Day in the life of a Midwife

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It's the night before my shift. I can feel myself getting twitchy, my body aches and my teeth are on edge. I know the shifts are short all through maternity. So I'm likely to be pulled everywhere/anywhere. I got to bed, use my meditation app, feeling guilty for being crap company for my husband all evening, he understands it but it still isn't fair or pleasant. I listen to my sleep story, still wide awake, no sign of sleep whatsoever. I listen to another, and another. I glance at the clock 02.15. My alarm is going off at 05.40... Is the alarm definitely set? I snatch the phone to check. Yes its set. I obviously fall asleep but it isn't restful, I wake and feel like a tense, anxious zombie. Smash a coffee and ready my travel mug with another and leave.  I come on and the board looks ok. We all have a patient, I start reading their notes to make a plan of care. The phone goes, its an internal call. The ball of anxiety in my belly twists, I'm being sent to labour ward, via triage to collect a woman with a suspicious CTG. I grab my water bottle and scoff at myself. I won't get drinking this. Best go for a quick tactical wee I might not get one of those again. I scoff again. "Might?!?" I definitely won't. 

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I arrive in triage as a woman and her husband are having a plan of care discussed with them as IV access is being acquired. I glance at the trace whilst introducing myself, it does look suspicious. I gain a quick handover as I transfer this couple to labour ward. The plan was ARM (break her waters) and start synt (hormone drip) to start contractions. The couple query if this doesn't work and we are concerned of the baby's welfare should we not opt for a C/S without attempting something which may make this trace worse. They have a point, I explain that it is all their choice, they don't have to start synt. The registrar is keen to start synt with the thought being there may be meconium. They couple consent to the ARM and synt. The liquor is clear. The synt is started. Within 20 minutes, bradycardia and decision for emergency C/S. I run to get changed into scrubs and grab the husband some. It's been 4 months since I was in theatre assisting and panic spreads that I will have forgotten what to do. Everyone has piled into my room. My notes are spread everywhere, I ask the husband to get changed whilst trying to reassure them both that this influx of people and quick fire questions is normal. The scrub nurse brings me back to reality with asking what latest Hb is... I literally have no idea. Cue eye rolls and tuts. 

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It's annoying because I have only met this woman 50 minutes ago. I received a handover of a handover. I have spent the last 50 minutes transferring her to a room that didn't have a BP cuff, toco's for the CTG, it also didn't have the function to put the CTG on central monitoring. So that took up about 10-15 minutes to sort. Then I had to leave the room to find a colleague to draw up the synt infusion with me then find a drip stand that wasn't broken and had a pump attached that was charged and ready to go. Another 10-15 minutes then monitor the synt infusion until the bradycardia. I hadn't so much as completed my SBAR let alone check bloods. 

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Everyone has a job to do. Which is fine, but when you are trying your hardest to keep all the plates spinning whilst explaining plans of care being offered to frightened couples in a way that they comprehend and ensure that it is informed consent you are gaining, it takes just one person who makes you feel like a plonker. 

 

This couple had a beautiful child born by C/S. We transferred to recovery. The elective midwife has 2 women there and was going in with the final one and gave me handover of the women in her care. So I had 3 women to give care to in recovery. 

So recovery obs. 

Trying to ensure skin to skin.

Establish feeding.

Checking lochia.

Urine output.

Do notes and computing.

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Next section comes out and the midwife comes out. It's time for the 1st to be transferred. No MCA free to help and as we muddle through with one (working) computer and one thermometer we manage to get 2 ready for transfer. 

The ward don't have any beds. Dammit. This causes a major backlog and the labour ward sister gets antsy about the bed blocking. You get this in the ear over the phone as the phone is slammed down on the other side. 

