First week of placement as an official second year

My placement this time is three weeks on a postnatal ward, unfortunately it is the postnatal ward I had a bad experience on the last time and the midwives aren’t known for being the nicest... However I went in there with the best intentions and promising to myself to keep motivated and not let any nasty moods ruin this learning experience for me.

I’ve had two different preceptors this week, neither of them were that into me getting involved, I haven’t once been asked to feel a fundus or do anything much more exciting than obs and weighing a baby. Once I took my own initiative though, offering to help the health care assistant and other more friendly midwives I got to do lots of baby baths (a great way to interact with parents), bring back a report from the neo for a woman whose twins were there (she appreciated it so much) and giving feeds for mums who needed help. Answering the call bells has been a saviour for me! It lets me spend some time with the women without a midwife over my shoulder, allowing me to chat to them and support them. One call bell summoned me to a woman needing help latching the baby, I was about to produce my usual phrase “I’ll just go get a midwife for you” when instead I felt I could help her myself-I felt competent! Together we managed to get the baby latched and feeding well, I was very pleased with myself. Next time however, I will remember to stay for the feed to observe it and chat to the mum, I only remembered afterwards I should have done this.

I also grew quite fond of a one particular couple and their twin boys the last two days! One time I had been asked to give one of the babes a formula feed (she was breastfeeding), it was the third day and she’d barely slept at all and couldn’t stop the tears, I just sat, reassured and chatted to her. Another time I spent about 45 minutes with her, showed her how to express and made her some fennel tea she’d brought with her-something no-one else had offered to her. Later that day her partner thanked me for spending that time with her. After she managed to get some sleep we went and bathed the boys, I bathed the first and showed them how it was done and then dad bathed the second, we managed to have a laugh and I felt like I was a valuable part of their care. As I left last night I wished them good luck and they said they think I’m going to be a wonderful midwife, soft spoken and gentle-it was a lovely end to my week and really uplifted me.

Also gave my first bed bath yesterday, not nearly as ‘scary’ as I thought it would be! The woman was lovely, I chatted to her about osteopathy and she said she found it really helpful and will be bringing her little newborn to it next week. I probably did the completely wrong thing as a healthcare professional, but I told her I thought that was great! Oh well...I’m not doing this to be the best ‘healthcare professional’ by the rules, but to be the best midwife I can be. 

Being the best midwife I can be means supporting, understanding, showing empathy and being friendly and kind to these amazing women and their babies.

Birth art

I love drawing, painting and generally being artistic when I have the time and have recently become more interested in birth art. There are some fantastic artists out there who focus their art around pregnancy and birth, my current favourite being Amy Swagman (themandalajourney.com). 
Recently I won a voucher to buy midwifery books (exciting!) and one of the books I chose is 'The Art and Soul of Midwifery' by Lorna Davis which I have now been reading with passion. So far birth art through history and using birth art as part of antenatal classes has been discussed, both very interesting and something I would be interested in using in the future.

I create art surrounding birth because it is something that I love and will be always a part of my life. The art I create reflect my own views of birth: the setting is usually in nature, the women nude and free. Nature to me symbolises life, peace and happiness. To be in nature, a beach, forests, grass, water, brings me joy. I spent most my childhood outside and am so grateful for that! I believe that pregnancy and birth should be embraced as a natural part of life, not a medical condition and women and their families should be supported and well informed, not treated as patients and expected to follow the medical professionals ‘blindly’.

This is my most recent piece, it’s not a masterpiece but just something I enjoyed making!  I hope you enjoy :)

 

Can you have a natural birth with an epidural?

I have heard people say they have had a natural birth with an epidural, is that really possible? To some people anything that is not a caesarean is a normal birth. I believe every woman who gave birth is a goddess, whichever way it happened, whether it was her choice or not, therefore I do not mean to disqualify any of them as giving birth!

This is how I look at it.....

Vaginal birth: The baby is born without a caesarean. Meaning the baby could have been born with the aid of a vacuum and with the mother using epidural analgesia.

Normal birth: The baby was born without any complications or assistance in the way of vacuums or forceps, ie. the mother pushed the baby out by herself. A normal birth can include the use of pain relief of any sort.

Natural birth: The baby was born as nature intended, without the use of pharmacological pain relief or assistance. 

