Again, it has been a while since I have completed a blog post; therefore I have decided to complete two. This post will entail my most recent experiences of delivery suite and birth unit, and the second will be focused on dissertation writing as well as top tips for either future or current student midwives on what to expect.
I was last on delivery suite between June and July 2018. I have had the most positive experiences and worked with a mentor that I had throughout second year, as well as a new mentor. Considering this was my last placement there as a student midwife, my mentors were very encouraging when it came to allowing me autonomy and independence when planning care pathways.
A large aspect of being in your third year of training is learning leadership qualities so that you are fully able to advocate the women within your care. Therefore, I found it really helpful when mentors allowed me to take the lead role in caring for the women. Personally, I found it really supportive when my mentors would take me outside of the room and ask “What are you going to do now?” This allows you to think in a less-pressurised environment, as well as having the ability to discuss with your mentor what the appropriate care pathway is deemed to be, how it is going to benefit them, as well as communicating this with the woman and her partner.
One of the key clinical complications that I have always found very daunting throughout my training is women with diabetes. Therefore I made it my mission to care for women on delivery suite with a procedure calling a sliding-scale. A sliding scale is a form of insulin therapy that women with diabetes can sometimes require throughout the antenatal, intrapartum, or occasionally postnatal period. Its purpose is to stabilise blood sugars by administering either insulin or glucose intravenously according to blood sugar level. One of the key but very simple questions a midwife taught me to ask the woman is “Do you have any symptoms when your blood sugars are getting too low (hypoglycaemia)?” It is imperative that women who are receiving a sliding scale are provided with one-to-one care, and knowing the answer to such a simple question can really assist on acting promptly when hypoglycaemia is suspected.
Another really helpful tip is to sit with the woman, and have a discussion with her regarding her diabetes – whether it’s gestational, type 1 or type 2. Ultimately, they control their diabetes every single day and will always know more about their bodies than we will. The woman within my care did become hypoglycaemic, and unfortunately she never had symptoms of when it was going to happen. However, a ‘hypo box’ is present on each ward, and includes a step-by-step guide on exactly how to treat it. It includes glucose tablets, instructions to provide orange juice, as well as glucose gel. Other more serious hypoglycaemic episodes can be treated with glucagon injections. However, in such circumstances the box provides you with all the information required as well as how often to test the blood sugar levels following an episode.
I have been very lucky throughout my training, and I caught 40 babies (the requirement to qualify) quite early on into my third year. Therefore, when I was on my delivery suite placement my focus was to look after women deemed as high-risk.
As a result, I cared for women requiring high-dependency care which can occur as a result of sepsis or infection, postpartum haemorrhage, pre-eclampsia/eclampsia, complicated vaginal tears etc. When you’re a student, and even after qualifying a lot of people do tend to focus on the number of babies you have delivered. However, this aspect of the profession is equally as important – if not more so. Throughout the first year of midwifery training, all your learning is focussing on the normal and low-risk. Therefore, when you are on delivery suite and women are deemed as high-risk it’s so important to make the most of every opportunity to optimise your learning.
Saying this, it is so important to be aware of what is deemed as ‘normal’. Midwifery is a specialised profession, and ultimately it is our responsibility to be aware of circumstances that deviate from the norm, and how to act accordingly.
An example of this is a high-dependency woman that I cared for on delivery suite. Once sepsis is suspected it is crucial that the ‘sepsis 6’ pathway is completed within one hour, as research has proven the best clinical outcomes are achieved. The pathway is inclusive of: ensuring oxygen saturations are >95%, inserting two large-bore cannulas to provide fluid resuscitation, a doctor taking blood cultures in an attempt to source the location of the infection, the midwife may also take other cultures for example urine, vaginal swabs, throat and wound swabs.
Furthermore, and ideally after blood cultures are obtained, a broad spectrum antibiotic must commence as soon as possible. Blood samples will also need to be taken for lactate levels as this is an infection marker. Lastly, urine output most be monitored very strictly, therefore usually a catheter will be inserted into the bladder to do so. Considering all of these tasks ideally need to be completed within the first hour of identifying sepsis, it shows the crucial importance of identifying deviations from the norm and how important this aspect of our training is.
Following my delivery suite placement, I had a few weeks allocated for my dissertation (see my next post for more information!), a much needed holiday, and I am currently based in a stand-alone birth unit. I am into my fourth week, and although I haven’t had any births there are a lot of triage attendances that have kept me busy, and I have cared for women in labour.
I have another two weeks placed on the birth unit, and then I go to the community for my final six weeks as a student midwife. I will complete another post once I have finished my placement here, as well was what it is like to return to the community considering I haven’t been there since first year. The last pieces of work to be handed in are our ongoing records of achievement showing all our numbers and a presentation that is based around a case we have been involved with, that I will also discuss more at a later date.
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