Newly Qualified Midwife Bowler.
I have just today finished my makeup time shifts before registering as a Midwife with the NMC.
I am over the moon as I have worked extremely hard putting in extra curricular effort and personal study to become a midwife over the last three years, but now the realisation hits me and wow, now what?!

I have had a million and one questions in my head recently about my upcoming role as a rotational midwife. Questions mainly surrounding preceptorship and how I will be supported as a newly qualified midwives.

It was highlighted in both the England and Scotland State of Maternity Services Reports by the Royal College of Midwives released on 12/09/18 that for the number of midwives leaving the profession there are not enough newly qualified midwives being employed. An ageing but skilled workforce are leaving and the staffing deficit still remains at around 3500 across UK.

So what does that mean for us newly qualified midwives?
The transition from third year student to newly qualified occurs over a few weeks and although we are signed off as proficient, working independently in a demanding service can be difficult to those trusts already having issues with burnout and staff retention.

A way to help with this has been developed by two different trusts.
Greater Glasgow and Clyde offer a 'purple watch' support system for newly qualified staff. NQM wear the purple fob watch and place a purple magnet next to the woman in their care so other members of staff can identify the NQM and are aware they may require further support during the shift. The NQM can stop wearing the watch once they feel more competent.

I love this idea as it identifies the NQM without the presumption they may need support, but allows team to structure support needed amongst them during the shift.



(Source: Elizabeth Barilli Twitter)

The other system was implemented for all new staff undertaking preceptorship at a South West England Hospital who were given a badge to identify they were undertaking their preceptorship year.


(Source: Nursing Times Twitter)

With many staff reporting unsupportive work environments, bullying in the work place, staff shortages and morale issues - implementing a support system from the beginning of people's career may help to build a different workplace culture and hopefully better working environment helping to retain staff withing maternity services.

As I enter my preceptorship year I'm looking to see if my trust can implement a similar system for NQM, and I will also bring this support system into my skills I hope to use as a future mentor to new student midwives.

How does your trust support newly qualified midwives in their preceptorship year?
Let me know in the comments below.

Ruth x

PS - My twitter handle will be changing soon as I am no longer a student! Keep your eyes peeled here and on my Instagram @sagefeminist_

Since creating this blog I have been flooded with requests and follows from loads of fantastic student midwives and newly qualified midwives about starting social media accounts. Asking for advice on how to develop a professional relationship between social media and midwifery, and how I developed my personal social media style.

I have been an avid tweeter personally but started a student midwife account (@ruth_stmw) at the MAMA conference in 2017 where I was inspired by the twitter power of Sheena Byrom!
I began by tweeting my thoughts and experiences of the speakers and topics at the conference. Tis helped me to connect with a number of other midwives and student midwives in the community.
I quickly decided to develop a blog to share my experiences as a student midwife but also develop an area using infographics to support students learning.

I was then approached by Sheena and Anna Byrom on twitter to collaborate with a few other students on a student persepective for the new The Practising Midwife Journal and I joined the editorial board. I also supported them with two other amazing student midwives (Charlene and Ali) to launch ‘the future midwife blog’ on All 4 Maternity.

Since then the community on twitter has grown,  and encouragingly the number of student midwife blogs has also grown! Social media usage has begun to be promoted and accepted as a form of midwifery learning and discussion. My university has promoted my blog on twitter, retweeted students opinions and now encouraged students to use social media to engage with midwifery community.

I have recently expanded my social media presence onto Instagram to link with this blog and document my journey to becoming a newly qualified midwife. I'm also hoping it will continue to benefit my passion of supporting new student midwives in their training and midwifery journey. By using visual imagery I'm hoping to put a more personal note to my blog posts and promote some visual learning and great midwifery personalities on Instagram.

So follow me at @sagefeminist_

Feel free to continue to send me messages on how to develop social media for student midwives, on developing a social media profile or any advice on using twitter in Midwifery Community.

