Open letter to a woman who sent me a thank you card

2cec725

Thank you so much for your thank you card. You have no idea how much it means to me. It has come at a time when I needed it most. Doubting my abilities as a midwife, doubting that I’d made the right choice in career, and doubting that I was making a difference to anyone.

You told me in the card that you were “just a number” to me but you could not be more wrong. I cared for you for 13 hours, I worried about you and I’ve thought about you a lot.

I remember very very well, almost every moment of that shift. I remember how scared you were, how scared your husband was, even before anything had really happened, you were both petrified of labour, and what it would bring. I remember you moving your leg and me noticing blood. I reassured you that it was normal, but inside, I felt uneasy. I asked for an opinion from another midwife, who called a doctor, then there was a rush as your baby was born with the help of forceps, while your husband stood outside, silently watching as people ran in and out of the room. Both of you were traumatised. I questioned everything I had done from the moments before your beautiful baby was born. I sat with a senior midwife, reviewing your notes and trying to make sense of what happened and if I’d asked for help soon enough. They told me I had (but I still felt guilty).

You made me realise that I should trust my instincts. I had a sneaky feeling that something wasn’t quite right with you, once you’d had your baby. Even though you appeared OK, I asked a doctor to see you. You very quickly (within a minute) went downhill and became very ill. We went to theatre, I stayed by your side. You told me about a million times that I could leave if I wanted (I wouldn’t/couldn’t), that you must be the most annoying woman I’d met (you weren’t).

I know you think that you don’t matter to me, but you do. Your card made me cry, a lot. I’d had a very similar experience recently, in which my care (my notes), had been questioned. You reminded me that I’m not a terrible midwife, and that most of the time, I do OK. Thank you. You’re not a number, you’re someone who has changed me.

Crisis of confidence

It was always going to happen. I knew bouncy, happy puppy time was too good to be true.

I’ve been qualified 8 months and have loved it up until the last few weeks. I was feeling ok, confident, (but not too confident) loving my colleagues, enjoying the work. Then i had a rubbish shift.

I looked after a wonderful woman, (lets call her Floella) with whom I really connected. Her and her husband were lovely, she was brilliant. A slightly gigantic PPH happened, which was fine, we dealt with it, Floella coped really well. I ended up having to stay late to clean up and complete my notes as best as I could.

My next shift I was called into the office to discuss my documentation. They told me it was dreadful, pointed out errors, omissions, just basic rubbishness. They pointed out things I’d written which they said weren’t appropriate (I like to write details to remind myself of events, in case i needed memory jogging – like women singing/dancing. Apparently, inappropriate).

The midwife going through it all was lovely but it’s still upsetting. As I left the room another midwife caught me and pointed out how bad they were (again) and told me that I’d be “torn apart” in court.

The following shift I started to get over it but then was called into a sister’s office and asked to meet with her as well. I then had to attend an ïnformal” meeting to discuss it.

The whole thing has freaked me out. I’m so nervous, I have loved this job but I feel constantly on the edge of something awful happening. I feel like I just need to write and write and write in the notes all day to make sure I don’t miss anything. I’d also like to point out that I am obsessed with reading NMC cases and am fully aware of how important documentation is. My documentation is usually something I’m proud of and am good at, maybe this is why I’m so sad.

God, I sound so whingy, but I’m just petrified all the time. I’ve even been looking into jobs outside of midwifery! I never thought that would happen.

Sorry, I promised mysef I’d never do a post like this.

How to make a new midwife cry

I had the most amazing week last week. I was dreading it which makes it even better! I was working three long days on the ward. I am not a ward midwife. At all! Our so I thought.

Day one – I came in and was allocated the antenatal ward, which I prefer to postnatal We had quite a few women being induced so we split them (just randomly) and got on with our day. One of my women arrived while I was seeing to something else and so a support worker showed her to her room, then came and found me to say that this woman was upset.

