Preceptorship Rotation Thoughts: Postnatal Ward

My rotation on the postnatal ward is officially over and what a strange rotation it's been. Due to short staffing levels, I unfortunately didn't quite get the experience that I had anticipated and hoped for. It was planned for me to have two weeks of supernumerary, meaning that I wasn't meant to be classed in the numbers in order to be able to learn how the ward works and familiarise myself with care and guidelines. I started my rotation as the Covid-19 cases started rising with the new variant, so staffing was minimal. 

My first shift had a number of students, so I worked with another newly qualified midwife who had not even been working 2 months herself so I felt it wasn't particularly fair to either of us. From there, it only got worse, as I got pulled to labour suite every single day on my next 6 shifts. Two of them were for half days, but nevertheless, meant it was very difficult for me to learn the ropes on the ward. We had agency staff who refused to be moved, newly qualified midwives who hadn't rotated to labour suite yet and core staff who didn't feel comfortable providing labour care. It wasn't the best experience. 

From there, it got even worse as cases amongst staff worsened, causing the trust to have to make the difficult decision to combine both the antenatal and postnatal wards. This meant that night shifts were very difficult as we were constantly over capacity, with limited staff available. As the wards returned to normal, it defintely got easier. 

Of course, labour care is the priority when it comes to maternity, so unfortunately, I still got pulled. I usually end up doing 2 night shifts and 1 or 2 day shifts a week. On my night shifts, there are usually only 2 midwives rostered on so I ended up staying on my scheduled ward for those days. I actually really enjoy night shifts. Although, it messes with my schedule a lot more and it takes me a while to recover, the pay is more, I usually get my breaks which I never do on a day shift and it's a lot less busy. Even though it can be full on and constant, people aren't asking "When can I go home?". You also don't have to juggle paperwork, chasing up doctors and medications as much. 

I would say out of my day shifts, I got pulled for 90% of them. Two weeks ago, I'd just said to some colleagues that I hadn't been pulled all week and then 2 hours before the end of the shift I got pulled. I do enjoy labour care, so it isn't necessarily torture for me, however I need to mentally prepare myself. I like to put my hair in a ponytail so it's completely out of the way and just reset my expectations. I find it very hard to just switch in a few minutes. Also, it's not hugely helpful to wait because I set my day and schedule around tasks on the ward. When it's just after handover, it's frustrating because I have to re-handover my women that I've just said hello to. Sometimes I can be about to do a discharge and then everything gets delayed, which is understandable frustrating for women and their family. 

Having said that, I have had some great experiences on labour ward when I have been pulled. I got my last few non-mandatory but useful bits signed off for my preceptorship pack and also looked after some lovely women. 

I got pulled on Christmas Day to "ward a few postnatal women", however when I arrived, two needed suturing, all three needed their computer delivery summaries completing and one wanted an early discharge. One of the ladies was fairly easy, so after suturing which took priority, I warded her. Another I had met before, so it was really lovely to see her again. Unfortunately, her baby was born preterm so had been taken straight to the neonatal unit. I ended up taking her to the ward, and then straight to the neonatal unit, and it was lovely to see baby and reunite them. The final women was lovely, so I did a lot of breastfeeding support, baby observations, the newborn examination and then gave her an early discharge. Once they'd all left, I looked after a lovely low risk labourer. The pair were so sweet and calm...hypnobirthing at it's finest. She ended up delivering a couple of hours after my shift finished, but a perfect Christmas baby. 

The highlight of the last few months was probably my first vaginal twins delivery as a qualified midwife. I looked after the woman and her family a lot throughout the week, from admission until the night before discharge. She was quite difficult to monitor, so it required me to be constantly moving the transducers throughout the day and she had literally no pain relief. She suddenly said she felt a lot of pressure, asked for the entonox (gas and air) and then the fetal scalp electrode (FSE, heart monitoring clip on babies head) elongated massively. I pressed the normal buzzer straight away to get the team in the room as I hadn't got the delivery pack, cord clamps or active management of third stage prepared. Two midwives came in and then quickly left, one returning just as babies head delivered with one push. Luckily, twin one came out perfectly. The second baby, just 8 minutes later, required a little more support but thankfully, the neonatal team were there by that point. The twins were premature so needed quite a bit of extra care and support on the ward so I was grateful to have continuity over the next 3 shifts. She was so lovely and the twins were truly beautiful. Also, note to future self, from now on, I will be getting everything ready in the labour and delivery room in preparation, even if birth isn't imminent! 

Overall, despite the difficult situations, I've loved my postnatal rotation just as much as I thought I would. I especially loved co-ordinating the night shifts and having that extra responsibility. Of course, it would have been nice to have a little more time there, especially as I had almost 2 weeks of annual leave, but I feel very comfortable there and it's all flooded back from my time as a student. I also finally got my mobile phone device. I can't wait to be back!