 Re: Reflections
Here is my first ever reflection in my first few days of practice.
A Reflection on ‘Soft Skills’ and the ‘birthing’ of my own style of practice.
Please note that the names of both parents and children have been changed.
Day one, of my first day in my Community Placement. I was called out at 19.20 by my mentor who advised that the woman who had undergone the stretch and sweep procedure I had observed in clinic that day had gone into labour. For the purposes of this reflection I will call her Niki. Niki is a Gravida 2 Para 1, who lived with her husband and her son. When I saw Niki I immediately recognised her, and she appeared to be pleased to see a familiar face on delivery suite. She’d only seen us a few hours earlier in clinic and here we are providing continuity of care!
Niki laboured for four hours, only using entonox and I took the role of actively supporting and assisting her. My mentor was very supportive and encouraging - getting me actively involved (listening to the fetal heart rate & taking Niki’s blood pressure & documenting in the notes). I involved myself in terms of ensuring she had water to drink as I understood the entonox would make her mouth dry, I felt that I wanted to ensure she was comfortable, warm/cool etc, and that I said reassuring words and held her hand. I was really pleased to show Dad some techniques that may help Niki feel more comfortable. My mentor had shown me how rubbing the base of Niki’s back may help with the pain and also cooling her head with a cold compress and pouring the bath water over her abdomen when a contraction was present. I actively took part in providing such care to Niki and also showed her husband the techniques I was using and offered him the role.
I found myself holding back slightly from being the ‘active care giver’ because I felt I wanted to get Dad active so they birthed their baby together. When I first saw him he was sitting next to her and not touching her and was even facing almost away from her (position of the chair) and he looked helpless. I felt I wanted to help him feel more involved, I said, ‘I expect you are feeling pretty helpless right now maybe you’d like to give Niki a back a rub at the base of her spine?’ (as Id noticed she touched herself there twice) he seemed pleased to be given a ‘job’. I made sure I told him he was doing really well as well as reassuring, calming and praising Niki. I understand from reading Lucas (2006) that the language that midwives use in their practice can empower or disempower women, profoundly affecting the birth experience. Therefore in practice I am mindful of using support, positive, encouraging and reassuring language.
When Niki answered she felt hot in the bath but didn’t want to get out, I checked her temperature and the bath temperature. I cooled her head with a cold compress and then passed it to her husband and asked if he’d like to carry on. He continued to do this throughout the birth (and rub her back). I kept replenishing his compresses and then later showed him how Id made the compress and he made himself more when he needed them.
I felt a strong connection with Niki when she was in the second stage of labour, I was holding her hand and also the entonox for her and she talked through her eyes when she wanted entonox and when not. I noticed just before a contraction started she would raise her eyebrows and drop them gently and 30 seconds later the contraction would become very strong. Observing these cues ensured I was able to provide the entonox at the right time and also words of calm, praise and encouragement. Niki became distressed when baby’s head was crowning and I kept quietly encouraging her, I took my lead from my mentor who continually praised her. Niki began to get panicky and my mentor and I calmed her down, I ensured I spoke encouraging words of support softly and calmly to try and keep her calm, I also stroked her arm and held her hand. I felt like I wanted to help her to not be afraid and to reassure her that she was doing really well. I wanted to pass to her the strong feeling that I had, that I had faith in her and her body to birth and baby and I wanted her to feel this too. I also reassured her partner that he was doing a great job of supporting her, at this point he was supporting one of her legs, my mentor supporting the other.
I felt a welling up of emotion as their baby was born and was incredibly moved by the experience. I felt honored to be present. When he was put on her chest/abdomen, she asked why his fingernails were dark I explained that’s normal and he will pink up all over and said what a lovely pinky colour he was in the face already. She looked reassured. Her husband was asked if he’d like to cut the cord and he said he would but was nervous and wasn’t sure he wanted to after all! I encouraged him and he did cut the cord. I even took a picture for him! I noticed Niki took a deep breath, and seemed to sigh a ‘release’ almost, as the cord was cut. She began to shake after the placenta was delivered and I got her a blanket and I rubbed her arms. She looked worried at shaking and I reassured her that it was fine and she was just feeling the sudden temperature drop after the baby was born and the placenta was delivered and not to worry (and added I’ll get the kettle on and make her a nice hot drink!). She looked reassured. I put the kettle on & checked the placenta with my mentor. I recall the strong iron smell of the placenta and was amazed at its size. I looked in on Niki and said we’d checked the placenta and it was fine and intact and that coffee was on its way, I also used it as an excuse to see if she was still shaking, but she wasn’t.
I noticed the fetal heart rate was consistent throughout except towards the end when it lowered slightly (within the normal range). I found this surprising as I had expected it to be consistent throughout.
I’ve realized through writing this reflective statement that I was observing Niki and her partner well aswell as observing uterine activity and the fetal heart rate. I think this may be the beginnings of my own practice style – observing the woman closely, reassuring her and getting the partner involved. I hadn’t thought about my own ‘style’ before it just seemed to be there naturally.
At a postnatal visit, Niki and I discussed her birth experience and she said it was so much better than with her first birth where she had received Pethidine and she had felt ‘foggy’ afterwards. She also said she felt ‘really pleased’ that her partner had a role and she felt this helped both of them as he noted he ‘didn’t feel like a spare part like last time’ and Niki said that it was ‘nice to have him close’.
Obviously as this was my first day and my first birth there is little I would have changed as I infact did little in terms of clinical management of labour and was instead able to explore and develop my own style. On reflection now I would liked to have participated more actively but I feel I learnt a great deal from observing and undertaking a minor role in terms of clinical management. From the feedback received from Nicky it was clear that my role had impacted on her birth experience and perhaps because she and her husband were so positive about his involvement this is why I have continued to actively encourage partners to participate in care. Whitehouse’s article in the Practicing Midwife entitled ‘That Loving Touch’ (2006) outlines how teaching fathers to massage their partners has a positive effect on pregnancy, labour, post-birth bonding and potentially on family dynamics.
I realise how much I learnt on that first day of my first placement at my first birth. I have carried these soft skills through the other births I have attended and supported at. As my knowledge of labour and birth increases I have taken a more active role in the care of the woman but still find myself observing the woman carefully and taking cues from her as to what she needs and when. I also use these observation skills in getting partners involved and helping them to stop feeling like “a spare part”. I also ensure I regularly take over this soft skills care to give partners a break and to ensure I can observe and take the appropriate medical observations.
References
Lucas, M . (2006) Think before you speak
Practising Midwife 9:4 pp46 |