And now there also exists a natural casarean, but I won't go into that! Here's a link http://www.youtube.com/watch?v=m5RIcaK98Yg

Do you have any opinions or thoughts to add?

Assessing progress in the first stage of labour

*Written before an exam as revision where I believed this type of question would come up and completed after the exam for here. The question that I answered was “How does the midwife assess progress in the first and second stages of labour?” I’ve only answered the first part of the question here.*

I will discuss the role of the midwife, and what the student midwife must learn, in assessing progress in the first stage of labour.

The first stage of labour can be defined as ‘from the onset of regular contractions to the full dilation of the cervix’. It can further be divided into latent phase-up to 4cm dilation, active phase-from 4cm to 10cm dilatation and the transitional phase-from about 8cm to fully dilated. [On a side note, I read an interesting article about the misleading guide of stages in labour-Winter and Cameron, 2006. ‘The 'stages' model of labour: Deconstructing the myth’. British Journal of Midwifery, 14, 8. If anyone would like to read it, message me through Facebook].

The midwife records labour progress on a partogram, including the cm’s dilated, engagement, foetal heart rate and amniotic fluid draining. The partogram contains a graph with an action line by which the midwife assesses and compares the woman’s labour to the recommended guidelines. It is considered ‘normal’ for the active phase to last 12 hours; NICE guidelines recommend that progress should be 2cm per 4 hours.

Of course, not all women and their bodies are the same, these are just common signs. We must always make our observations and conclusions specific to each woman we care for in labour. 

There are a number of external signs of progress the midwife can observe, these include the strength, length and frequency of contractions, the mother’s behaviour, her breathing, her ability to cope, her voice, the presence of a bloody show,  the ‘purple line’ and the Rhombus of Michaelis.

During the latent phase of labour when contractions start they are usually short, far apart and not very strong. The woman can cope with them well and is able more or less to continue with her day. The latent stage in the primiparous woman usually lasts 3-4 hours, shorter in the multiparous, however this is can vary greatly.

 As labour continues into the active phase once the contractions increase in length, get closer together and stronger. She will now require more support and coping mechanisms to manage with the contractions. Contractions should build up to three every ten minutes and be approximately 45 seconds or longer in length, they should continue this way throughout the active stage of labour. The mother will not be able to talk through these contractions and her breathing may be deeper and heavier through them to cope. Bloody show is mucous from the vagina and blood from the cervix combined and indicates cervical dilation, as the cervix dilates there is usually more bloody show present. The purple line may become noticeable now, this is a purple line that appears from the anus up the buttock cleft. As the second stage progresses it will become longer towards the top of the buttock cleft and many midwives have noticed that once it reaches the top the woman in fully dilated. Another sign that midwives have found over the years that indicates nearing full dilation is the presence of the rhombus of Michaelis. The rhombus of Michaelis is a diamond shape protrusion (for want of a better word!) on the woman’s lower back that becomes visible as the bones adjust to allow the baby’s further descent into the pelvis. It is most visible when the mother leans forward and reaches her arms out, apparently also a sign of transition.

It has often been noted that once the woman meets the transitional stage her contractions may ease off a little but her urge to push will begin taking place. It is well known to hear a woman claim she cannot do this anymore, demanding pain relief and asking for the care providers to ‘end it all’ once she reaches transition stage (Fraser and Cooper, 2009). During transition if the membranes have not ruptured yet this is often when it occurs. This allows for the presenting part to descent further into the pelvis and apply itself well to the cervix. A sign from the baby that full dilation is nearing are decelerations during the peak of a contraction, this can indicate ‘foetal head or cord compression’ meaning the head is descending well. 

The first stage ends and the second stage of labour begins once pushing commences.

As mentioned before, every woman and her body is different and it is only by observing and working with each individual that we can care for her and assess her progress accurately. All of the above signs can be observed by interacting with the woman, asking her questions and simply becoming aware of her behaviour.

Feel free to ask me any questions about anything I’ve said here. Sorry if I’ve got something wrong, do correct me! Also, I happy to try find articles for people on any of the above :-)

Fantastic related listen: The second recording on the list, ‘Ungloved and Observing’ by Gloria Lemay http://internationaldayofthemidwife.wikispaces.com/International+Day+of+the+Midwife+2011