Student Midwives - what do you think?

[mears]

As most of you know I am a midwife and am based in the labour ward. I have a real passion for midwifery and wish to impart my knowledge and enthusiasm to student and junior midwives.
I have real concerns that student midwives are not gaining enough experience as they train to be confident midwives on qualification.
How can students get proper labour ward experience?

Often midwives and students feel uncomfortable at asking women in labour if both can perform a vaginal examination in order to learn, so the student goes without the learning experience. You also don't want to ask someone for permission to do examinations etc. when they are obviously sore.

What do you think is the best way round this issue? Should women consent to students antenatally before coming into the hospital to show that they understand that there are students under training? They obviously would be able to opt out of having students participate in their care.
Any thoughts will be gratefully received.

Just to say that I had no problem whatsoever with students doing all sorts of monitoring/internal things during dd birth (and at my ante-natal appointments). Having said that, I was asked in advance if I minded, and I don't know if I was one of the few people on the ward that day who said 'No problem', or just that I was an interestingly difficult labour, but I did see about five different students (possibly more, I was a bit 'out of it' at the end) during the birth. I was introduced to them all, which made a big difference, and I found one thing very positive about having students around - namely that I listened to what the midwifes were telling them, and if I thought it was something I should know about, then asked the midwife or student what it meant. So I had a reasonably informed labour. I think a consent before coming in is a wonderful idea. That way, people who aren't comfortable with the idea can say so straight up, and people who are totally comfortable with students around can be used to give as much experience as possible in the given time. I do think that my happy acceptance of all these students sprung from the attitude of the MW's towards myself and them. The students were clearly part of the team - and at no time did I feel alienated or excluded from the discussion of the midwife and student(s).

Oh I had a student doctor, brought in at the last minute, to watch me give birth. Completely forgot about her during the whole experience since I did it on all fours with my a* in her face! Think it must have been worse for her than me!

Thanks again for your positive postings. I think information prior to the event and informed consent is the key. I really expected much more negativity so perhaps I have needlessly been concerned about the 'intrusion' of students. Thanks again.

Bundle,

The most recent research findings support elective caesarean sections for breech presentations. It is also recommended where possible an 'external cephalic version' should be attempted to turn the baby into the head down position a few weeks before the due date.
Midwives on the whole are not experienced except independent midwives who specialise in vaginal breeches. If there is an unexpected breech delivery in our hospital then the medical staff, preferably the consultant, will deliver the baby.
these deliveries are rare and therefore the skills have been lost. I would only consider a vaginal breech if I knew I had access to a skilled midwife/doctor who could safely assist.
Here is an news article you might find of interest.
this

Mears, my mum had a vaginal breech delivery which interested my midwife (who was asking my mum about her deliveries to 'guess' how mine might be) as it seems to be unusual now. My sister was born this way in 1970? ish. No particular point to make, just interesting that this (midwife delivered) skill is seemingly being lost from what you say.

I must admit I have mixed views about it. I think it is sad when a woman has a C/S for breech when she has had previous normal deliveries. I am secretly pleased when a missed breech presentation in labour results in a vaginal delivery with no complications ( has happened a few times therefore is not that rare I suppose).
Unfortunately the research evidence points to C/S as the safest option so anecdotal evidence is not enough when giving women information to make a choice. I have to say that all breeches are delivered by elective C/S at our hospital and it is not questioned by the women.
My second ds was breech for a while and I would have preferred to attempt labour. That was 13 years ago and I am afraid I am beginning to change my mind. It is more to do with the skills of the attendant and they are certainly being lost.

By the way I am not still pregnant trying to make a decision regarding type of delivery

Ds turned on his own and came out head first.

