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!!!!

PTSD and Midwifery- Don’t be ridiculous!

So I arrived home today after a  day of lectures to find the latest edition of the Midwives journal- The Royal College of Midwives (Winter edition 2016) . Having a read through I stumbled across an article regarding PTSD in the workplace.  ‘Facing the truth- PTSD and the profession’ (RCM 2016).

As I read the first paragraph my heart sank- thoughts of nightmares, comments of panic attacks, drinking to stop the thoughts, ascribed so eloquently, this sounded more like a scene from Full Metal Jacket.  As I read further it was revealed that the account was taken from a first year student midwife who had witnessed a horrendous birth at the end of her first year.  My heart sank further- statistics now show that 1 in 20 midwives will experience clinically significant post- traumatic stress disorder in the UK (Sheen et al 2015).

dont-panic-1067044_960_720

PTSD affects anyone who has been exposed to trauma, as student midwives, registered midwives and practitioners we are all aware of the enormity of our profession- the severe lack of funding and TLC our precious NHS needs deserves. The RCM (2016a) report that the pressure on midwives has never been as great, longer working hours, no time for basic human necessities like having a wee! Not getting breaks, teamed with the fact that the birth rate is up almost one quarter in the last decade (Office of National Statistics 2014) ,compounding staff shortages and increasing multiple births, increase in maternal age and expectant mothers with pre-existing conditions means the strain and stress on the midwife has never been so prevalent.

The RCM  has recognised this and has adapted the ‘caring for you’ charter.  The aim is for organisations to acknowledge and sign the charter.  To improve the health, working conditions and quality of care of student midwives and midwives.

What I take from this article and what I think we all need to remember is that we must care for ourselves- A midwife who works in a positive, compassionate and supportive workplace is more likely to deliver positive, compassionate and supportive care!

SOOOOOOOOOOOO TAKE CARE OF YOURSELF AND EACH OTHER!!!!  WE ARE ALL IN THIS TOGETHER

Tips for first year Student Midwives….

CONGRATULATIONS! YOU MADE IT!!! YOU ARE STUDENT MIDWIVES!

How are you all finding semester 1? Terrifying? Is life sciences sucking the life out of you? Have some lectures left you running for the hills crying into your pints at the SU? Have you actually got over the shock of being a student midwife yet and now the reality of being a student midwife is kicking in?

cell-pic

Ok…so as a second year the horrors of that first semester are still fresh enough in my mind that I get goosebumps at the thought of how I felt this time last year but I am also sat here having survived so feel it may be a good idea to share how I got through it! I will add that maybe not everyone finds this first semester as a student midwife hard but I did and a lot of my cohort did so here are some tips that got me through to semester 2 in one piece and nearly sane!

