It’s my third long day in a row

On my walk to work I try to scan my NHS pass at the traffic lights – that’s how tired I am! I call in at a cafe, get coffee and a pastry, and try to push away the thought that the cost is equal to half-an-hour of work at my Band 5 salary. I should have made breakfast to bring in, but I fell asleep on the sofa last night.

I step onto the ward; everyone I pass says hello. I am thankful to work with such lovely colleagues. I go to get scrubs and see almost empty shelves, which usually means it has been a busy night. I pull XXL bottoms over my small frame, and pray they don’t fall down during the day!

I trudge alongside my bleary-eyed colleagues to the midwives’ station. People say hello to me with their ketotic, coffee-scented breath. The board is chock-full of patients, with scarcely enough midwives to care for them all. As a newly qualified midwife, I always have a tinge of anxiety at this stage: who will I be allocated to, and will I feel capable of coping with whatever lies ahead of me?

I am immediately sent into the room of a woman who is pushing. I take a verbal handover, but it is impossible to write a full history or check her blood results on the computer. In between contractions I try to quickly build rapport with the couple. The next thing I know, the doctors and midwife in charge are here for the ward round; they seem annoyed that I don’t know her latest blood results and that I haven’t yet examined her. I’ve been here for ten minutes! The midwife in charge has a stern word with me about the couples’ luggage blocking access to the Resuscitaire. I feel like I’m drowning. The doctors examine the woman, confirm the baby is in a good position for birth, allocate us 15 more minutes to push, and leave.

My head is swimming; the CTG appears normal… should I have asked for more time? What position can I try next to help her to have this baby safely and quickly? I try to ask the couple if they are happy with the plan, but here comes another contraction… the head is visible. In vain I press the call bell for a second midwife, though I know that usually nobody is free to help. Do neonatologists need to be present for the birth? What are their birth preferences? What was the partners’ name again? Is there Syntocinon in the room? Do I hear a deceleration in the baby’s heartbeat? My eyes flick to the notes, where I still haven’t written a single thing…

My heart lifts when one of the lovely Band 6 midwives enters the room; she gets the notes and scribes for me whilst I assist the birth. I can relax and focus on the task in hand. The baby is in good condition, the parents (and myself!) are elated. It all went smoothly!
There’s no time to relax though. After delivering the placenta, I check her perineum and it needs repairing. I am gaining confidence with suturing, but the tear is deeper than I’m used to and I could do with some support.

I call again; another midwife comes and I explain my plan for the repair and she agrees. She cannot stay as she herself is giving one-to-one care. The tear is bleeding so I know I need to start. It takes a long time; I wish someone was available to look over my shoulder. The baby starts crying and the parents want to feed. I am sweating. I ask them to do skin-to-skin and I will help them to breastfeed once I have finished.

It’s now been an hour and a half since the birth and the feeding is delayed for no good reason; if only there was a spare Maternity Support Worker to help, but there’s only one on the ward today and she has several beds to clean. I finish suturing, and get the baby on to the mothers breast. The midwife in charge knocks on the door and asks how long I’ll be as she needs the room. I lie and say “soon”. I race to the computer to type up the notes. The couple ask me to take pictures of them, which, of course, I do with a smile. I look at this incredible, beaming person who I’ve assisted to birth their child. This part of the job is so gratifying.

I manage to get everything ready to transfer them to the postnatal ward, when the woman asks for a shower. I feel myself getting annoyed; that will take at least another 15 minutes and the midwife in charge must already think I’m so slow! Then I catch myself: of course she wants a shower, wouldn’t I?! I feel ashamed. I smile and help her to shower – she says how much better she feels, and I do too.

When I return from taking them to the postnatal ward, it is midday. I am sent for lunch, which I am glad of. I gulp my stone-cold coffee and wolf down my pastry in giant clumps, I’m so hungry! I try to relax; it’s only half way through the shift, and I feel like I have done a full day of work. This job can be so hard yet it is so fulfilling; even now, as my feet throb and my head aches, I am still glad I left my previous career to do this.

I cried five times today

I remain cocooned in my duvet for a while, trying to squeeze in every last second of rest possible before getting ready for my shift. As the sick feeling in my stomach begins to return, I realise that I should be thankful that I managed to get any sleep at all. I am in a constant state of anxiety and nerves before every shift. The second alarm goes off. I turn it off and sit bolt upright in bed. I check my phone to see who I am on shift with, and most importantly, how well staffed the shift is. I am on my last shift as ‘supernumerary’, but by looking at the off duty I already know there is no doubt I will be included in the numbers tonight.

I start to put my make-up on to make myself appear alive. My housemates have always teased me about it, but I stand by the fact that a woman would much rather see a midwife who appears awake than one who looks like she’s not had sleep for several days. None of my housemates are at home today, so I quietly reheat my food and prepare the first of many cups of coffee for the night.

