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Showing posts with label clinical skills. Show all posts

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

'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

#70MidwifeBloggers

I haven't blogged in a while and while putting out content about midwifery practices and recent news reports, I realised I hadn't yet finished my reflection on completing teaching antenatal classes.

After my first post on beginning antenatal classes I then had the opportunity to teach another group of prim mothers - and I jumped at the chance. Midwives are both healthcare supporters and educators. And I needed to build my confidence on the education side of things, especially as more and more opportunities approach me to do public speaking.

I really enjoyed the first set of classes as it was like reaching out into the unknown. I developed systems and trialled use of resources to engage both mothers and father. I found my tone of voice when discussing certain subjects needed changing and that my wide experiences of working in midwifery-led labour care and obstetric unit labour care helped greatly when answering women's worries about pain relief, mobility and options in childbirth, and postnatal care.

Class 2 was Labour 2 - focused around pain relief and options in labour and birth. I also found it important to discuss potential for change in birth, including touching on need for forceps or emergency c-section deliveries. We discussed birth plans and mobility in labour. Here I felt the women listened intently to the science around childbirth and it was fun to discuss the hormones which supported birth and this time the group was very vocal in asking questions.

Class 3 was Infant Feeding - I outlined at the beginning of the class about the UNICEF baby friendly initiative and that the session was focused around breastfeeding initially, but did outline to the mothers choosing formula feeding that I would discuss sterilisation and making up feeds correctly. I tried to involve both types of feeding when discussing key elements such as skin to skin, bonding, and wet/dirty nappies. Honestly I found this difficult as I am very pro breastfeeding however it was great to answer questions surrounding mothers worries about milk production and how best to care for themselves when breastfeeding. I had positive feedback from the mothers choosing formula that they didn't feel excluded.

I didn't undertake the fourth class as this was relaxation and was provided by a trained midwife. However I encouraged my group to attend as we had discussed a lot about breathing, feeling of control and I felt this would be beneficial.

Overall the feedback was positive with some expectant mothers recognising me at clinic, or working in day assessment unit and discussing classes with me. I felt it helped build trust and rapport with mothers. Especially as a third year student midwife as I felt a positive experience with a student might make then more open to having students present at their births (something I have found is still declined in our trust).

I developed a lot of skills from those classes and hope to apply then to my parent craft presentation I have at university soon.

Ruth
twitter: @ruth_stmw

I recently came across an article when researching another blog post. The title grabbed me straight away “Am I too emotional for this job?” - An exploration of student midwives' experiences of coping with traumatic events in the labour ward (Coldridge and Davies 2017). I was interested because of a few experiences I'd reflected on recently and the articles coming out in the news last year about change from normal birth and the reduction in nursing and midwifery applications and more midwives leaving than joining the profession (see here and here).

What is happening? Is it case of the profession not being appealing to young people, the politics of the NHS budget, the pay cap (read more from the RCM here) or simply the removal of the bursary in England and Wales?

For those who are studying and coming to the end of our student midwife journey - it is important that we continue to be well supported and encouraged when studying and in clinical practice in order to sustain the demand for passionate and empowered midwives needed across the UK.

New UCAS data has revealed the number of students applying for midwifery and nursing degrees are down by 8%. (RCM)

So back to the article. Coldridge and Davies look at students experiences of coping with traumatic experiences in a labour ward in a consultant led hospital in the North West of England. Focusing on a psychotheraputic perspective of a study undertaken by Davies and Coldridge in 2015. Here they examine the psychological tensions and anxieties that students face.

A few key points that stood out for me when reading this article include

The awareness that student midwives are more vulnerable to psychological distress due to having a more empathetic relationship with woman and the unpredictable nature of birth itself
In many instances students are left to make sense of experiences alone
Which can lead to feelings of being unsupported, traumatised, uncertain of their abilities and even questioning their abilities to be a midwife.
Students often flip between role of observer and practitioner and this can be uncomfortable when discovering how to best advocate for the woman - they feel uncomfortable discussing the best versus safest options.
Lack a feeling of belonging between the space of the woman and the midwife ('No mans land' Coldridge and Davies 2017)
Students are often disillusioned by reality of working in a busy labour ward
More often the student has a higher personal investment in labouring woman

Unbelievably a few of these points were sounding familiar to what I had read in regard to midwives leaving the profession - so why are students being left with a feeling of uncertainty and a loss of their 'Midwifery spirit?'

Overall the article looks to mentors to recognise the students need to talk, discuss and debrief from difficult and traumatic events. They need to creatively think about student midwives anxieties and make sense of them in order to mentor and work together appropriately.

Student midwives also need to be encouraged to reflect and focus on self care when experiencing adverse outcomes in clinical placement settings.

Great article, and really made me think of how I will reflect on my experiences to come - with a new found awareness that psychological distress and upset is natural, normal and need to be managed in order to practice effectively.

