ATTENTION FIRST YEAR STUDENT MIDWIVES… Your PAD, White book and signatures!

I APOLOGISE AS THIS IS LONG…STICK WITH IT….. IT’S IMPORTANT INFORMATION;-)

Ok…you first years are all starting to think about placement right? It’s about a month away for the student midwives so your uniforms will be arriving shortly if you don’t already have them and you will have your documentation staring out of wherever you have hidden it because, if you’re anything like me, the thought of even starting to read that huge PAD document thing on top of all the studying you have to do is so out of the question it’s unbelievable!

Well I am here to hopefully hold your virtual hand through the whole documentation experience and share my many mistakes so you don’t make them!

First of all let’s clarify the difference between your

pad

 

PAD (Practice Assessment Document)……

 

 

 

 

white-book

 

 

……..and your white book (Record of Statutory Clinical Midwifery Experience).

 

 

 

 

 

You may not believe this but it took me a good couple of months to work out who can sign what and how equally important but different these two documents are!

 

So I’ll start with what I think is the easier one-the White Book. This will be held by you for the full 3 years then handed in at the end of your degree. Your AA will look through this during your individual meetings just to make sure you are ‘on track’.

The White book is where you record your statutory skills which every student midwife at every university will have to get signed off before they can qualify. You have the space in here to log your 40 births which seems to be the area of focus for a lot of students but there are A LOT more skills you need to achieve as well as delivering babies. For example, you need to record evidence of  antenatal examinations & care of 100 pregnant women and examinations & care of 100 postnatal women and their newborn babies.

In these midwifery areas any qualified midwife can sign off your evidence. They DO NOT need to be a mentor/sign off mentor. This is important because you will work with a lot of midwives when on placement and you may carry out a beautiful abdominal palpation and listen to the fetal heartbeat with a pinard whilst your mentor is on a break and you are working with another midwife…..WRITE IT IN YOUR WHITE BOOK AND GET IT SIGNED OFF! The white book just needs the woman’s hospital number, the date, what you did and the midwife’s signature. It can be written up in a couple of minutes and signed there and then! Otherwise you will get home, not written down half the hospital numbers for the women you have worked with that day, for the ones you have written down you’ll have forgotten what parity the woman was or the pregnancy gestation and for the ones you can remember you will realize the midwife who you worked with is now on maternity leave and so won’t be around to sign that evidence off (YES…ALL these have happened to me!!!-it’s gutting!).

There’s areas of the white book which can be signed off by qualified Healthcare professionals who work in other areas i.e. neonatal staff  or breastfeeding support  workers but the important thing to get into your heads about the white book is…

ANY QUALIFIED HEALTHCARE PROFESSIONAL CAN SIGN YOUR EVIDENCE FOR THE RELEVANT AREA YOU WERE IN WHEN YOU COMPLETED THE SKILL

AND

GET IT SIGNED THERE & THEN!

 

OKAY…..big, deep, breath…..THE PAD! Unlike the white book your PAD skills and interviews get handed in at the end of each academic year but you keep the folder (mine is already wrecked!). Your PAD skills are handed in through an official process where you are given a deadline (date & time) and you complete a front sheet for each set of skills and hand them into an exams officer (I point this out because this process was much more official than I expected it to be and it unnerved me a bit!). Your AA will probably take your interviews but this does depend  on the AA; I still have my complete set of first year interviews but I know a lot of my cohort have handed theirs in.

Signing stuff- this is a bit trickier than the white book as the people who can sign your skills off are limited. Let’s just talk about the actual documentation as an opener……..

Interviews

Ideally, at the start, mid point and end of each placement you and your mentor need to sit down and do your interviews. These will be read and checked at your AA meetings and are important for all parties involved as they help you assess where you are up to and also help you gather your thoughts on whether you are getting what you need out of the placement and if not how you can be proactive in accessing more opportunities.

During your mid placement interview do not forget to get your mentor to sign the actual interview AND the mid placement interview section on the front sheet of the set of skills you are working on (i.e. in the community this may be ‘Midwifery Care Pregnancy & birth antenatal skills’ section of your PAD. If your mentor has students from different universities they may not be familiar with UoM paperwork as every uni is different so its your responsibility to ensure every thing is completed.

As an aside, I did not realize our skills directly related to the academic units we were doing until about 6 months in…..don’t judge me I was overwhelmed!!!

Also you will have your progression points at week 19 & week 52….these tend to coincide with final placement interviews but not always so stay on top of these dates….get them in your diaries as both your mentor and AA need to write comments and sign these.

