lisamct

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)

Our hospital policy is still no mobile phone use and still has all the signs up banning the use of mobile phones and Im pretty sure the main medical building keeps to this ban. However in maternity, where I am, mobile phones are used pretty freely in our labour and LDRP rooms (although we do discourage partners using them whilst women are in active labour) however within the inpatient areas its still definitely 'frowned upon' by some staff. As for internet well there's certainly no internet access provided by the hospital and Ive never known anyone to even ask about internet use, i guess in maternity women are in for such a short time and pretty much too busy caring for a newborn 24/7 to worry about surfing the net.

Very true. Im sure our home birth and 6hr discharge rate is due to womens reluctance to be admitted to the post natal wards and I dont blame them. On several occasions Ive had to transfer women from our midwifery led unit to out consultant unit and their biggest concern is that they will most likely have to be admitted to the wards afterwards for post natal care (no LDRP rooms in the CLU) I think, in the UK, we give excellent care to women ante natally, intra natally and post natally once they're home but the post natal care in our hospitals is pretty poor and definitely lets our service down (despite the back breaking work put in by the very short staffed midwife teams)

I totally agree, quite often it doesnt feel safe either. They do try to have 2 midwives on a night shift but often that can be 1 MW with a support worker or, on occasion one MW on her own. Only the basics are done at night, in the main its mostly breast feeding support and dealing with the odd crisis when it happens. Day's usually have 3 MW's and a support worker (with a student or 2 thrown in for good measure) Something else to consider is not all our mums get a single room post natally. If they deliver in our midwife led birth centre we have LDRP rooms so they are obviously single en-suites (where they will often go hame after 6hrs anyway) but, if they need to go to the post natal wards they may be sharing a room with up to 3 other women and their babies therefore overnight visitors just isnt feasible.

No nursery's here, babies and mums are together 24/7. Us midwives do try to help out at night on the post natal wards as much as possible but often on a night shift there is only 1 of us to up to 16 mums and babies so often its just not possible.

For a UK perspective we have no visitors in labour ward at all. Women can have 1 support person with them during labour/birth or on occasion 2. but only with special permission from whoever is in charge and doesnt happen very often. We dont even have a waiting room for visitors in LW, if you want to hang around outside the hospital than thats up to the individual families but after the birth they are allowed in for 10 minutes only then they have to leave till official visiting times. Post natally birth partners are allowed into the ward from 10am-9pm otherwise visiting is 2pm-4pm and 6pm-8pm. Post natally there are no overnight visitors, not even birth partners.

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.

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.

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.

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.

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 lady partsl 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.

lady partsl 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)

Ive supported a couple of women birthing babies still in intact membranes, I just leave them intact until the baby is born and then rupture them then if they havent gone spontaneously during the birth. I guess (certainly where I work) we dont artificially rupture membranes much in normal labours so we might see it a bit more commonly here.

Our expected time limit to transfer to post natal ward is 2 hours from delivery (regardless of type of delivery) This doesnt always happen however, either due to labour ward issues (difficulty getting babies to latch on and feed, mums not well enough to transfer, no midwide to do the transfer) or PN ward issues, usually waiting for a bed to become available. W We also dont do transfers in the hour overlapping shift handover (30mins before and after) to allow the new shift to get a chance at an un-interupted handover so that can hold things up sometimes too.

We do manual removals of clots here too but just using the usual mid-forearm length sterile gloves. We do have full arm length gloves that we use in the birthing pool so it might be an idea to stick a few pairs in the pph box. I forgot we do also keep foleys and catheter bags in the box too.

The unit I trained in had one (this is in the UK so contents might be a bit different) Ours contained; IV fluids (Harmanns, NaCl etc) Gelafusin Venflons Venflon dressings Tape IV tubing sets Blood bottles Needles IV fluid labels Gloves Sterile speculum Torch Sterile swabs Theatre paperwork pack (includes everyhting you might need if going to theatre including consent forms, checklists, tape measure, fluid balance forms, anaesthetic forms etc) We also have a 'quick grab' box in the fridge that includes one box each of Syntocinon, Syntometrine and Ergometrine.

Before I start Im aware that I seem to be always posting "we dont do that" type of posts but just want to give a different perspective so here goes... We never suction on the perineum, in fact those bulb suction things dont even seem to exist over here, at least ive never seen one and they dont have them in the unit I work in. Usually we will wipe of babies faces but thats it. With more minor grades of meconium, if babies cry at birth then they're not suctioned however with more severs meconium they may have some suctioning if needed. We also never suction at c/sections unless they baby is compromised.

For our post C/S women our routine assessments include BP, Pulse, Temp, Resps, O2 sats, lochia, pain, leg/calf pain, itching, nausea, alertness, urine output. We do these every 5 mins x4, then every 15mins x2, every 30 mins x2. Then women move from our recovery area to our post natal wards where their observations are carried out twice daily and then only BP, pulse, temp, lochia, leg pain. For our post SVD women we assess basic obs, BP, Pulse, temp, lochia, fundus immediately post delivery of placenta, then we would check lochia and fundus after @15 mins, once more prior to them getting up (if they've been in bed that is) and then the whole set of basic obs again prior to going to post natal ward. Obviously this would change in frequency should clinical condition dictate it. As far as our third stage management is concerned we use Syntocinon 10iu IM on delivery of the anterior shoulder For women who are deemed high risk (previous major PPH, para 5 or above, vbac) we use Syntocinon 5iu IV plus Syntometrine 1amp IM. We also have quite a few physiological third stages however their management doesnt change from other women as far as observations are concerned. With managed 3rd stages we have most of our placentas delivered within 5-10 minutes although we are happy to wait 30 minutes before getting the docs involved (we'd have tried all the 'tricks' before this though!) With physiological 3rd stages we have an hour before we'd consider intervening. Hope that helps.