I went into the room and this lady was crying, she gave me a death stare. I asked what was wrong and she told me she didn’t want to be induced. This made my blood boil! I asked why she was being induced if she didn’t want it and she said she had to be because she had gestational diabetes and her baby would die if she didn’t. I looked at her notes. The consultant had written “GDM, well controlled by diet, for IOL at 38 weeks.” this lady was now 40 weeks pregnant so had done a great job of fighting her corner but just felt that it had been too hard to argue any more. As I may have previously mentioned, I find it really difficult when parents aren’t given options in their care and are basically forced to do things against their will. Of course, we all want the best outcomes for people but I felt that this family needed some love, rather than threats. 

I sat down with her to talk (whenever i could). She had a really set view of her birth plan. She’d got this ideal birth in her head and thought it would never be possible with induction. She said she would decline the drip (synto) so i told her I wasn’t willing to start a process she wouldn’t see through because it was more likely to cause a problem. If we were to use the pessary, then break her waters and that still didn’t get her into labour, she’d most likely end up being persuaded to have an emergency section for “failed induction”. 

Basically i chatted to her (luckily i had time), about the process, about how it’s not always dreadful, how things might or might not go etc. She agreed to go along with it but was still not happy. Then I wrote on her notes that she was willing to be induced but wanted things kept normal and as low risk as possible. (massage, low lights, quiet voices, intermittent auscultation, if possible). I’d looked after someone in labour the previous week, however, who was being induced for simply being “post dates” and really had to fight to use intermittent auscultation and being NQ I chickened out and persuaded the family that they needed to be continuously monitored (not proud :(). SO although I was trying to reasure her, I wasn’t that optimistic that things would go how she wanted. 

The following day i came in to see her gone from the board, hooray! I assumed she’d gone over that morning for her ARM. I saw her later in the day (walked to the postnatal ward to see her).

After I’d left, she’d had a few tightenings, but had drifted off to sleep. She woke up in the night feeling super intense pain and rectal pressure. She told the midwife on the ward who said she was probably still not in labour, but agreed to VE her, she was 4cm and there was room on DS so she went there. The midwife who took over there was awesome! (i need to find her and hug her – and also try and be like her when I grow up). She read everything I’d written and went with it. She even did intermittent auscultation. My lovely lady described it as “the most wonderful experience” and said that I’d made her day and her birth experience wonderful. She then text all her pregnant friends and told them that out hospital is wonderful and that the midwives are ace. Needless to say I was touched. And when I say touched I mean I had a little tear in my eye, and when I say I had a little tear in my eye, I mean I sobbed, big ploppy, sobby, losery tears all over her as I hugged her. 

Sorry about this self indulgent post. It’s just EXACTLY why I love midwifery. I want women I have a half decent experience, even if it doesn’t go how they expect. I know that a lot of it was down to her body and this wouldn’t happen for everyone but I feel that in some way, I kind of helped her a bit. (God, I’m such a big head). 

A challenging shift

I’m a massive advocate for giving women informed consent. I feel really super strongly that women are properly informed of what we’re doing and why, and that they know that they can say “No, leave me alone!” if they want to. The other day I had a shift which really challenged that ideal and freaked me right out.

I was having a lovely shift the other day, nice and relaxed, lots of time to help with breastfeeding, time to have a tea, time to write in notes! Then I was asked to see a lady (I will call her Sarah) who spoke no English and had presented to A&E. I went in and thankfully she had a lovely (female) interpreter. Basically her membranes had ruptured the night before and she was having some contractions. She was quite distressed, but still smiling. I explained that everything was sounding good and normal and that usually, at this stage we’d offer a vaginal examination or a speculum (or both). Sarah seemed agreeable to it…

Sarah refused to lie down at all (totally understandable when you’re in pain!) and didn’t want to take her underwear off. After about an hour we discussed her lying on her side so I could examine her. I thought she understood what I was planning on doing but clearly I had NOT explained it well because she screamed when I touched her. I tried to explain again and she allowed me to start examining her but not enough for me to know where she was in labour.

