I'm a student midwife - AMA

[greenluna]

I'm also a single mum and ex drug addict. Ask away!

Patapouf

That's just simply not true. I have said countless times that I am speaking from my own experience, as well as what happens in my trust. You have just completely made that up.

Hello, congrats on turning your life around - that is great achievement.

I’ve got a couple questions, based on my own experience (which was very mixed!). For the majority of my labour, a newly qualified midwife was with me. She missed quite a lot, including meconium in my waters, that I was fully dilated and that the baby was in a position that would make an unassisted delivery pretty much impossible (according to my debrief). In the end, these various issues were all picked up by a senior midwife or doctor. Afterwards a consultant wrote to the MLU, highlighting the issues with my birth and pointing out that they had left me too long after my waters broke (more than 24 hours) and with meconium in my waters. Since the midwife was newly qualified (two weeks in the job I think), would anyone have sat down with her afterwards and helped her understand what went wrong/what she missed/how to ensure it didn’t happen again? And would any attention have been paid to the consultant’s letter?

I had a very mixed experienced with my midwife-led care in the same trust - amazing community care and brilliant breastfeeding supporting on the postnatal ward (I will be forever grateful), but my experience with MLU was pretty terrible. Do you think there is a way to ensure consistency of quality of care?

Good luck in your career. It is an important job and not just the delivery bit!

I’ve got a couple questions, based on my own experience (which was very mixed!). For the majority of my labour, a newly qualified midwife was with me. She missed quite a lot, including meconium in my waters, that I was fully dilated and that the baby was in a position that would make an unassisted delivery pretty much impossible (according to my debrief). In the end, these various issues were all picked up by a senior midwife or doctor. Afterwards a consultant wrote to the MLU, highlighting the issues with my birth and pointing out that they had left me too long after my waters broke (more than 24 hours) and with meconium in my waters. Since the midwife was newly qualified (two weeks in the job I think), would anyone have sat down with her afterwards and helped her understand what went wrong/what she missed/how to ensure it didn’t happen again? And would any attention have been paid to the consultant’s letter?

Sorry, can I jump in as a midwife and help answer this one? Because there’s a couple of things I want to pick up on. Firstly I’m sorry you had this experience, does not sound great. Yes, the consultants letter should (and I expect would have been) taken seriously. But I’d also hope the MMU would actually look at this as a systems error, rather than a NQ midwife error…..though I’m sure the midwife would have been spoken to.

One important point is that she didn’t necessarily miss the meconium though…..it’s moderately common for mec to not always be apparent when the waters break, but can be apparent later on or even not until birth (this can be true for old stale mec, not just fresh mec, it’s almost as if there’s pockets of clear fluid and pockets of mec stained fluid).

The main issue is you were left so long (in labour?) after your waters went. The MMU must have had a band 7 in charge who should have an overall view of what’s happening and really it’s their responsibility to say you needed transfer. Which ties in with missing the malposition. As a midwife with lots of experience I can generally pick up a malposition these days, some are harder to detect than others. But really as a midwife the main role is to recognise there’s a delay in labour and then seek medical input. I’ve only ever worked in a consultant led unit but it’s not unusual for a midwife to get the registrar in and for the doctor to say “oh it’s a brow presentation “ or whatever. Even in a MMU with no doctor the NQ could Have got support from a more senior midwife or a transfer to a consultant led unit been arranged if you were having a delay in first stage of labour.

@ButYouJustPointedToAIIOfMe

Women can often lose themselves and need grounding.

This attitude is what caused me to have birth trauma.

I’d agree with the OP’s comment about how women can lose themselves sometimes in labour and need help/support. It’s quite common for a woman to get like this and with support return to a much calmer place. It’s hard to explain. But personally I certainly hope that anyone I’ve supported / “calmed down” doesn’t feel that they’ve been fobbed off. I think it’s an important part of our role and works a lot of the time. The important thing is to recognise when it’s not working (and I’m sorry if that didn’t happen for some people on this thread).

I always have a chat with women I look after in labour and explain that I will never offer pain relief….but I talk through the options available and explain if they feel they want something at anytime then to say. If someone asks for an epidural at the height of the contraction I’ll support her through that contraction and then when it’s eased off I’ll ask her if she’s serious about the epidural (some women say no). If she says yes then I go and get the anaesthetist. I never tell them that she’s doing so well/she doesn’t need one, etc. It’s her choice. Sometimes I think am I too quick to get one hooked up? But if a woman has regrets after labour I’d rather she had regrets about having an epidural rather than regrets about not being listened too/being left in pain.

What is your opinion on epidurals?
I had one and it was fantastic.