Skills

The skills section of your PAD is divided into 4 sections. Familiarise yourself with the sections, notice which sections coincide with your academic units so you can use what you are learning in university to inform your practice and vice versa, then write them up! Sounds obvious but it isn’t always! For example, if you have been learning about abdominal palpation in university and you are out on practice in the community, tell your mentor you have had a session on abdominal palpation and the use of pinards. Let your mentor know that you would really like to practice this in clinical placement. Your mentor will support you in this (if the opportunity arises) then you can write this skill up using all the theoretical knowledge and the practical skills you gained then get your mentor to sign this skill off! This, I recognise, is an ideal world scenario but this is YOUR clinical placement….make it work for you. This is your opportunity to apply what you are learning in theory to your practice; it is NOT your mentors responsibility to work out which skills you need to practice and get signed off!

Mentor/sign off mentor/SIGNATURES

You will be assigned a mentor when you go on placement for every clinical area you will be working in. You need to find out if they are a sign off mentor (they are usually quite forthcoming with this information!). Only sign off mentors can sign your paperwork and assign you a grade. If your mentor is not a sign off mentor ensure you know who the sign off mentors are in that clinical area and try and work at least a couple of shifts with them. Your mentor can sign your skills but the sign off  mentor needs to countersign them. THIS IS NOT THE SAME AS YOUR WHITE BOOK ! So if your mentor signs off that you are amazing at communicating with women the sign off mentor needs to countersign and date this skill as well.

I am going to **star** and bold and italic this next sentence because this caught me out on my placement and meant I spent most of my last shift at my first year trust running around trying to find one member of staff and ringing my AA almost in tears……..

******AS SOON AS ANYONE SIGNS YOUR SKILLS IN YOUR PAD MAKE SURE THEY SIGN THE SAMPLE SIGNATURE SHEET FOR EACH SET OF SKILLS THEY HAVE SIGNED AND WRITES DOWN WHEN THEY LAST HAD A MENTOR UPDATE******

(i.e. if a sign off mentor countersigns a skill in the ‘intrapartum care’ section of your PAD and the ‘tackling health inequalities’ section of your PAD, THEY NEED TO SIGN THE SAMPLE SIGNATURE FOR EACH SET OF SKILLS.

Imagine the scenario….you are finishing a night shift on the midwifery-led birth centre and the midwife you worked with observed you support a couple during a lovely labour & delivery. You had the opportunity to write up the skills you demonstrated during this shift and you got your midwife mentor to sign these skills off and she quickly got the sign off mentor, who’d just come on an early shift to countersign them before both you and your mentor floated off home to sleep…… WITHOUT GETTING THE SAMPLE SIGNATURE SHEET SIGNED BY THE SIGN OFF MENTOR!!! YOU NEED TO GET THE SAMPLE SIGNATURE SHEET SIGNED (yes this is what happened to me!!!) If you don’t, as a first year your PAD will be referred and you will have to return to your old trust to track down the sign off mentor to sign the sample signature sheet and then resubmit the whole skill set. If you do not have all the signatures completed on the sample signature sheet in second and third year YOU WILL FAIL (this makes me feel sick!).

Another starred, bold, italic section coming up……………………….

****YOU NEED TO DATE EVERYTHING YOU SIGN****

A LOT of my cohort got our PAD skills returned to us because we hadn’t dated our signatures on our skills documents! We had ensured our mentors had dated everything but we actually hadn’t! There is no ‘date’ prompt next to the student signature section but you do need to date it! I cannot begin to tell you what a complete pain in the rear it is when you have finally tracked down the sign off mentor to sign your sample signature sheet, hobbled, exhausted and emotional to hand in the PAD documentation hoping you never have to see it again, only to get it ALL handed back as ALL my signatures needed dating! Literally, every single one of the 60 or so skills I needed to go through and date! DATE THEM!!! Believe me you will not want that PAD handed back to you! If you aren’t sure if something needs dating and signing do it anyway! I am very much ‘better to be safe than sorry’ …once bitten and all that!!!

Think that’s all the terrible tales I need to pass on about documentation!! I do wonder how I managed to even get on this degree as reading back over this makes me look a bit lacking but I blame sleep deprivation!

You will be getting your uniforms soon-empty all pockets before you take it off and buy a tub of vanish….white is a TERRIBLE colour! What were they thinking giving nervous, tired students white?!! One night shift my pen had leaked in my pocket and because I was on an antenatal ward and the women were sleeping, all the lights were dimmed ….by the time I realised my pen had leaked I had fingerprints on my uniform, on some lovely white sheets, on a couple of CTG monitors and on my face!

uniform I was very glad I had purchased a tub of vanish big enough to bath a baby in!

Good luck and DATE EVERYTHING!!!!

 

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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.

