Well, that has been a bit of a break hasn't it!

I was reminded about my blog by a student midwife the other day and I had (honestly) completely forgotten the last time I updated it. And as you know, LOTS of things have happened since 2019.

I thought I might post a little update and this might spur me onto blog again. I enjoyed it a lot when I was a student midwife and newly qualified and it helped me to talk about topics that interested me and a little release for projects I was passionate about. I've never seen myself as a 'blogger' or 'influencer' and the majority of my social media now is on Instagram (@ruth.midwife) as I like the one shot and caption kind of sharing. 

So to no ones surprise - I am still a midwife!

I'm currently in my rotational post and the third rotation of my career - Triage and Induction Ward. I've been here for a little over 15 months and really feel like I've found a good fit with the team I work with and the care I provide. It may seen odd that our Triage ward also manages Inductions of Labour but that's because we aim to provide as many outpatient inductions as possible, and often women we Triage are admitted for induction.

Triage has challenged my decision making skills, team working and ability to assess patients as quickly as possible, especially in more emergency situations. I work with a fantastic multidisciplinary team which helps a lot! The communication between medical staff and midwifery staff in Triage is key and something I believe my hospital is lucky enough to be good at!

I've also dipped my toe (or been thrown head first) into Quality Improvement. In September 2020 I started a project focusing on altered fetal movements and reducing perinatal adverse outcomes e.g. stillbirth for my health board.  Alongside this I completed the Scottish Coaching and Leading for Improvement Programme, a course designed to support healthcare providers completing quality improvement. 

I think I'll write a separate blog on QI and the midwifes role as it has been a big eye opener for me. I always thought I'd like to complete a Masters degree but doing QI alongside my clinical role fulfils that academic/improvement focused part of me!

And then there is… COVID19.

Working during the last year and bit in the NHS has had its challenges. There have been days I've cried during shift and felt like giving up - the constant change in policies and procedures, lockdown, not seeing friends or family, having to treat COVID19 positive patients, the constant swabbing and trying to be a 33 year old single woman all at the same time has been difficult.

But I wouldn't have got through it without the support of my amazing colleagues, undertaking (personal) therapy, mental health support, running and my family. Oh! and getting vaccinated!

So there - a brief snap shot in of my last 2 years.

Is there anything I've missed? If so comment below or tweet me at my new twitter handle @ruth_midwife.

Best,

Ruth x

Instagram: @ruth.midwife

As a newly qualified midwife I am often astounded by the amount of students we have in the wards. As a student I just 'got on' with my placements - working hard to achieve good grades and enhancing my skills and never much paying attention to the number of other students the midwife may have mentored.
Since I only qualified 4 months ago, I don't yet meet the criteria to be a sign off mentor for students however with the increasing number of student midwives it sometimes means I will have a student shadow or work alongside me for a shift and honestly it is fantastic.

As a student I valued the different input from the variety of mentors I had and really enjoyed working with some colleagues and adapted my practice to fall inline with how they worked - a pick and mix of skills and behaviour to shape who I am now as a midwife. Knowing that another student is learning from how I practice and I am influencing their experiences is overwhelming and often extremely satisfying.

I've worked with all three year group students over the past few months and it has made me realise that it is not only our job as midwives to care and advocate for the women and families in our care (family centred care is a BIG priority for me) but I'm also able to provide student centred care where I can support, supervise and allow the new generation of midwives to grow and learn within our working environment.

My main tips for students entering a placement with a new mentors are:
1. Be profession - listen to your mentor and ask questions, do not assume because sometimes that can lead to confusion and ultimately bad care decisions.
2. Speak up if you don't know - there are no silly questions and if you are feeling put of your depth, tell us! We don't want you to have a bad placement.
3. Reflect, daily if need be. On decisions made, the outcomes and most importantly on your feelings.
4. Use other students as learning tools too - active discussion can make you understand more sometimes than the black and white of a textbook.

I'll be applying for my mentorship as soon as I am able and until then I will be asking (sorry!) the students I work with about their experiences and how best I can support them while they are working alongside me, whether it be for one shift or three.