The midwives I had were all lovely, very positive and caring. I was really touched when my labour went over my first midwife's shift and she was disappointed she couldn't stay with me until the end.

The midwife during my second birth panicked as things were progressing very quickly and called the consultant (even though not entirely necessary). It was fine and I saw she wasn't that experienced. I have always wondered did she / midwives go through births after with more experienced staff to improve their skills?

Have you had any funny / unusual experiences?

I feel after my two DC that labour/midwifery has a scientific side and a less scientific side as you describe ie transitioning signs of saying can't do it etc. Is that true? Like you're relying quite abit on what the lady says or how she acts?

I'm quite a private person and would keep as quiet as I could while contracting so feel i did myself injustice both labours by being like that.

I wasn't believed on my last birth (a month ago) but student MW and other MW that one I was in as much pain as I was and when I said I felt involuntary pushing and rectal pressure I was dismissed and I physically heard the student MW tell the other MW I wasn't as she left that conversation. I then moved a few steps and this almighty roar came out of nowhere and their faces changed.
What did I say wrong?! Were they key words I should have said?

I had moaned about the pain (and said I have high pain threshold, physical high risk of some bruising at least most days type job!) and said I'm not sure how I'd cope with the pain as they wanted to send my home only 2 hour previous. I did leave as felt I had to and I had days of labouring to do as they said but I just waited in the car for 90 mins as I was convinced. When I eventually broke down in tears in the car, I came back in and could barely walk.

I thought student MW would've given me extra care and attention but sadly I feel quite let down. So by time I was pushing I still hadn't had any pain relief! As they wouldn't examine me again when went back as the 4 hours weren't up. Even when pushing they said 'we should examine her, it is early but we should see what is going on'. No surprise, the outcome of the VE was I'm bloody ready!!!

But I do think it is a worthwhile job and I would consider it at later life as would love to help people have a different experience to my 2. The first was horrific and so so long but MW care was great.

I find it interesting that you think that direct entry midwifery gives a more thorough training than converting from nurse to midwife. I have always thought the other way round. In my trust there are often calls to general wards to do ecgs etc and general nursing care does not seem to feature. All the midwifes I know that converted have excelled in their midwifery careers, not to say of course that direct entry midwifes haven't excelled!
In my personal experience my nursing care on the post natal ward was poor. I asked for pain relief and was told I had to wait because "even the ladies who have had sections haven't had pain killers yet" if I said the equivalent to a patient on a general ward I would quite rightly be slated but that was the culture on that ward. I was in pain from a terrible tear I could barely move I still had a catheter. Yet because I had a normal delivery I just had to get on with it.

@Oldandcold

I find it interesting that you think that direct entry midwifery gives a more thorough training than converting from nurse to midwife. I have always thought the other way round. In my trust there are often calls to general wards to do ecgs etc and general nursing care does not seem to feature. All the midwifes I know that converted have excelled in their midwifery careers, not to say of course that direct entry midwifes haven't excelled! In my personal experience my nursing care on the post natal ward was poor. I asked for pain relief and was told I had to wait because "even the ladies who have had sections haven't had pain killers yet" if I said the equivalent to a patient on a general ward I would quite rightly be slated but that was the culture on that ward. I was in pain from a terrible tear I could barely move I still had a catheter. Yet because I had a normal delivery I just had to get on with it.

I may have worded it poorly, I meant that direct midwifery training is now 3 years, which is longer than it used to be. Being dual qualified definitely means you're more thoroughly trained.

@Patapouf

We can adjust the lights, play music, run them a bath, talk to them, scream with them, hold their hand, rub their back etc. etc.

Absolutely none of that helps and it's common delaying tactics to avoid giving women decent painkillers.

My questions:
If a woman asks for an epidural what is your response?

Do you think coercive language is appropriate if a woman isn't following your advice?

Actually, I found it did help me. My birthing plan stated I fid not want epudural, wanted an active labour and use of a birthing pool.

In the thick of it, I was exhausted and begged the midwife to pull the baby out (forceps). She reassured me I could do it, no need for forceps. She coached me through and I'm very grateful. Childbirth IS painful and I'm grateful my midwife allowed me to see through my birth in the way I envisioned.

Was it hard to get into uni? Did you have to do an access course?

Do you notice any difference between the midwives who are direct entry midwives and those who have been nurses first?
Good luck with the rest of your training.

@greenluna - thank you for answering my question - it sounds as if the poor experiences I referred to are the exception - which is good to hear.

I can see the benefits of the current midwifery training and the training that happened in my day - as you say, the current training focuses more on midwifery, which is vital for any specialism - but the older training meant that every midwife had spent time in all the other specialities too, during their training - medicine, surgery, accident and emergency, psychiatry, theatres etc - all of which cover things a midwife will encounter in their practice.

