Freshers…all fresh faced and in information overload!

Welcome freshers…..WELCOME! To all the first year student midwives (and nurses)…welcome:-)

You are probably feeling a little overwhelmed with information? You are trying to settle into a new room/house/city if you’ve left home, getting to grips with MyManchester/ Blackboard, meeting new people, finding your way around campus, trying to work out how to fit in all your study skills & core skills, finding your way to campus and battling traffic for 9am lectures, trying to find somewhere to eat which doesn’t involve queuing for half an hour…. etc etc! I am feeling slightly panicky just reading that back! I am not here to throw more information at you just to guide you gently in a supportive direction!

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I am going to give you a few tips to get through the next few weeks of block uni before you head out on placement:

  1. The huge amount of information you are being given is just that…….MASSIVE! Don’t panic. Use your independent study as timetabled and give yourself one whole day off at the weekend where you do NO studying at all. Do something you love on this day! Your brain needs time to consolidate the huge amount of learning and information you are taking on board. Cramming more and more information in constantly is counter productive. Have a day off, do something you enjoy, spend time with friends and chill. You will be more refreshed starting again the following day.
  2. Eat properly! You are freshers and it’s the first time away from home for some of you. Midwifery is not a ‘normal’ degree where you are in lectures 11 or so hours a week! You need to be in good health and that means taking care of yourself physically (as well as psychologically!) to ensure you can maintain the required high energy levels to sustain you through the next 3 years of this degree.
  3. On the same note-get plenty of sleep! Go out and enjoy yourselves but allow time to recover properly…burn out is a huge issue on this degree so start as you mean to go on by resting plenty and being sensible with drinking alcohol! I am hiding my eyes as I write that as I know I sound like an old lady/mum (I am both!) but you can still go out and enjoy yourselves but don’t go out every night and ensure you rest!

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4. Try not to look too far ahead…..get through today’s lectures learning as much as you can and do the extra study but try not to worry about what needs doing tomorrow. After this first 6 weeks you will be on placement where you will only be in university 2 days per week (with the associated independent study/extra reading) so this is a really intense period of learning compared to the rest of your degree. See these next few weeks as the foundations being laid for what is to come. You are first years, you are not expected to know everything (we are never expected to know everything but certainly  not as first years!).

5. Be KIND to yourselves, be KIND to your cohort (believe me…they will get you through the next 3 years as few people outside of this degree understand the intensity!) and use us (the 2nd/3rd years, your PASS leaders and all support mechanisms out there!) we are here to help and we want to help.

Go forth and immerse yourselves in the adventure you are embarking on! xx

 

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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

 

 

 

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.

 

 

Maintaining Friendships Old And New

I moved into halls for the first year of university despite already living in Manchester (well, Greater Manchester). I felt ready to gain some independence by ‘flying the nest’ and wanted to be within walking distance of university. When I lived with my mum before university I was only less than twenty miles away from the main campus so my friends from home who I used to live super close to aren’t incredibly far from my accommodation. The nursing course can get pretty hectic at times; more often than not all you want to do when you get back from placement is have a good kip!

Seeing my friends from home can be tricky to plan, to be honest, especially seeing as they have commitments like work and studying just like I do and it’s not just a ten minute journey involved in meeting up. I probably don’t tell them enough that I miss them, but I really do, and I really look forward to going home to meet up with my friends or having them stay over at my flat. Seeing my friends from home is so good for helping me stay grounded and true to my incredibly Mancunian roots and it reminds me of a big reason why I’m doing this course. I really hope I can make the people I care about and who care about me proud. If you don’t have the opportunity to meet up with your friends from home very often you’ll understand that the time you spend together is golden and you’ll appreciate it all the more. I’m so, so fortunate to have maintained friendships with such a brilliant bunch of people even after all these years.13151090_226356241076122_2131036156_nI enjoy spending time with the friends I’ve made on my course too, as I think we have a good balance between chatting about nursing as well as unrelated things. We’ll talk about what skills we’ve been learning on placement and helping each other stay motivated when writing assignments by offering suggestions of resources to look at and just offering a pep talk sprinkled with the essence of ‘as a fellow student nurse, I really know how you feel’ then five minutes later we’ll be having a conversation about something like make-up or food. I’m so, so fortunate to have made such a brilliant bunch of friends at uni.