When I had ds six months ago there were 2 student nurses present at the birth. These were in their first year of nursing training (about 17 or 18) and doing a 2 week placement on the maternity ward. It was their first day, they arrived on the ward at a quarter to eight and were ushered into the delivery room at 8 to see me give birth at half past. They had never been at anything like this before. I said yes when they asked me about it as I was doing it for the second time - I wouldn't have liked it at all if it was the first delivery but I don't have any inhibitions about that sort of thing any more. It was a simple vaginal delivery and I needed about 6 stitches. I only used gas and air and screeched a lot (as I do!!!). I would have thought it was scarey but they both came into my room later on to thank me effusively for letting them be there and be part of it. They both held Aidan within minutes of his birth and were awed at that, and the next day we got a present from them. I was SO glad I let them come in as it was a 'good' birth with no horrible interventions and they said they learned so much from being there.
At the other end of the age range, the midwife who delivered Aidan is in her mid 50's (and wonderful - she was also there at the birth of dd coincidentally although she was a ventouse birth and therefore the consultant did it). The younger midwife on duty was trainrf to stitch and she did most of it, but the older lady asked to watch, she said you were never to old to learn and she did my last 2 stitches, the first 2 she had ever done.
I know some people might not be confident in letting students look after them but I was delighted to be a training ground for several people in my labour. It is a private experience and should be allowed to be that way if you want, but I was glad others could benefit. They could also see the wonder of a new life and the delight and joy of me and dh weeping over our new son, something 17 year olds should maybe be allowed to see a little more often!

I had a vaginal breech delivery in 1987, dd no2. There was a team of doctors standing by in case of any problems. Only problem was it was very hard to push her out whilst lying down ( midwife needed a good view).
dd was breech from 20 weeks. No-one suggested trying to turn her. (SIL had that done and found it very uncomfortable, also her baby turned herself back again!) They measured my pelvis using X-ray and a metal ruler held between my thighs (mears you might have to explain that better!) Prior to measuring, a caesarian was mentioned, but not after the Mersey Tunnel had been charted!
Labour was induced because my waters had broken.
First stage of labour was 17 hours, because the bum doesn't mould the cervix like a head would.
Second stage was under 20 mins!
After dd's body and legs were born (bum first) they applied forceps to her head so that it would not deliver too quickly, and possibly cause damage.
She had been in the extended breech position for so long, that for a couple of weeks it was difficult to hold her little legs down when I changed her nappy!

I had a very good experience with student midwives - although I eventually had an emergency c/s so they won't involved in a vaginal delivery however I was introduced to the student formally during labour & she was extremely helpful & pleasant and was with my DH immediately after DS was born (I was still under the GA!) and spent a lot of time with me over the next couple of days, especially when DS had a medical problem diagnosed. I also received a lot of help from another student midwife who took a long, long time helping me to get b/feeding established. Maybe I was lucky in that the hospital was relatively quiet and also both students were 'mature' & had had children themselves - but I really valued their help & support.

A friend is training as a MW and she said the biggest problem for her as a student has been getting to witness deliveries in which there have been no interventions such as induction. She was really struggling to reach her quota, at one point. But as the unit where she is training has a 35% CS rate, I suppose the lack of 'normal' deliveries is not surprising.

Mears (the resident expert!) you might be able to help with this - my SIL had her baby recently, all very straightforward. However, the midwife was a community midwife, returning to the labour ward and hospital midwifery for the first time in several years. She was the only attending medical staff as things were fine and this was her first delivery on her first day back. But when it came to the actual delivery it wasn't "managed" inasmuch as baba came shooting out in one fell swoop - none of that head out, stop pushing, one more contraction, then delivery scenario. As a result sil was torn so badly (pretty much as much as it's possible to be torn to the back, without being too graphic!) and had to be taken to theatre, anaesthetised etc for a surgeon to stitch her back together. Surely there must be some sort of re-induction programme for midwives who haven't delivered in a while???

PS I had a midwife all the way through my labour - is it normal for them to come and go? Maybe it's because it was so short. I can't imagine not having someone there all the time. I'll probably be brought down to earth with a bump with no 2.

I thought there had to be 2 midwives at the delivery? DD was born in hospital, delivered by a community midwife who was doing her quarterly stint on the delivery ward but a second midwife was also in the room for DD's arrival. Had the boys at home with same community midwife delivering but a second midwife came for the arrivals. Hopefully lovely Helen will deliver no.4 at home as well.

On the student thing, I've happily let student midwives examine etc but won't let medical students near me. Guess that i've known too many of them and have been worried about their attitudes (very pro c/s for everyone and disparaging of midwives).