She kept telling me that I could continue but it was so distressing for her that I felt it was inappropriate. Because of how she was behaving (like someone in early labour) I decided to send her home, and for her to return later. She was chuffed because she said she’d feel happy at home.

A few hours later she returned. The same situation happened with the examination, however… her interpreter had gone home and she had two older ladies with her who spoke no English either. When I attempted to examine her (at her request), she again got extremely upset, but this time, was held down and shouted at by the women. They were shouting at me to continue. I stopped at this point because Sarah was screaming, crying and very upset. I just felt horrible. It was a challenge.

Because her waters had already gone over 24 hours previously, the local policy dictated that her labour be induced. It was hard to imagine how that could happen if she couldn’t even cope with a VE. I am totally up for women declining intervention but I felt with her, like she didn’t have a proper choice because she didn’t really understand what we wanted to do or why. I had to leave at that point and hand over to another midwife.

I’m not sure what happened with her yet. I will find out tomorrow, I really hope that she was able to relax and just have her baby herself without being fiddled about with. But I suspect that that wasn’t the case…

ETA – I just found out that she had an epidural and then a normal delivery a few hours later. I just hope she wasn’t too traumatised. Sometimes the fact that everyone is discharged so fast makes me sad that I can’t follow the women up, quite so much.

Being a midwife is ace

I’ve been rubbish at updating this. Really rubbish (I knew I would be). But I’ve got a day off and the little one is in nursery and I’m not just sleeping all day so feel like this is a good thing to do. 

I’m still completely loving midwifery. Just before I qualified (my last ever shift, in fact), an experienced midwife told me I was going to love being qualified. It was so refreshing, literally everyone else had told me it was going to be awful; “just expect it to be frightening, and overwhelming and horrible”. I’m so grateful to this midwife because she’s right. I do love it. It is absolutely overwhelming and frightening at times. But I feel so free.

I can make a plan with a woman and, although the team of midwives and doctors will advise me if needed, I can go with it. Having said that, for the first few shifts I worried my pants off during handover, completely petrified that I’d get given someone who was going to deliver as soon as I got into the room, or someone high risk who I just wouldn’t know how to cope with. 

I don’t know why I worried! The band 7s aren’t stupid. Why would they give me someone scary? They have been so supportive. Often giving me an option in the women I care for. On my first proper shift I was given a choice of two women. I chose the one who had some social issues but was more likely to have a nice normal delivery. It was hard work but she did it! The first baby who’s birth I facilitated was a little boy. I did call the doctor in at the last minute as the CTG went a bit scary (but now I look back on it, it was a second stage CTG). 

Image

 

The following shift I was given a lady who’d had a long latent phase of labour, she’d wanted a super low intervention, all natural birth, but she had a significantly raised BMI which meant that some of her wishes weren’t really advisable. In the end she decided to have an epidural as she was exhausted. At the point I met her, during the hand over in the room the FH was 90 BPM, for ages. The coordinator came into the room as she heard it and it picked up, we changed mum’s position and things seemed fine. However it carried on being slightly wonky so I called the doctors in. They did a fetal blood sample (FBS), which showed that the baby was coping ok, plus mum was progressing well. Carried on like this… another FBS was done which showed deterioration so they made the decision to take her to theatre, for a trial of forceps if she was fully, or a section. The Mum freaked out. This is where I felt like a proper midwife, I was trying to do all my theatre paperwork etc, plus talk to the parents. She was so scared, and requesting a general anaesthetist. I advised her on risks etc and that her partner would have to stay out of theatre etc. Then when the doctors came back I mentioned how worried she was. The doctor decided to examine her, and then decided we should stay and deliver the baby. That was a scary delivery, I felt a bit shouty, but the mum was AWESOME and the coordinator stood by my side helping me, which felt really really good.

