Mind your language!

I have realised as I’ve reviewed my previous blog posts that they tend to be quite personal. This post started as a very non-personal post but then, as I rolled ideas around my mind, I was reminded of times when the language used by Healthcare Professionals (HCP) had profound effects on me; some of these were positive and some negative but all forever imprinted in my memory and all influenced my experience of particular situations so, once again, this post will include my own experiences!

Late summer is a very bad time for me as in August 2013 my beautiful husband left me and our 3 sons and disappeared for 3 hauntingly long, soul crushing days when he made a serious attempt on his life only saved by the fact he was a pretty clean living fella with a nice healthy liver which did its job and chucked the massive paracetamol/ibuprofen overdose out of his body causing permanent liver damage but leaving him alive. This is not a post about mental health or suicide so the details of the lead up to this are not relevant here but suffice to say those 3 days were the worst of my life. I envisioned having to tell our 3 young sons their daddy was never coming home and having to raise my boys without my best friend and soul mate by my side. I imagined trying to support my in-laws with the grief of a second child having already buried their daughter…..they were the darkest 3 days of my life. The reason I am sharing this is to demonstrate the importance of the language we use as HCP.

By day 3 of this nightmare I was fully expecting a suicide note to turn up in the post, instead I got a phone call from a nurse from an emergency department in a hospital ‘down south’. She rang to tell me my husband had turned up and was being treated for the overdose he had taken. Now, the past 3 days had pretty much broken me but I did not break down in tears on the phone for many reasons, one of them being I was a practising counsellor at the time and was familiar with the language of attempted suicide and depression and I heard the news in a seemingly calm way. I then came off the phone and broke down both physically and emotionally.

My husband informed me, during a conversation much much later when we were debriefing during one of hundreds of conversations we had about that time that the nurse told him she thought I was “very clinical and a bit cold considering what she had just told me”. This stayed with me and continues to. I felt judged and misrepresented. I wanted to ring her and tell her that the reaction she heard was the result of 3 days without food and very little sleep, the reaction of a desperate wife and mother clinging to the only version of herself which was solid (the counsellor). I doubt that this particular nurse would even remember that conversation  a week later never mind 4 years later, but I remember it and my husband remembers it. He didn’t need to hear his wife had been clinical; he had no idea what sort of reception he was going to receive when we finally spoke to each other but what he needed to hear was that I had been informed and was ready to talk to him when he felt ready (which is actually exactly what I had said).

In situations of high emotion if you don’t know what to say, stick to the facts. Do not include your opinion and do not pass judgement.

So, onto another example of poor communication and the use of language.

During and after the traumatic delivery of my eldest son (for the midwives amongst us he was an undiagnosed malpresentation and a 36 hour induced labour ended with a rush to theatre for a trial forceps then emergency c-section). Things midwives said to me included:

During labour:

“what do you mean you aren’t getting the sensation to push, everyone gets the sensation to push” (not true, however I believed I was weird and not a ‘proper woman’ as I wasn’t ‘doing it’ right)

“you aren’t trying hard enough” (I used quite a lot of bad language at this point)

“Please try to push harder we need to see more maternal effort” (I cried)

post delivery:

Well, if you had pushed that baby out you’d have broken his neck” (Yes, yes this was actually said to me – his ear was the presenting part so it was probably true but I did not need to hear it)

“We took bets that you wouldn’t deliver him naturally” (so many things wrong with this sentence I do not know where to begin!)

So….therein ends a couple of examples of the poor language used to me personally during interactions with hcp (I have lots of examples from friends but I won’t share them as they are their stories!)

I now want to share some good examples of when HCP have used language in a positive way and how these have also stayed with me.

Following the above traumatic delivery my community midwife (who I respected so much she is a major reason I wanted to be a midwife and who I now know as a colleague) said to me “none of this was your fault. You did nothing wrong and nothing you did could have changed the outcome” (she knew I had wanted a homebirth with candles and words of love not theatre lights and words of terror). These words alone gave me permission to let myself off the hook for not being good enough to have a ‘normal’  birth.

*side note*  Please be mindful of using the word normal it can be very damaging. In terms of delivery I feel ‘vaginal delivery’ is enough without the word normal in front of it, its unnecessary. 