Look up the following hashtags to join in! Hashtags help community interact and find like minded individuals on twitter / Instagram.

#WeMidwives
#InItTogether
#StudentMidwife
#MidwiferyStudent
#NewlyQualifiedMidwife

My style has continued to be the same level of friendly professionalism I bring into my work, however I love to share personal achievements and opinions hence why my twitter bio includes 'All Opinions Are My Own' an important inclusion in a world where our employers or educators can see what we put out into social media platforms.

If you're inspired - start with twitter and check out my Inspirational Midwives blog post on some midwives as I've included their twitter handles!


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.

Wow! What a year. I've had some amazing opportunities, said yes to ideas and plans I'd usually be very nervous about committing too and I've managed to have my first third year placement on community midwifery signed off as competent for entering the NMC register THIS YEAR, when I graduate as a Registered Midwife in September 2018!

So I'm popping a few of my highlights here to inspire myself, and others, for the rest of 2018!

• Establishing myself on twitter as an active student midwife tweeter - follow here at @ruth_stmw for tweets and retweets surrounding midwifery care and student midwife learning

• Starting my blog 'SageFeminist', it has been a real creative output for me and open lots of doors and opportunities! From designing the log, to post headings and research - I've enjoyed every seconds, especially creating info-graphics for other students to use and learn from. Here is my first POST.

• Being asked to join the wonderful midwives at All4Maternity editorial board, and starting a brand new student project for them... coming soon in 2018!

• Being highlighted by my university for my extra curricular work with The Practising Midwife and All4Maternity.

• Attending the RCM Conference in Manchester. Travelling and meeting a lot of twitter buddies was a fantastic networking and learning experience. I thoroughly enjoyed it - and wrote about it HERE.

• Becoming treasurer for my Midwifery Society at university and using social media to recruit and encourage first and second year students to engage with midwifery on social media, and through activities run by the society.

• Passing my first placement of third year with an A, and being signed off as competent for NMC register for community midwifery - what a dream come true. And a wonderful placement all round. Seeing a newly refurbished MLU in a community and rural setting made me want to explore normal birth in the community so much more.

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

The beginning of a new semester or module has always been a particular challenge for me. Starting something brand new. Re-organising notes, getting in a new routine and dusting off the cobwebs of my brain since being on annual leave.
This week is my first week of teaching after introductions to my third year modules. I'm to choose an essay and report topic, start reading for my essay and begin planning my accommodation for my placement in November/December.
Phew.
Not to mention my twin sister is getting married in England in 11 days and I'm her Maid of Honour!

At 22 I was diagnosed with depression and anxiety disorders which have fluctuated my mood over the last 8 years, but which, I say with trepidation, are now stable. I am very open about my depression and anxiety as I feel there is too much stigma attached to young women and men who experience it. Especially university students.

Breaking down the stigma of getting stressed, being diagnosed with depression or anxiety can actually help people get the support they/you need.

I've thrown together a little self care info-graphic that I'd love student midwives to download and keep on them when they feel like they've run out of options or don't know where to start.

It can be found in my info-graphics tab and includes:

• Keeping track of your sleep - using an app or diary. Getting the right amount of sleep is vital to brain and body health.
• Eating well, at the right times of day - no carb loading at night, no coffee at 9pm! :/
• Mindfulness / meditation - again phone apps are great for these, also using the moments before you sleep to clear your mind and relax.
• Reflection - can release thoughts and feelings from your day, help you work through experiences.
• Not criticising yourself - it's okay to feel how you do. And if you want to watch Netflix instead, do it. You need to work when you feel productive. Promise yourself you'll wake up earlier the next day and start fresh.
• Accepting your mood and working to the best of your ability - don't overload yourself with tasks and responsibilities. Say NO, it's OK to change your mind if you don't want to go to that party, meet up or dinner.

I hope this helps.
I've found my practising a few things on the list I can help centre myself, accept my feelings, validate them, and work to the best of my ability.
Even if that means incorporating naps into my schedule!