  1. Don’t look too far aheadby this I do not mean do not plan…planning is GOOD (see point 2!) but do not look at your timetable for 4 weeks time and think ‘how can I possibly manage to do ALL THAT WORK?” . Think about what you need to do today and what you need ready for tomorrow. Have an awareness of assignments whilst you are reading stuff but don’t be consumed by it! One day at a time…your knowledge is building up one brick at a time so if you look too far ahead you will overwhelm yourself and you cannot possibly know what you do not know so just be with what you need to do now, today.
  2. PLAN –  you need to be organised! USE the time allocated to you for Guided independent study and independent study. If the timetable says 3 hours do 3 hours! It sounds silly but this will help you ensure you are doing the right level of work. I have a list of studying to do which I add to and cross things off as necessary! It helps me sleep at night not worrying I may be missing something i need to be doing!images-1
  3. Do not over think it (at this stage!)  At the moment you are bombarded with information and, lets face it, you’ve been accepted onto a highly competitive midwifery degree because you LOVE it and want to read and research EVERYTHING around it but you WON’T HAVE TIME! This was a downfall for me! More than once drafts would be returned to me as ‘too complicated’, ‘too complex’ etc because I didn’t want to just read and write about a nice straightforward pregnancy I wanted to research why a perfectly straightforward pregnancy and labour could result in a retained placenta WHY??? Goddamn it!!!! This is not the time for that level of ‘reading around the subject’-read what you have been told to read at this stage as you will have little time to read around the subjects if you want to get through the massive amount of material you need to get through and your FIRST YEAR is focusing on normality do not confuse yourselves by needing to know about the complex stuff….yet! Imagine your knowledge is being built and you need to embed the foundations nice and solidly before branching out further into the more complex stuff!
  4. Use everybody who offers support we are not just being nice we want to help you! Your AA, your PASS leaders, your mentors, midwives on your placement, your lecturers, your PEFs, your ward managers, your PEERS! They are all there as support – support each other! Knowing you are not alone in the struggle is such a bonding experience! Tell people if you are finding something so hard you are questioning your decision to train as a midwife! Take time to check out within yourself how you are feeling and reach out when you are struggling-learning to reflect on your experiences is important on  a lot of levels so the sooner you start the better!
  5. Be kind….to yourselves and others– please be kind to yourselves! Give yourself time off; spend time with your family and friends! Do non-midwifery related stuff! It is EASY to be consumed by this degree but self care is fundamental to resilience and good health so start as you mean to go on! Sleep well, eat well and invest in ‘you’ time it will benefit everybody around you especially you! Look at your cohort-are some people struggling? Reach out to them-this is not a competition we really can ALL succeed but its much nicer if we all help each other along rather than revel when people fall! We are training in a compassionate profession this starts with how we treat each other!
  6. Attend revision lectures – that is it really! Attend them-they are important!
  7. Use social media sparingly– so you did well and got 110% on your first assignment….AMAZING!!! Well done! Please consider why you would put this on Facebook! It’s super you’ve done well and you should be proud of yourself but tell your folks, tell your friends, shout it from the rooftop but jusocial-medast ask yourself why you are sharing that somewhere so publicly when you know others in your cohort are going to read it and maybe might not have managed to get such a great result! We all have areas we are strong in and areas we are not so strong in-support each other and celebrate successes but be mindful of how your fabulous result may make somebody feel who only managed 35% this time.
  8. Enjoy it! You will be frantic at times and wonder how you are ever going to get through your life sciences exam as well as hand in your poster assignment draft, get that presentation ready, complete your placement documentation plus have any kind of extra curricular life! But enjoy being a first year student midwife! Take time to stand on the 4th floor of uni place looking down Oxford Road at the buildings and the hustle & bustle and remind yourself you are a student at MANCHESTER a highly prestigious university! Go to the library and breathe in the smell of ALL THOSE BOOKS embracing how far you have already come and that YOU GOT CHOSEN! Do not be so consumed by panic that you lose sight of why you want to be a midwife. Oh….and learn to scan read! An essential skill!!!

 

My day with the Health Visitors

As an adult student nurse, I don’t encounter many babies/children, so I was keen to try something a bit different. So when I found out that the Health Visitors were just down the corridor of my placement’s main office base, I soon popped my head in to organise a spoke! I had an absolutely wonderful day with the team! Not only did it help me understand the workings of the Community Multi-Disciplinary Team, but its exposure to another field of nursing! Plus, my current district nursing placement is largely based around treating patients, so observing some preventative public health care was great. Oh, and I got to play with some adorable children- I love being a student nurse!

Each Health Visitor is a qualified nurse (adult, child, mental health or learning disability!) or midwife, and their role is based around family care. By leading the delivery of the Healthy Child Programme, they ensure that expectant mothers and new babies up to the age of 5 get the best start in life! They visit families in their homes, GP clinics, Nurseries and Sure Start Centres. It’s an incredibly varied job.

pincer grasp

A tiny grasp for baby, a huge step for development!