When my middle son broke his wrist and I waited 24 hours to take him to a&e because I thought it was just a ‘bit bruised’ I felt like the worst mother in the world and told anybody who would listen how awful I was and how could possibly I leave him 24 hours in pain poor little soul etc etc. A lovely radiographer took me to one side and whispered in my ear “I am a radiographer, my son broke his ankle and it took me 24 hours to bring him in; I thought he was just moaning”! Brilliant! Still makes me smile and instead of coming out of that situation feeling awful I came out feeling forgiven (although the middle boy still mentions it when he is wanting sympathy!)

All my sons have been in hospital for one reason or another most of which were when they were babies and the language used when communicating with me as a terrified mother has mostly been lovely and comforting (we will ignore the paediatrician who told me I would not be ‘allowed’ in the room when my 8 week old son was having a cannula sited in his head as we mothers tend to get ‘hysterical’ AND the paediatrician who looked at the 90ml bottle of breastmilk it had taken me AGES to express and said “is that all you’ve managed?”……we shall ignore them!!!!).

But this is what I want to leave you with (and something I remind myself of when working with women and their families)…

We may not remember all the people we work with and support or all the things we say but they remember us and they remember what we have said.

…………………….Years and years later.

Ask your friends and family about the midwife who delivered their babies….ask them what she was like (my Nana,at aged 95, could still remember the midwife telling her to stop screaming when she was delivering my 11lb mother as she may disturb the neighbours!).

Ask your friends and relatives about their GP and the things they have said to them over the years,  or the nurse who looked after them when they had their tonsils out when they were 7 years old (“eat the cornflakes or your mummy won’t be able to come and see you” ….I realise I have not had great experiences with HCP!!!!); ask them about the student midwife who took them to one side when their wife was haemorrhaging post delivery and explained who all the scary people who had just rushed into the room were and what they were doing; ask them about the consultant who told them there was nothing more they could do for their beloved dad; ask them about the importance of language and words.

Also, don’t lose sight of the influence of non-verbal communication: our body language speaks VOLUMES. Being clinically good is fundamental to being an effective HCP but being kind and respectful ensures the experience of the people we care for is remembered for the right reasons not the wrong reasons.

What we say matters. It MATTERS. If we are having a bad day and we are a bit too blunt with our language or we are too harassed to sit down and explain a procedure or we are tired and turn a blind eye to somebody you know is on the verge of tears and needs a friendly ear…..these things matter. Of course we have bad days but share these with your colleagues and friends; try really really hard to not let this influence the experience of the people we care for as they are mostly vulnerable and usually scared.

Thank you x

 

 

 

Collaboration: the future of our NHS- #nurswivesunite

13151090_226356241076122_2131036156_nI write this not to highlight the negatives of our current NHS in crisis, but to address how we can collaboratively work together to save our glorious institution.

I don’t need to talk about our failing health service, I don’t need to talk about the millions of pounds needed from the money tree to keep our beloved institution a float. I don’t need to talk about what the NHS means to Britain and its people, I don’t need to talk about the pressures, the constraints we as healthcare professionals all face.

What we need to talk about is how we can change the future.  I don’t think I’m wrong in saying this is without question the hardest time ever to train to be a nurse or midwife.

We’ve lost our bursary, some of us have lost our passion, our dreams of delivering the care we want to.  Who do we thank for this? Is it a question of politics? Or has our health service just reached a tremendous plateau of increased life expectancy, a rise in population, increased complex care which have become a potent mix given the current economic climate.

How do we adapt?

Collaboration that’s how!

Collaboration– “A purposeful relationship in which all parties strategically choose to cooperate in order to achieve shared or overlapping objectives.”

I love this definition, it epitomises what I believe is at the heart of what we all signed up for; whether you are a student midwife or student nurse we all have overlapping goals, we all CARE.

 We all want to deliver the best care possible whereby it be to a baby on neonatal unit, an Alzheimer’s patient, a child, a patient on a high dependency unit, a labouring woman, they all deserve the same amount of care and compassion.

 We are governed by the code (NMC 2015), we all follow the code, are regulated by the code, we all follow the same overlapping objectives -care, compassion and empathy.

