Speaking out: A Student’s Perspective by Ren Forteath

I was recently asked to speak at a conference organised by our consultant midwife on the topic of Person Centred Care. She wanted to hear thoughts on the topic of ‘Speaking Out’ from a variety of perspectives and asked me as a midwifery student on placement. I was delighted to be asked to present, perhaps the first indication that speaking out may not be something I find overly daunting! Having a background in amateur dramatics gives me an advantage when it comes to assessed presentations or even leading parentcraft classes when on community placement. The same could not be said of everyone in my class. Even approaching the end of our final year, many of my peers quake with nerves when asked to give a presentation. This fact caused me to consider ‘speaking out’ not only from my point of view, but from that of other students who might be younger and less outgoing than myself. (As a mature student I have quite a few years on some of my class!) The topic encompasses a variety of scenarios, and I tried to think of personal experiences that illustrated my feelings.

On a shift to shift basis we speak to women we care for, other students, midwives and doctors – and sometimes that is no less nerve racking than giving a presentation! Naturally as we progress through our course we become more confident, we gain more knowledge and our comfort zone broadens. But inside there is always a kernel of fear that we’ll say the wrong thing – or not say the right thing. Personally, I’ve had a couple of experiences that spring to mind.

In first year I was with a woman who had written in her birth plan that if things didn’t go as expected and she needed help, she would rather have a kiwi delivery than forceps. I thought no more about it until we reached that point. The reg was called in to do an assisted delivery – and he immediately went for forceps. The woman was fairly out of it on diamorphine and becoming distressed. She couldn’t speak up for herself.  So, I swallowed my fear, took a deep breath and said…’eep’. Then I took another deep breath and said “Doctor, um , she’d really prefer the kiwi, if you don’t mind, please, thank you very much”.  And he did it! She got her kiwi delivery and she was so happy. And I was absolutely on top of this world! It was so exhilarating. I had been an advocate for my woman. I had spoken up to a doctor – and he hadn’t bitten my head off! And then second year happened.

I was on shift and we heard an emergency buzzer, so we all ran to room 7: and it was a shoulder dystocia skills drill. Well, really, what were we expecting? There was only one woman in labour that day and she was in room 3! So one person took charge and started working through the HELPERR mnemonic and I thought “hey, I remember this, I know this stuff”. Then the consultant walked in, made a quick assessment of the situation and said “O.K. with a little fundal pressure, I think we can get this baby delivered.” Everyone else just looked at each other and I was thinking “that’s not right  – I know that’s not right – it’s suprapubic pressure.” And then someone suggested doing exactly that but the consultant said again “Come on now,  a bit of fundal pressure! Please, will someone put their hand on the fundus?” And I thought “it’s not right, is it?” And as if of its own accord, my hand started to move. Well, his voice was just so hypnotically consultanty. Then my mentor shot me such a daggers glance that, seriously, if looks could kill, that midwife would be in prison today! My hand shot back down, but not before at least two other people had seen it. So that sparked a useful discussion on listening to your inner voice and always speaking up, diplomatically, if your knowledge of evidence based practice tells you something is wrong. It also sparked a debate on whether it’s appropriate to use ‘making the student feel like a prize turnip’ as a teaching technique. And I wished the floor would open up and swallow me whole.

And now I’m in third year. There is light at the end of the tunnel and I’m beginning to believe it is not an oncoming train. I still have a lot to learn but I’m really starting to feel like part of the team. I suggest things and people listen. I coach women through fear and panic to relief and joy. I hold my own.

A large part of how easy or difficult it is to speak out is the people you are surrounded by. In my clinical area we have great teams, both in hospital and on the community. My classmates who have been here on rural placement always say how much they enjoy it; the working environment, the attitude, the team. People are encouraging, patient, willing to listen and keen to teach. They are inclusive and welcoming. I have rarely been berated for starting to do something the way I was shown at Uni rather than the way the midwife I was working with that day would normally do it. Not never, unfortunately, but rarely and never by a mentor.