Have many other newly qualified midwives worked with students yet?
What is your opinion?

How do you think the new NMC #FutureMidwife pre-registration guidelines will change to support mentors and students in the future?

Ruth x

twitter: @Ruth_NQM
instagram: @sagefeminist_

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

During my third year of student placement I was fortunate enough to spend some time on our specialised ward which focuses on pregnancy loss, early pregnancy care and miscarriage management.
Initially I was extremely apprehensive to begin this placement. Honestly I was scared.
But what of?
Not the babies
Not the families
Not the situations and dealing with difficult moments

But my emotions.
Was I strong enough to look after people when some of the worst experiences have happened to them?
My belief was kind of baseless as I realised very quickly - no matter if you are a member of staff or a member of the family, you are never alone and always supported.

I attended a SANDS training day a month prior to the placement and we re-watched 'A deafening silence' - a fantastic learning resource surrounding communication during the period of pregnancy loss and still birth.

I am using both of these terms 'pregnancy loss' and 'stillbirth' as technically they have different legal and medical meanings.

Early Fetal Demise / Early Pregnancy Loss
Spontaneous loss of products of conception prior to 12 weeks gestation.

Miscarriage
Defined as spontaneous loss of products of conception before 23 weeks and 6 days of gestation.

Stillbirth
Death of a fetus after 24 week of gestation


Many find it difficult to discuss loss using terms such as demise so it is important to be sensitive when discussing with parents and families. However it is important that information is given clearly and no doubt is passed along. Phrases such as 'There is no heartbeat. Your baby has died' is often used.

The NICE Guidelines on Ectopic Pregnancy and Miscarriage (2012) suggest that women in Scotland should have access to an early pregnancy assessment unit (EPAU). This was where my placement took place. My trust's hospital is lucky to have this ward as many staff shortages and cut back sometimes threaten wards like these to close. Unfortunately then mothers undergoing miscarriage or loss then have to experience this in wards with mothers and their live babies - and non specialised care.

A number of my duties included; answering telephone calls, booking early scans, taking beta hCG blood samples, discussing management of miscarriage with families, supporting women during discussion of management of miscarriage, supporting women undergoing medical or surgical management of miscarriage and 'delivering' mothers undergoing termination of pregnancy for fetal abnormality (Many of these were non compatible with life if carried to term, or had passed away due to events such as early rupture of membranes).
I also was involved, and utterly honoured to be involved in, making memories for stillbirth babies.

Our ward used SIMBA boxes (pictures below) and although the idea of making memories, taking photographs and spending time with their babies was sometimes abnormal to families, they really appreciated the amount of time and effort we took to ensure their baby was treasured that day and for many days, years to come.

Photo from: https://www.simbacharity.org.uk/what-we-do/

One story which comes back to me as I write this is a fathers story of seeing a beautiful yellow butterfly in the ward outside the families room. We often used butterflies to symbolise stillborn babies. He knew, and their daughter also knew that this was their daughter/sister visiting them, although she had passed on. I cried a lot on this placement. I was never made to feel bad for this.

I was supported the entire time by the amazing team of midwives and healthcare support workers who worked tirelessly and emotionally all day for these families.

Below I have made a little infographic for student midwives. Please share!!




Ruth x
@Ruth_NQM - new twitter handle!

It's back! The Channel 5 docu-series following a group of Midwives from the Highlands of Scotland undertaking rural midwifery at it's best.
This season they've introduced new group of midwives working in North East of Scotland in Peterhead - which is where I had my third year community placement!

So maybe, slightly biased review coming up. Especially as I working with some of the midwives and involved in the setting up of the renovated Midwife-Led Unit.

For that reason I'm going to do a slightly shorter review of the first three episodes with a little pros and cons list.

PRO's

• It is so great to visit each of these women's unique story and see their choices and requests being discussed in an open and honest way with the midwife
• The midwife-mother relationship remains a strong theme in the series
• Midwives praising the continuity of carer they can experience
• Showing elective c-sections as a CHOICE for women and no shaming
• Outlines the geographical issues women have in the Highlands of Scotland

I'd love to hear people's views on the how as I have had positive feedback from friends of mine who have experienced maternity care in Scotland. Also, perhaps how this show compares to One Born Every Minute?