As a whole we are truely invincible.  We have the power to stand up and fight. We have the power to change OUR NHS !!!

Let’s get to know one another, the roles we represent, the care we provide and how we can support each other.  Once we are fully united then I believe we have the power to transform and adapt to the future of our glorious glorious service.

 

Hello from the other side…

We’re delighted to share this guest blog from Lizzie, a fourth year Bachelor of Nursing and Midwifery student from the University of Queensland, Australia. Lizzie shares her incredible experience on exchange at the University of Manchester where she is completing her final nursing placement in A&E at Manchester Royal Infirmary:

“Hello… Can you open your eyes please… What’s your name? Do you know where you are?

My name’s is Lizzie, I’m the student nurse looking after you. How can I help?”

Welcome to the adrenaline packed, electrifying, exhausting and incredibly humbling world of Accident and Emergency. I’m one of two UQ final year Bachelor of Nursing/ Midwifery student’s fortunate enough to have the incredible opportunity to go on Exchange to the University of Manchester, and complete my final Nursing Undergraduate Placement in A+E at the Manchester Royal Infirmary.

Lizzie 1

I can’t believe in just under three weeks I’ll be finished my nursing degree! When I was little I always dreamt of being able to help people with my hands, my heart and my brain. I actually have come to feel so at home in the hospital – nursing has fit me like a glove. I love to learn, I’m a people person, but most of all I feel such a sense of satisfaction when I know I’ve made a difference. That’s why I’m excited, and proud to (almost) be a nurse.

I’ve been in the UK for 3 months now. Words can’t describe some of the things I have seen, how much I have grown personally and professionally, and how much I love it here – but I’ll give it my best.

Lizzie 2

A+E is a never-ending puzzle. In comes a person with a list of symptoms, and (in the time constraints of the National Health Service’s 4-hour max wait times) you assess, stabilise, gain a history, conduct tests, perform interventions, monitor for the impact of these interventions, and then either refer them to a specialty or (hopefully) send them home. The true skill comes in managing many patients simultaneously – yet still treating, valuing and respecting each as an individual.

While every shift is an adventure – here are some of my highlights:

In A+E when there is a really critical person about to come in we get pre-alerted by a call from the Ambulance service to a “Red Phone”. The Nurse in charge takes the call, and then alerts the department over the loud-speaker – “Red Standby, Adult Major Trauma – ETA 5mins”.

One of these “Red Standbys” was a motorbike vs car head on collision, resulting in fractures to the patient’s femur, hip, wrist, and back… I got to look after and stabilize the patient, and follow them through to the Orthopedic Trauma Operating Theatre. The surgeons and theatre nurses were so kind, they not only talked me through the 3 operations, but they even let me scrub in so I could stand right next to the surgeon as he used metal rods, plates and pins to reconstruct the patient’s broken bones.

I have been actively involved in eight cardiac arrests (one was on my first day – but that’s another story). I’ve helped wheel a patient down the hallway while they were actively receiving CPR, and get them to the “Cath-Lab” where under X-ray guidance surgeons were able to guide a wire up the patient’s femoral artery, and use a stent to reopen the diseased blood vessels of the heart, and save his life.

Lizzie 3

I have been blessed with a plethora of opportunities to learn – just over a week ago I traveled to Chorley to complete a simulation training day in “Out of Hospital Emergencies” with the Paramedics and Army Reserve. I’ve worked with an advanced practice nurse running a Community Clinic for Chronic Diseases, and have done home visits with a GP for the day – visiting some of the sickest home-bound patients.

Just yesterday I got to ride in an ambulance for the first time as we transferred a patient to a specialist hospital for neurosurgery. The patient was critical, so we traveled on “blue lights”. The paramedic crew were amazingly skilled, calm and good at balancing as we tore down the highway.

Manchester is a beautiful city to explore, and the rest of the UK is so close that I’ve being doing my best to see as much as can on my days off. So far I’ve day-tripped to the Lakes District, spent a weekend in Bath visiting the Roman baths and Stonehenge, seen some stunning castles in Wales, and travelled to Dublin for St. Patrick’s Day!