Later that shift a lady I was caring for went to theatre for a section. As I took the baby he cried, but not very hard. I’d called the paeds because of the reason for the section (fetal distress). The paed told me he was happy with the baby after about 5 minutes and left. I wasn’t overly happy, as although he was crying and his tone was ok, it just felt wrong. I picked up the baby to weigh him and as I put him on the scales he went grey and just didn’t breathe at all. No tone, no effort at all. I was petrified! I shouted to the paed, who had only just left and he came back, we fast bleeped the reg. By the time they arrived he was breathing again and I have no clue what I did in that time (I think I did inflation breathes). By the end of my shift I was pretty much convinced that baby was going to die (he just kept getting worse all day). So I went home and cried all over my OH. Actually he was fine in the end, he was suffering as a result of a maternal condition but responded well to treatment. 

I’ve had one lovely, normal delivery this week, and one more totally different traumatic event but I might leave that for another day. It certainly tested my skills and ability to offer informed consent. YIKES. 

PS being a midwife is still ace. 

Happy bouncy puppies and MLUs

 

I’m really aware that I sound like a happy bouncy, eager puppy at the moment. I’m hoping that this diary will serve to remind me that I LOVE my job in times of stress (of which I’m sure there will be many). I’m still just a student so I’m not accountable for my actions (although obviously morally I am!). I’m sure that things will feel different once I’m qualified.

This week I’ve been working at the MLU. Its been awesome and I nearly forgot to write about it because I’ve been loving my time off with my son. I’m reminding myself to do so because I want to be this kind of midwife when I qualify. Normal normal normal please! Oh how I love you.

So, shift one, I looked after a woman in early labour. She was lush but not really establishing, so after keeping hold of her for a while (she had no transport and was frightened to go home as had laboured quickly previously), we sent her to a ward for the afternoon to mobilise and relax. I felt a bit awful because she really wanted to be there with us but it wasn’t really appropriate. She was perfect for the Midwife Led Unit (MLU). Really up for a lovely normal birth, pool, no pain relief, she’d had a previous really managed labour and was scared that we’d do things to her or force her to have intervention. I was nervous that we’d send her to the ward and then she wouldn’t be able to come back because there was no room and she’d end up on delivery suite.

Then a lovely woman arrived. She was breathing through contractions and then giggling and chatting in between. “pah, she’s not going to be established” scoffed I. “First baby? Managing amazingly? Pah. “

I examined her and she was 5cm! Harrah. She, again, wanted everything normal, wanted the pool and had a lovely extensive birth plan.

I went through and it was all standard stuff. One thing caught my eye though (remember I said I’m obsessed with managed third stages?). She’d mentioned “I would like the injection for the placenta”. I asked her about it. Telling her that the usual thing for the MLU was to wait and see what happened, if she had a normal birth, and didn’t bleed heavily to just allow her body to do it. If she started bleeding (or just wanted it) then we’d recommend the injection. I told her a bit about the side effects of syntometrine (shakes, vomiting) and she was quite shocked. She’d basically used the NHS birth plan template and used that. I decided to check it out. This is what it says about the placenta…

After your baby is born your midwife will offer you an injection in your thigh. This contains the drug syntometrine or syntocinon which helps the womb contract and can prevent the heavy bleeding that some women may experience without it.

 Grr! Why doesn’t it mention side effects? I know that this template is designed to prompt you for things you should bring up with your midwife but seriously. That information is so half bottied. It makes it sound like you really should have it or you will bleed to death. No mention that your uterus can contract without it, or that breastfeeding your baby straight after birth can help it contract. Hmm it annoys me. It would be so easy to just add a bit to that. The whole template is a little bit rubbish really. Maybe i’ll invent my own.

Anyway.  I had to do a bit of conflict resolution on this shift too. The dad text a few people to say that she was doing amazingly well and was 5cm, and a female relative of hers replied asking if she could come along and see the birth (another of my bug bares – it’s not a spectator sport!). Dad replied, “no thank you, it’s ok at the moment. We’ll call you when the baby is here”. An hour later she turned up!

