One of the things I’ve found being a student is as soon as your start feeling settled in an area, and like you kinda know what you are doing, you get moved to another area, or go back into uni for a bit, and then when you get back to that area again it’s like you’ve gone back a step. Granted, its not back to where you started, but it always seems to feel a little like it’s two steps forward and one step back each time you leave an area for a short time and then come back…
Thats exactly what I was facing when I headed back through the doors of the Labour ward on the week after my NIPE exam. I’d done 4 weeks there in November and then we were on study leave and then Christmas, followed by the dreaded exam…so all in all, I’d been out 5 weeks before I headed back in. I’d started feeling my confidence in all things “high-risk” building and really felt like I could actually provide good care and know what I was doing in most cases that came up on the high-risk labour ward…and then I had a 5 week period where I wasn’t there at all…it’s tricky, but I’m starting to get a bit more used to it now I think.
Anyway, week 121 of this mad course I was back on the labour ward after finally getting my NIPE exam done. I had three shifts and a new mentor, so I definitely had to hit the ground running!
I think it’s really interesting to see the different approaches that each mentor takes to teaching and supporting a new student. Some are very strict and quiz you with theory at 3am, making you question your own skills at every corner and challenging your techniques at every opportunity (this isn’t necessarily a good or bad thing, sometimes you learn things that make tasks so much easier moving forwards, but others seem to be trying the break-you-to-build-you-up-again approach, which works for some but definitely not everyone)
They say that you end up as a “soup” of your mentors, taking on what you like about how they work and leaving the parts that didn’t gel with you so well. I really like this analogy both for my practice as a midwife but also, once I qualify, when I become a mentor for other students (which, scarily enough, due to the new mentor guidelines, could be as early as October when I start working as a Newly Qualified Midwife!)
All I can say is the if I become a soup of my mentors for the way that I support other students, I want to take a HUGE amount of what my latest mentor had to offer! She really supported me and pushed me to be the midwife I want to be, and I know she is someone I won’t forget! Even in this first week with her, she pushed me and supported me, above and beyond what is “required”.
This placement isn’t one of the ones that is being “graded” and as such, I don’t have a “learning contract” like I do for most other placements; with my learning objectives and anything specific I would like to do while on this placement. This mentor simply said to me “we’ve got three weeks together, and as you don’t have a learning contract for this placement, I want you to think of three things that you want to learn or do on this placement, and I will do what I can to facilitate that” – how good is that?!?!
I thought about it, and immediately thought of two things that I had done all the theory and practice for, but had never actually done: 1. Suturing and 2. An Episiotomy.
As this was my final placement on a high-risk delivery area as a student, these were things that I wanted to make sure I had done, if the opportunity presented itself, before I qualify…and so this would be the last chance!
I couldn’t immediately think of a third thing, but those two seemed pretty focussed anyway!
So, we started our first shift together and headed into the room we had been assigned to. We were looking after a lady who was undergoing induction of labour, and really interestingly, who had a bicornate uterus (can vary from having a heart shaped uterus through to having a proper septum down the middle, essentially resulting in two uteruses) It was absolutely fascinating to see both uteruses visibly contracting, independently of the other – the human body is amazing!
When we took over, she was in early labour – starting to contract, having had her waters broken about an hour earlier. She was relatively comfortable and so we spent the first few hours having a really nice chat and monitoring the baby. Come midnight, the contractions had kicked up intensely and she had an epidural, which made her comfortable enough to have a couple of hours sleep before we noticed a few slight dips in the bay’s heart rate on the monitor. This can be a sign that the baby is distressed, but it can also be a sign that good progression has been made and that she is fully dilated. We woke her up and suggested that we check to assess the progression due the baby’s heart rate, which she accepted – and she was fully dilated! She started pushing and less than 20 minutes later he beautiful baby girl was born into my waiting hands. A beautiful calm delivery, and catch number 25 for me too!
After delivery, as normal, I assessed to see if any suturing was needed. She had a tricky second degree tear, which definitely needed suturing, so I went to step out of the way and let my mentor in to do the suturing, but she just gave me a firm look and said “set your things up for the suturing then” and that was it. I was going to be doing it. I set up my equipment and made sure the woman was completely numb from her epidural still, before starting. My mentor was sitting just behind me, reassuring me and giving me tips throughout – and it really wasn’t as scary as I thought! In a weird way, it was quite satisfying, and I was really relieved to see that the practice I’d put in at the skills lab had paid off – I remembered everything and it went really well. Before I knew it, it was done – and I’d done the whole thing myself! Eek! First suturing – done!
Once the suturing was done, the woman was settled and my blood pressure had come back down to normal, it was time for paperwork – and pretty soon, the sun was coming up, the paperwork was finished and it was time to go home and get some well earned sleep! Night shifts normal wipe me out, but I drove home from that shift on a proper high – can’t beat the feeling you get from trying something new and succeeding, and helping a baby girl into the world to boot! Awesome night!
On my next shift, we were looking after a lady who, again, was being induced. She had an epidural in place already and was really comfortable. The baby was on the monitor, and all appeared to be going well so she was resting.
The majority of the night was, frankly, quite mundane. A lot of monitor watching, an examination in the middle of the night which showed good progression to 6cm, and the couple both sleeping the rest of the time. At around 3am there was a period where the baby’s heat rate dropped suddenly for about 4 minutes. I was in the room alone with the couple, which is very normal now I’m approaching the end of my training – my mentor was watching the monitor at the main desk – and so I pulled the emergency buzzer, woke the woman and asked her to turn to her left side. By the time someone else came into the room, the baby’s heart rate was back to normal, so everyone else left and I just monitored the baby even closer for the rest of my shift, and the woman stayed on her left hand side, as it seemed to be better for the baby. Come 6am, she was fully dilated and after an hour to allow the baby to descend, she started pushing at about 7am – just before the end of my shift.
When I left, she was still pushing, and making really good progress. The midwife who took over let me know on my next shift that she had delivered about 45 minutes after I left, and had a beautiful healthy baby boy – so love hearing the outcomes; a lot of the time you just don’t hear what happened to the women you have to leave, so its really special to hear when you get the chance!
My final shift of the week I was looking after a woman by myself as a kind of trial – my mentor was out at the desk, watching my notes on the computer and I was keeping her up to date. Really good practice and also so nice for this mentor to give me the chance after only working with me for a couple of shifts but she clearly thought I was capable which was pretty reassuring.
Mid-morning, I was started to see some of the external signs that this woman was fully dilated, and so I examined her, and I was right – she was! I let my mentor know and made a plan to allow an hour for descent – something which is often done with women who have epidurals to allow the baby to come down more and hopefully mean less pushing time (provided the baby isn’t getting distressed)
My mentor was happy with my plan so we went ahead and after an hour she started to push.
Unfortunately, as soon as she started pushing, despite being able to see the top of the baby’s head in the first push, the baby’s heart rate started to show signs of distress so I called the doctors in to review her and they decided it would be best to carry out a ventouse delivery in the room – the baby just simply wasn’t coping with the pushing.
Within 5 minutes, the baby was born, and passed up onto the mum’s chest – crying and pink!
It was really special to have cared for this woman pretty much by myself and was definitely a huge confidence boost for working more independently moving forwards – after all, I’ll be doing it by myself in October whether I like it or not! Eek!
Lead image by Markus Spiske
To read my last Midwife Mondays post, click here: