Maternity - Hospital Placement Reviews

So my second week of hospital placements was in Labour Ward! This was really exciting to me because I wondered whether or not I should be a midwife and I am really excited for the first time that I will catch a baby on my own on the road! If you have not read about my first week of placement, that can be found here.

Background
So I required 37.5 hours for this placement block, which equates to three long days as the midwives work 12.5 hour days. I worked Monday, Tuesday and Wednesday (and then I moved house!) so the week was quite tiring. I was at the same hospital that I did my Acute Medical Unit placement in, which was great as I knew roughly where to park and how long it would take me to get to and from placement (approximately 30 minutes). I was not given any prior information and I was not designated a mentor, so I just turned up on my first day!

Day 1
My day started at 6am (which is quite the lie in after the previous week!). I had breakfast and some tea and left the house. I packed my bag the night before to ensure that I had everything and to save time. I left the house at around 7am and arrived at placement just after 7.30am. I got changed into my uniform and went to the maternity department. Obviously all wards are different, but on this placement, after putting my bag in the locker room, I waited in the staff room before finding my way to the neonatal resuscitation room for a handover. This handover is huge! Not just healthcare assistants and nurses like I was used to, lots of midwives, doctors, consultants and anaesthetists. They discussed who was already in, where they were in the timeline of labour and also the electives of the days - AKA c-sections and inductions.
I was allocated a midwife who I was going to be following and we introduced ourselves to our mum-to-be. She had been moved from a low risk hospital to our hospital because she had become high risk as her pregnancy was not progressing quick enough. She did not realise that a birth plan does not dictate how your birth will actually happen, and that sometimes things do not go to plan. The midwife asked the woman if she minded me being there and she said it was fine.
The night-shift midwife handed her over to us and we were left with our patient at about 8.30am. The plan was for her to start pushing at 9am. Earlier she had an epidural which had slowed her progress down a bit and one of her legs was completely numb so she could not get up. When she started, her pushing was not really effective, and an hour passed really quickly and nothing was really happening. A doctor came in to check on her and said that she could only push for another hour and if nothing happened, then they would have to intervene. For the woman this was quite scary as she had planned for a completely natural birth.
After another hour and very little progression, the doctor came back an encouraged the woman to have a forceps delivery because they needed to get the baby out, as she and her baby were exhausted from the 24+ hours of labour. She agreed and went to theatre. I went and put scrubs on and went into the theatre too.
As she was having a forceps delivery she required an episiotomy (a snip to give the baby more room to come out) and an epidural to make her completely numb. After all the preparation, it took three contractions to get the baby out with the forceps, with the midwife telling the woman when to push as she could not feel her contractions. A beautiful baby boy was delivered at 12.30pm and given to mum for skin-to-skin contact whilst the mum was stitched up. It was quite intense, watching her be snipped, having the baby pulled out and then being stitched up, but it was amazing to see what the doctors are able to do. In that sense, the human body is amazing too!
The baby had it's checks done and then went back to mum and then they were moved into the recovery room. They did some more checks and then the mum was encouraged to breastfeed (which did not really work too well for a while) and then she was moved back into her room. The plan for her was to: 1. get some rest. 2. be able to walk and 3. urinate. Because she had an epidural, she required a catheter, and this can sometimes cause the bladder to retain urine, so she has to show she can urinate to make sure everything is working well. At this point it was about 2.30pm ish, and it was time for lunch.
After lunch we went back and checked on the mum and she was doing great but she had not urinated yet. She wanted to go back to her original hospital because her husband could stay overnight with her in a private room and it was a nicer environment than being in a ward. We went and did paperwork (I filled out my POD and my mentor completed some notes) and then she discussed difficult births with me so I could sign off some more. We continually checked back on our new mum, who was doing well, and then the day came to a close. Once we had handed over our patient to the night staff midwife, we then went home.

Day 2
I went to watch a low-risk, natural birth today, which was more relevant to what I would be doing in the future. I was allocated a midwife and the patient was happy for me to watch. It was similar, however the baby and mum-to-be required less monitoring and we were required to be in the room for less time with them. We came and in and checked on them every 15 minutes, checking heart rates and progress. When it was time to push, the midwife coached her through it. Unfortunately she tore slightly during the birth however she also delivered a beautiful baby boy at 1.10pm! Due to pressure on the head, he had some slight swelling which made his head dome shaped, but this is normal for babies and has no effect on their health.
The midwife stitched the new mum up (it is a work of art, I kid you not!) and did some checks on mum and the baby, and then we went to have lunch at about 3pm. We then did some paperwork whilst checking in on mum and baby every so often, and discussed some other situations so I could get more things signed off in my POD.

Day 3
There was less going on in the birthing unit today, and a total of three paramedic students in the department. I was allocated a woman but she did not want a student watching her because she was really anxious, so I opted to work in the Day Assessment Unit where I could watch triaging of patients and examinations. I learnt how to urine dip and determine what the results meant, and did obs on the patients who came in. I watched some examinations (saw a cervix - as you do) and discussed with the doctors who love sharing information if you are interested. It was a slower day, full of cups of tea (which suits me down to the ground) but I got to observe examinations and discuss the process of pregnancy - what is normal and what is not. This was really important to me because I felt like I knew nothing about pregnancy until after this day. The ladies are less stressed and really lovely and I really enjoyed my day. I was also able to fill in some of my POD paperwork which got me caught up on my ever-increasing workload.

Conclusion
This week was quite varied and I really enjoyed it. I learnt that I chose the right career pathway for me, I am not a fan of hospitals but I do think that the midwives are amazing and really knowledgeable. It is definitely more difficult for boys to get placed with a woman giving birth, so boys: try really hard and get your midwife to get you in there! You need to see it. It was really interesting, and what made it even better was discussing the rarer bits so I have more knowledge on the more difficult births. I am glad that I got to watch some assessments in the day unit, and it is really important to know that high-risk births are not the most important part of your maternity placement. I heard a lot of student paramedics saying there is no point of being in low-risk or the assessment unit as you will not see anything going on... You will not be seeing a c-section, forceps delivery or kiwi on the road, but you will be seeing your nervous pregnant ladies who are worried from a bit of bleeding or pain, and you will be seeing natural births - usually from women who are already mums as they will find it easier to have the baby, but this is not always the case. This has been a great placement and I have learnt loads that I will be implementing into my own practice.


Read the others in this Hospital Placement series!
Acute Medical Unit
Maternity
Community Mental Health Placement - Prosthetics
Cardiac Intensive Care
Paediatrics



Comments

Popular posts from this blog

My first week as a Student Paramedic

What's In My Paramedic Uniform

A Guide to Passive Income