Midwifery Year Two: Placements

I have actually already written about some of the placements from second year, because they are split between midwifery and non-midwifery placements. This post is going to focus on the former. Once again we had the main placements of community, ward and labour placements. As the midwifery placements are very similar to first year, I am not going to go into quite as much detail as first year, so go ahead and read about my first year placements here.

Working in an "away" trusts gave me a new perspective of midwifery work life. It is very strange how different trusts work and the guidelines that they follow, despite the essence of care being the same.

My community placement was very close to the hospital and therefore very easy for me to get to. The community teams were set in purpose built "hubs" in community centres e.g. gyms, which I absolutely loved. It made it really accessible for the women. The days were longer than the traditional 9-5, starting at 8am and often finishing at 6pm. It actually worked out quite well for me, because I usually missed the bulk of rush hour and it meant I only had to work 4 days a week. I was once again, very lucky to have a lovely mentor, but one who was very old school. Her easy-going nature often left us very delayed in clinic because she knew everyone's background story and chatted to them all like old friends. To be honest, it was really lovely to watch and witness. It reminded me of the friendly atmosphere of a Call the Midwife midwife, where time pressures and limited resources didn't impact compassionate care. I also loved getting to experience home visits, with about 40% of my time doing them. Although, I wouldn't say I got comfortable with community clinic this time round. 4 weeks was quite a brief amount of time to get my head around the new computer system and due to the small nature of the room, it was quite difficult for both my mentor and I to work together, so I often had to sit on the sidelines.

At this trust, the ward was for both antenatal and postnatal, rather than separated. Plus, jobs were rotational, so you moved between labour and ward shifts continuously. Honestly, I quite liked it! It meant that you never got bored of one area, nor did you forget the skills you needed for the other. Towards the end, I did have to fight a little to make up my labour hours, but as long as you remain aware of how many hours you do on each placement, it works out in the end and the team try to be accommodating as possible.

I found the use of central monitoring very strange. I was so used to being in a room with a mother during labour care the entire time, barely able to get a break to use the toilet, so having to almost force myself to sit at the desk instead was different. Of course, the midwifery led women still called for constant care, but those on electronic monitoring and epidurals really was just a quick pop in every 15 minutes or even 30! That may be a slight exaggeration, but going from a crazy busy unit with constant turnover and little break, to a much smaller, quieter and relaxed atmosphere took me a little while to get used.

The other big thing about the labour placement which was new to me - and I also absolutely hated it - was that they had a second midwife for every delivery. For my first two experiences it was the co-ordinator and one in particular, who scared me to death. Shouting in the faces of women while they push is not something I practice and I found myself very uncomfortable with it. Likewise, the second midwife would often be the one to weigh the baby, do the check and give the vitamin K. I just thought it was a little strange that they would break skin-to-skin before the woman had finished labouring to intervene with that vital intervention. Oh, and it didn't actually have to be a midwife. Often it was with one (or two) maternity support workers instead. Plus, I had never done hands on care before, nor directed pushing, both of which seemed common practice at this trust. Similarly, episiotomies were much more common. I had only seen these done for instrumentals prior but often midwives would initiate, which was eye-opening and I learnt some new skills.

Having not worked on an antenatal ward before, I found it very similar to community care. For the vast majority of women they just needed a single routine set of observations and examination. Mostly, they just wanted company because they were either bored or incredibly anxious. As a student, I've really tried to give them that time because I know it won't be so easy when I graduate. Simply sitting and listening, being someone they can share their fears with, is often all they need.

I actually really enjoyed my away trust. I loved how the team was made to feel like a family. All the staff really respected the students and whilst I often thought it was perhaps due to my new found confidence as a second year, with more knowledge, I truly think it is more to do with how close the unit was and it was really lovely. I felt my home trust was great but I did often feel on the outside. Also, the doctors were just as trusting and engaged with the midwives. I really liked the regular (fortnightly) inter-professional learning classes too, which I felt were really helpful.

Overall, I think the placements clarified that I am very comfortable and confident working on a ward. It is defintely my happy place and even though it can get a little hectic, I really enjoy it. As always, I still need to continue to develop breastfeeding support skills, having met two very difficult babies who I very sadly, could not get to latch. I even tried the crawl method but with no luck. I think that's always going to be a passion of mine, and hopefully over the years, I get better and better. Labour continues to be my favourite and one I find most satisfying but I worry about it and I find it the most daunting. Despite mentors giving me incredible feedback, the thought of them not being there worries me. I feel like I could do the care and the notes, but doing them both together is a scary thought.