Have you ever wondered what a midwife gets up to in her day to day work? People often ask me what I actually ‘do’ during my shift when I’m not ‘delivering a baby’. So I thought I’d give you a little insight into my shifts over the next couple of weeks.
Week 1 – Delivery Suite
06:00 Alarm Goes Off
Never one to enjoy an early start, I drag myself out of bed whilst trying not to wake the peacefully sleeping bear cub baby next to me! Anyone who has experience bed sharing with your babies knows that yes although it might get you more sleep, trying to extract yourself for an early start or midnight toilet trip often means you disturb them!
06:45 Park up at the Hospital and Head to the Delivery Suite Office for Midwife handover
This is where the senior midwife will delegate each midwife an area to work in for the shift. You also learn all about the women who are currently in labour on the ward and any scheduled work that is expected to take place that day, such as women booked for inductions or elective cesareans. It is also a time when any messages can be relayed to staff about changes in the department or issues with equipment.
07:10 Meet the Woman in Labour that I will be Caring for this Shift
Once the senior midwife has allocated a woman to be in my care, I head to her room to meet her. Here I find the weary night shift midwife who has been on duty since 7 pm last night. She provides me with a detailed handover of this woman’s medical, obstetric and social history. She also lets me know what has been happening during her shift, at what stage the labour is, and if there are any tasks that I need to complete in the immediate future. I bid the midwife goodbye as she races home to her bed and focus my attention on getting to know Sarah and her birth partner Craig (names have been changed to protect clients confidentiality).
08:30 Obstetrician’s Ward Round
I have spent the last hour getting to know Sarah’s individual circumstances, understanding her wishes for her labour and helping to formulate a plan of care. It’s perfect timing as the morning medical team are knocking on the door to come and meet Sarah and Craig for themselves. A doctor’s ward tends to happen at the handover of each shift. It is a chance for the Doctor’s to meet the women under their care on the labour ward, review their case, make any plans for their ongoing care and alleviate any fears on concerns clients may have. The doctors tend to only visit women who have medical complications in labour and are therefore considered ‘high risk’.
10:00 Labour Assessment
Sarah is due a labour assessment, it is the policy of most hospitals to offer these every four hours. However, there are a number of situations where they are recommended more frequently than this. Some women decline internal examinations entirely. As a midwife, you must respect your client’s wishes and find a way to assess the stage of labour in collaboration with your client and if necessary the obstetrician. Doing a vaginal examination (VE) is not the sole way midwives assess the stage of labour. During the last few hours, I have been observing the length, duration and pattern of Sarah’s contractions. I have been monitoring her baby’s health by listening to its heartbeat and watching for fetal movements. I have been assessing any fluid Sarah may be losing, checking her vital signs regularly. Most importantly I have been monitoring her behaviour, how she copes with contractions and the noises she makes. Sarah’s cervix is now 5 cm dilated and she is contracting well, her labour is well and truly established!
11:00 Assisting the Anaesthetist Site Regional Anaesthesia
Following a discussion of her birth plan, Sarah decided she would like further pain relief and opted for an epidural. I give her and Craig some written information to read and the anaesthetist (specialist doctor in providing different types of anaesthetics) discusses the procedure with her. I support her to sit in a curled up position, whilst ensuring I can hear the baby’s heartbeat. I am then needed to help the anaesthetist with the epidural procedure. The total length of the procedure takes about 20 minutes but Sarah continues to experience some pain with her contractions for a little while longer whilst the medication takes time to work.
12:00 Monitoring and documentation post epidural
Now Sarah is comfortable, I take some time to catch up with the paperwork that is expected of me. Her baby is now being monitored by a continuous cardiotocograph (CTG), which I need to assess and comment on at least every 30 minutes – more frequently if I am concerned about it. I also now monitor and record her blood pressure more frequently, her pulse and her temperature. All this gets written in her notes and is also summarised on a chart that I need to complete called a partogram. See here for an example of a partogram chart used to summarise a woman’s health when in labour. The good news is Sarah is now pain-free and after a long night of contractions I help get her into a comfortable position and she manages to have a little sleep for a while.
12:30 Lunch Break
Today is a good day! Another midwife comes to care for Sarah whilst I have a lunch break. After starting the day at 6 am, I am now starving! So I handover and take a short break to refuel.
14:00 Labour reassessment
As it has now been 4 hours since Sarah’s last vaginal examination (VE). I offer her another one which she agrees to. Before proceeding with this intervention, I ensure that her baby’s heart rate trace is satisfactory, her observations are good and that she continues to have regular contractions. Prior to an internal examination, I perform an abdominal palpation, which is where the midwife assesses the size and position of your baby from feeling your tummy. This gives the midwife or doctor important information which can be used in conjunction with the VE findings. On examination Sarah’s cervix is now 8 cm dilated, her baby appears to be in a good position and the fluid draining is of a normal volume and colour. All is going well! On average a woman experiencing her first labour should dilate approximately 1/2 cm per hour, so I have no concerns about Sarah’s progress.
14:30 Midwife Handover
It is almost the end of my shift so a new midwife comes to take over from me. I fill her in of all the key details and wish Sarah and Craig the best of luck for the rest of their birth experience. Leaving clients halfway through their labour is often difficult, after all, I just spent the last 8 hours getting to know the most intimate details about Sarah, her body and her baby. However, it is not possible to be there for every baby born. I am lucky to work with a bunch of fantastic midwives who I know will take good care of her.
*Disclaimer – the events of this blog are based on my experiences of a typical day working on a delivery suite and any resemblance to real life cases is entirely coincidental*
15:00 Nursery pick up
I head to the nursery to pick up my own little bear cub and resume my other job as a Mummy!
If you are interested in midwifery or thinking of joining the midwifery profession then read my experience of becoming a newly qualified midwife here at my blog post ‘The Birth of a Midwife’.
Did you like hearing about what I got up to during this shift? Look out for my next ‘Day in the life’ blog series to be published next weekend!