My mouth is parched, my teeth are sticking to my lips. I look at the clock. Its 15.55 I last ate at 06.00 and had a sip of water at 08.30. I'm thankful for that tactical wee before I came downstairs. I'm tense and I ache all over from holding the tocos in place and writing on the CTG, assisting with the C/S, reaching over to help with breastfeeding and trying to write notes and do computing on a teeny desk space. The elective midwife then tells me, she finishes at 4pm. Which leaves me with all the women to care for and transfer. No-one comes to relieve me for a break. No-one comes to offer me a hot drink..... 

 

The feedback from the labour ward sister was that she would send an MCA to help me transfer but that she wanted recovery cleared before the nightstaff came on. Being a rotational midwife, you get to know what really annoys other departments. One of the most annoying things for postnatal ward staff and coordinators is all the women being transferred before the nightstaff come on. It isn't fair and it is annoying as a postnatal midwife to handover of care as shiftchanges occurs. What is also crap is being that midwife who has been told to transfer these women. You're the one who gets the brunt of it. You're the pawn in this crappy game. I will admit that I always daudle and get the women settled and handover directly to the nightstaff. However on this occasion I was bringing all the women up so this wasn't possible. So I had to give the overworked and stressed postnatal midwives all the handovers. Seeing them get more and more stressed everytime the doors went and it was me with yet another C/S patient. By the time I transferred the women, got them water, made sure they were settled and orientated to their bay, had the buzzer, had some tea and toast. Transferred their files written their details on the board, finished my SBAR's. It's now 20.45. My shift finished at 20.00. I realise I've left my water bottle in recovery. My feet and head are throbbing. I have a 50 minute drive ahead of me. I need my water bottle to be refilled with icy water to keep me awake on the motorway alongside a coffee that is also necessary but also so badly timed that I won't sleep properly tonight. I walk to the birth centre to collect my belongings.

The staff there are horrified I am still there and offer to put in my time owing and make my coffee. I change and head down to get my water bottle. When on the labour ward I'm "kindly" informed I've forgotten a set of notes and that I haven't transferred someone on the bed state. I mumble an apology and offer to do it before I leave. Thankfully someone takes pity and does it for me. I tip out the lukewarm water from my bottle and top it up and take a quick sip. The cold water makes my head thump more as I amble down the stairs to walk to my car. I can feel tears prickling in my eyes but nothing comes of it because I am so damned dehydrated there is no moisture in my body. As the doors slide open the fresh air is so beautiful and I fill my lungs. I get in the car and cry tearless sobs, once I've given myself time to build a bridge. I message my husband to say I am leaving and quickly receive an angry face emoji. "You and me both" I think. I wind the windows, turn Annie Mac up as loud as I can get away with and start drinking all the fluids and aim to keep the car on the road. The exhaustion that creeps over me on my drive home is overpowering. I eat, I drink,I sing, I chew gum anything to remain awake. I'm back on shift tomorrow so the merry-go-round starts again. I get in and drop my bags and try and go for a wee. It is the stingiest concentrated kidney exploding pain ever and I realise as I'm sat there feeling so faint I might vomit on my shoes. When I realise, I've come on my period and didn't notice. My pants are soaked. I'm thankful my work trousers are navy but I suddenly think.. 'Oh shit my scrubs are blue?! Did I bleed through and nobody told me?!' The second guessing and anxiety floods in, along with the feelings of inadequacy. 

Not giving good care. 

Not knowing all the answers. 

Not having 8 arms to do all the things all at the same time. 

Everyone probably thinks I'm useless. 

I am useless. 

Why am I doing this?

 

I come to with a knock on the door from my husband. 'I've made some pasta'. I cry a little bit more, but this is out of a rush of love and compassion for him. Offering me, a sweaty, miserable period pants woman a bowl of pasta at 22.00. I can see he is worried about me. I can see he wants to talk to me. All I can manage is to hoover up the pasta. Say thanks and that I'm going for a shower before bed. Off I trot. I stand in the shower and try and tolerate the hottest setting to ease my aching muscles and just end up with scalded skin. I roll into bed and reach over. Anxiety balling up in my belly again. Yep alarm is set. Meditation app is running... 

Same shit different day.