lisamct

lisamct specializes in learning disabilities/midwifery.

lisamct's Latest Activity

1. 

   Nursing to be all degree in England..

   lisamct replied to madeleine's topic in International

   I think its interesting that Midwifery became a degree only profession in 2008 and didn't receive one inch of media coverage but it happens in Nursing and its widely reported. Im genuinely interested in why this might be the case (other than the fact that 90% of the population are still not aware that we're totally different professions)
2. 

   Midwife pay progression

   lisamct replied to expatnurse's topic in International

   Ive just qualified (Sept 08) as a midwife in Scotland, sadly what band you start on and how long it takes you to progress up the ladder depends greatly on where geographically you plan to work (AfC has done nothing to provide equality in midwifery bandings, if anything all its done is allow Trusts to keep midwives at a lower pay scale than they would have been at on Whitley and for longer) We all (well those of us who have been lucky enough to find a job at all), both direct entry students and 18month conversion students have started at the bottom of Band 5 (£20,225 per annum) In theory you should progress to a band 6 by no longer than a year however I know of many Band 5's who have been stuck on their pay band for 3years+. Also, once you do get to band 6 it can take many years to get to band 7, lots of midwives have sat at band 6 (or the previous equivelent grade) for the majority of their careers as, depending on where you work band 7 posts can be very hard to come by. Of course this all depends on where in the country your planning to work. When I first qualified I did have a post lined up in London where I would be starting straight onto a band 6 post (the Trust I had a post in didnt have band 5 midwives) however I ended up taking a band 5 post close to home instead. Also different Trusts have different criteria for passing through AfC gateways. Some have set skills criteria you need to meet (e.g you might need to be proficient in suturing and cannulation prior to progressing to band 6), others automatically upgrade your banding after 6 months or a year regardless and others will keep you on a band 5 as long as legally possible.
3. 

   Elective Primary C/S

   lisamct replied to mamafeliz's topic in Ob/Gyn

   Fantastic to hear, good for her! I think statistics still show that Moxibustion is just as effective, if not more so, at turning breech babies than ECV as well as being less interventional and therefore safer for all involved. Our docs dont personally provide Moxibustion treatment but will offer it as an option and refer onto either one of our trained midwives or a private practitioner if thats preferred/easier for the women.
4. 

   Elective Primary C/S

   lisamct replied to mamafeliz's topic in Ob/Gyn

   Being in the UK we dont have the financial issues you guys in the US have with insurance etc but one of the big things recently where I am that has reduced the amount of elective c/s in general has been the change in timing of offering the procedure ante natally. Although as I said before we have very few elective primary c/s, when these happen this is usually always due to a suggested medical complication e.g placenta placement issues, maternal health issues, breech (although un-necessary c/s for breech is another of my soap box issues that I wont go on a rant about here!) Plans for method of delivery arent put into place here until women at 37/40 so elective c/s arent even discussed until this point. We have greatly increased the onus on the medics who consult with these women to discuss both the pro's and cons of the procedure in detail to ensure full informed consent is gained (I know of several women who have been put off after this as they had no idea that the recovery time may be so long or that they would be required to have anticoagulant jabs for 5 days afterwards and have instead gone on to have lovely physiological births) We also ensure women are aware of the alternatives e.g ECV or Moxibustion for breech babies rather than going straight to c/s as well as the true statistics of repeat perineal trauma etc. Of course some women still go on to choose the c/s route or feel the medical concerns warrant it and so be it, they're often taking the safest route for them and their babies but at least we know they're doing it with all the information on board.
5. 

   Pain Meds and Epidural's during laboor

   lisamct replied to Act238RN's topic in Ob/Gyn

   There was some research noted in the BJM recently which suggested that the earlier in labour an epidural was sited the less of an effect it had on the duration of labour itself, if I can find the reference I'll post it. As others have said individuals react differently to different medications so its really difficult to tell. We have no strict guidelines for when you can and cant get an epidural, Ive seen them sited at 1cm and 9cms. Later epidurals are most seen in our unit in primips as even if theyre examined and found to be 9cms they may still have several hours of labour to go and if theyve decided on an epidural at that stage then so be it.
6. 

