17th December 2018 was the very first day I worked as a Midwife. It also marks the first day I was in full time employment, had to pay taxes and start adulting. Two years later and I am still working on the ‘adulting’, still a long way to go…
A few days ago, it was my two-year work anniversary. I spent the day working on a busy labour ward (as you do). When I got home, I began to reflect on all the things I have learnt in these two years. Many midwives have said to me that Midwifery is a ‘learn on the job’ vocation and I could not agree more!
Even this past week, I have come across things I could never even imagine. I have learnt the importance of differential diagnosis, especially in pregnancy. I have revised how to facilitate a water birth; I have learnt how to draw up drugs I would always shy away from. Every day of being a midwife is a lesson, I learn what I did well, would do again and I learn what I would change about my practice.
Recently I came across a diary I started keeping back when I was a student midwife, it was very humbling and took me right back to a time where I had little knowledge and understanding of pregnancy and birth.
This is an account of my first day at placement. My placement was with a midwifery team. I had only lived in London six weeks at this point and was still finding my bearings. For this placement I remember taking two tubes and a train and then a walk! I had no idea where I was, and I owe it to City-mapper (not an ad/sponsored) for navigating me around this strange (not so friendly) city. To arrange my first day as a student midwife, I had to contact a specific midwife who would then send me the location to meet. The night before I went over my journey and the best time to leave my accommodation with leeway as I was rubbish with directions back then (and still am today).
I arrived at the surgery where I waited for approximately 20 minutes, a woman did ask if I was here to see the midwife, but I presumed she meant to see the midwife as in for a check-up, so I said no.
I remember wondering if I looked pregnant, I know I was a little bit chubby but surely not pregnant…
Another woman then walked out of the room, I told her I was here to start my placement and she told me to come with her. I entered the room where I was greeted by two other ladies, one of them I had previously spoken to. I then sat down, and the midwife called A gave me a short introduction on what goes on, I told her I wanted to observe first before getting stuck into any actual practical clinical work.
I was so afraid of doing anything remotely clinical,
The midwife was phoning up mothers to remind them that they have appointments, she did not disclose all on the phone, at this point she told me it is good to have discretion in communication, especially over the phone as sometimes not everyone will know the woman is pregnant. A while later, a woman came in for her antenatal check-up. She was overdue, she looked tired and had already spoken to the team as the night before she was getting frequent pains. The midwives had advised her to take a warm bath and some paracetamol to relax. The midwife said this was important as it takes the strain off a little if you are relaxed rather than when you are jumpy.
A warm bath and paracetamol are still my go-to today!
The woman had already taken a urine test which was all fine, the midwife then took her blood pressure electronically, and this was also fine. The woman then lay on the bed for the midwife to do an abdominal examination, the woman let out a slight cry as the midwifes hands were very cold, the midwife then rubbed her hands against the woman’s hands to create a familiarity and relax the woman.
This was the first time I witnessed how touch can be so powerful! This midwife was ‘with woman’ in every entity! I soon learnt to caution women before I went ahead to do an abdominal palpation. “Now my hands might be a little cold at first…”
The midwife first measured the fundal height, and then felt around for the head and back and bum, the woman measured 39cm, all was normal.
Those I look after are still mesmerised by how I can figure out where their babies head or bum is. I love going through this with them!
The woman wanted a membrane sweep but according to protocol this could not be done today so she was booked in for another appointment for a few days later. I found the practice of this midwife to be effective, at one point I thought that she may have scared the woman a little however she apologised for this to erase any anxiety from the woman’s head. She had told her what could happen if there were complications during labour. The woman was adamant to have a normal birth with just gas and air in a special room, the midwife assured the woman if the rooms were available, she could birth in these special rooms.
At this point I was not aware of what these ‘special rooms’ were. Turns out they were midwifery led rooms with a pool and a pretty picture on the wall. They really were beautiful rooms; I remember facilitating several births in these rooms.
I was then given information on documentation; the women have a special book just for themselves which contains all their notes. Another expectant mother then arrived, I sat in on this appointment. she was a soon to be young parent early on in her second trimester. Midwife L was leading this appointment, another midwife was trying to find the patients notes but failed to, the patient herself was well prepared. I found that the midwife leading the appointment was very quiet and could have communicated a little more with the patient. The midwife went through all her notes and then manually took her blood pressure, she was unable to take a urine sample. She went on to do an abdominal examination and listened to the baby’s heartbeat. The midwife explained that it may take a while to find the baby’s heart rate so early on in pregnancy. Everything seemed normal and the girl was booked in for her next appointment.
I was then told about a woman who failed to show up to previous appointments, they mentioned there were domestic violence issues and were quite worried. I was then sent with one of the midwives to the woman’s address. She had been quite rude when previously contacted. We got to her flat, but she was not in and the midwife left a note through her letter box but was careful not to disclose too much information. When the other midwife (back at the clinic) was informed about the note said it should have been added that social services may be contacted if she failed to communicate with the midwives. I personally thought this was not the best way to approach an expectant mother as it may well scare her away and there was also the issue of patient confidentiality.
I was so surprised by this. Prior to Midwifery I had been an A-Level student and I guess I was oblivious to domestic violence and the involvement of social services. I had learnt that Midwifery was so much more than what I expected! It is so interesting to slip back into the shoes of a fresh student midwife and try to understand how I perceived what I saw! I was an 18-year-old with little life experience or understanding of a world outside of my small Northern town!
After this I was told to do some independent study as the clinical hours were over. I was told to go over abdominal examinations as I may get the chance to carry it out on my next placement day.
I remember this! I had no idea where I was or how I could get back to my accommodation. It took me a while to realise I was waiting for a train on the wrong platform.
From my first day I have taken a lot away, I know for definite that I have chosen the right career pathway for myself as I could see myself as one of the midwives. I also learnt that all midwives have a different way of doing things, but they do all reach the same goal. I understand the importance of patient confidentiality and how there are always several issues that we need to think about, also it is not good to take rash decisions when in a difficult situation. Also, I realise that it is vital to make the woman feel as relaxed as possible.
Aims from today would be to study how to do abdominal examinations and why they are important, as well as this do some more studying on urine and blood pressure.
Aside from the obvious poor grammar I loved reading this! Five years ago, Midwifery was a world that was alien to me. Reading back, I have been able to see it all through fresh eyes (no pun intended)! It has taken me back to a time when I was an outsider and on that first day of placement, I witnessed just a glimpse of what Midwifery entails. Reflection is super important regardless of what profession you are in. Writing helps me and truth be told I have not reflected in writing in a long time. Finding my placement diary has given me the excuse to get back to it. I love how I have been able to relive past experiences, it is nostalgic and if anything reinforces my passion for midwifery. My thoughts and opinions were so raw and unfiltered. If someone had told me on my first day of placement that I would be cannulating and running IV lines or examining someone in a pool or even just having the courage to bleep a doctor to review a patient I would have laughed. A lot. And not believed them.
Sometimes I can be too self-critical and doubt and question my actions, whilst this can be healthy in moderation, it can also be damaging. I am learning every day and I cannot believe the skills I have developed…
As humans we should reflect on how far we have come and appreciate that we have learnt so much and we continue to make mistakes and learn! For anyone reading this, think back to your first day at school or university or placement or at your job and if you cannot think of three skills you have developed or learned I will be surprised! We often become so wound up in what we have not done, that we forget all that we have done…