Having my student placements there has made my own experience a hugely positive one and has equipped me to find my voice and to know how and when to use it. I know that many in my class feel the same way about their mentors in their own areas. Speaking up and speaking out are still not always easy…. but we’re learning, and as we complete our degree programmes and step out into the wards as shiny new midwives, we will find the strength to speak for our women, and for ourselves.

  • Trust your learning – if your evidence base tells you it isn’t right, say something (even to a consultant)
  • You are her advocate – if she can’t speak for herself, it’s your job to speak for her
  • Be diplomatic – just because you need to say it, that doesn’t mean you have to upset anyone
  • Find your voice – you can have a positive impact by saying the right thing at the right time

Ren Forteath is a Student Midwife

“My Neonatal Journey” by @GillyMoffat

Gilly 2This time last year I arrived for a night shift to be met by my manager who wanted to send me to Glasgow on a course. To be honest I didn’t even hear what the course was going to be about, all I heard was a night away in a hotel, on my own, away from my lovely (but always up before the crack of dawn) boys!!! Well the answer was a loud “YES” from me. However, what I didn’t appreciate on that night was how involved I was about to get or how passionate I was about to feel around the subject of Person Centred Care.

My journey started in 2001 when I qualified as a Midwife and came to work in Dumfries and have been here ever since. In 2004 after working in the neonatal unit for 2 years I gained a further qualification to become a Neonatal Midwife. I did not find university easy and through both times I will openly admit I have struggled. The only answer I have come up with is that I am a people person, definitely not academic and never will be. So, I thought people at the centre of health and care as the perfect subject for me but I will now go onto tell you how there have been times recently when I have thought otherwise and the reasons why I will continue.

I have now attended 2 out of the 3 collaborative sessions at the SECC in Glasgow with the next one happening at the end of May. There have been moments of laughter during these sessions and moments of inconsolable crying (not sure if that was just me as I was hiding behind my tissue) but overall the principle message is one that we are all potential patients and we should treat everyone the way we would want to be treated. Yes, I know this is one of the oldest cliché in the book but I think taking time to reflect on this will make us all better carers. Hearing first-hand accounts of poor care during what is the hardest of times is not easy but to know that the person carrying out this mistreatment is working in the caring profession is disgusting and unforgivable. So the question has to be what can we all do to make our services better? I have heard lots of buzz words/phrases like “listen to hear not to reply” and “nothing about me without me” and for once they actually make sense to me.

Gilly 1I feel the message is very clear, the first step to improvement is to ask our patients and their families what it is that they want and stop assuming that we always know better. This is where I started. My manager gave me a copy of an email she had been sent with an attachment called my neonatal passport. I began to adapt it to fit in with where I work then I can only describe it as my obsession began. I have asked parents, friends, colleagues, really anyone who will listen to read and comment on every version I have made (and there have been many!!). The title has gone from “My Neonatal Passport” to “My Neonatal Journey” and changes to the content have been carried out due to my most recent small test of change and I am now ready to try out the next test.

The booklet is designed to give parents a record of their stay in NNU. The information they need to gain confidence and knowledge to care for their baby while in NNU and on discharge. It will replace the parents’ information folder we have at the moment which I am told very few parents read. Each day the nurse/midwife is allocated a baby to look after, time will be taken to go over the pages designed to be signed by staff and parents. My hope is that by doing this any issues that arise can be dealt with and communication will be encouraged. Something that comes up time and again in complaints is lack of consistency in information given I believe that through time we can use the booklet as a reference point so we are all saying the same thing.

There have been times since I took on this project that I have felt it is too big a mountain to climb, when a small test of change highlights the booklets failings or I have realised that I am not being successful in communicating my vision to my colleagues it has been hard. I want more than anything for this to be a success although I have no doubt that I am still a long way from the finished product.

Before I started this project I had never heard of a “pdsa” or a “driver diagram” and to be honest I am still struggling at times. I know what I want to achieve but making it clear on paper is so difficult. I have spent so many hours working on “My Journey” that I can’t tell whether or not it makes sense so I rely on my colleagues in the neonatal unit. Thankfully I am lucky that I know they are behind me and will put up with my endless pleas for it to be read and re-read.

I am now looking forward to the next learning session in May, now, not only for the night away and a lie in past 6am but to hear examples of what others are doing around Scotland. Maybe even come away with inspiration for my next obsession, sorry meant project!!!    