My day with the Health Visitors started with a visit to a local SureStart centre, where the local ‘Baby Clinic’ is held. This is where one year old’s attend and the health visitors evaluate their progress. Its not as scary as it sounds, I promise!! They look for certain markers in a baby’s development and then, if needed, can give the parents pointers on how to help their child. For example, by the age of one they should be ‘babbling’ (repeating words they’ve learnt, usually nonsense), pulling themselves to stand and using furniture to wobble around on two feet, and using a pincer hand gesture. We had two lovely little babies visit us, both of which showed these developmental markers but at different stages. Each child, of course, is different and they have started to develop their personalities at this point. Our first baby was very outgoing and had his older sister to make him confident enough to play around and show us how well he was doing. The second child was a bit more shy, and preferred the company of her mum. However, after I showed her the wonder of some bells on a stick, she did everything we asked of her.

Alongside looking for the developmental markers, Health Visitors are also looking at the bigger picture. Their aim is to ensure that the family is happy, healthy and safe. How do you do this? Use a good old pyramid of course!

health visitor bible

Who doesn’t like a pyramid?

The Safeguarding and promoting welfare pyramid is designed to help pinpoint the areas which children should have. So, for example, if the Health Visitor detects that the child doesn’t seem like they have enough stimulation for the child to grow and enjoy themselves, that would question the parenting capacity. It’s useful for identifying a variety of factors that may be affecting a child’s development, as it’s never usually just one thing. Anything that is identified as missing can be worked on, via the Health Visitors, Social Workers or Family Support Workers.

If you want to learn more about Health Visitors, NHS England has a load of information about their role and how to become one! Or, if the chance arises, go and spend time with some!

What a difference a year makes…..a message to those starting uni in September

This time last year I was 2 weeks away from packing up my beautiful little counselling room and walking away from a career which I had worked in, enjoyed and become competent in for 15 years and I COULDN’T WAIT!

office-1Don’t get me wrong I loved….LOVED being a therapist and in some ways it defined me but I had pondered long and hard about the decision to change careers and it had been an exhausting slog getting to the stage where I felt confident to finally end my practice and leap into this new world of placements, essays, exams, university life, uniforms, night shifts, long days, hospitals, babies, women, families, doctors, midwives, HCAs, colleagues, blood, faeces, vomit, paperwork, paperwork, paperwork and STRESS but I was ready I WAS READY TO GO …or at least I thought I was!

What would I say to me this time last year:

“read everything you want to read which isn’t midwifery related because in a year you will feel guilty every time you pick up a non-midwifery related magazine/book”

“knit what you need to knit, sew that skirt and dress you’ve been desperate to get on with and RUN for hours in the evening when the kids are in bed whilst you still can as that time will swiftly become ‘study time'”

“play with your sons, read with your sons, cwtch them at bedtime and in the mornings before school because these are times you won’t be around for and you will be intoxicated with guilt for all the times you could’ve done this and didn’t. Enjoy taking them to school and picking them up as this will soon become a treat not a chore”

“go and visit your parents and explain to them that the next three years are going to be tough and you will work weekends and when you aren’t working weekends you will be studying over weekends as you have worked all week and yes, this is dreadful as dementia is slowly taking your dad away but drink him in now, absorb him and how he is in 2015 as 2016 will bring a bit less of him”

“go out with your husband-he’s a good, decent man and over the next 12 months he is going to prove time and time again that he can and will step up and be both parents to your sons and keep the kids fed, the house clean, the washing basket empty and the animals fed and you sane(ish) despite you doubting his ability to do any of these things at this moment in time”

“invest in the right people. You have amazing friends in your life, some will still be around this time next year and some won’t-friendships have seasons but you will meet the MOST amazing friends on this course and, along with a couple of decent friends already in your life, they will hold you and wipe your tears and tell you that you can do this despite you truly believing, in your soul, you have made a massive mistake. The friends you make over the next couple of months will be your ticket to making it through the next 3 years and hopefully the rest of your career because your midwife sisters are the ONLYpeople who truly understand what it takes to make it through this career choice. It is HARD but MY GOD it’s worth it”

“and most of all EMBRACE every opportunity….you are going to be scared at times, really scared; you’ve been really scared in your life before and you’ve managed to get through it but this will be a different fear; this is a fear of failure, a fear of actually causing harm because you don’t know what you’re doing, a fear or letting your family down, a fear of letting yourself down but don’t let the fear get in the way of being in the moment and experiencing every opportunity that comes your way because this job you are training for, this career, this vocation is a gift and a privilege and NOTHING that precious comes without a price”

Would I have heeded any of this advice….NAH! I was too excited but it’s nice to look back on and reflect!

