Labs and Practice

We did intramuscular injections this weeks in the practice labs. It was hilarious, but I'm a bit nervous about my first practice on a person because of the greater risks.

I've selected the visit with J* to write about in detail as N* got me to lead the assessment. We turned up and J* was int he shower. N* had mentioned that she believed J* had a cultural view of pregnancy as an illness and that her approach to her pregnancy experience reflected this.

We spoke to J*'s husband about his job and their preparations for the baby. He commented that they have a strong family network. They also plan to purchase baby equipment in one shopping excursion. R* said that he might be able to get two days off a week when baby arrives. R* then went to bed as he works a night shift job.

Starting on the assessment I was quite nervous. I knew about the palpation, blood pressure and urinalysis but was worried I wouldn't remember all of the appropriate questions. I recalled to ask about sleep, movements, iron. We definitely covered those and exercise, antenatal education, support networks, bowel and bladder function, pain in her legs.

I'll have to check the notes for the blood pressure reading. On palpation her uterus was very firm. I was mentally fascinated in comparing her abdomen to the previous client who was also at 30 weeks. J* was big for dates and on palpation N* assessed size on palpation at 32 weeks.

Blood pressure and urinalysis were both satisfactory. J* has been advised about hydrotherapy and exercise classes to relieve thigh pain but hasn't attended any. I suggested that is J* knew someone who was pregnant she could attend classes with a friend. N* mentioned that for hydrotherapy women could wear just a t-shirt and shorts and that if desired the hospital could provide swimsuits.

Busy

I have to finish writing up last week before writing up today.

S* lost a baby earlier this year. We met her at work. She has an extreme anxiety about the pain of labour and this is of concern to N*.

S*, 12 weeks, has moved from Auckland. I was made aware of non-midwifery aspects because she takes Thyroxine for Hashimoto's disease.

We also did venepuncture last week in class. What a nightmare! We have an odd number in our class so I practiced on our lecturer. I got the vein but went through is, so I obviously need practice. [NB: Lecturer note in journal "That's OK"] N* suggested going on rounds with the phlebotomists at the blood lab.

Today's visits. D*, 39 weeks. I did the palpation and was thrilled to correctly detect that her baby was posterior. It was so exciting to get it right myself with no cues. N* did a vaginal examination to assess the favourability of the cervix. I met D*'s husband today as well. Looks liek the induction will be assessed next Tuesday for favourability as D* will not have pessaries, only artificial rupture of membranes.

R* came into the hospital from out of town for her antenatal appointment today. She is at 28 weeks. Of concern was her level of depression. She noted that her mood had improved, but throughout the appointment I got the impression that she was holding back a really big cry.

I felt as though I really clicked with L* (36 weeks) and would love to be at her birth. She is really fun and intelligent and onto it. I commented to N* about how a midwife is in the position where you click with some women, do your job with others, and sometimes badly clash. She mentioned that both parties need to remember that they can change when necessary and the midwife may be able to facilitate this by opening up discussion.

S* is 24 weeks with twins. She looks to have a very supportive family and network. It was great to be able to palpate her abdomen, but I have no idea what I was feeling.

R*, another one, was fit and well postnatally. Already back into her jeans! Baby was gorgeous with a wee rash on her cheeks and chest. Likely from milk.

I nearly forgot A*. Last postnatal visit at 3 weeks. We were so busy...

D* was a postnatal as well. Baby appears to have a heart condition and it may or may not correct itself. We were there for her first bath. D* was really upset when N* listened to baby's heartbeat with the sonicaid.

One really nice thing today was that N* believes I will make a wonderful midwife. The confidence I have dealing with the women and my intuition based on experience and knowledge will stand me in good stead.

Independent Midwifery

My first day with N* was fantastic. The first woman we visited was the first woman whose birth I would attend. N* asked me to take D*'s blood pressure. I felt like a complete wally when I couldn't hear anything and Noreen turned the stethoscope head around.

D* was 38 weeks, gravida 3, and easily palpable. Next time I do a palpation I should really do it without watching N*, or before N*. D* will have a planned induction on 8 August if she does not go into labour prior to 40 weeks gestation. Baby was ROL. D* may not have much support for rest prior to the birth.

A* is gravida 2 and at 24/40. She had an amniocentesis to identify risk of Down's Syndrome. Amnio came back negative and identified baby is a boy. She has difficulty with her daughter C* who requires a special diet. The concern is in respect to family dynamics and risk of problems if baby is difficult. Constipation a problem. Decision points covered.

Back to School

Back at school. I am relieved to be back on track after a wonderful, but somewhat tedious, school holidays.

It already looks as though assignments are going to be very heavy going in September and October, and we're to plan to do the births then too.

We get pagers to use this half. It seems to somehow raise the importance of our courses by being on call.

I've contacted N* and briefly outlined what I need to achieve. She is absolutely fantastic and we have scheduled a meeting for this Saturday to go over my schedule and discuss goals and objectives. N* will also permit me to attend all of her Monday scheduled visits. Lucky me!

A 'B'

I was really disappointed in getting a 'B' pass in Introduction to Midwifery for the health concepts assignment. I shouldn't be, because of the amount of time I spent on it, but the marking indicates that I was marked down mainly because of layout. I have learnt something, but a 'B' for the assignment means a 'B' for the course. I'm worried because I made the same mistakes in my interview assignment.

Shaped by Practice

Nearly the end of my clinical practice. It has been fantastic and I have learnt from every midwife I've worked with. Even though J* had had a large break in her career she had heaps of experience. While she respected the old school midwives, she tended to a social model and definitely believed that less intervention was better, but didn't mind the odd formula feed if that was the woman's choice.

I got a completely different perspective about autonomy and safe practice observing and working with J* (a different one). As an independent midwife working as a casual resource at the hospital she was very cautious in her measures when caring for women. This included expressing breast milk and giving it to babies on a spoon if baby had not had a reasonable feeding atttempt before 8 hours. Also in respect to autonomy she believes that midwives working hospital shifts do not really have the same right to make care decisions when they go home at the end of a shift and leave care of the woman to the next midwife.

My most enjoyable experience was working with B*. She was a direct entry midwifery graduate and is really easy to talk to and understands my perspective because she's been through it. She was accomodating, helpful and friendly. What I most liked was the response she got from women. Everyone seemed relaxed and confident in the care and advice she provided. Out of the three she, I believe, best served the needs of all women she cared for.

I will continue to experience different ways of practising and differend personalities. I can see that i will take it all in over the next three years and mould and shape my own unique style and methods for practice.

I am slightly curious about how I will react in my first emergency, at the first caesarean, at the first normal delivery, and after my first big mistake. Needles are another area of wariness and nervousness. Lots of firsts to come, but at least I survived my first clinical practice.

Experience

Two things I learnt today. First, when talking to a woman only relate a personal experience if it will create a sense of empathy for her. Relating my experience is midwife-centred instead of woman-centred. I could hear myself relating something and realised that it didn't contribute much value.

Second, and most valuable! It has been obvious and reinforced time and time again. Don't ever overlook or ignore experience just because I might have learnt differently, being proud, be feeling stupid, cocky and confident. Experience counts for more than the fresh new learning. Reading a book, doing an assignment or test, don't count for as much as years and years of experience. And remember that on the ward we are a team providing care. Remember all the bad, sad and silly stories whenever I go out on practice or after I graduate.

A good point J* mentioned was to trust my instincts. Also reinforcing the classes to look at "the whole person" not just taking obs. Consider their mood and coping and support as well.