Midwifery Year Three: Placements

Unlike previous years, I didn't talk about much of my placement experience in my overall review of the year because I thought it was better placed in this section of the posts. My placement in third year has obviously been a little more difficult. Not only was I a third year, with all the added responsibility that entails, but it was also during a pandemic. Changing policies in the country was nothing like the changing guidelines in the hospital. We were constantly being updated daily with new policies, especially at the very start of my placement, so I was honestly grateful when we were pulled. The staff were struggling to keep on top of it all, so there wasn't much in place from a student perspective. Personal protective equipment (PPE) was limited, we had one set on the ward to start with, and the ward manager was going to daily briefings and reporting back. It was such a strange time for everyone. 

When I returned back to placement in August, it was much calmer. There were clear procedures in place and social distancing was in place, especially in terms of spacing patients and limiting visitors. Of course, PPE was now normal and in abundance. We had to wear a mask on entry to the hospital, then change on entry to the ward, and keep it on at all times, bar whilst eating and drinking in the staff room. When we are having any contact with patients, we have to wear plastic aprons and latex free gloves, even when answering a buzzer. 

My first placement was on the antenatal ward. Honestly, antenatal is one of my least favourite placements because I find it quite slow and repetitive. However, I do love the continuity, the relationship you get with the women and it is quite a nice break from the hustle and bustle from other areas. Of course, this  is just how I see it in my eyes, and that may change when I become newly qualified. 

I thought it was actually really good to start on this placement first because I managed to get to grips with the online paperwork, having been away for almost a year and a half. I also did all my medicine management competencies, which gave me a great advantage going forward into the rest of my placements. Looking after a number of early gestation women was an area I hadn't done so much before, so it was a good learning opportunity and a gained skills in auscultation. I did make some mistakes, especially after coming back from so long away, but it quickly all came flooding back. There was also some interesting cases, with a complex postnatal lady (here due to capacity on the postnatal ward) and a birth on the induction lounge.

Straight from there, I went to the antenatal ward and it was honestly, so disappointing. They weren't particularly expecting me, and even though they were all lovely, possibly the friendliest in the hospital, they wanted me to relay to the university that the placements there were not appropriate in the current times. Many of the appointments for clinics were online so there wasn't much clinical contact. I was really looking forward to the ECV clinic and then it got cancelled last minute. Two days, I had to work with the MSWs taking bloods, BP and dipping urine. The other two had morning diabetes clinics, which were the only useful part as I was able to follow a few women though the clinic, however this was difficult due to social distancing and not being allowed in some of the rooms due to capacity. For some other bits, I attended the ultrasounds, which were interesting but not an area I want to specialise in, in the future and I found a lot of the technicians required quiet, so I didn't feel I could freely ask questions. 

My next placement was labour suite. I ended up having the most amazing mentor to work with but what I didn't realise to begin with was that she wasn't Practice Supervisor trained. I did however, have great continuity and learnt a lot. She really advocated for women and the way she spoke to women with such care and respect, is something I will always take away with me. 

Having already got my 40th births in second year, I wanted to be re-equated with normal birth and my mentor encouraged me to take more responsibility. I began by doing all the clinical care, and then slowly began to take on more responsibility, by documenting and caring simultaneously, rather than one or the other.

I had lots of great experiences, especially working my way through items from my red book, and then I moved to the postnatal ward. This is by far my happy place. I love babies, providing breast feeding support, and supporting mothers in their new roles. It's the placement area I feel the most comfortable with and so it's defintely my happy place. This placement was no different and sadly it only lasted 3 weeks. However, I did have some difficulties with a Practice Supervisor as due to not re-registering, I ended up having to work with a random person each shift. Luckily, everyone was lovely but it did make it a little tricky. 

I had a very clear game plan at the start of the placement because I had a number of things I needed to tick off. When I was the only student on shift, I would do my NIPEs because I needed to get them ticked off. I ended up working with 2 amazing doctors and a great midwife and completed the qualification. I also needed to get my last few postnatal assessments done, and then 3 more breastfeeding observations. Finally, I wanted to do a day of elective caesarean sections to finish my receivals. This was all relatively easy to do luckily, and I was able to discuss my learning objectives with my mentors at the start of each shift. Once they were completed, that was actually everything I needed to get that was mandatory and I could enjoy the rest of my placement nicely. By my last shift, my Practice Supervisor had her pin back and was able to tick all my competencies off and upload comments, which was great timing. 

I actually had to fight to have my postnatal placement, because they were going to put me in community. Whilst I love community, due to the pandemic, we were originally told we would not be going and therefore I had 6 weeks of antenatal placement, instead of 3 weeks. That meant, I still had all my NIPEs to do and some postnatal bits, which I wouldn't have been able to achieve in community. Especially, given that home visits have been almost removed and most appointments are virtual or phone calls. I did eventually get the change approved which I appreciate, even though I had to fight for it, and whilst I believe it was the right decision, it is now daunting to go back as a newly qualified, having not been for over 2 years.  

Finally, it was back to labour suite and this is where I really feel I came into my element. My mentor was still amazing and after discussing my priorities for learning, she really spoke out for me and gave me so many different experiences. We caught 24 week twins, which was my first premature delivery and was truly amazing. I fell completely in love with the family and they will forever change my practice, my career and my heart. They will all stay with me forever, and I only wish there was a way I could reach out to them. I wrote a card and got them a little present to say goodbye, but by the time I went to give it, they'd already left. I was devastated and told I wasn't allowed to post it to them for understandable GDPR reasons, but I still can't bring myself to through it away. 

Another was bereavement care. I feel very honoured to have ticked off all my mandatory bits so I could really enjoy learning about other aspects. I didn't want to go into being newly qualified midwife without the experience, and I joke that I ended up becoming the "queen" of bereavement, because it just seemed to find me. Each of the families have touched me in some way, and their babies will always be remembered with me. I feel very lucky that I was one of the few people to meet them, and I will never take that for granted. I even got to be there for the delivery of one of the babies, and that was truly an honour. 

I finally got a practice supervisor for my last 3 weeks of placement, and as a co-ordinator I was a little scared of working with her but in the end I am so grateful. She pushed me in ways I would have never pushed myself, and forced me to take so much more responsibility. On our first shift, she said she'd heard how amazing I was from other members and had every confidence I could handle the care myself. I ended up doing a confidence case and did the entire labour care by myself. It felt amazing and everything went textbook. 

We then did some complex cases, with high dependency, triage, diabetic care and others. They were all great experiences, as were episiotomies and a lovely delivery with a second degree tear, where she talked me through suturing in completion. Suturing was another goal of mine, but not many required it in the end so I didn't get much opportunity. She talked me through the entire thing and it made so much sense. I wrote a lot of notes and really feel confident going forward. 

The other memorable delivery was another confidence case, which didn't quite go to plan and ended in an emergency. But for the first time, I felt so supported by the team afterwards, and we reflected on the experience so well. She gave me a lot of encouragement and was my biggest cheerleader, saying I did everything right and made the right decisions at the right time. She even stuck up for me and was a true mentor. 

Overall, this year has been absolutely amazing despite everything. I have absolutely loved each and every experience. I feel so lucky I didn't have the pressure on me to do compulsory aspects, and so I was really able to hand pick cases that would provide me with the best learning opportunities. I am a little disappointed I've been unable to do an ARM, but I have tried multiple times, and I have a few tips to try next time, in the hopes of succeeding going forward. I feel positive, of course nervous, but ready to start my new career with the support of an amazing team going forward.