 

Student midwife information services-From an educational and practical perspective

I seem to live, breath, eat and sleep midwifery!  Last thing before bed and the first thing I do in the morning is read the latest updates from Elsevier, Midwifery Journal, RCM, MIDIRS the list goes on!!!

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No amount of reading can ever be enough as a STMW.  As students we are adult learners, responsible for our own learning, expected to keep up to date with current research, information and clinical guidance.  There is so much to midwifery, I never truly appreciated the enormity of my vocation before starting my journey.

Information services are invaluable for our learning.   I am subscribed to many different learning tools and organisations.  One information service I find particularity invaluable is MIDIRS.

midirs

‘Our Mission:
To be the leading international information resource relating to childbirth and infancy, disseminating this information as widely as possible to assist in the improvement of maternity care’ (MIDIRS 2016)

MIDIRS is an information and resource service for midwives and student midwives, keeping in touch with the latest up to date midwifery knowledge and research, hot topics and articles in midwifery as well as having an in-depth database of research.

‘MIDIRS – or the Midwives Information and Resource Service – is a not-for-profit educational charity providing effective information resources that help maternity health care professionals or students succeed in their professional development and studies.’ (MIDIRS 2016)

Publishing a journal/digest quarterly of the latest research studies and news so you can always rely on the fact the information in the journal is current and reliable information you can use in your studies.

Upon starting my degree I went out and bought umpteen midwifery textbooks, although my course requires me to use this literature, journal and database use is seen as extremely favourable by the university as it shows initiative, breadth and depth of knowledge and passion.  I strongly recommend any midwifery student or nursing student to use current databases and journals to keep up to date with your subject area, I find these invaluable to my practice, learning outcomes and knowledge as a STMW.

 

 

 

 

 

 

 

Call the Midwife- I need a pinard!!!

Pinard’s- Funny horn like instruments that remind me of a trumpet.

Pinard’s- what are they? Pinard’s- why call it that?

These are the questions I first asked myself as a fresh 1st year shuffling through my clinical skills book. They want evidence of antenatal assessment using a PINARD!! 😇

Once I got into antenatal clinic I was introduced to the pinard, ahhhhhh I thought…. Call the midwife!!!! I reminisced back to the series, scenes of the nuns and midwives using these funny shaped horns , pressing into a woman’s bump to hear the baby’s heart beat. Ohhhh!!!!  So what is a pinard and how does it work?

The pinard was once called a fetostethoscope, before the days of the doppler or sonic-aid, midwives would use the pinard to listen for the FH- fetal heart. It was named a “pinard” after French obstetrician Adolphe Pinard.  A pioneer in perinatal and antenatal care, he specialisesed in palpation and fetal activity. In 1895 he invented the “pinard”.

I love the pinard- I see it as a right of passage, an essential authentic midwifery tool that has been replaced by technology.

 

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It amazes me how the midwives of the past used these simple yet effective stethoscopes to keep track of fetal development.

Nothing beats the feeling of actually finding the heart beat of a baby in clinic, I adore discovering the fetal position, listening to the fetal heart and with technological advancements women are now able to hear their baby’s heart too, the sound of a fetal heart is so soothing and it is lovely to see the women comforted by their babies ‘thud thuds’.

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I do however wish the pinard was used as frequently as a sonic-aid, it is a piece of midwifery history that I believe is just as important.  I took my pinard-

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(My pretty pink pinard!! 🙂

to antenatal clinic this week, determined to practice the art!!  When I heard a beautiful beat I was elated!!!  Safe to say I will be taking my pretty pink pinard with me on placement next week, determined to keep this historical practice part of my future practice.

I recommend visiting Sara Wickhams blog about pinard use, Pinard Wisdom – Tips and Tricks from Midwives (Part 1), fascinating read into pinard use.

 

 

International day of the Midwife-“changing the world, one family at a time”

International day of the midwife- blog PIC

Last Thursday, May 5th, was the International Day of the Midwife.  First established in 1992, each year on the 5th May the International Confederation of Midwives asks the world to focus on the role of midwives and midwifery.  Every year there is a different campaign theme. It is a day for every individual midwife to think about others in the profession,  make new contacts within and outside midwifery, helping to widen the worlds knowledge of what the role of the midwife is and how it fits into the today’s world. The constant overarching theme is “The World Needs Midwives Today More Than Ever” (ICM2016) this is part of an ongoing campaign to highlight the need for midwives, reflecting on the World Health Organisations call for more midwives globally.

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This year the focus was on  ‘ women and newborns’.  ” Midwives around the world work hard every day to ensure women and newborns receive the quality care that they deserve.” (ICM 2016)

Midwives globally were encouraged to share a photo and a statement on social media ( #IDM2016) of what there role is and how it in corporates the above ethos in daily practice.  The RCM encouraged the use of social media, local seminars, study days to promote locally the meaning of IDM.

http://www.internationalmidwives.org/events/

The above link takes you to the International Confederation of Midwives events page.  There are some exciting and informative gatherings happening across the globe over the next couple months following on from this years theme.