Have you read this article? What are your views on students exposure to traumatic events?
Are we really in danger of losing our 'Midwifery spirit' if this is not managed correctly?

I hope not. Until next time,

Ruth x

twitter: @ruth_stmw
#GetYourTweetOn

Links to news articles are click through in the blog post.

Article reference:
Coldridge, L. and Davies, S., 2017. “Am I too emotional for this job?” An exploration of student midwives' experiences of coping with traumatic events in the labour ward. Midwifery, 45, pp.1-6.

Many midwives find discussing weight and BMI with women can still cause issues with judgement and stigma relating to unhealthy lifestyles and diet. Weight and height are documented at first booking appointment to calculate BMI, from which women are categorised and care plans made. This can cause issues as many women feel they are still stigmatised for being overweight in the media, they would not be expecting it from health care professionals - especially those in place that are not specialists in diet. However obesity is a risk factor in pregnancy and is becoming increasing apparent in maternity services.

World Health Organisation note that worldwide obesity has nearly tripled since 1975 and in 2016, more than 1.9 billion adults, 18 years and older, were overweight. Most of the world's population live in countries where overweight and obesity kills more people than underweight (WHO 2017).

As mentioned addressing obesity in pregnancy begins with the calculation of the expectant mothers BMI.
BMI or body mass index was created in 1830s to calculate healthy weight. It has come under much criticism as the weight in kg/height formula tends not to take into account body fat %, or muscle %. It sometimes also can be skewed from a woman's height. People now are also eating different foods, introduction of more non-healthy cheap foods into the market has affected the national weight average and body shapes have changed since 1830s. It is still used however in medicine to determine a 'healthy weight'.

BMI reporting of 30+ is classed as obese, with BMI of 35+ being classed as morbidly obese. The term "obese" itself tends to come with stigma and judgement as this can be difficult in addressing when talking to women.

The best option is to use compassionate care (which all midwives should practice) and discuss the subject without trying to sugar coat the topic. One way to approach would be to discuss the health risks associated with the woman's weight at booking.

Healthy eating and foods to avoid can often lead to conversation about current eating habits and in turn weight gain/BMI. In my trust the women are allocated to a 'red pathway' when presenting with a high BMI and are explained concerns surrounding options to place of birth, anaesthetic and gestational diabetes. By presenting these risks at booking or in first appointments, midwives can help woman to continue her pregnancy eating healthily for both herself and the baby.

One thing that should be avoided is prompting the woman to think about dieting. the RCM are partners with Slimming World, the only national weight management group which have specialist plans for pregnant and breastfeeding women. However this also has it's critics. Focus should be on health whereas company's such as Slimming World often use body image and being 'slimmer' in advertising their services, presenting a distorted version of body image to women who are going through substantial body changes during pregnancy. A body image in which they should embrace.

Healthy lifestyle management again needs to be addressed holistically, looking at lifestyle, family and socioeconomic status.

By using skills in communication midwives are in a great position to promote health education surrounding obesity and risks in pregnancy and should make advantage of this, through building trusting relationship and not dancing around the subject. This is especially needing in planning birth environment and preferences in regards to pain relief, positions in labour, place of birth and even small issues such as ease of access to veins. This has all been noted as factors which may affect the birth experience of women with high BMI's.

How have you managed in addressing this antenatally or during birth planning?

Ruth x

twitter: @ruth_stmw

As mentioned in the beautifully written editorial piece in the September 2017 issue of The Practising Midwife by Anna Byrom, I am one of the few who have been working on a twitter campaign to support the relationship between students and mentors in clinical practice.

On today - national mentoring day, it’s important for Midwives and students alike to discuss the mentor relationship and how this is crucial to the future of midwifery care.

#InItTogether is the twitter hashtag and it is for collating stories, advice, experiences and support for student midwives, midwives, new mentors and other healthcare professionals to read and bring awareness between the importance of the relationship between student and allocated mentor.

The NMC are currently consulting a review of the standards and frameworks for both midwifery and nursing education and one of the recommendations that has come out of this includes the introduction of mentorship into the job role for a registered midwife. Standards have been reviewed to allow any midwife who has one year clinical experience to be able to support a student in practice and mentor them.

With this introduction more and more midwives will be expected to teach and support students in placement experiences. Some midwives who have not mentored a student for a while, and some newly qualified. Students will also be able to experience a range of clinical skills and techniques from a range of midwives. I believe that when you experience so many different practices that make you think and make you wonder, then that is where the learning happens. You can develop the type of midwife you wish to be by experiencing different practices.

Hopefully this will help to standardise continuity of care between midwives in placement areas and trust, and bring more fluidity between theory taught at university and clinical practice.

The more people who contribute to this campaign and help support the student/mentor relationship, the more the relationship can develop, and benefit both students and midwives.

Ruth

twitter:@ruth_stmw

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