The couple were such lovely people that they allowed her into the room for a while and then said maybe it would be best if she waited in the corridor. I then asked them if they wanted me to ask her to leave. They did, but they didn’t want to cause an argument so I agreed to be the bad guy. I went and told her that it could be hours until the baby was born and that it wasn’t really appropriate to be sitting in a corridor. There were other people there and that it was quite a private time for families. She argued that it would be soon as the woman was amazing. I agreed that she was amzing but that it would still be a long time. She argued that they wanted her there and I pointed out that maybe they could call her nearer to the time of birth if they wanted her and that she should rest in the mean time? She eventually agreed, I felt awful!

As we were walking out she stopped, turned to me and said “Look, i’m just so scared for her”. This rang alarm bells in my mind. I wondered if maybe she was worried about things at home, maybe there was some domestic abuse or other issues we didn’t know about. So i asked what she meant. She replied “well, childbirth is literally the most dangerous thing you can do! She might die!”.

This is quite a hard thing to reply to, especially as you’re ushering someone out of a door. I didn’t want to sound dismissive because she was clearly panicked. So I kind of reassured her, I’m not denying that birth can’t be dangerous for some people, but the risks for this lady were tiny. She was very normal, low risk, very fit and well with a healthy baby on board.  I can’t really remember what I said, it was probably mumbly and stupid, but that’s basically what I meant.

I didn’t deliver that woman’s baby, unfortunately, she was amazing in labour though and did have a nice normal pool delivery after my shift ended (10 hours after I asked the visitor to leave!).

Oofffff I love labour care!

A productive day on the ward

I nearly forgot to write in this today! I’m so disorganised. So I did a shift yesterday with a different midwife. Blimey, I feel awesome today! At the time I felt it was a good shift but now i’ve reflected on it i feel great! Like maybe I actually might be able to be some kind of midwife, maybe, at some point! (once I grow a proper brain).

So my shift started and the midwife I was working with asked to go through some of my paperwork (for once i’d actually done some – phew) (is anyone noticing how often I say phew? I am). She was happy with what i’d done. It was basically a summary of previous learnings, and what I was aiming for this semester. I’d written that I would like

  1. To carry a caseload of women each shift whom I will manage myself under indirect supervision (that is, where the midwife is around but I would see the women alone and then report my findings back to her and she just countersigns the notes I make etc).
  2. To undertake the drugs round myself with direct supervision (because drug errors are on the rise and also because serious errors can occur it is a legal requirement that students are heavily supervised when organising medication. I’m still not 100% clear on what I can and can’t give. I’m pretty sure we can give most things but IV drugs. So I would like to do the drugs round with the midwife looking over my shoulder and shouting if I am about to do anything wrong).
  3. To coordinate a shift (So, I would decide who gets which women. I would be in charge of beds, if anyone from another ward rings to ask if we have any spare beds I would work out where they should go. Etc etc).
  4. There wqas one other which i’ve forgotten.

So, she was pleased with that and we went through other things I have left to sign off, I need some postnatal checks signed off so she agreed that she’d watch me do the first (a postnatal discharge) and then would let me get on with it. Ahhhh, so empowering!

It was relatively quiet on the ward (shhhhhhhhh! Don’t say the Q word!) so we were given two bays, an antenatal bay (with two women) and a postnatal bay (also with two women). We went to see the antenatal women first because they tend to be higher risk. We had two women in with PV bleeding, one awaiting a growth scan (let’s give her a pseudonym – Marge), the other (pseudonym Mabel) awaiting a decision about her elective section (she’d had two previous emergency sections). Both were anxious for different reasons, we took their observations and spoke to them about how they were feeling.

Mabel was booked for a section for in just over a weeks time, however she had a history of severe clotting disorders and whilst waiting for the section was not on any anticoagulants, which was making her (and us!) a bit twitchy. I asked her what she would like to happen. She told me that she’d like to have the section asap as she was getting worried that something would happen (she’d had two previous placental abruptions and considering that she was currently bleeding, a possible symptom of abruption, she was scared). All the antenatal women on the ward are weighed daily (because sudden super weight gain can be a sign of PET), have a urinalysis, and regular obs (the frequency depends on their reason for admission) so we weighed them both, tested the urine and checked Mabel’s pad to confirm the level of bleeding.

