 weeks. We should then be notified by delivery suite (or by the attending midwife on call if a homebirth), and provide intra partum care (which hopefully includes delivering the baby!). We can ask any of our ladies whether they would like to be case-loaded, they could be planning a homebirth or an elective caesarean. Personally I am intending my caseload to comprise of predominantly low-risk ladies needing midwifery-led care, so that it is more likely that I can be her primary care provider throughout pregnancy, during labour and birth and post-natally.

Unfortunately, the majority of the women I am now booking on the community are due over my annual leave (and also my 21^st birthday). I have my heart set on booking the ladies I take on, so I’m hoping for a ‘late booker’ (past their first trimester), otherwise I may have to settle at asking women at their 16 week appointments. I am so nervous about taking the lead for an entire pregnancy and beyond- but I can imagine this experience is going to be incredibly rewarding. It is a huge responsibility however I will still have my mentor for support and assistance along the way.

University of Greenwich Midwifery society

I cannot believe it is 2015 already! I qualify next year… Oh my goodness.

2014 closed with an exciting month, a brand new placement setting and the launch of the University of Greenwich Midwifery society!

The midwifery society was set up to compliment the degree programme, and is a chance to expand our knowledge with student midwives from other cohorts. I was excited for the opportunity to network with midwives, doulas, and whoever else attending with a passion for midwifery and obstetrics. I had been anticipating this event for some time, with the line-up being as impressive as it was. We had the honour of world-renowned obstetrician Michel Odent heading up the launch event, as well as midwives Amanda Burleigh and Tara Pauley delivering seminars.

Amanda Burleigh spoke to us about the importance of delayed cord clamping. Those who are ‘pro’ cord clamping had a real breakthrough just last month when the latest NICE (National Institute for Clinical Excellence) guidelines recommended not clamping and cutting the cord for at least one minute after the baby is born. At delivery, the placenta still contains up to 1/3 of the baby’s blood supply, and has been associated with a lower incidence of infant anaemia. I find this image of twins below really interesting. Baby A (on the left) had immediate cord clamping and Baby B had delayed cord clamping. Look at the difference in colour!

We then had Tara Pauley, a research midwife, talk to us about her complementary therapies clinic she has recently set up at Hitchengbrooke Trust for post-dates women. As I have mentioned in a previous post, after a lecture on complementary therapies by guest speaker Denise Tirran, I was very keen to learn more. Tara and her team offer services to their maternity clients including acupuncture and aromatherapy alongside optional membrane sweep with the aim of reducing their unit’s induction rate- which they have by a fantastic 5 percent! The NMC states that ‘You must ensure that the use of complementary or alternative therapies is safe and in the best interests of those in your care’ and ‘Registrants must have successfully undertaken training and be competent to practice the administration of complementary and alternative therapies’. Becoming a qualified complementary therapist is something I am interested in upon qualifying- however evidence on its benefits are sparse and often inconclusive. It is estimated that around 80% of pregnant women are now using complementary therapies- however this is rarely disclosed or documented with midwives. Whilst complementary/alternative therapies can be advantageous, they can be very dangerous when not used correctly- this includes ‘natural remedies’ like the well-known raspberry leaf tea. It is important for women to be aware that everything has its contraindications. I was surprised by the vast amount of women using complementary therapies and felt that my knowledge base in this area was still limited. With this in mind I decided to contact Tara Pauley and arrange an observational placement in her clinic for my transition project in July. To my excitement, Hitchengbrooke trust are happy to have me and I cannot wait to work with them in the Summer!

The final speaker of the evening was Michel Odent, who is famous for introducing concepts like home-like birth environments, birthing pools, and the application of ‘gate control theory of pain’ to obstetrics. Michel Odent is known for a few controversial opinions too, such as his view that men should not be in the birthing room. Despite being a relatively new expectation of fathers, it already seems engrained into our culture. Whilst historically women have been known to labour alone or with only female companions, I am not sure I entirely agree with Odent’s statement. Unfortunately I didn’t get the chance to debate this topic with him on the night! However, the in-depth discussions on the use of water in labour, cultural conditioning and microbirth were equally fascinating.

Here are few pictures from the night- a big thank you to the amazing Midwifery Society for putting together such a fab event!