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
- 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).
- 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).
- 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).
- 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).