Gillian Moffat is a Neonatal Midwife at Dumfries and Galloway Royal Infirmary                                                                                                                                                                                                                                                                                                                                                                                                       




Pizzas are delivered……… by Karen King

Karen 1As a Consultant Midwife my job description tasks me with promoting and supporting normal birth. Well how hard can that be? Women have been giving birth since time began and the size of the global population suggests very successfully. Women have been Karen 2supporting each other through childbirth for centuries. The first known usage of the word midwife was in the 14th Century and originates from old English for mid (with) and wif (woman).                

The World Health Organisation (WHO), International Confederation of Midwives (ICM), International Federation of Gynaecology and Obstetrics (FIGO), Royal College of Midwives (RCM) and the Nursing and Midwifery Council (NMC) all agree that pregnancy and childbirth is a normal physiological process and life event and that midwives have a unique role to play in promoting and supporting normal birth.

 So I find myself asking why is it in the 21st Century we require a specific midwifery role to promote and support normal birth – is that not what a midwife does?

Karen 3It is complex and multi-factorial and relates to changes in culture and society, the medicalisation of childbirth and the emergence of litigation.

Women have always been anxiousand/or fearful of labour and childbirth which is normal and healthy. However, in 2000 Hofberg and Brockington first identified a condition known as tokophobia (a morbid fear of pregnancy and/or childbirth). This condition has led to an increase in the number of women requesting elective caesarean section. Women no longer support each other in childbirth and are not directly experiencing the process. Women now get information from TV and social media sites which tend to focus on the dramatic and emergency situations. In addition sadly some women are so traumatised by their first birth that they simply cannot face the process again.

The medicalisation of childbirth saw doctors take over from the traditional female birth attendant and women were no longer “with woman” whilst they gave birth but doctors (generally male) were “delivering” women. Control was taken away from women and how a woman was to be delivered was quite prescriptive – generally on her back with legs in lithotomy. Some medical advances were extremely positive with the advent of antibiotics seeing a reduction in deaths from puerperal fever and oxytocic drugs preventing deaths from post partum haemorrhage. However despite the many advances we still cannot find a better way to give birth than nature in that any of the interventions we use all have potentially harmful side effects.

Karen 4Karen 5It seems it is best to let nature take its course and as far as possible use natural sources of pain management such as water immersion which has robust evidence of efficacy with no side effects.

With medicalisation comes litigation and the perceived risk that someone will sue can lead to fear amongst health professionals and defensive practice which generally means more intervention.

 It is therefore my job to work with midwives and our obstetric colleagues to have confidence and trust in the women we care for to achieve a normal birth and crucially to identify when that is not going to be the safest option and advise and support her accordingly. The emphasis is on achieving the best birth experience and not necessarily about the type of birth.

We need to work together to reduce the fear. It has been demonstrated in many ways that fear can be toxic – from its ability to alter the labour process and outcome to the culmination of fear across a whole organisation resulting in harm to patients.

Midwives do have a unique role in that they are with women through hours of labour and are privileged to be present at the birth. If we are hard to negotiate with it is because we are advocating for and protecting women against unnecessary interventions. I aim to ensure that midwives are truly person centred in their approach to labour and birth and women tell us what their hopes and aspirations are for their baby’s birth. It is the midwives job to do everything she can to help achieve those aspirations.

I was sad about the nature of the announcement of Prince George’s birth. “Her Royal Highness The Duchess of Cambridge was safely delivered of a son at 4.24pm today”. So who gets the credit for “delivering” the Prince– the Queen’s Gynaecologist! This young woman gave birth – it was she who laboured for hours and felt all the pain, followed by the joy of greeting her new son.

Karen 6So any women reading this and considering having a baby I would urge you to take back control of your birth – the midwives are ready to support you. You will give birth to your baby (however that may be) and we can leave deliveries to the pizza guy.

The midwives in Dumfries and Galloway are mounting a campaign to encourage women to take back control and have the best birth they can. Look out for the MPower event on 24th May 2014.

Karen 7

Karen King is a Consultant Midwife in NHS Dumfries and Galloway