There had been a suggestion that the bleeding wasn’t necessarily from her vagina. Nobody said it outright, but she had shown her pads to both midwives and doctors but whenever a speculum had been used there was nothing visible, which is unusual. I’m not saying that anyone was suggesting this but it isn’t unheard of for women to cut their finger (or other body part) and put it on a pad in order to be delivered sooner. Having checked her pad, however, I am 100% sure that it was vaginal. Happily the registrar was on the ward at the time so I went and spoke to her (thankfully she’s lovely and easy to talk to). She agreed that not being on anticoagulants was a bit of a worry so went off to think about options. In the mean time we went to see the postnatal women.

All was normal and lovely in one bed, so we discharged her (at her request) and sent her on her way. My mentor made me go through all the information myself, didn’t interrupt me once and was fab! (I heart her). I felt like a real midwife.

The other woman was slightly more difficult. Her baby had dropped to the floor as it was born (nobody’s fault – just one of those things) and the umbilical cord had snapped. Thankfully the midwife was there, scooped up the baby and held the cord tight whilst pulling the emergency buzzer so the baby shouldn’t have lost too much blood. The parents, however, were concerned (obviously!) about the fall. I went and read the notes about what had happened and realised that a paediatrician had seen the baby immediately after birth but not since. I decided to take the initiative (GULP) and rang SCBU. The nurse who answered the phone was lovely, really supportive, and really understanding that I was a student.

“Oh crumbs!” She said when I told her the story “I would bleep the on call paed and get her up.”

She gave me the bleep number, made sure I knew how to do it and I hung up. She was ace. I felt super confident so picked up the phone and bleeped the on call paed. She was grumpy! She told me she already knew about the baby, and that she’d come and see it and then hung up without saying goodbye. About five minutes later, up she came and grumped at me to get the baby. I duly did so and she grumped at me again for bringing it before she was ready. Then she grumped at the parents and then grumped at me as she left. Ho hum. I went and spoke to the father later and asked if he was happy, and if I should call anyone else. He said that he was ok with what had happened and the paed had promised to refer them for a scan the following day. I documented it anyway.

Then I came out to see the registrar who told my mentor and I that our lady would be sectioned today! Hooray! She would be so pleased! We went and told her and she was shocked and a bit scared but super happy. As we came out of the bay we saw the anaesthetist, who was there to talk to her about it (talk about efficient). He came back a few minutes later and said that because she’d just had some cake the section would be done in six hours time.

We carried on with our day, there was a NQM working who I adore. I won’t mention her name but I think she’s fab. She is lovely with the women and has been really supportive of me. We had a chat, and she was telling me how nervous she was about going down to delivery suite on her next rotation. She asked me how I was feeling about being qualified. I’d not really thought about it for a while. I think i said excited, scared, and nervous that I know nothing. She basically said

“Just know that it will be awful and scary and frightening and horrible”. Which filled me with dread. “if you go into it expecting it to be lovely then you will be disappointed – it’s scary!”.

Yaaay. This filled me with glee/dread.

Anyway, i decided to be organised, while my mentor was busy i checked that Mabel had cross matched blood on delivery suite (she didn’t). APH (bleeding in pregnancy) can be a risk factor for PPH, depending on the reason for the bleed. So i worked out how to get blood there and did it. I felt ace. Like a real midwife. My mentor was pleased that I’d taken some initiative.

When the time came to take her down to DS she was nervous. We all walked down together and handed her over, the DS coordinator grilled us, making sure we’d done everything (we had, Yay!). As we left to go back upstairs my mentor said good luck to Mabel and kissed her on the forehead. It felt weird, but also not weird. It’s the kind of thing that if i’d done it i’d have panicked for ages afterwards that I’d done something wrong…

Anyway, that was basically it for that shift. I felt good, like I might actually have been a bit of a help. Next shift is on the Midwife Led Unit (MLU), next week. I’m VERY excited about that (I love normal birth, and high risk birth, and women, and my whole entire job).