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 2 – Maternity Triage
*Disclaimer – This post is based on a typical day working in triage and any resemblance to real life is entirely coincidental*
I make my way to the triage ward to receive handover from the midwife who has been working in triage in the morning. There are currently five women waiting for various things. Once I have heard about all their medical and obstetric conditions, I make a mental list of tasks I need to complete and in what order they need to be done. Prioritisation is the name of the game when working in a busy triage department. I set to work in the order, saying hello to them all so they realise I have taken over and will now be caring for them.
14:30 New admission
My first big job of the shift is to assess a woman who has not long arrived in the department. She is 36 weeks pregnant and concerned that she has not felt many movements from her baby today. Reduced fetal movements is a complaint that midwives take very seriously and anyone phoning the department with concerns about their baby’s movements will be invited in for assessment. For further information from Tommy’s charity in conjunction with the NHS see this infographic on reduced fetal movements in pregnancy. I take her history, check her observations and commence monitoring her baby’s heart rate with the cardiotocograph (CTG) machine. This will provide us with an assessment of the baby’s current well being but unfortunately, is not a predictive indicator of future health. Therefore once reassured that all is OK today she is sent home with advice to call the hospital again if she has any further concerns about her baby’s movements.
15:30 Complete tasks for the remaining clients
I have now completed a variety of tasks that were remaining for the other women in the ward. These included taking a blood sample and sending it to the lab, chasing the pharmacy department for some outstanding medication and transferring a patient to the antenatal ward as she will be staying in overnight for observation.
16:00 Phone Calls
During the last few hours of this shift, the phone has not stopped ringing! I have answered calls from women at home requesting a variety of advice and support. There have been enquires about signs of labour, vaginal loss, contact with chicken pox, how to access care for someone who has just found out she is pregnant. Questions about flying in pregnancy and a woman who was concerned about her caesarean section wound. I answer all their questions and point them in the direction of the appropriate person. This might be visiting their GP or arranging a home visit from their community midwife. There is one woman who I ask to come into the hospital as she thinks her waters might have broken. During the calls, I also log the woman’s details, condition and record any advice I give out in the hospital records at it all has to be traceable.
A woman arrives through the door who is clearly in advanced labour. One look at her body language, which is hunched over in pain as she squeezes her birth partners hand tells me all I need to know! I call the midwife in charge of delivery suite and immediately transfer her straight over to be looked after in the privacy of her own room. Us midwives are pretty good at guessing how far along in labour a woman is by observing her behaviour. I later learn that she gave birth within an hour of arriving in that room!
17:30 End of the day for 9-5 services
Most community-based services like GP’s, community midwives and maternity day assessment unit have now closed up for the day. This has a knock on effect to our 24-hour triage service and we suddenly have an influx of women waiting to be seen and assessed! Three women arrive at once and two more are on their way in to be checked.
18:30 High Blood Pressure
Despite having a ward full of women, one particular client has needed to receive my full focus for the last hour. She has arrived from her GP with high blood pressure at 34 weeks gestation. After monitoring her blood pressure, urine and baby’s heart rate. She is quickly seen by the doctor. As her blood pressure is not settling she is transferred to the delivery suite where she can receive one to one care by a midwife in a more intense setting. For more information on high blood pressure and pre-eclampsia read NHS guidance here. For some women, the way triage works can be frustrating as it is not always a first come first seen service. Sometimes certain medical conditions put women and babies in danger and need to be seen more quickly despite the fact someone else arrived first.
19:00 Dinner time
I manage to eat a quick dinner to get me through the last few hours of my shift. Unfortunately, there are no other midwives available to relieve me for a full break today, but fed and watered I happily continue on through the queue of women waiting to be seen.
20:00 Doctors ward round
A lot of the women have been waiting in the triage to be seen by the doctor. The remit of the midwife is to provide care and advice to women experiencing ‘normal’labour at term (37-42 weeks). Therefore anything out of this criteria needs to be reviewed by the on-call doctor. Once I have performed initial checks, taken a history, monitored the baby and the mother, it is my job to refer these cases to the obstetrician. Therefore, I have a few clients waiting to be seen by the doctor because they are preterm and experiencing pain, have experienced a small bleed or have had a ultrasound scan that needs a medical opinion.
20:30 Labour Assessment
Unlike the client who arrived earlier and was obviously in advanced labour, I next assess a woman who has been experiencing contractions for the last few hours and is unsure if she’s in labour or not. I go on to review her medical, obstetric and social history, monitor her observations and check the baby’s heart rate. She accepts a vaginal examination and I discover that her cervix is 2 cm dilated. She is in the latent stage of labour. Following a lengthy discussion about her options, she decides to go home and wait it out a few more hours to see what happens.
After handing over any remaining women on the ward to the night shift midwife, I drive home to find the little bear cub curled up in his Dad’s arms asleep in front of the TV! His Dad did not want to move him for risk of waking him! After a quick drink and snack we all crawl in to bed and after a short breastfeed the little one is fast asleep.
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!