It is so important to celebrate IDM, to remind ourselves of the challenges other countries face, to celebrate what we can learn from each and how we can improve midwifery care globally.

High risk women and the importance of continuity of midwifery care

  So this week I’ve enjoyed working within the birth centre at my trust. The birth centre is midwifery led care for low risk women.  This unit only has midwives, there are no doctors, no CTG monitoring,  no medical equipment just relaxing rooms with lava lamps, pools, tea and coffee making facilities, a calm safe place to give birth. The women who are able to use these facilities ’ will have had the pleasure of MLC- midwifery led care throughout their pregnancy, enjoying the continuity of midwifery.  Whilst enjoying my first day me and my mentor got called to go to a heart and lungs ward to see a woman who was extremely anxious about her baby. At 36 weeks she was to have a C- Section at the advice of her  medical team and Consultant Obstetrician. The woman had cystic fibrosis and due to the long term use of steroids to treat her condition she had also developed gestational diabetes.  Once we got to the ward the nurses informed us of how anxious she was about birth, attachment and bonding, feeding, all the anxieties a low risk woman would have. They had been unable to calm her worries.  Throughout her entire pregnancy the woman had not seen one MW apart from the booking appointment at 12 weeks. This was because she was “high risk”. Being high risk she automatically qualified for Consultant led care .  All she had seen were her CF doctors and a Consultant Obstetrician. All the woman wanted and craved was midwifery care, she wanted to discuss her pregnancy, her pending motherhood, her feelings and thoughts of what was to come. Seeing a midwife made her pregnancy seem real putting her anxieties to rest. As midwives we are in a unique position, our role ultimately is to listen to the women we care for. Doctors obviously have to listen but from a medicalised point of view. Anatomy and physiology is always at the forefront of their mind.  It was rewarding to see how our chat had helped the woman, the relief on her face was plain to see, she opened up to us, spoke about her greatest fears, I found the whole experience so hugely rewarding. This is why I came into midwifery- to make a difference, to listen to women, to support them at their most vulnerable, to make them believe they can do it, they can birth, they can get through pregnancy, they are amazing! listening This experience got me thinking- High risk women need continuity of midwifery just as much as low risk women do, in fact in many ways potentially they are in greater need.  This woman had been medicalised her entire life and craved for the normality of pregnancy.  It is so important these women are not forgotten about. Yes absolutely high risk conditions must be monitored by obstetric means during pregnancy, intrapartum and post natal but midwifery offers a unique form of care that is just as important. why  

Receiving cars…. receiving babies..

Receiving cars to receiving babies…. its a funny old life

 

cars

During the last few days on my delivery suite placement I’ve started to experience a strange surreal feeling. Last week I was stood in theatre observing a beautiful c section birth and I zoned out momentarily.

I zoned out to my previous life, I zoned out to my customer service 9 to 5, I zoned out to reports, targets, receiving keys, checking cars, answering phones.  ! BANG ! Back in the room! I’m here!!! I did it!!! I’m stood in theatre as a student midwife experiencing the start of someone’s life, experiencing the wonder of what we can create, experiencing something that is so so precious!!! Being able to share this wonder with families, from all corners of life.

 

recieving cars

The night before every shift I have a funny mix of excitement and anxiety, I pull up to the car park and sit there momentarily wondering what the day will bring, I used to have the same feelings in my old life but the difference is I get to see the most amazing things ever! I get to support women when they need support the most, I get to develop friendships with families nervous and scared waiting for what is to come, I get to work with midwives, the most underrated profession.  A profession that deals with everything you can think of. How lucky am I!

So I ask myself, was it worth it?, the studying, nights of worrying about my applications, getting that dreaded ‘something has changed’ from UCAS on my email, the endless preparation for interviews, maths tests, essays, english tests, group interviews, one to one interviews, the cycle goes on and on!!  Yes it is worth it, never give up, I thought I was too old and past my prime to start this amazing journey, with 3 children, a house to run and the general everyday rubbish that comes with responsibility I thought I didn’t have a chance, the lovely ladies I met at interviews out shone this ageing lady with a little tribe, by luck or miracle I was offered a chance and I took it.  This time last year I was on cloud nine, I remember finding out in work I had got in, I started crying, blubbering in the office, everyone looking bemused at me!!  I drove home that night in disbelief,really me???????????!!!!

shocked face

 

So do i miss my old life?

Receiving cars or receiving babies…..

No contest!!!!!

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