I have now completed my first placement as a third-year student midwife. As mentioned in my previous blog post I had 2 weeks on the maternity ward consisting of antenatal and postnatal care, 2 weeks on the neonatal intensive care unit (NICU), followed by a further 2 weeks on the maternity ward.

I will begin with my experiences on NICU. NICU consists of 4 different bays; the intensive care unit (ICU) where the most poorly babies are placed, 2 nurseries which are not deemed as such ‘high risk’ but still require the support of a nurse for example tube feeding. A transitional care bay where mums stay with their baby’s and basically fulfils its name – assisting with the transition between baby being on the unit and going home, and lastly, individual rooms which also consists of transitional care.

The main units that I switched between were the ICU and nurseries. I was surprised at how daunted I felt going onto a new ward – as third-year students it is expected of us that we are predominantly autonomous so going from that to feeling like a first year again was very strange! Throughout my time there I had the opportunity to look after very premature babies – born from 25 weeks gestation, provide basic care such as top and tail washes, changing nappies, feeding the babies through nasogastric tubes, as well as providing parents with additional support when it comes to syringe/cup feeding or initiating breastfeeding. There was a lot of information to learn but I came away with 2 key positive points that I wish to apply to my own practice.

Firstly, the importance of thermoregulation right from birth. It was explained to me by some of the nurses how admissions to NICU can be reduced by remembering to keep the babies warm right from the second they are born, alongside the impact this can have on their blood sugars. Secondly, by expanding my knowledge on some of the equipment used. An example is a baby placed on Continuous Positive Airway Pressure (CPAP), I feel much more confident in explaining to the parents what the process involves and why. For me, I feel this is really important as before my placement on NICU I knew what it stood for but didn’t really understand the depths of what it does. CPAP is used to maintain a low amount of pressure in the lungs whilst the neonate is inhaling/exhaling spontaneously. It is predominantly used for infants with respiratory distress (mainly in premature infants) to ensure that lung volume is maintained, oxygenation is improved and reduces the amount of fluid contained in the alveoli of the lungs. Prior to this placement, I would never have been able to explain this so I’m really pleased I have come away having learnt so much.

Additionally, I spent quite a few days working with the advanced neonatal nurse practitioner (ANNP) who was absolutely incredible. I am currently doing my newborn and infant physical examination (NIPE) as an additional module and she came to the maternity ward with me so that I was able to complete 16 out of 20 of my NIPE checks that I need to get signed off for the module, so this was a huge relief so early on in the year. There is so much to learn in the NIPE module and my exam is on May 8 2018, so actually performing so many examinations has really helped to consolidate my knowledge and has been a great form of revision to prepare me for my objective structured clinical examination (OSCE). Another great aspect of working with the ANNP was that she was a bleep holder so we had the opportunity to attend high risk deliveries in the delivery suite as well as theatre. One particular delivery we attended was a caesarean section where the mother was put under general anaesthetic for fetal distress. The baby needed resuscitating and although there were other more experienced practitioners there to help, the ANNP told me exactly what I needed to do in order to facilitate inflation breaths (using a neopuff on a resuscitaire to inflate the lungs after birth, 5 of these can be given – however, if you don’t see the baby’s chest rising, re-check head position and give 5 more inflation breaths) followed by ventilation breaths which are effectively used to breathe for the baby until spontaneous respiration is achieved. Although this was incredibly scary, it was an experience that I will always remember – and again, has helped to consolidate my learning and knowledge on neonatal resuscitation.

Now onto my experiences of going back to the maternity ward as a third year. Yet again, I was incredibly lucky to be assigned amazing mentors. One of them was designated to antenatal care and the other postnatal – so I had the best balance between all clinical experiences. I remember when I started on the maternity ward in second year and feeling quite out of my depth, and it’s amazing how coming back as a third year the penny starts to drop and everything starts to fall into place. Don’t get me wrong, I still have so much to learn (and will continue to do so throughout the rest of my career), but I felt much more on the ball this time around. I’m a very practical person and I learn by doing much more so than being told what I need to do. Thankfully, my mentors allowed me to be the ‘lead care giver’ whilst supporting me when I needed them – so I actually felt like a proper midwife! It’s scary to think that the next time I am working on the ward I will be a fully qualified midwife, but it’s also really exciting as I really am starting to see the light at the end of the tunnel.

I now have a week off which I will be frantically cramming in more revision for my NIPE OSCE next week, followed by my final 4 weeks of theory in university and then a 6 week placement on delivery suite. So my aim will be to complete another blog post at the end of this block.

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