Ruth x
twitter: @ruth_stmw

As the news has broken that the Duchess of Cambridge (or the Countess of Strathearn as she is known in Scotland) is pregnant with her third child she is yet again being treated for Hyperemesis Gravidarum (HG).

As noted in the news, they often refer to HG as 'extreme morning sickness' however it is far more complicated than that. As a student midwife you learn about HG in your pregnancy complications classes - so not exactly classed as a usual side effect of pregnancy.

So what is Hyperemesis Gravidarum or HG. HG is diagnosed by ruling out other pregnancy related complications such as UTI's or increased thyroid levels.

Signs and symptoms often include:
Vomiting more than 3x a day, all day
Nausea
Fainting
Weight loss +5% of body weight
Ketoneuria
Dehydration
Reduction in Vitamin B1, B6, B12 levels

Reasons are often unknown but women are at a higher risk if they have experienced HG in a previous pregnancy, have a family history of HG, are obese, it is their first baby or they are carrying twins or triplets.

HG is usually treated by dietary control - eating bland foods and drinking electrolyte replacement drinks such as Lucozade sport.
Many women however will need hospitalisation, with a IV Fluid regime and anti-emetics.

HG is not just 'extreme morning sickness' - for a start HG occurs all day, throughout the entire pregnancy. HG can be debilitating, reducing woman's energy levels by affecting how much she consumes for fear of vomiting and can effect mood. Time off work should be sort by women suffering from HG to help maintain healthy energy levels for the mother and baby.
HG affects between 0.3-2% of pregnant women.

The effects on the fetus for women with HG can be increased risk of low birth weight, and small for gestational age baby and potential to be born before 37 weeks gestation.

So if you have a mother coming to you antenatally complaining of continued sickness and feeling faint, has a small or low diet and ketones in her urine - guidelines state she should be managed in the community with anti-emetics first before admission to hospital for monitoring and an IV fluid regime (RCOG 2016)

And don't believe the old wives tale that 'morning sickness is a good sign' and 'it means you're having a boy!'.
Hopefully with the media attraction to Kate Middleton more information on HG will be widespread in the community and women suffering from HG can seek advice and support.

Here are some support lines:
1. Call your midwife!
2. Pregnancy Sickness Support 
3. NHS Choices - HG


How much have you read on complications on pregnancy? Or have you met anyone with HG?
Tweet me @ruth_stmw

Ruth x

Infographics to go with blog can be found at http://sagefeminist.blogspot.co.uk/p/infographics-from-blogposts.html

Hygge (pronounced Hoo-ga) was all the trend last autumn/winter as people began to prepare for the cosier months and an easier, happier way of living was introduced to use by the Danes.



Hygge is defined as the practice of creating cosy and congenial environments that promote emotional wellbeing - sound familiar?

Birth environments should be cosy, congenial and promote emotional well being. So why not apply the elements of Hygge to birth, specifically homebirth.

Here's a little infographic I put together on how this could be achieved by both mothers and midwives.
Infographic for this post can now be found at http://sagefeminist.blogspot.co.uk/p/infographics-from-blogposts.html

What do you think? Could these elements help create a better birth environment or even make us remember elements which can promote natural physiology of labour.

Ruth x

twitter: @ruth_stmw

Congratulations! You have been accepted and begin your journey into midwifery this year (or next).
If haven't read my Journey into Midwifery blog post yet - go back and read that (click this link), if you have, then thank you and hopefully this little post will help you face those university fears as you approach your first classes.


I have gathered a few hints and tips from my experience to help you in your first few weeks...

1. If you haven't already join your university's midwifery course or society Facebook page. Introduce yourself there and find a few names of people in your cohort.

2. Join twitter and follow a bunch of inspirational midwives who will sign post you to interesting blogs, articles and news stories about current midwifery.

