Sunday, March 23, 2008

Advice to senior midwifery students

One of the last challenges I have to address in the 31 Day Blog Challenge is making a reader famous, which is the challenge for Day 21. So I have asked Megan to write a guest post for me.

Megan is a new midwifery graduate working as a Lead Maternity Carer in New Zealand. This means she carries a total midwifery caseload, caring for women from conception until 4/6 weeks after they have had their babies. I asked Megan if she could pass on any advice to senior midwifery students who are contemplating life as a new graduate. Whilst Megan's thoughts are focused on midwifery in New Zealand, a lot of what she says has relevance to midwifery students anywhere in the world. Thank you, Megan.

Your biggest learning begins when you graduate”. These were the words a midwife said to me in my first month of practice and these words ring in my ears most days!

I graduated in December 2007 and am practicing as an independent Lead Maternity Carer (LMC) midwife in a practice with three other midwives. I am well supported within the practice and have a mentor outside of this practice.

Sarah suggested to me that I might like to do a 'guest' blog with advice/suggestions for senior midwifery students who are about to embark on their midwifery practice.

The one thing that struck me the most after graduating was that the responsibility and decision making for the women in my care fell on me and me alone! I needed to make decisions and deal with the middle of the night phone calls and try and remember all the things to ask! This gets easier with experience, as do most things, but I remember being asked what I wanted to do in terms of a woman's care and I didn't really know! One of my colleagues I graduated with keeps her New Zealand College of Midwives “Handbook for Practice” by her bed, so that she can refer to it if a woman rings her in labour in the middle of the night. This way, ensuring she doesn't miss anything!

If as a third year student you are doing your placements in the area you are planning to work, the first suggestion I would make is to network. Networking with the midwives who already work in the area is beneficial in a number of ways. Firstly, they can help you through your third year, these women are a great source of knowledge and wisdom and are more than often happy to explain something to you and help you, whether it is assistance with finding equipment in Delivery Suite or practical help with a clinical skill or the institution's paperwork! When you graduate the most significant benefit I have found is the support given as a new graduate. It can be a frightening and overwhelming time as a new graduate if you're with a woman in labour for example, and the labour is not progressing normally. There are a number of possible things that may need to be done, for example, documentation, the woman needs support and an explanation of what's happening, as well as discussion with the core midwifery staff and possible consultation with the medical staff. If you have developed a relationship with the midwives, I have found it is easier to ask for their help and support and to make use of their experience and wisdom!

A lot of these midwives have a huge amount of wisdom, knowledge and experience. This is a great source of learning for a new graduate! Being able to openly communicate your personal needs, whether you need a cup of coffee, or professional advice. Being able to ask for support and making the most of the midwifery knowledge is hugely beneficial, often our midwifery colleagues have the information and can provide the guidance you need to make the decision without the need to refer to a doctor straight away. Of course, there will be times when it is necessary to refer to the medical staff straight away, and their advice and support in this situation, is reassuring and a good way to discuss what your actions might be. I accept that the culture in each institute is different and therefore, the way a new graduate midwife is accepted (or not) is different as well.

Another challenge to a new graduate or in fact all midwives is how do we keep up to date with the latest research in order to have an evidence based practice. This would be especially challenging for those midwives who are not working in major centres with access to a library or an institution where you can access online databases or journals. Another challenge in keeping up to date with the latest evidence could be finding the time! Getting your head around the paperwork and other responsibilities that come with being a midwife, sometimes leave little time, at least initially for making the time and effort to find out where and how to access relevant journals.

When I think about finding time, it always tends to lead me to thoughts about finding balance in your life. Making sure that it isn't always work and finding time for yourself and your family. As individuals we determine what works for us and what we need. I personally need time off call without a pager when I know that I can spend time with my young children without the thought that I could be rung or called out. In order to achieve this, I made a decision from the beginning that I would start as I meant to continue and take every second weekend off. This works for myself and my practice partner. Taking this time off, as well as planning a longer break in the year I hope, will lead to a long and sustainable midwifery career!

My final thoughts that I thought I would share on this subject is being kind to yourself, treat situations that don't necessary go as expected as a reflective and learning experience. Having a mentor or a trusted person to debrief I've found is of great benefit.

Image: 'ellie_newborn_4_bw'


Anonymous said...

hi Megan
great to see your thoughts here. Good tip re the handbook by the bed - I think I remember doing similar all those years ago - but before long my partner (the one in my bed - not the practice one) was prompting me as well...LOL... Anyway, my question is; you think there is anything more we could have put in place for you when you were a student (especially in third yr but through out the degree) to more prepare you for that time when you and you alone were responsible?
Or was there some aspect of the course that made this transition easier or do-able?
I think about this often and guess I have decided - you just have to go thru holding the responsibility to know you can - but is that correct do you think?
Is it just something that you have to experience (ie: being the one with the responsibility)to confirm you can do it?
What are our thoughts?
I would like to think if there is something you can identify that would help with the transition more....we could implement it.

