Student midwife due to qualify this year. AMA.

[Anonymous2003]

Thought this may be fun :)
Please no questions seeking medical advice

@overthinkersanonnymus During our preceptorship (the period when we first qualify) we are rotated between delivery suite, the ward and the emergency obstetric unit. Sometimes community too. Some midwives go on to specialise in things like breastfeeding, diabetes etc. Some go on to be sisters. Some do their health visiting course and change career. You could also be part of a continuity of care or homebirth team if that is available where you live

Why would midwives not want them to become the norm again? Assuming if they were more supported then skills would be re-learnt and there would be better outcomes for women?

Ha with my 2nd birth my partner sat on his phone 😂I was having an induction so on my side of the bed I had a drip to one side of me, and the monitor on the other side of me (i stayed stood up for virtually the entire labour) so not really anything dp could do, he just sat playing games on his phone on the other side of the bed while I went into myself with my music and the gas and air 😂! I think he even nodded off at one point! Once the hormone drip kicked in and things got heavy he held onto my hand the whole time until baby was safely out :)

Following on from both of these points- is it true that they are talking about getting rid of gas and air?! I don't know how I'd give birth without it. I don't like the idea of an epidural. All I had for both of mine was gas and air. Well got a shot of pethidine with number 2 but don't think it made a blind bit of difference other than make me trip out a bit so won't do that again.

Also re GBS. What if the mother refuses the antibiotic drip? I had it with birth 2 and it was vile, the canulla was worse than giving birth I hated it so bad, plus the antibiotics gave my baby a really upset stomach. I have no idea if I had GBS with baby 1. It only came up because I was swabbed due to spotting with baby 2.
So because it isn't routinely tested, surely it can't be that bad if 1 in 4 women have it? I read all the scare stories about sepsis so went for the drip with Number 2 but think I may decline for baby 3?

Have you ever been put in the position during your training where you feel the safety of the women and babies you are attending has been compromised? I gave birth to my first child in England and had a student midwife, the poor girl had four women all in established labour and I only saw the qualified midwife at the end of my labour when the alarm had been rung because my baby was in danger and the entire thing was a mess tbh. My second labour was attended by two midwives, one of whom was with me for the entirety and the registrar came in at the end as I delivered. They were incredible, it was literally a scene from call the midwife, they even had warm water which they used to help me not tear as he was crowning. It was honestly the most magical experience I could have imagined and really showed me how incredible midwives and women are working together to bring life into the world. My experiences were worlds apart and I imagine it all comes down to funding. Do you feel that this impacts your practice?

Sorry just seen your response saying some hospitals have done away with gas and air. So what do they offer instead?!

Also the rule that if a woman in labour arrives and is less than 4cm dilated will they take into consideration previous fast labours.

I also think they need to consider that not ALL first time Mums have long labours, it just seems to be the assumption. My first labour was less than 5 hours from start to finish.

@SP2024 I suppose breech birth does bring additional risks compared to cephalic birth. which people dont't want to face. We could talk about it all day but it will take a while for things to change if they ever do

@Boardingschoolmumoftwo four women were left alone to labour on a ward, or in individual rooms? We provide continous one to one care for women on delivery suite never heard of anything different.
I think women and baby's safety is compromised on the ward when it is so busy and short staffed and things can be easily missed

What are the risks in turning the baby?

In individual rooms and she was running between us all, it was insane. This was the height of Covid though so maybe they were extremely short staffed or something, I just thought that was sort of the norm for England

Bit of a random one but do you have to 'tick off' certain births? Like one with no pain relief, one with certain meds, instruments etc?

I ask as when I had DD she was coming pretty quickly (I thought) I was 5cm on arrival and by the time I'd been examined and taken to the room I was 8cm!

I wanted a water birth but then refused to get off the bed once I was on it (mistake!) anyway, the midwife asked if I'd like gas and air which I said yes to, I then asked for pethadine (?) and was told no you're doing fine without it.

I also put on my notes to give me an episiotomy if needed - I was left with a 2nd degree tear and it took over an hour to stitch me back up 🙈

Would you be offended if a woman asked not to be treated by a student?

I had a horrendous first birth experience due to mistakes made by a student midwife (and those aiding them of course!) and now I’m pregnant with my second I feel really guilty about saying ‘no thank you’ when asked if students can be involved, but it’s a real sticking point for me.

@Elfie23 we have to care for a set number of women in labour with additional care needs, but there's no specific requirements

@NatMarshalll aw I would a bit, as it is so important for us to get our 40 births and experience and I believe students can add so much to women's experiences (although not always in a good way from your experience). I understand though that it is up to the woman at the end of the day and I would respect her choice.