3. Join your university's midwifery society. Get involved in attending events, making new friends.

4. Sit next to someone new for each class for the first week.

5. Start conversations - you all have one thing in common, you want to be midwives. Ask if people have twitter/Facebook, are subscribed to any journals; exploit your mutual passion.

6. Do your class reading. It will help. Answer questions in class even if you're not sure of the answer. Have a voice.

7. Attend any midwifery events in your university. It could be a welcome cake stall (my university do this) or talk. Maybe someone has arranged a movie showing.

8. Make friends with the people you live with even if they don't study midwifery. I have spent the past two years living with a student child nurse and student social worker. Although I have my friendship group within midwifery, its nice to step away sometimes.

9. Go out and have fun in the first few weeks. The work load can get heavy quickly so use freshers week to let off some steam, meet people and socialise. Especially the freshers fair (or equivalent) - get your hands on free stuff.

10. Prepare for your classes and placements. Buy all that new stationary, new placement shoes, new textbooks.

and remember...
11. Don't worry about being homesick. I'm 30 and moving to a new city to study at 27 was daunting for me too. Facetime, Skype and trips home. Share your university experiences with friends and family. Talk to someone if you're feeling down.

If you're looking for any specific tips or have questions tweet me at @ruth_stmw using hashtag #studentmidwifeQ and I'll try and help or point you in right direction.

Good luck!

Ruth

twitter: @ruth_stmw
#GetYourTweetOn
#studentmidwifeQ

Channel 5 have a new mini documentary series on midwifery and the first episode aired this Wednesday 5th July at 8pm. It is call 'The Highland Midwife' and follows a group of community and continuity of care midwives in rural Scotland.

On the show we meet midwives, mothers and families going through the last few weeks of pregnancy and labour and birth. Each woman discusses her past history and relationship with the midwife.
Honestly, it made me very teary. It was fantastic for the media to show this honest portray of the midwife-mother relationship in communities in Scotland.

Midwife Morven Fioretti from Channel 5's 'The Highland Midwife'

A few things I noticed during the episode and wanted to discuss will make up this blog post but if you haven't already seen the show I would highly recommend it. It can be found on my5.tv catch up and the next episode airs next Wednesday 12th July at 8pm on channel 5.

Continuity of Carer - What an absolutely fantastic way to introduce to mothers the standard of maternity care that Scotland is working towards. One of the main topics of the maternity review 'The Best Start' by the Scottish Government (2017) outlines the move towards case-loading midwives and continuity of carer. You can just see how this makes a different to each of the women. How they discuss the midwives as being parts of their family, how the woman having a cesarean section is missing the support of her antenatal midwife and  the trust the women have in the midwife when they are referred to hospital for review.
It is inspiring as a student to see this practice when sometimes you are faced with the reality of hospital midwifery as the only experience of midwifery in your city/town. Rural midwifery is different. The passion of midwifery shines through these midwives as they discuss the job and their role in these families lives. Still getting excited seeing a baby be born after 20 years of being a midwife? Incredible, and I hope that's how I'll feel in 20 years time.

Reality of limits of Rural Midwifery - This show does not gloss over the reality that sometimes birth at a midwife-led unit isn't possible and also the restrictions that living in a rural area can have on maternity services. For me this makes the best argument for having highly resourced midwifery-led units in rural communities to bring the services to the women, rather than have them drive 4 hours to have a midwife-led 'low risk' (yes I hate the term 'risk' but it fits here) birth.

Breech birth - I hope this show raises questions regarding why we go straight to cesarean section for breech birth, and honestly I think it should be questioned in this day and age. Lack of skilled breech birth attendants and resources is the only thing holding these women back from having vaginal birth - something which hopefully will be focused upon as maternity services head back to midwifery care but who knows. The power of the Hannah Report (2000) still seems to control breech birth. We need to start a conversation to change it.

Breastfeeding - SO MUCH ACTUAL BREASTFEEDING ON SCREEN. Yes I know all caps can seem like I'm shouting and believe me I almost did - with enthusiasm! Seeing mothers putting baby to breast soon after birth was beautiful not to mention the uninterrupted...