To those about to start university-yes you’ll have doubts and you will probably cry and wonder if you’ve done the right thing at points over the next 12 months (& beyond I would guess!) but always force yourself to go and do your next shift as you just never know what might happen on that shift that confirms you’ve done the right thing! Plus-if you need support its there don’t be alone in your worry.

 

DILP Week 5 – Teaching and Learning in Maternity ft Muetzel

Well the outrageous fact that next week is my FINAL WEEK is madness. Right now I’m sitting pretty at 208 hours (40 to go) but it almost feels like a dream: I’m so full of questions about the culture and the way of working out here so I feel like I’m always engaged in some sort of discussion, which makes each day really rush by.

13570100_10209880158430843_164513180_o

Shout out to my amazing Nursing Therapeutics Seminar Lead – you know who you are!!!

After one such discussion with the ward Matron, she said she felt the staff could improve their communication and social skills with patients, creating more of a rapport (this took a while to figure out as she speaks rather broken English). So I briefly explained Muetzel’s model of the therapeutic relationship, which is based around Partnership, Intimacy and Reciprocity. She was so interested I ended up making a couple of posters and giving talks to staff members in little groups over the course of the week. It was a really rewarding experience for me to see these Nurses taking on this academic knowledge and applying it, almost immediately, to practice.

It was also wonderful for me to realize how much I’ve learnt during these last 2 years at UoM. Lots of what I was teaching hasn’t come up in exams and I haven’t been fastidiously revising it, but it was still there in my brain, informing how I interact with patients and being able to pass this on was such a great feeling.

All my questions though did make for a slightly awkward discussion with a consultant this week when I asked why it was the normal procedure in Sri Lanka to give Episiotomies, no matter the size of the baby: “Because Sri Lankan women are far more petite than Western women” Fair enough, I thought (the average height of a Sri Lankan woman is 4ft11) but that wasn’t what he was getting at… Gesturing with his surgical scissors he added; “For example this woman’s vagina is far smaller than yours would be”. THANKS DOCTOR. I almost died of embarrassment.

My questions haven’t all had such uncomfortable endings though. For instance I’ve become fascinated by the many superstitions and traditions deeply woven into everyday Sri Lankan life. One very common belief is that the exact time of a person’s birth is holds great importance over the course of their life.

horoscope_matching_1

Its a bit of a cross between buddhism with a big emphasis on horoscopes, couples are often matched based on Birthdays

It is always noted to the minute and this information is taken to a spiritualist (Tamil or Buddhist astronomer) who produces a big document/graph thing that contains key dates to be wary of and dates of good fortune. These can be days or years. During the times of misfortune the family can offset this bad energy by giving alms, doing charitable work or attending the temple more regularly. Equally there is some level or risk management that is involved. For example if someone is predicted a bad 2016 because they were born at 4.33 instead of 4.34 then even if it made sense with every other facet of their life, big dates such as having a baby or getting married would be delayed until they were back in good favors.

I personally would not respond well to such strict time frames but I was far too curious to know what my prophecies would be. So, luckily, I was able to take a short 20-minute stroll from my apartment to the hospital where I was born, 20 years, 6 months and 5 days ago. After a quick 5 minute trip to the records room a nurse produced a huge leather-bound book, identical to the one I have been writing baby’s birth records in for the last two weeks. Except in this one, “Baby Girl Wragg” made an appearance! Thanks to this hand-written entry I am now armed with my birth time and am setting a meeting to speak to a tamil astrologer to find out how things are going for me! Hopefully 2017 with my dissertation looming, will be a very very lucky year for me or else I’ll just have to find a Buddhist temple somewhere near Stretford.

13575540_10209880163830978_449468205_o

Baby Girl Wragg OG Sri Lankan