SageFeminist

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Wow so that is me three months a qualified as a midwife and it still doesn't seem real some days and on others I absolutely relish the ability to make decisions with women in my care, and support women and families postnatally and some antenatally.

I've experienced many things from a 35 week PPROM delivery, treating women with Diabetes on steroid protocols, an unplanned 32 weeker c-section on Christmas Day, and countless breastfeeding and expressing support for new mothers.
I've experienced day shifts where my caseload can range up to 8 women, and night shift where I care for half of the ward at 12/13 women. Both antenatal and postnatal, many women experiencing a variety of needs including; blood pressure profiles, control of blood sugars in gestational and insulin dependent diabetic mothers, unstable lie of fetus, PET, twin pregnancy, premature labour, PPROM, breastfeeding support, care post general anaesthetic, family bonding, alcohol detox and so many others. Each day is different.

Working in the postnatal ward is hard work, there is always challenges but the team I work with have been fantastic at settling me in. I've even had a student or two shadow me and it feels surreal that I will soon be mentoring students.

That's one thing that was always a key part of my learning journey, the ‘student-mentor relationship' and with the new first year students arriving on the wards we've experienced the different personalities and learning types of different students. I'll be writing a post on this soon. Watch this space. I'll be a post a week hopefully, and a few ad hoc when there are topics to discuss / events to review.

Call the Midwife has started up again and I find that with each episode I'm experiencing and being reminded where and how our practice has developed over history. It's so interesting to see, in a dramatised fashion of course, how crucial midwifery is. Every woman needs a midwife.

A tweet I saw from Yana Richens, (Deputy Head Maternity Services NHS England) that the 'public are educated through social media, #midwives now need to be more involved in letting the public know what #midwives do'

This is my new aim with this blog and my twitter and instagram

Follow me... twitter: @Ruth_NQM / Instagram: @sagefeminist_

Ruth x

'We're going to get the doctor to give you a hand'
'Baby doesn't like when you do that'
'Its best if baby comes out sooner'

How often are we told that one of the key roles of the midwife is communication, and yet how often are we experiencing old outdated phrases from medical staff and colleagues, repeated merely in learnt behaviour, to women and families?

As a first year student I found it difficult to find my 'voice' when caring for mothers and families, often repeating what I had heard from other midwives and medical staff - often patronising and unclear.

We are constantly taught that to communicate well we should avoid technical and medical jargon, but I question whether this is really helping mothers in regaining the control they often desire during childbirth.

After developing my Midwifery style three years I have become more focused on creating a positive birth environment including keeping women informed during the journey. This is more commonly experienced when caring for women in labour ward, and interventions are required.

Often I find myself using my advocating role to explain procedures and medical staff plans to the woman and her birth partner.
This has developed from my experiences of really being 'with-woman' and experiencing the look that they often get when procedures or intervention are discussed and they physically glance to myself as the midwife, not for guidance but more for explanation.

Many times I have found myself looking at the woman and partner explaining 'this means the doctor is suggesting a forceps delivery' when they are faced with the comment 'we will give baby a hand to be delivered'. The consent is often ignored and I find myself being the one to put the control back into the woman's hands by explaining why this is suggested and if she wishes for this to happen. Often this takes a matter of seconds but is often followed by a thank you or understanding nod which relaxes the woman and removes some negative energy surrounding the impending intervention.

Language can build trust, which is key in providing women centred care and I find talking with the women I am caring for, discussing their wishes and wants for birth, along sometimes with discussions surrounding potential interventions (for example, the potential need for neonatal resuscitation if meconium is present in liquor) creates a bond, and can promote calm well informed birthing experience.

Many families I have cared for state they 'didn't know what was going on' in previous traumatic deliveries and as this is my area of interest I always ensure I spent time discussing their worries or concerns and answering any small or large question they have. Even non verbal body language such as a smile during a contraction, a nod of the head when they reach for the gas and air. I believe good communication can prevent birth trauma occurring again.

I will constantly be reminded of this from an experience at the beginning of this year where continuity meant I had spent two days caring for a woman undergoing induction of labour. Our communications surrounded the reasoning for this (reduced fetal movements), her concerns, her previous births meant that when her membranes ruptured in the induction ward and she felt the spontaneous urge to push, merely eye contact allowed her to calm and be transferred to a labour room. Each contraction she made direct eye contact with me, a direct form of non verbal communication, a show of trust built on a developing relationship.
Afterwards she stated she looked at me because if I was calm she knew everything was going to be okay.

Most recently I have been studying and composing an essay on the importance of leadership within the midwives' role and it made me think about how student midwives' can best develop their skills to be prepared for role model and leadership role when they become newly qualified midwives.

Leadership is difficult to define in the context of care services as you can have very definite role of leadership, be that Band 7 or Senior role, but a lot is discussed in relation to allowing women to be the leaders of their care, mentors leading their students and policy leading practice.

I think it is important to discuss the concept of empowerment alongside leadership, as many theories relate now to relationship models of women centred care, and within that the empowerment of the woman and the midwife to provide autonomous care.

With new policy being introduced in Better Births and The Best Start, caseloading opens options for midwives to become not only empowered autonomously, but also leading their own time, caseload, resources and continuous professional development.

A big part of being able to develop leadership skills, whether that be for a team, your caseload or your own practice, is understanding emotional intelligence (EI) and how it affects us in providing the bet possible care. Emotional intelligence for those unaware is the ability to examine one owns and others emotions - a key skill for a midwife. By developing this skill, we are able to develop a higher emotional capacity for the work and understanding when it comes to informed choice, empathy, adaptability, approach-ability and effective communication. All of these being aspects of the role that women note could be improved (The Best Start SG 2017).

It is true that developing the skill of EI and leadership is a struggle in the current climate of the NHS with staff shortages, burnout and increasing numbers of midwives leaving the profession. However, by cultivating these skills along with building resilience and sustainability it may be possible for midwives to facilitate positive attitudes to changes and workplace pressures. Clinical supervision in Scotland aims to address this by supporting colleagues and facilitating empowerment of self and others.

So for a newly qualified midwife entering the profession, it important overall to maintain your passion for midwifery through empowerment of women and others, keep up with CPD, developing strategies from role models and mentors and building resilience through self care.

A great way to do this is develop your own support network of midwives and members of the multidisciplinary team. Social media is a fantastic place for this - from blogs to Facebook, Instagram and Twitter. Meeting like-minded people online to discuss midwifery, life and all sorts of things can help balance out some of those tougher days. Reflecting on care can also help facilitate the transition from student to newly qualified midwife.
This is why I think the new generation of midwives have a lot more resources to pull from to support them in becoming leaders in maternity care, and are well placed to develop and adapt to change in maternity services for the better.

Ruth x
twitter: @ruth_stmw

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