Tweet me @ruth_stmw

Ruth x

Here's a picture of me in the Peterhead birth room, Moonlight.

Being a third year student I am honestly constantly plagued with thoughts of impostor syndrome.
I feel as though these three years have gone so quickly and I have learnt so much but questioning my ability and practice comes daily and I believe sometimes makes me a better student midwife.

It's known that during placement in third year as a student you are seen as 'senior' and often expected to take on your own caseload and while this is exciting and often wanted by students it does sometimes cause more nerves (especially in me).

I am one of those people who requires support and praise or critique during the learning process. I am keen to learn from my own mistakes which often causes me to ask questions before I approach a task to be sure of what is being asked of me - both a positive and a negative for a midwife!

During my postnatal ward placement I was given a caseload of women requiring care from both spontaneous vaginal births, instrumental births and cesarean section births. The ward was extremely busy during this time and I benefited from seeing how my care and support to the midwives and my mentor assisted in the running of the ward. I worked well with my mentor and this allowed autonomy in my practice and a taste of working as a 'proper midwife'!

My experiences were enhanced by being able to provide continuity to a few mothers who I saw day to day and those who I knew had babies in the Neonatal unit. Again I was able to support mothers with breastfeeding which has become a special interest of mine, and encouraging mothers with babies in NNU to express and build bonds between mother and baby when baby I requiring intensive care.

By the end of my short four weeks I didn't want to move on but knew I could potentially be coming back to work on this ward when I qualify so made great relationships with all staff.

So for students concerned with taking on more autonomy and experiencing a bit of impostor syndrome I would say EMBRACE IT. Ask questions, ask to be involved in specialised care and always check in with your mentor if you need to - the most successful midwife uses her team to support her practice.

So that's my third year experiences. Just a heads up that my next post will be on early pregnancy care and loss, I will be practising confidentially and therefore it will not include personal family experiences but rather my experience as student and how miscarriage and stillbirth is viewed in society.

Until then...
Follow me on twitter  @ruth_stmw

Ruth x

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

#70MidwifeBloggers

Description:
Most recently my cohort have been back in our theory block, planning our final assignment on critically analysing a research piece. For my degree in Midwifery we do not do a research piece ourselves for a 'dissertation' but analyse a current piece of research to establish a mind to read evidence based research to establish ourselves whether all research has a place influencing midwifery.
I've noticed in class I'm starting to speak up more, volunteer and assist other students with studies or problems. One class we were asked to write down our perfect shift three years from now and I could see myself teaching. Not in class but in a placement setting.

Feelings:
Of course I know in my future I will have mentor roles but it made me realise how much I enjoy supporting and discussing midwifery and new evidence based practice or guidelines with my class. I didn't realise that I would be so keen on the theory base as my heart really is in practical placements and the job performance itself, but I am starting to see part of me that cannot wait to mentor student midwives. This was the basis for my twitter and blog and most recently I have been feeling uncertain about the future of my blog and social media presence but getting encouragement from my lecturers and cohort have really boosted my communication skills and confidence.

Evaluation and Analysis:
Whats good about this is having a focus, an ability to write goals for my future and the next three years, the next year even. Building my confidence to speak openly about being unsure about evidence, skills or decision making will put me in good stead for becoming a newly qualified midwife in 5 months time (!). But I also worry about getting too headstrong, saying yes to too many things and then reducing my communication and confidence due to other loud voices in the room. Criticism I often take to heart.

Conclusion:
I think I need to trust myself more and say yes, okay to the few more smaller opportunities I have to develop my skills and put my voice out into the midwifery community, no matter how scary and big it can seem sometimes.

Action plan:
Write my goals for the next year down. Yes it seems simple but if I reflect back on this image of me teaching students I need to know how to get there are not be surprised which way my midwifery career will go. I have lots of big ideas in my head but I think it's important I focus on the attainable ones just now.



Perhaps I'll do a blog post on those goals to help other Students and NQM write some, would that be something my readers would be interested in?


Ruth x
twitter: @ruth_stmw