For the last two weeks I have gone back to being a midwife again and worked as a locum down in the Lumsden Maternity Unit. This involved being on call for births, and carrying ante natal and post natal visits in the community.
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Returning to practice
I have to admit that I was nervous about returning to practice because I haven't had a midwifery client for nearly three years. To be honest, I got a little burnt out and have been very reluctant to return to practice. However, it was a matter of having to or else I would lose my annual practicing certificate which I need to be able to teach in midwifery programs. It is also important for me to keep in touch with latest practice, policies and procedures because of the research projects I am involved in.
Just like riding a bike
I was thrilled to find that I have not lost any of my clinical skills - that is was like riding a bike - you never forget. I took blood for blood tests, did heaps of abdominal palpations, carried out a vaginal examination, and took baby blood for a serum bilirubin (a job I absolutely hate!).
My decision-making was probably on the conservative side driven in part by the fact I was a locum and didn't know people or their context very well. Knowing we were so far away from medical help was also a major contributing factor I had to take into consideration when I was planning care.
The highlight of the two weeks away was the middle weekend when my mate, Carolyn McIntosh joined me. We have never worked together in a clinical setting before - our connection is through our jobs as midwifery lecturers at Otago Polytechnic. I was hoping that a woman would birth her baby during that time. I was really keen to have at least one birth so I could tick that of my list of 'to-dos' and I knew that Carolyn would be really supportive especially as she is a very experienced rural midwife. However, we were very quiet so we went shopping in Winton instead.
What has changed?
I didn't think things have changed much in the three years since I last practiced. The main things I noticed is that some antenatal tests are pretty much routine now such as the 12 week nuchal translucency scan.
Areas I need to develop
I was extremely pleased at how well I got back into the swing of things. The main areas I feel I need to re-visit and "revise" are current medications in use and how to prescribe them and antenatal tests. I also need to update myself on breastfeeding, which is a requirement to maintain an APC as well as maternal and neonatal resuscitation. Otherwise, I am extremely confident working in antenatal and postnatal areas.
I would like to attend a birth or two but I am very anxious about my back. I did find that it played me up although some of that I put down to the terrible bed I was sleeping in at the Lumsden Motel. However, now I am home and back in my usual routine, my back has settled back down again and I have stopped taking anti-inflammatories. Maybe the compromise will have to be that I am second midwife who offers support and back-up but doesn't take the lead for hours on end.
Plans for the future
It was great working with women and their families again and I thoroughly enjoyed my time in Lumsden. I have always enjoyed being a rural midwife even though you do an incredible amount of driving between home visits. And it was very satisfying to be able to support the local midwives to have some time off - they were and still are very much in need of it.
I hope to go back again and help out at some stage. It's convenient to do locum midwifery work at the moment because I can fit it in with the other projects I am working on while I look for more permanent employment. Maybe this is the way forward for me - temporary contracts while I build up a profile as midwifery and education consultant/project manager.
In the meantime, I take my hat off to the dedicated midwives who work very long hours and are on call 24/7 (often to the detriment of their own families) to provide a midwifery service to rural woman who would otherwise have to go without.
These photos and more can all be found in Flickr: http://www.flickr.com/photos/sarahmstewart