Also good tip re the networking. This year I have been telling students that their reputation as a midwife or in the midwifery community starts now - as a student. I think it is important they are aware that how they approach their work now ...will matter in the long run.

Megan said...

Hi Rae

I don't think there is anything that you can do to prepare a third year student for the responsibility when you hold that 'reponsibility stick'! I found that I had to go through it and realise that a) I held the responsibility and b) I could deal with it! I had a huge range of experience in my first month of practice, from one extreme to the other really and I came through it realising that I was ready for it and that I could deal with it. So, I agree with your thoughts, that you have to do it to realise you can do it!!

I totally agree with your comments about an individual's reputation starting when she's a student, especially so if you are a third year student in the area you are planning on practicing. I have picked up a lot of locum/cover work and women through networking at NZCOM meetings as well as making myself known last year, and of course being polite, asking questions etc throughout my training and now!

Sarah Stewart said...

I also agree about that third year and building networks. My mentoring survey of NZ midwives that I carried out a couple of years ago showed that the majority of students set up practice with the midwives they worked with in their 3rd year.

Lil said...

It's always nice hearing that grads "survive". Me, at the start of my training... sometimes I wonder 'how will I ever learn it all? How will I get through this year' But they all do. Everyone survives :) Great post :)
Luv Lil xox

Sarah Stewart said...

Thank you for that, Lil. Yes, you're right, everyone does survive. The journey along the way is different for everyone and people arrives at different times and in different vehicles, so to speak, but everyone does arrive eventually.

Megan said...

Hi Lil

You will survive! It it likely to be a bit of a journey of highs and lows at times, but there is nothing like the feeliing of graduation day! I can remember very clearly sitting in class in first year and looking at the skills "they" (being the lecturers etc) thought I would and could learn! I was thinking 'no way'! Now I'm doing them as second nature! Enjoy your journey. Megan :o)

Anonymous said...

yeah i think the thing to remember as a student is "...all in the fullness if time..." It's important to hold onto some perspective and invite outside perspective from safe people - to carry you thru the inevitable challenges - or the times when you just have a little more to learn to really polish your practice.
How you feel as an overwhelmed 1st or 2nd yr student will pass - the evolution should take place.

Anonymous said...

Hi Megan,
It was great to read your blog! Thanks for the comment on the "skills" becoming second nature. I feel like a robot low on batteries attempting them at this stage. I have felt scared about the whole responsibility thing since the start of 1st year. I'm a big second year now and boy has the workload of study and placements increased. That coupled with a large family makes me feel a little overwhelmed. I wonder how you coped with this?
I think the networking is a great idea and believe you should be doing this even as a novice 1st year student. People remember you if you are enthusiastic, polite and helpful even if you are useless!!! Good luck with your exciting career Megan.

Megan said...

I remember a friend telling me it will all come together in third year (and it did!). This was when I'd been accepted into the Otago Midwifery programme. I could feel my skills coming together more as the second year went on and then in third year, doing it all the time was great. I remember the first day I did about 10 palpations in one day on 10 different women... it was great and I realised I could do it and trust myself in what I was feeling!

The only way I managed to deal with the demands of second year, was to be very organised. I was the "queen" of the slow cooker! Meals were often organised in advance and dinner was cooked before I went to class! I decided housework was not a huge priority (although sometimes it was a great diversion from my study - the oven all of a sudden needed cleaned!!). In terms of the assessments, I was always thinking 2-3 ahead and trying to have research started well in advance. I got a bit of a 'reputation' with my classmates of being the 'one' who had done her assessments and in fact managed to get through the year with one extension which was given to the class and I didn't really need anyway!

You will manage to juggle it in your own way I'm sure! I won't deny that I got very sick of the constant juggling but it is no different to being in practice and working!

Good luck with second year :o)

Sarah Stewart said...

I've been thinking, Megan - you really ought to start your own blog!

Anonymous said...

oh god - she says that to everyone!!!! lol

Megan said...

LOL... I'm not listening to you Sarah! La, la, la *fingers in ears*!!!

Sarah Stewart said...

No one ever listens to me!! Why;s that?!

Megan said...

Can't understand it at all Sarah! LOL

Funnily enough, you may have planted a little seed somewhere in my head about postgrad though... I may, just may have listened to that :o)