My advice to anybody studying on a course that keeps you super busy (ring any bells?) would be to appreciate and make time for your friends from home whilst still being open to making new friendships at uni. Your friends from home will be glad that you’re enjoying yourself and have support for when they can’t physically come to see you. Believe me, you’ll have no idea how you would have made it through uni without your friends – old and new.

 

“The doctor says I’m dying”: tough conversations about death

One of my most vivid placement memories was my first conversation with a patient about dying. One afternoon I went to check on Joan (name changed), a lady in a side room on an elderly ward. I was helping her to have a drink when she looked up and said: “the doctor says I’m dying.”

I froze. My stomach turned and my mind started racing, taken aback by a statement I felt totally unprepared to respond to. I had grown fond of Joan and to see her so distressed was upsetting. I felt a sense of panic, worried that I might say the wrong thing.

I knew from the handover that morning that Joan was receiving end of life care and from what the other nurses had said, she was deteriorating and it was unlikely that she would get any better.

Taking a deep breath, I thought back to our communication lectures which covered how to deal with difficult questions. I drew up a chair next to Joan and holding her hand, I asked some straightforward questions like ‘when did you discover that?’ and ‘how does that make you feel?’, trying my best to mask my own anxiety and appear relaxed.

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While I think I started off ok, all of a sudden I panicked; I didn’t know what to say next.  Almost without thinking, I said: “Don’t worry Joan, we’re all doing everything we can to get you better and back to your normal self.”

I immediately felt awful and her face said it all; she knew I was covering. I said it out of a desire to help Joan stay hopeful, optimistic, but in reality it sounded trite, like I was brushing her off and trying to avoid a deeper conversation. I think that it made her feel worse.

Kicking myself, I spoke to my mentor who reassured me that she too struggled with questions like those and some research when I got home that night revealed that I wasn’t alone – apparently it’s common for healthcare professionals to avoid or block difficult questions, particularly about death or dying. I suppose we like to focus on how we can ‘fix’ things and don’t want our patients to lose hope.

Looking back, I wish I’d spent more time with Joan, even just to sit quietly by her side. She may have had more questions that she wanted to ask and as a student nurse, I may not have known the answers but I could have found out on her behalf.

Honesty and courage are such important parts of nursing, especially at the end of someone’s life. Sometimes the best thing we can do is to be there; to listen, answer questions and ease fears – or just to hold someone’s hand and let them know that they are not alone.

Mid-Season Blues??

Tired?      Stressed?      Had enough?

Feel like a failure or like you’ve made a big mistake?      Too much work and no play?

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This could be a case of the mid-season blues!

Okay so there isn’t anything technically proven about mid-season blues but I bet nearly everyone has felt it at some point in their journey.

I used to be a holiday rep and every season there would be an almost mass exodus of reps half way through the summer as they were mainly homesick, fed up of long hours and most were feeling pressure as the main summer had kicked in and it was busy!!!

I noticed the same thing in the nursing degree course. It would hit everyone at different points in the course however, but the feelings seemed to be the same.

People felt down and fed up (mainly in second year if I’m honest as the end just seems so far away).

If you find yourself feeling this way, don’t worry! It’s not just you – you are not alone.

It seems this feeling is perfectly normal and any lack of motivation right now could affect your judgement on if this course is really right for you.

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Please don’t make any rash decisions. Talk to your family and friends. Talk to your peers and tutors and discuss your feelings with them before you decide anything.

You will more than likely come out the other side and carry on with your degree with great success. Yes there will be some who do realise that now is not the right time for them, and that is ok too. No one will judge you and you shouldn’t judge yourself either. Tough decisions aren’t called tough decisions for no reason!

I sit here now in my final year that last placement and sign off is getting closer and closer! Yet I remember my friends and I, all experiencing the mid-season blues. We helped and encouraged each other through it. Providing moral support in words and tissues for the tears when they came! But, we made it and I for one have never felt prouder of myself for staying the distance!!

A good moan can do you wonders, a few beers with friends, a weekend off the study. Whatever it is you need, just have that break and look forwards and reflect with fresh eyes.  You’ll soon find yourself job hunting and thinking where did the time go –I did!

Go for it – You can do this!  – brush those mid-season blues to one side and get your head back on track to becoming the awesome nurse you will be!

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