I keep half an eye on the time, counting down the minutes until I must leave. Eventually my alarm sounds again, reminding me that now is the time to leave. As I gather my belongings and prepare for the drive to work, I take a deep breath and blink back my tears.

Sitting in the staff room with my flask of coffee in front of me, I watch each midwife slowly filter in through the door. Each one of them greets everyone in the room. I smile back each time, still undecided whether it is acceptable to say ‘good morning’ when it’s 7pm. It just feels so unnatural to say good evening when you’ve just woken up. I turn to my phone again to see a message from my mum. I reply and end the message with “I’m at work, pray for me”. I’ve been qualified for seven months, but only rotated to the delivery suite two weeks ago.

My first seven months have been enjoyable. They have also been stressful at times of course, but overall I have really enjoyed the confidence and independence I feel when on shift. I love that after all my hard work during three years of training, I have finally made it. I have achieved my goal, the one I have been dreaming of ever since I was in school. I love talking and building a relationship with women, and I love talking to my colleagues and feeling part of a team. I love that I feel like I am making a difference to people’s lives. I feel like I have developed immensely, both as a midwife and as a person.

But I always knew the delivery suite was going to be hard, and I recently had a run of shifts which made me feel incompetent and knocked my confidence completely. I suddenly feel no better than I did as a student, and I have become much more anxious about what my colleagues think of me.

Suddenly, the day shift coordinator pops into the staff room to begin handover. I snatch a glance at the message from my mum; “you will be fine, try not to worry”.

After receiving my allocation, I grab a piece of paper and make my way to the room. Gently knocking on the door, I say softly; “just night staff”, and walk into the room past the curtain. It still feels weird to me to say I’m working a night shift. Occupational health has only just let me do them again. Most people think I am crazy for wanting to do night shifts, but I don’t mind. I felt guilty when other midwives were allocated weeks of night shifts and I didn’t do a single one, so I guess my guilt was overwhelming.

On night shifts, women and their partners generally want to sleep so, and as this particular woman had had an epidural, I encourage her to take the opportunity to rest before the pushing stage to come. Consequently, for the first few hours, my work consists of categorising the CTG (monitoring), and occasionally checking her pressure areas and doing some observations. I don’t mind it really, this work is what I’m more comfortable with so overall I am able to act independently. There are still times when I am unsure of my classification, and have to muster up the courage to ask for help. And I am still nervous every time I ask someone to buddy my CTG, as I am scared they will disagree with me.

Shortly before midnight I am relieved for my break. On my return everything has changed immensely. I feel like I am walking into chaos; the woman is groaning in pain as her epidural eases off. I receive handover again from the other midwife, who informs me the woman is now fully dilated. After an hour of ‘passive’, where the woman continues to moan in pain, it is time to start actively pushing.

Gradually the CTG (monitoring the baby’s heart rate) starts to deteriorate, and an hour into active pushing it becomes suspicious. I always hate the active pushing stage when I’m on my own. It’s hard to be both a cheerleader for the woman and maintain your clinical skills. I still feel so new to everything and even basic activities seem to take me so much longer.

A doctor and midwife come in to review the case, and a decision is soon made to use forceps. Immediately my heart sinks, never in all my time training have I had to go to theatre for a forceps delivery. The other midwife pops in and out of the room with checklists, consent forms, and hospital gowns. The doctor discusses the consent form, and the anaesthetist comes in to review the epidural block. All this time I’m standing like a lost child in a shop while people go to work around me. I try to go through the theatre checklist, but that is quickly interrupted by the midwife saying they are ready. I look at the woman, who is still in her own clothes and hasn’t even had her pre-theatre medication, and wonder how other midwives manage to prepare people so quickly. I throw the gown over her and rush to theatre.

Once inside you are met by bright lights and the sharp smell of recently cleaned equipment. The floor is sparkly clean, and it almost feels like an ice rink. I am immediately instructed to focus on fetal monitoring, so I quickly attach the transducer to her bump. The number of people around me has doubled now and I can’t help but feel overwhelmed, but I try to put on a brave face so as to comfort the woman in my care, who I can tell is becoming overwhelmed too.

The theatre team fumble at the bed around me. I go to help but immediately get told off by the other midwife behind me; “focus on fetal monitoring” she tells me, and after looking into her eyes I feel extremely nervous. For the first time I panic, thinking that this baby may be born in a poor condition because of me.

Like clockwork the theatre team put the woman’s legs into lithotomy, and shortly after, the obstetric doctors arrive. They reassess, determine the baby’s position, and prepare for a forcep delivery. “I need you to palpate contractions” the registrar tells me and I nod back, trying to seem confident but secretly crying inside. In all my midwifery skills, I find palpating contractions one of the hardest things to do, and now I’m having to do it surrounded by an audience.