Lizzie 4

There are some exciting opportunities on the horizon – in my final week as a student nurse I’ll be attending a conference in London and on shift with the London Ambulance Service.

I have been so lucky to have worked as part of an incredibly supportive team and mentored by inspiring nurses and doctors. I won’t sugar coat it – I have seen some heartbreaking things (as is the nature of Accident and Emergency), but I wouldn’t change a thing. I’ve found my calling – caring for people when they are most vulnerable. Be that at the beginning (as a student midwife) or at the end (as a student nurse), it’s my privilege to love, support and provide dignity. Not as a healthcare professional, but as one human being caring for another human being.

I have learned there is never a situation in which a non-judgmental ear, a hand to hold, and kindness won’t help.

I’ve realised how precious every moment is.

Miscarriage & Midwifing

Before continuing to read this please note it may be triggering for those who have experience of baby loss…..please bear this in mind and take care of yourselves before reading further. This is an incredibly personal post so please note all experiences are based on my experience of miscarriage.

I recognize I am a person who processes life events by writing about them. I realized quite soon after my miscarriage that I would need to write about it to help me grieve but now the time has come I don’t really know where to start. I do know I want to reflect on my experience as a student midwife grieving over my lost baby and how I felt/feel.

I started this blog post by doing a quick search for research and other blogs written by midwives who had experienced baby loss but the area is quite sparse. I was surprised by this as midwifery is dominated by women and as miscarriage effects 200,000 couples each year and 1 in 4 pregnancies end in miscarriage (Tommys.org.uk) the chances are a lot of midwives are touched by miscarriage.

I feel like midwives losing babies is a subject not really talked about. Maybe it is discussed among colleagues, friends and peers but my experience is it all feels a little taboo…..like if I talk about it I may be judged as not being able to do my job or might fall apart when taking care of pregnant women….I can’t really verbalise my feelings regarding this other than this was my personal experience of miscarriage as a student midwife. I felt like I needed to just carry on as taking time off may be perceived as a sign of weakness (this is not something I was told by anybody but it was how I felt). This degree is relentless…if I took time off I may never go back so I felt I needed to be ok…to show resilience, put my head down and ‘power through’.

I started my midwifery degree with 3 school age children and felt my family was complete. Both my lovely husband and I were both told, for various reasons, our individual fertility was irreparably damaged so as a couple our chances of conceiving were zilch….which was fine! After a particularly gruelling schedule of placement, exams, essay deadlines, family pressures etc I felt ill…..really ill. More than tired ill and more than stressed ill…I felt dreadful. I have been pregnant 3 times so I recognise the signs. I returned home after my first exam and did a pregnancy test……which was positive!!! I was stunned! Being a StMw (Student Midwife) the first thing I did was calculate my EDD (estimated due date)……our baby was due on our 13th wedding anniversary…..surely this was a sign that the little miracle bean growing inside me was meant to be?

After the shock settled for both me and my husband we started to get excited….this was a door that was firmly closed, bolted, locked and double padlocked! We had been given a chance! I knew the stats….I am 41 for goodness sake! I recited the stats to my husband to try to keep us grounded in the reality that this pregnancy was unlikely to continue but we had got pregnant against the odds so surely I would be ok?!

I went through a whole array of emotions and my thoughts were racing:

I wouldn’t graduate with my cohort which was gutting BUT I would have a much wanted baby…. which was wonderful!

We had no money…..no answer to that really except we would manage!

We are OLD – our youngest is 7 so we would be starting again when all our friends had similar aged children to ours….we didn’t care, we love babies and children!

….and many many more random thoughts…but most of all we were thrilled and, as all couples who are pregnant with a longed for child do, we made plans. We planned when we would tell people, when I would leave uni, when I would return, how I would cope with the pressures of a full on degree when pregnant in my 40’s, who would do my booking as I know all the community midwives in my area? Would people judge us as irresponsible and foolish? The odds of having a healthy baby were not in our favour so would family/ friends/ fellow midwives judge us for getting pregnant especially given all my husband’s health issues and my ever depressing age?! Do you know what?….we didn’t care! We felt so happy and blessed!

I grew our baby for 10 days….10 remarkable, wonderful days when I felt fertile and hopeful and excited. 10 days of hope and dreams and of improving stats (I found an app that showed the likelihood of me miscarrying reducing by the day)…I fell in love.

