Midwife Mondays 107: Starting on the Antenatal Ward & Scrubbing up in Theatre!

So my first placement of third year has started. I can’t write believe that I’ve now properly started 3rd year. The weeks seem to be flying by so quickly at the moment it’s more than a little bit scary.

My first placement of 3rd year is on the antenatal ward; an area I haven’t been placed at before and somewhere I have always been quite keen to go to. In my first week on this ward I have had a really wide range of experiences, and I’ve really enjoyed it!

This ward has a real crossover of long-stay and short-stay patients;
There is a woman whose waters broke early and who has an unstable lie (so it wouldn’t be very safe for her to go home in case of cord prolapse) and another woman who has one twin smaller than the other and needs three-times-daily CTG monitoring – they’ve both been in for weeks and most probably will be staying for a good few weeks longer at leas for monitoring.
And then there are several women a day who come to the ward for induction of labour and head to the delivery unit as soon as their waters can be broken or women for one night on IV fluids for Hyperemesis (severe morning sickness) – and these women are there for a much shorter stay, sometimes less than 24 hours.

The thing that has struck me about this ward in comparison to every other area I’ve been to, is the real variety of cases that are treated there. On labour ward, yes, there are the higher risk women with diabetes or pre-eclampsia, and on the post-natal ward there are the women who are post-caesarean or post-forceps delivery, but there is a limitation on how many different cases you come across in one day – there is only a certain amount of variation you come across…
…on this ward there is such huge variety!

One thing that I think is really lovely about this ward is that they occasionally also have one or two postnatal women on there whose babies are on NICU; purely because it is kinder than placing these women on a ward full of newborns if they are separated from their baby – how lovely is that?!

So, on my first week, what have I been up to?

Well, as seems to be the way with ward work generally, its quite hard to write about. I think its something about the way you are caring for several women throughout the day, and a lot of it is routine care, rather than specific moments, so I’ll just mention a few highlights rather than go into too much detail of “We gave the lady in 1C her antibiotics” cos frankly that just wouldn’t be very interesting to read!

This week I have been involved in the care of a woman who had come in with a nasty bout go food poisoning, the day before her induction was due. I was on for both days, so cared for her sickness the first day and then when the sickness had gone, helped with her induction the second day. I love the continuity that you can get in this type of ward care – you just get so much more of a relationship with these women, you really get to build trust with them and it really feels like you can give them better and more individualised care too! After looking after her for two days, transferring her to the Labour Ward, contracting regularly, was really exciting and I was so pleased for her. My mentor and I went down to see her on the postnatal ward the next day, and met her gorgeous baby girl – love seeing these women through and seeing what happens to them.

On one of my shifts we were looking after the women on the Elective Caesarean Section list; the women having caesarean sections electively, either because they have had one before and have chosen to have another, because they have a condition that would make labour dangerous for them, or because there is a known abnormality with the baby and it has been deemed safer to deliver by caesarean section.

The latter was the case with one of the women on this day – after studying it only last week, there was a baby with a known exompahalos (with it’s abdominal organs in a sac made from the umbilical cord, outside the body) being delivered. Despite the high-risk of the situation, the paediatric consultant was happy for me to still be the receiving midwife for this caesarean, on the condition that I fully scrubbed, gowned and masked up, so I found myself 10 minutes later, scrubbed up in a huge green gown, with a hat, mask and surgical gloves on, ready to receive this little baby at delivery.

It was amazing to see, and I had to be extra careful when handling the baby and carrying it to the paediatricians so as to avoid bursting the sac, but it all went well and the baby was even breathing by itself (which the parents had been warned might not happen). They’ve got a long road ahead of them, with treatment and possible surgery, but when I left at the end of my shift it sounded like everything was looking much better than originally anticipated so hopefully all will be fine.

One of the consultants also let me stand in and observe while she placed a cervical suture this week. This would be placed when there is threatened preterm labour or with a woman who has had previous multiple miscarriages and has been found to have a cervix that prematurely dilates. Essentially, the consultant sutures the cervix closed and then when they are ready to deliver (hopefully at term or as close to term as possible!), the suture is removed. It was really interesting to see, particularly as, whilst I am on the antenatal ward, I am caring for women with threatened preterm labour, some of whom have this suture in place.

Outside of the hospital, I also made my first batch of homemade mince pies this year – yes, ok some people must think its a bit early, but frankly, I don’t care! They were yummy and homely and were just perfect for a chilly autumn weekend!

It’s been a busy start to this placement, but I really like this area; the days go quickly, I’m kept busy, and I love the continuity and relationships you build with the women. Looking forward to seeing what the next few weeks bring!

To read my last Midwife Mondays post, click here:

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