Similar to a previous poster - have you been conscious of women receiving poor care on your ward? Due to understaffing etc? Like women being left a long time after birth covered in blood, women being delayed at triage, women waiting a long time for breastfeeding help?

Is it common practice to check patients notes before talking to them? Quite a lot of things were missed when I gave birth- I rather suspect the being called mum thing is because lots of staff don't know who you are...

@Earwiggoearwiggoearwiggo yes I have unfortunately and the vast majority of the time it is not down to individual staff, the NHS is totally failing and everyone is trying their best.
Checking notes before seeing a woman depends on the situation, sometimes you genuinely don't get a chance as you are absolutely swamped

Not a question just a point for some midwives to note! (I think you will be an amazing midwife as you sound full of empathy and I really wish you well!)
I felt dismissed with my first birth. I was induced , waters broken at 10.30am and had very strong contractions by midday. Midwife kept dismissing my pain and said I would be there all night. Thankfully there was a change of shift and a new midwife came in. She checked me and I was fully dilated. Gave birth at 1.35. Some women can give birth very quickly..luckily with my second I knew that it might be quick again. Got to the hospital an hour before he was born. I've spoken to a few friends whose pain was also dismissed as midwives said it would take hours and hours. Obviously this rules out some pain relief as it may be too late. If a woman wants an examination please listen to her!

@Thornybush I totally agree with this as I had a similar experience with a fast labour and feeling dismissed however I will just say that my friend has recently become a student midwife and she said that they turn 40 women away a day who attend and aren't actually in labour, just experiencing braxton hicks or similar.

I suppose after time, it would be difficult to trust that women know what's going on, when you see so many every day who don't. I can see why women rely on their experience so heavily as opposed to what they're being told, but then again, in an ideal world they should always check!

Hi OP, not really a question but I do really urge you to try and get some exposure to homebirths. I firmly believe it is so important for all midwives to have had some exposure to this as it is the only way you are 100% going to see a truly physiological birth (i am not saying they don’t happen in the hospital setting).
I think you have some great qualities which will make an excellent midwife, but some of your answers are a little concerning (regarding not really understanding the language question, and your responses to breech birth). Working with a homebirth midwife may enlighten you a little.

Absolutely agree that seeing a home birth is valuable. I am biased as DD2 was born at home with the support of an independent midwife after a traumatic hospital birth with DD1. DD2's birth was easy but I believe that had I been in hospital it would have been very different as her hand was up by her ear and a vaginal examination would have been 'strongly advised' before the pushing stage when she was making a quick exit like superman 😀
I know someone whose mum was a recently retired midwife. Friend had a home birth with NHS midwives and her mum there as a birth supporter. The mum had never seen a home birth in her entire midwifery career and could not believe how different it was. I think that is a tragic lack of knowledge and waste of opportunity in a career.
There was an American obstetrician who said (paraphrase) 'the first intervention in birth is when a healthy woman leaves her home. From that intervention other interventions follow.' I've already suggested one book to you but I'm going to suggest another, Abigail Cairns book "Home birth, stories to inspire and inform."

I personally think you can’t give the best and safest “high risk” or “medicalised” care without a sound understanding of physiological birth. So even if a student midwife/midwife doesn’t want to be a community midwife, or birth centre midwife, and wants to be a labour ward midwife, they still need some good, solid exposure to true physiological birth which you are mainly going to see happen at home. Additionally, I think it’s important to have exposure to women choosing care outside of guidance, which again is mainly going to happen with homebirths.

Obs anaesthetist. Its high wcc we worry about predominantly, wcc will naturally raise in labour, even up to 20 at times, if we are concerned about sepsis then is really helpful if you send off a crp for us as that doesn't rise with labour and we use in our decision making process

I'd still do at fully in a primip if consented may not work in time

Similarly don't need to be >4cm if being induced we still do them as on a path to deliver

Just for your benefit, if someone asks for an epidural regardless of all of the above, ask us to come chat/break the news if we aren't keen (it's v rare that we don't and can explain why in a lot of detail) and will cover yourself for later complaints and help mum feel listened to

xx

We generally don't do epidurals for spinal metal work (as the risk of metal work infection can be devastating and need removing). We do spinals for section providing mum accepts that risk (in some trusts), others don't take that risk and just GA the lady if they need a section. No reason to not have a normal birth though

Both affect our decision

Stil happens relatively frequently, we just do our best diplomacy if it's incorrect info