We were going away for a few days to end my 3 sons’ fortnight holiday from school. I had 2 exams and an essay deadline during this fortnight so the boys had been bribed to tolerate my emotional absence and grumpiness with promises of having 100% mummy for 4 days at the end of their holiday. On the Friday morning we were going away I started to bleed. By Sunday night it was pretty much all over. The hcg line on the pregnancy test had gone from a strong line to a faded line only visible when held up to the light. I was inconsolable and angry….why let me get pregnant for this to happen? I felt my body had let me down. I felt foolish for hoping….this was an incredibly early miscarriage and in a cold, clinical light I could accept that my very efficient body had dealt with a non-viable pregnancy quickly and with little fuss; but this knowledge did little to stop my heart from breaking.

I called my local EPU (early pregnancy unit) on the Monday morning we were leaving our mini break to confirm what I already knew. The very lovely, kind sounding nurse confirmed I was likely miscarrying and informed me to repeat the pregnancy test a week later to ensure all the ‘products of conception’ had gone and to ring immediately if I started to haemorrhage, have severe pain or pass large clots. My pregnancy was all but over. When we returned home I found the pregnancy test with the strong hcg positive line and I sobbed; that proved our baby had been real, albeit momentarily.

I was on placement in the community the next day and was also scheduled to attend a 20 week ultrasound anomaly scan with one of my caseholding couples.

Would I be ok?

Part of me felt silly for being so upset…this was very early (I was about 6 weeks) and people lose babies at all stages of pregnancy how dare I be so upset about such an early loss? But I was…it was the loss of hope and loss of a future we had dreamed of and imagined. The loss of us being parents to 4 children and being a family of 6 ….or more! We had joked it may be twins (my age and a family history of twins increased this possibility).

I was a counsellor before training as a midwife and during my 15 years as a practising counsellor I experienced major personal life traumas but, with increased support from my supervisor I maintained my practice throughout. I know I am able to acknowledge my own feelings whilst also allowing the space within myself to empathise and be present for others in a professional capacity. For this reason I felt I would be okay to attend placement but remain mindful and aware of my own emotions whilst staying grounded in my role as ‘student midwife’. I have always felt it is my role as a professional to empathise not identify. Allow an individual to experience their own situation without inflicting my personal feelings and experience on them.

I sat in the 20 week ultrasound scan with one of my caseholding couples and I was genuinely excited for them. Their baby looked healthy and they were told they were likely having a baby girl. I was thrilled for them and felt emotional and privileged at being able to experience such a lovely, personal moment. I went home after finishing the rest of my shift and felt ok but the poignancy of the situation was not lost on me as I could still feel my body dealing with the loss of my baby.

So what can we do as midwives?

…….Baby loss is a fact of life…the stats prove this. The stats don’t show the women and their partners behind that loss. The stats don’t show how many midwives experience baby loss. The stats don’t give you the tools to manage that loss. I have coping mechanisms thanks to my previous career but I am not made of stone…..what I found hard was not a 20 week ultrasound scan but an 8 week booking appointment when I would have been 8 weeks pregnant and it would have been around the time of my own booking appointment. I didn’t fall apart and I was (I believe) fully present for the couple during that booking appointment but did I go and have a cry on the toilet after it?…. Yes I did.

What needs to change?

……I am not sure……more talking amongst midwives of their own experiences of baby loss (hence this blog…..very few people knew I was pregnant so I feel quite exposed writing this but I am trying, in my own small way, to challenge the perceived taboo) and an acknowledgement that miscarriages, even very early ones like mine, leave a footprint. Our wedding anniversary will come and go and we will acknowledge our baby existed for however short that amount of time was.