   Elective Primary C/S

   lisamct replied to mamafeliz's topic in Ob/Gyn

   Im sorry but to say C/S is not detrimental to babies or mothers (which Im assuming your also suggesting) is pretty inaccurate. C/S puts babies at risk of respiratory problems, diabetes, hypertension, adult mental health issues, injury from surgery itself, effects of anaesthetic, depletion of immune responses and amongst other things the risks from prematurity as often elective C/S's are carried out to suit the medics and the mother without much thought for the best time for baby itself. As far as mothers are concerned C/S is major abdominal surgery and carries the same risks as all other surgeries of the same nature including issues with bleeding, infection, trauma/injury during surgery. There are alsoi studies that suggest more postnatal mental health issues in women post C/S than after vaginal birth. I have plenty of references to back this up if your interested. To the original poster, we see very few primary elective C/S where I am although I fear it may be becoming more commonplace. It scares me that medics are happy to perform major abdominal surgery on request, often for simple reasons of convenience only, its pretty shocking really.
7. 

   How often are your postpartum vital signs and assessments?

   lisamct replied to babyktchr's topic in Ob/Gyn

   Vaginal deliveries - In labour ward; Once within 30mons of delivery and again prior to transfer - Once in in-patient ward; Once daily C/S - In recovery area; 5mins x4, 15mins x2 30minx4 - In in-patient area; On admission then twice daily (Im in the UK)
8. 

   Number of procedures scheduled per day?

   lisamct replied to L&Doldtimer's topic in Ob/Gyn

   Im in the UK so lots of variables are different here but for comparison; in my unit (@300 deliveries/month) we only have 2 days a week where we do schedules C Sections (mon and thurs) and on those days we do 5, 3 in the morning and 2 in the afternoon (we never do scheduled CS's after 5.30pm) Mon-Fri we also have up to 4 scheduled inductions each day.
9. 

   Stirrups?

   lisamct replied to CEG's topic in Ob/Gyn

   We pretty much never use stirrups unless its an instrumental delivery. Most of our women deliver on all fours, left lateral or standing up so it wouldn't be an option even if we wanted to (which we dont!)
10. 

    Induction craze

    lisamct replied to Blizzard's topic in Ob/Gyn

    Im pretty shocked at how early your docs will do inductions in the US. We describe a term pregnancy as anything from 37-42 weeks and women are made aware of that at booking and pretty much told to ignore their 'due date' and assume their baby will be born at some point before they are 42 weeks. So, our policies (which are pretty strictly followed) are that for non-medically necessary inductions we wont even see women to discuss their options until they are 41+3 weeks with an aim to induce at 42+. All we will offer before 41+3 is a membrane sweep at 40+ weeks if its possible. There are also strict criteria for our medically advised inductions which are upheld across the board and women are always advised that the procedure will be to aim to keep them pregnant as long as is deemed safe for them and their baby before starting induction. Obviously there are a few exceptions to every rule and every now and again we will induce someone at 38 weeks for psychological reasons (previous term stillbirth is a common one) but we try to avoid that by offering women the option of coming into our Daycare dept for daily monitoring.
11. 

    Just having a moan...

    lisamct posted a topic in International

    Just having a moan really. As a few of you might know Im about to qualify as a midwife (12 shifts to go till I finish!) and Im facing the very serious prospect of having no job to go to. The shortage of midwives is all over the news these days but in reality there's no shortage of midwives just a shortage of jobs for them to work in. There are probably hundreds of people qualifying from uni's all over the country who are unable to get posts when they finish. I know of people who qualified anything up to 2 years ago who have been unable to get a NQ post. There are 26 of us from my uni qualifying in a few weeks and almost the same amount again from the next nearest uni (less than 15 miles away) who will all be scrabbling for the same non-existant jobs. So, this is the reality of the situation for NQ midwives where I am. I have an interview for a post next week...in Belfast. Although I cant move (OH runs his own business and cant relocate at present) they will hopefully allow me to commute by giving me all my shifts for 2 weeks in a row (so basically 7 long days on, 8 days off which may actually kill me!) This means I would need to rent somewhere full time in Belfast for the days that Im there and fly back and forth to Glasgow once a fortnight. This is going to cost me @£600/month which means I'm going to be coming home with the same money, if not less, than I am now as a student. I have also applied for both of the jobs available in the whole of Scotland at present, one unit is a 2 hour commute from home and the other, although only 30 mins away has already attracted the attention of the whole of my cohort, the cohort of students who will be qualifying from the uni that uses that unit as a training site and all the girls who qualified last Sept who are still without jobs a year later. I knew when I started this course that the job situation wasnt rosey for NQ midwives but the reality is still hard to take. Its especially difficult when I go on placement every day to see how short staffed the units are (26 postnatal women to 2 midwives) but there's just no money to employ anyone else and its not only the midwives but, more importantly the women and their families that are suffering for it. Its just so depressing and makes me wonder why I bothered. I love midwifery, I love being with women at one of the most important times of their lives and I love being able to hopefully help to make it the experience they wished for but, right now, its totally soul destroying and I feel that I might be best just to walk away and try to forget I ever did it.
12. 