I only had one midwife present for both of my births.

Mooma - I'd imagine the metal ruler was just a reference for measuring everything - you, baby, pelvis etc

I had a student midwife, and a student doctor with me when I was in labour, and both were fantastic. They were actually more gentle when doing examinations, and I'll definatley allow students in with any future pregnancies. I am hoping to go train as a midwife at uni next year, and hope that I get to have lots of experience whilst I train. I think experience makes you a better midwife when you're qualified

After being in the care of 7 different midwifes (due to shift changes, ward changes and a ridiculously long labour) I had a student midwife brought in as I had fully dilated. She was introduced with the words ' This is ***, she needs 2 more to make her 40 ', and with that the previous midwife left the room.
I wasn't at all concerned that she was a student but very upset by the fact that she proceeded to lecture me on choosing to have an epidural - especially since the epidural wasn't working. I wish I had had the energy to demand that she either shut up or left the room but I was busy trying to cope with the pain.
Ds was eventually delivered by c-section as his position was such that natural delivery was not possible.
The student midwife then 'visited' us on the ward the next day with a cheery 'Well, what do you expect if you have an epidural, natural next time!'.
Grrrr.
She may have received good training in most things but her bedside manner still needed a lot of work.
I'd still be happy to have student midwives use me as a 'guinea pig' but if there's a next time I'll be taking an 'assertive' female friend or doula along.

bundle - yes you're right, but there was an allusion to being able to get a double decker bus through, that I found a little insensitive at the time!

My ante natal teacher advised us (the class) to refuse students and to put it in our birth plan. She very much gave the impression that if we agreed, we'd have a gaggle of 6 - 10 curiosity seekers gawping at us. She also said our risk of infection through too many internals would be greatly higher. As an ignorant first timer, I (and all the others I think) heeded her advice.

Perhaps then, Mears - you need to educate ante-natal teachers too!

Now I've been through the experience, and feel a little older & wiser, I'd definitely agree to it, & feel sad that this teacher could possibly have hampered the training of lots of training midwives.

I know what you mean, Mooma, I've always thought my own 'child bearing hips' (inherited from my mum!) would do me proud...but still ended up with emergnecy c-section

Monkey - what a silly old moo your teacher was...was she an independent one, or through an organisation?

As a medic, I had a stint in Obs & Gynae as a student and we were well supervised. The rule in the units was that we had to see the labour from start to finish so we had built up a pretty good rapport with the parents by the time the baby arrived. We even were encouraged to make the tea and toast afterwards- we really learned about holistic care. I think the midwives were very fair to us. I still remember my first delivery after a very long day.

I am so grateful to all the mothers who let me watch/do their deliveries and therefore when I was on the other side had absolutely no problems with students being involved although ended up with an emergency C-section. Sorry to the student wh missed her 1 of 40!

Like everything else I think it is a matter of what you feel comfortable with and also that the issue of students needs to be handled sensitively and agree they should be encouraged to build up some rapport with the mother rather than arriving to catch the baby (unless the mother arrives and the baby does 20min later ) I think that no student should be let out on their own. Most teaching hospitals have guidelines for students.

Mears- I think midwives are just fantastic!

Thanks duck - I thought most medics thought we were the Witches of Eastwick

During my first pregnancy (DD 20 mths now) I had student midwives present during most of my hospital visits - starting with my "booking in" appointment (where I also had a freebie scan "just to be on the safe side", which was great for us). I have to say that when I went into labour the midwife I had at the hospital was probably the worst one I had throughout my pregnancy - she hardly spoke to me at all during the labour, and even when she did it was in a brisk and unfriendly tone of voice. Towards the end of my labour, a student midwife came in - her name was Lisa, I can't even remember the name of the qualified midwife! - and she was such a breath of fresh air! She really encouraged me to try different positions etc and gave me lots of advice and encouragement when pushing. The other midwife just stood back and said nothing. I'm now pregnant with No 2 and I would have absolutely no problem with having a student present during my labour.

PS: Deborahf - I had DD at Farnborough in Kent too! Nice MWs, shame about the state of the hospital!