Miscarriage is discussed in a very clinical way with terms like ‘products of conception’, ’tissue’ and ‘chemical pregnancy’ but I needed to talk about my ‘baby’ and ‘hope’. I needed to talk about how I felt about my 3 beautiful sons not having the chance to meet their baby brother or sister. I needed to sob & sob and not feel guilty for crying over somebody who only existed for a short space of time. I am not a Christian or a particularly spiritual person but our baby existed to me & my husband and we need time to be sad. My husband was quite pragmatic until we did the final (negative) pregnancy test …until that point he must have been carrying some hope (I was not; the test for me was a relief that my body had dealt with everything and I didn’t need to go to hospital and have any medical procedures) and he cried. I was shocked…..I am embarrassed that I was shocked as I feel like I should know better but I was genuinely surprised he was so upset. Fathers need acknowledgement within baby loss too and they tend to grieve differently. My experience as a counsellor is it seems to take longer for men to acknowledge loss and therefore grieve. This is worth bearing in mind when supporting families with loss.

If you are working with women and their partners following baby loss, please acknowledge the loss; acknowledge the sadness and grief. Being told “well it was very early” is unhelpful as it undermines a couple’s grief, we needed permission to be sad not platitudes in an aim to ‘cheer us up’.  Being told “well at least you can get pregnant” is also unhelpful as that does not acknowledge the loss of this pregnancy and this baby which is what we were experiencing. What helped me was my amazing trio of fellow Student Midwives who were my friends. They were not clinical or ‘midwifey’ they were my friends and gave me permission to grieve.

Thank you for reading.

 

 

Antenatal parent education- does it have a place in modern society?

ctmI adore parentcraft, why? Because I adore discussing the subject I love so very much. I love talking to women, their partners, their families about something which to them is unknown and very very scary.

Parentcraft is a funny thing! Some midwives adore it others can’t think of anything worse than “preaching” in front of a group of perspective parents.

It saddens me the lack of funding and hours the NHS invests into parent education. Year after year, maternity reports publish how important antenatal education is in facilitating positive mother and baby outcomes.  How discussing stages of labour, mode of delivery, pain relief, postnatal care and infant feeding to name a few are absolutely vital to achieving positive outcomes.

This week I was lucky enough to look after a lovely couple I had met in my parent craft classes.  Half way through her labour she told me how much she loved parentcraft and how informative it had been!! She recited aspects of the sessions I had spoken about including the stages of labour and the amazing oxytonic affects produced by feeling supported, loved in labour! I felt such a sense of achievement that the sessions had really helped the couple and I went on to deliver their beautiful baby girl!!!

I believe there is a place in today’s society for parent education but midwives must evolve and adapt in order to engage the audience. Nowadays information we all need is just a click away on an app or a search engine. But nothing beats a positive engaging face to face session.

I certainly won’t be shying away!!! I can not wait to get stuck into antenatal education when I qualify!! Spreading the word of the wonderful physiology of pregnancy, childbirth, infant feeding and much much more!!!!

 

 

Mysterious midwife? Vs obstetric nurse

So at the end of this week I will have finished my nine week community placement and I am absolutely gutted! 😩

Community to me IS midwifery- community encompasses the entire midwifery continuum. From booking to postpartum the community midwife is highly skilled in all areas of midwifery. For those who are unaware of what a community midwife does an average day from personal experience is a full antenatal clinic dealing with a wide range of medical, social issues, recognising safeguarding problems- including domestic violence, mental health problems, poverty amongst many many more.

Postnatal home visits, parent education, meetings with multidisciplinary agencies, phone calls from colleagues, anxious women, the hospital…. the list goes on!!!!!!!

One of the most beautiful amazing things we get to advocate in community is homebirth. Indeed research tells us that giving birth in the comfort of your own home with your family, partner, home comforts round you increases oxytocin- the hormone of love, childbirth, bonding and feeding which will therefore lead to positive outcomes. Of course some women are not suitable and we throughly risk assess all women in our care at booking to determine plan of care for delivery, providing the woman with the most upto date evidence based practice.

Of late, being an avid tweeter I have become increasingly alarmed by a small but growing consensus of people who believe midwifery has no place in contemporary society. These people believe it to be an ideology, a fantasy, a dream concept. I was very disturbed to read one post attacking midwives for our quest to promote normal birth as being for our own selfish gains. Believing that promotion of normal birth, home delivery to be nothing more than a ridiculous ideology that no longer features in a medicalised world.

This is the very reason why I feel midwifery is not just underrepresented but STILL in 2017 the average joes’ knowledge of childbirth and maternity is so poor that it is very easy to whip up so much negative hype- particularly on the back of terrible tragedies such as morecombe bay.