    Ever have a day like this???

    lisamct replied to at your cervix's topic in Ob/Gyn

    Our women are only able to have 1 person with them during labour and birth. That rule is very occasionally relaxed to allow 2 people to come along but that has to be arranged prior to 'the event' and in writing with our labour ward co-ordinator. Also, under no circumstances are children allowed in our labour rooms. Other than birth partners we do not allow anyone to wait in our labour ward. We do have a waiting room but it is for birth partners use only if they want to get a bit of a break for 10 minutes and not for other relatives to wait in. I always though our rules were a bit strict but reading all your tales makes me kinda glad we have them.
13. 

    Policy on leaving AMA w/baby?

    lisamct replied to cherokeesummer's topic in Ob/Gyn

    For a UK perspective; We usually have women having vaginal deliveries in for 2-3 days with women having sections in for 3-4 days although this can extend for both groups if there is a need (breastfeeding issues/parent confidence/social problems) Or it can go the other way and Ive seen post section women up and about after 12 hours and going home after 2 days if they're happy to do so. However we also offer a 6 hour discharge option to women having vaginal deliveries. It does mean that they need to either return the next day for the paeds to check the baby out or have one of our midwives who are trained in doing the full neonatal check to go out to see them. Our community midwives so all the other metabolic testing etc at home within the first week so there's no issues with coming back to do that at the hospital
14. 

    Is this birth plan reasonable

    lisamct replied to wulfbourne's topic in Ob/Gyn

    Probably not much use to you but thought I'd give a bit of an international perspective; Overall I think your birth plan is totally acceptable and pretty much standard practice where I am. We also dont use antibiotic eye ointment on any babies so that wouldn't be an issue either.
15. 

    the 78 week midwifery course

    lisamct replied to ayla2004's topic in International

    I'm not sure about the situation with the trusts and funding for the 18 month courses but I do know that a lot of uni's are considering dropping the course and that a few have already done so completely. My uni (in Glasgow) attempted to change their shortened course to 24 months but werent able to so they have kept it at 18 months for now but are considering dropping it in the future. Another thing to consider is that it can be very difficult to get a place on the 18 month course even if you can find a uni still running it. We only have 1 intake for the short course in my uni and there's only 6 places each year. From speaking to the 18 month girls who have just joined our 3rd year cohort some but not all, are struggling to fit everything in. I think they feel its possible to get all your clinical 'numbers' in 18 months (40 deliveries, 100 post natal checks, 100 antenatal checks etc.) but that it was more difficult to pick up the 'art' of midwifery in the short time they have. I wouldn't say there is any bias against 18 month midwives, some would say there's actually more bias towards 18 month students if anything but thats a whole other debate. Sorry if that all sounded a bit negative and stuttery, just in from a mad shift on labour ward and havent quite sorted my head out yet.
16. 

    Becoming a neonatal nurse in UK

    lisamct replied to Sun*shine's topic in International

    Im one week into my neonatal/SCBU placement at the moment (Im a 3rd year student midwife) All the staff in our unit are either paediatric nurses or midwives (although ths use of midwives in SCBU is being phased out across the country) I dont think you can work in neonatal areas without having one or both of these qualifications. Might be worth considering converting to child branch once your qualified if it still really interests you, a lot of uni's do provide branch-to-branch conversion courses although they're not widely advertised so its worth asking.