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 3 – Midwifery Led Birthing Unit
*Disclaimer – This post is based on a typical night working in the midwifery-led birthing unit and any resemblance to real life is entirely coincidental*
21:15 Midwife Handover
I head straight to the midwifery-led unit to begin my shift and receive handover from the midwife currently caring for Sheena. I learn that Sheena has been here for a few hours, she is using hypnotherapy techniques to help her relax, at the last examination her Cervix was 6 cm dilated. She has expressed a wish to get into the pool for labour so I explain a bit about waterbirths and fill the pool with warm water. Sheena is being well supported by her mum and husband, they are talking to her in hushed tones and helping her find good positions. If you’re interested in how to offer good support to a loved one in labour then have a read of my blog post, A midwife’s guide to being a great birth partner.
22:00 Entering the pool
I assure myself that all is progressing normally with Sheena’s labour by reviewing the partogram (graph used to summarise labour), monitoring the frequency of her contractions, assessing her observations and the baby’s heart rate. The birthing pool takes a little while to fill to the necessary level, it is desirable to have the water up to the mother’s nipple level so that her bump will be completely submerged below the water. Both myself and Sheena check the temperature and after a quick safety briefing, she enters the water.
23:30 The water is having the desired effect.
Sheena is relaxed, calm and in control. She uses Entonox (gas and air) to help her breathe through the contractions. The NCT have information on water birth that you can read here. She has background music playing which helps provide us all with a nice ambient atmosphere. I continue my role of supporting her with encouraging words, offering her drinks and monitoring her baby’s heart rate with the handheld sonic aid at least every 15 minutes.
00:00 Second Stage of labour
Sheena’s behaviour starts to change, she makes different noises and I can see her start to bear down. It looks as if her body is transitioning into the second stage of labour. In some labours it is necessary to offer a vaginal examination at this stage to determine full dilatation, however, as everything is progressing normally there is currently no need for me to intervene. So I wait patiently for other signs the baby is ready to be born. Meanwhile, I prepare any equipment I may need for the birth and check the water temperature is warm enough for the baby to emerge.
00:30 First sight of the baby
Sheena is now involuntarily pushing. This means her body is showing her what to do and the contractions are pushing the baby down. In this stage of labour, there is little else women can do but go along with how their bodies are directing them. I begin to see the tip of the baby’s head at the height of these contractions. During this stage the monitoring of the baby must increase, I now listen to the baby’s heart rate at least every five minutes and check Sally’s pulse every 15 minutes. This way I can be reassured that Mum and baby are coping well with labour.
A second midwife arrives in the labour room in time for the birth. Sheena has been unbelievably strong and the baby glides out into the water. I gently place the baby on her chest and her newly born baby girl gazes up at her. Water births are a truly magical experience and by far my favourite type of birth. Sheena has chosen to have an actively managed 3rd stage of labour so after 5 minutes of allowing the baby to receive blood from the cord I clamp and cut the cord (For more details on optimal cord clamping read this statement from the royal college of midwives). I then help Sheena climb out of the pool and go on to deliver the placenta.
02:00 The Golden Hour
The first hour after birth is often referred to as the golden hour. This is where the baby is nestled in with his mum, skin-to-skin and it is the best time to latch on and have his first breastfeed. Babies during this time are naturally quite alert and will root around the breast looking for milk. As a midwife, it is my job to facilitate this special time and allow the mother skin to skin in an unhurried environment. Meanwhile, I have lots of other jobs to be doing post birth, monitoring blood loss, checking the placenta, checking the mothers perineum and possibly suturing, completing record keeping, tidying up and making the new mother some well-deserved tea and toast. Once the baby has had his first feed I go on to check and weight the newborn.
It is time for me to take a well-deserved break! With Sheena comfortable in bed and her baby warm and fed. I leave them for some family time and rest whilst I sit down, eat and recharge. Water births might be magical but they can be exhausting for the midwife, the room is often warm due to the hot water and you find yourself in all sorts of positions leaning over the pool to carry out your job!
04:30 Early discharge
As everything went so well Sheena and her husband are keen to get home as soon as possible. I start making arrangements for her to be discharged directly from the midwifery-led unit. This involves mountains of leaflets, referrals and documentation. The minute I sit in the office to sort this out another mother in labour comes charging through the doors.
05:32 Quick Birth
This mother is not hanging about! She quickly proclaims she want’s gas and air and I can see she is in advanced labour. I scan through her pregnancy record to ensure there are no conditions I need to be immediately aware of for the birth. I listen to the baby’s heart rate, check her pulse and rush to slip on some gloves as she yells that she needs to push. Her third baby slithers into the world with very little coaching from me, a squealing baby boy. I place her son on to her chest and she gleefully grins up at me with that ‘I did it’ look that women get after birth.
06:15 After Birth Care
So now I have two postnatal women to care for. Once the new mother is safe and settled, I pop back in to see Sheena and apologise that I have not been able to complete her discharge paperwork as got tied up helping with another birth. Luckily she is very understanding and is happy to wait until the morning staff arrive before going home.
I tell the day staff midwife all about my exciting, eventful night and she promises to take good care of the two new mums. I head home for a few hours sleep before collecting my own little bear cub from nursery at lunchtime.
If you are interested in midwifery or thinking of joining the midwifery profession then read my experience of becoming a newly qualified midwife ‘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! Find my previous posts in this series at A Day in the Life of a midwife working on Delivery Suite and Maternity Triage.