Why is childbirth seen as such a mysterious entity??? Why compared to most industrialised countries do we have abysmal breastfeeding rates?

Who do we blame for the increasing trend towards the medicalisation of child birth and the entire maternity care package?

Its somewhat of a wicked problem but all I know is the role of the midwife is to show care and compassion, to recognise deviations from the norm and REFER!!, promote normal pregnancy and labour. To be a midwife you need to care, care about the woman you are looking after, the baby in utero. Our strive for normality in childbirth proves how much we care! We want the very best outcome for the gorgeous ladies and babies we look after.

So please help spread the word-……..Midwifery is a vocation not a cult!!!!

Mentoring-who has the power?

I am sat here just an hour away from heading out onto placement for a final shift on the ward I have been working on and am pondering the nightmare that is getting paperwork and skills signed off. Finding the time, apologising profusely for the massive amount of writing up of skills I do to justify that I am good enough, hoping the mentor feels the same and signs them…..will the anxiety ever stop?!

Part of my thought process has left me wondering about the power balance in the midwife mentor-student relationship. Ideally there would be no power imbalance and the mentor/student would be engaged in a mutual, respectful and supportive pairing but I feel this is unrealistic and ignores the fact that, as students, we are reliant on our mentors to provide good, honest feedback and ultimately grade us which can mean the passing or failing of our degree. Surely, even with my basic degree in psychology, this puts the power balance very firmly on the side of the mentor?

Students, generally, want to please our mentors and not just for the sake of a ‘good grade’ (I feel this is a little simplistic and patronising) but because we want to do well! As a second year I have not struggled and battled my way this far through a very difficult degree to be mediocre and just ‘ok’….I want to be GOOD and COMPETENT. This means when I am working with mentors I ask a million questions and watch, listen and then ask another million questions because I want to be the best I can be.

I wonder if mentors are trained and updated on the power they hold in the relationship? I am sure they are and every mentor I have been lucky enough to work with has been supportive and encouraging whilst providing excellent constructive feedback when needed. Have I been lucky though or is this standard? I am not so sure……

The issues of boundaries in the midwife mentor/student relationship is interesting. My previous career was in an appropriately, heavily ‘boundaried’ arena and I feel I am acutely aware of boundaries at all times but  there have been occasions when my mentor has been made aware of my personal circumstances when necessary as this will, of course, impact on my practice…..could this be perceived as over stepping a boundary? Or, for example, if I ask a mentor if she is ok because I know her child was ill and she left work early during our previous shift….is this overstepping a boundary?

Is this a little too ‘pally’?

What is ‘too friendly’?

What could be perceived as forging a ‘too close’ relationship with a mentor when you are together 8 hours a day/ 5 days week in a car and in clinic and you have your lunch together and you talk……most people come into this profession because we are compassionate so we reach out to each other as 2 women sharing information about our lives…..is this overstepping a boundary? What should we discuss? Should we limit ourselves to just discussing midwifery at all times? But this feels incongruent and, again, unrealistic.

Also, what of mentor-student relationships that are not nurturing but, dare I say it…..toxic and damaging? Where does that student go? Every student knows that we are reliant on the mentor for passing us therefore, dare we complain if we don’t feel happy? Dare we mention to our PEF, link lecturer, academic adviser, ward manager etc that we are not happy?

We SHOULD do but do we?

What if we are branded a trouble maker?

What if we are considered to not be resilient enough for this degree because we have struggled with a mentor?

What if we still have to work with that mentor and they know we have an issue with them?

What if we don’t have to work with that mentor but one of her colleagues and they know we have complained?

We absolutely MUST speak up if we are struggling as the damage of ‘carrying on regardless’ is insistent and could lead to further issues both psychologically and practically further down the line but I hope that midwife mentors are aware of the power they hold and that forging a good, strong, supportive relationship is tantamount to bringing out the best in a student and that the majority of students just want to be the best midwives we can be!

Thank you to every mentor who has treated me with kindness and compassion-you have modelled how to be an excellent midwife and excellent mentor.

To those students struggling with mentorship-please speak out.