Skin to skin - Passing the baby straight to the mothers chest, initiating bonding and feeding and showing this as the norm is encouraging. Babies covered in vernex and blood and being cuddled by their mothers was an honest representation of birth. As a student I was so happy to see actual reality being shown on screen. But can I also mention the skin to skin after c-section?! Absolutely thrilled and I hope this opens up mothers minds to having uninterrupted skin to skin even if a c-section is planned.

Language - The praise for the midwives was wonderful but to see midwives praising the mothers during birth made me realise how important the power of words can be. I'm not sure if everyone picked up on it, but even the narration (Pam Ferris!) even said the mother had 'given birth' after the c-section. So important to use that language to empower the mother and family.

To me, this show was inspiring and although I know I am not working as a registered midwife just yet, I hope my passion for positive birth representation in the media doesn't make me sound naive.
I have a passion for midwifery, and I with application numbers dwindling I think we need to hold onto midwives with that passion with both hands to show women how maternity services should be.
And hopefully inspire a whole lot of future midwives too.

Leave me some comments below - I'd love to know your take on the tv show.

Ruth x

twitter: @ruth_stmw

Scottish Governments 'The Best Start' Maternity review can be found here: http://www.gov.scot/Publications/2017/01/3303 or by clicking link in paragraph above.

Hello! I best start with a little introduction. I'm Ruth, a student midwife and a feminist. To me the two are synonymous and you can't be one without the other, which is why I've named my blog Sagefeminist. 'Sagefemme' being the french for midwife or 'wise/with woman' and a play on words with femme/feminist.
I like to think I have a little literary creativity in me. You can decide.

Right now I've just passed my 30th birthday and I'm in my second year training as a student midwife. But my story didn't begin two years ago.
Aged 16 I was asked to decide what I wanted to do as a career. Imagine that, just about working out who I am as a person and I have to start deciding WHAT I will label my 'job self' as well. I chose midwifery - at 16. It influenced my A-level decisions and I started my journey planning to study midwifery at university.
Sixth form college is never what people except and I changed some courses and didn't do well enough in others. One being my Biology A-level (which I eventually passed with a C). My tutor discussed with me that she didn't think midwifery would be a good fit for me and maybe I should look at a more structured university course. I was persuaded and in my second year of sixth form college my application for UCAS went in for a Marketing degree. Polar opposites.

I graduated the University of Stirling with a 2:1 BA (Hons) in Marketing in 2009 and promptly went to into management in service industry. I felt uncomfortable. I didn't enjoy my job. I didn't enjoy the profit focused aim of the business. However, I didn't know any midwives, only the birth stories I'd heard were from my mother and older sisters.
I always believed that I would return to University to study again, originally I was focused on women's studies but eventually my passion for midwifery couldn't be hidden. Inspired my my Father, who changed careers to Para-medicine when he left the Royal Marines, my Mother who did her MSc the year before I began my midwifery course, and my Nanny who did went and studied women's studies in her 60s. I guess changing careers is a familial trait!

Luckily, the universe answered my thoughts and I won some money in a TV prize draw (who knew people actually win those!), so I left my job and applied to study Midwifery at the age of 28.

I haven't looked back.

I've moved cities, found out who my real friends are, moved flat for the first time in 10 years and redirected my skills towards a more caring, supportive and fulfilling career.

So that's where my journey started. I'll be sharing reflective pieces, comments on articles/news pieces/inspirational posts and general feminist and midwifery chit chat as I cover the last placement of my second year into my third and and final year as a future midwife.


I hope you enjoy.

Ruth x

twitter: @ruth_stmw
#GetYourTweetOn

((Disclaimer: All opinions are my own and I will be respecting NMC social media policies on confidentiality at all times. If you have specific comments I cannot respond to due to this, please respect that this is why. Thank you))