If their membranes rupture and they're not in labour, babies head is engaged and all is 'normal. our women are sent off home to do whatever they can to get themselves into labour and brought back 24-36 hours later for induction if nature doesnt kick in first. If they rupture and are in labour and staying in the hospital then they're encourage to mobilise as much as possible, use the ball, the shower/tub or the birth pool pretty much the same as someone who's membranes are intact. Only time it would really be different would be if there was another issue that made them more high risk. Saying that, the only time they wouldnt still be encouraged to mobilise would be if the babies head wasnt engaged otherwise they can mobilise as much as they want and as far as CTG cables allow!

I guess here its just that its another intervention thats generally not needed so why make all women go through what can be a very painful experience if there's not a clinical need to do it. Most of our maternity care is based around the principle that if there's no real justified clinical need to do an intervention then we dont do it. Ive only twice had post c/s women show clinical signs that suggested the need for fundal assessment (although I admit Ive only been doing this for 3 years so have limited clinical experience compared to others) I actually had a look through our national guidelines after I posted the last time to see what they say and fundal checks arent mentioned at all in our post-c/s care guidelines. As far as post SVD women the guidelines state that checks are not required unless clinical condition suggests a need.

Im in the UK. Where I am we dont do any routine fundal checks on post CS women unless there is a clinical indication to do so (pain, increased lochia, temp, abdo changes etc) We also dont routinely do fundal checks on women post lady partsl delivery once they're out of labour ward (again unless there is a clinical indication to do so)

Might be worth contacting your local uni to ask what options you have available. Before I retrained as a midwife I considered converting from my original Learning Disability nursing qualification to adult nursing. I searched around for conversion courses but couldnt find any so called up a local uni just to ask for some advice. I found out that they didnt officially advertise their conversion courses as they devised individual programmes for conversion dependant on your experience. Their programmes were totally individual with course lengths ranging from the basic 14 months to 24 months dependant on how they assessed your relevent knowledge/skills. Most of their theoretical component was done online with some compulsary class time and placements were arranged by students themselves. This allowed people to continue to work whilst doing their conversion as you could arrange placements to coincide with days off. Might be worth a phone call to see what they can offer.

Just being picky because its a bug bear of mine but just wanted to say that there are no 'midwife nurses' in the UK. Here nursing and midwifery and 2 totally different individual professions we have completely different routes to qualification and nurses cant work as midwives and midwives cant work as nurses. In the UK only midwives can work within obstetrics (other than some nurses who provide purely post operative care for post section women) and we are the main care providers for women with normal healthy pregnancies (these women will often never see a doctor, only midwives) Hope that helps.

Hi Firstly where in Ireland are you from? If your in Southern Ireland and therefore not a UK national it will be pretty difficult for you to get into uni over here and you will need to fund yourself entirely, you wont have your course fee's paid and wont be eligible for a bursary until you've been resident in the UK for (I think) 4 years. But if your from Northern Ireland and a UK national then it will be much easier. I take it your looking at Napier University who Im sure do the shortened 18 month course for RN's. You wont get paid as such whilst your training but you will be eligible for a non-means tested bursary that amounts to around £6000/year, your fees are all paid by the NHS. Its also maybe worth mentioning that the shortened course has huge competition for places, just as bad as the full 3 year course. I trained direct entry in Glasgow and our recent shortened course class only has 6 places with around 100 applicants which I believe is pretty similar numbers around the country. The UK midwifery qualification is pretty much recognised throughout the EU however different countried practice midwifery very differently to here in the UK so its something I would look into closely before I considered working elsewhere. Its also recognised in Austrailia, NewZealand and some parts of the USA but these countries may require you to complete some extra training prior to working there. Edinburgh is a lovely part of the country although being a West coast/Glasgow girl I have to be a bit biased and say its not as nice as over this way! It is a pretty expensive place to live however but its full of history and culture with great social/entertainment opportunities so its a nice place to live. Hope that helped.

An anterior lip isn't an indication for section so there must have been other factors going on that you maybe didnt pick up on. Babies position may have been a factor although there are often maternal positions you can use to try and 'fix' this (if your woman isnt flat on her back with a total block epidural that is) or maybe there was an issue with fetal distress. Do you now if anyone tried to manually help with the anterior lip by trying to push it back during a contraction? Crappy thing to do to women but if its the only way to get her a lady partsl delivery its often better than a potentially un-necessary section. As for her chances at a VBAC I'd say that here in the UK they're pretty good. VBAC's, or at least trials of labour, are becoming more and more common especially when the cause for the original section is something that may have been specific to that original labour.