As I’ve been out of nursing for over 20 years, I don’t know enough about current training and degree syllabuses - but what I do know is that most nurses are passionate, intelligent, caring individuals, and deserve the best training - training that covers the basics of care and the highly specialist and technical things that have become part of the nursing role too. And I really hope that that’s what nurses and midwives are getting.

I had my son at 18 weeks and he survived for 45 minutes. The midwife who delivered him was amazing and I will never forget her. We know it affected her as she cried, not in front of us but when she returned to the room her face and eyes were visibly red. I wanted to meet her again/give her something as a thank you for all she did for us but soon after covid /lockdown happened and well it wasn’t the time. So we passed on a thank you when we had our de-brief.

So my question is, have you experienced a birth like that? I know everyone is different but how does it affect the midwife? As you can imagine it is the worst thing to happen to us, seeing my son die and not be able to do anything was the worst but I do think about our midwife every now and again.

I’m pregnant again (26 weeks) and have had amazing support and care. I’ve had a cervical suture not so long ago and have recently been diagnosed with cholestasis so will be attending hospital weekly for blood test/monitoring. I’m due in next Friday at 9am and would like to take something for breakfast. I was thinking pastries and fruit. I am going to make this a habit every week as it’s the only thing I can do to repay them. Is there anything you can suggest that I should take in? A firm favourite of midwives?

Thank you for all that you do

@greenluna what year are you? I’m a 1st year and your births suggest the same but you speak so educated I can’t tell! I definitely don’t know as much as you seem to yet 😄

@CovidCorvid thank you very much for your reply. I really appreciate you taking the time - I’ve thought a lot about the labour since and it’s really useful to hear a Midwife’s point of view.

I think with the meconium, it was pretty apparent

• not when my waters broke originally (which happened before established labour) but about 12 or so hours into established labour. It was first spotted by a senior midwife running down my leg while covering for her colleague’s break. And I was leaving stains all over the place. Potentially part of the issue was I was using the pool, and the newly qualified midwife had never done a pool labour/birth before. I was getting out regularly for checks/use the bathroom, but appreciate it was a new experience for both the midwife and I. At the time I felt quite sorry for her as it felt like she had been thrown in at the deep end. For example, when I was finally transferred to the consultant-led ward, she came too and she was told to set up the monitoring equipment etc but because she was new, she didn’t know how to do it or where anything was.

After I was fully dilated but before being transferred, both a more senior midwife and the newly qualified one were with me for a couple of hours. After pushing for what felt like a long time with no success, I said I felt I needed to be transferred but they really pushed back against that. I guess this is one of the examples where some women might need extra encouragement but perhaps in some cases, other women might actually have realised something was not going right and should be listened to.

Thank you again for taking the time to reply.

ADVICE please

Long story short I’ve missed quite a few hospital appointments last month due to having to isolate. I had to check for diabetes and had to rearrange the antenatal blood appointment like twice and then in the end she did it over email and confirmed I didn’t have it.

I missed one midwife appointment on the 16/6 due to isolating. Then I had a consultant appointment on the 10/06 but was isolating so tried to rearrange that but got nowhere so left a voicemail. They rebooked then cancelled then rebooked but I never got the letter but it looks like I’ve just bloody not attended.

Then I had to change GP which meant I changed area so rang the new midwives and it goes to a voicemail so left them two like 3 weeks ago and nobody got back to me. So I rang them on Monday and they offered me an appointment yesterday but obviously couldn’t go because of Ed so I rang them to cancel and got voicemail and explained why, left my name and number etc. Then missed a phone call about 2 hours later from a midwife saying I hadn’t attended and they’d booked me in for next Tuesday. Rang them back, voicemail again.

Im freaking out and probably being dramatic that they are going to like get social services involved and take baby away (I know how dramatic that sounds).

So last time I was seen I was 28+5 and I’m now 36. So I’ve missed 31 week app and 34 week app but nobody has been in touch. Basically lots of confusion with appointments, rearrangements and having to leave voicemails all over the place.

I also tested positive for Covid today and rang to let the MAU know. They have said I don’t need to inject and just to take vitamin D. I had a midwife appointment with the new midwife booked in for this coming Tuesday so rang the hospital and they have changed it to a telephone appointment.

I’m worried because by the time I can be seen in person will be 37 and a half weeks. I’m worried they will think I’ve been neglecting care.

Any advice?

My DD18 applied to 5 uni's for midwifery and didnt get offered a place even with her grades.
Shes been offered nutrition and adult health....