Time, which had been flying faster than ever before, suddenly slows. I feel the whole room watching and waiting for me to announce a contraction is incoming. Seconds seem to drag on into minutes, and the ticking of the fetal heartbeat is the only sound echoing through the room.

“I think one’s coming” I mumble, but the doctor just looks urgently at me and I realise I have to be more confident with my decisions. So I just repeat myself, louder, with more confidence and hope I’m right. Pull one is complete, but the head is not quite delivered yet. The other midwife declares “fetal bradycardia”, and I look over to the CTG machine in the corner.

I hadn’t realised, but the numbers had slowly started ticking downwards. 90bpm… 80bpm… 70bpm… The doctor looks at me again, almost willing me to declare a contraction. I palpate her uterus again and announce another incoming contraction. I look to the woman now, who is surrounded by her partner, the anaesthetist, and the theatre staff, all urging her to push. Eventually, the head is delivered and after another contraction, the baby is born.

I always find the cry of a newborn baby the most relieving. It’s when you know that everything is alright. All that work you have done has been successful. The baby is in the mother’s loving arms, and for the first time there is a sense of peace.

The other midwife comes up to me to discuss the birth. She tells me that I need to go through my notes and documentation because I missed certain things. I immediately think of all the times I was overwhelmed and forgot to write something down. I apologise and she softly reminds me that it’s all okay. Nonetheless, I still feel my eyes slowly filling up with water. She looks at me, more meaningfully than before, and asks if I’m ok. For the first time in my career, I’m honest with her. I shake my head and somehow utter the words that I need to speak to someone, but I can’t do it at this moment. She understands and tells me to go and take a break.

I soon find myself in the bathroom sobbing on the floor as my mind races with all my past wrongdoings. I want to speak to my mum, but it’s 4am and she won’t be awake. I snatch at my breath in between hyperventilating, and look at myself in the mirror. I dab at the red rings around my eyes and take a few deep breaths. It has only been five minutes, but I know I have a job to do and I can’t leave now.

So I walk down the corridor, avoiding eye contact with anyone who passes me so they can’t see that I’ve been crying. I stand outside the door for a second, listening to the voice of the woman inside. I smile to myself, practicing the brave face I need to put on in the room. I enter and congratulate the couple again, coo at the baby in her arms, and joyfully support the mother to feed her baby. Anything to hide my meltdown and the heavy feeling of failure inside.

I go outside to grab a thermometer and the coordinator catches me; “you’ll be able to relieve yourself, won’t you?” My mind fills with the long list of tasks ahead of me which will need to be fulfilled. I nod in agreement knowing that this is the only acceptable response.

At 5:30 am I get my second break, which I realise I should count as a blessing since there have been many shifts where I’ve only got one. The midwife from theatre walks in and sits down next to me. Most times I can stay strong, but there is something about this night where as soon as I open my mouth to speak, I burst into tears. All I can think is how I can’t do this job anymore.

I can’t deal with the pressure of caring for two precious lives. I can’t deal with the feeling of being incompetent and the feeling of uncertainty. The fear of losing my PIN, of a complaint, and of my colleagues judging me. I feel like I should be better; I should know more and feel more confident. I realise that the pressure and stress I feel in this job has slowly been outweighing the positive experiences I have as a midwife. Gradually, and without realising, I have slowly grown to dislike my job. As a student I felt bubbly, excited and proud to be a prospective midwife. I studied hard to achieve my dream, but now my dream is becoming a nightmare, one which wakes me up in the middle of the night. I am unhappy, but I don’t know what else to do, midwifery has been my life for so long.

And then there was the final blow; “I don’t want to be a midwife anymore”. And in that moment, I truly believed it. I could have given my last handover and walked out of that hospital never to return. Perhaps in another life that would be the reality. But midwifery had also taught me to be brave, dedicated, and to persevere.

So when my thirty minutes was up, which I largely spent crying, hyperventilating and hugging the midwife, I left the staff room with a brave smile on my face. Another midwife, who had been on her break at the same time, came up to me and hugged me. “You’re a good midwife”. And as I heard those words, I forcibly blinked back more tears. I looked at her, only a couple years older than me but considerably more experienced, and I realised that she too had cried like I had early in her career.

I cried five times that day, and I know I will cry many more times in the future. But I studied for four years in school and trained for three years to get this job. It wasn’t easy, and at times the thought of being a qualified midwife was my main motivation in life. I had come so far, and I didn’t want to give up so easily. So I carried on, and two months later I’m still a midwife. Still struggling at times but becoming slightly more confident each shift.

I hid in the toilets and cried today

I’ve been qualified for 10 months and I thought the days of crying in toilets were over. I’ve grown in confidence and experience, and I’ve needed to ask for help less often. It’s a satisfying feeling that on a day-to-day basis, I can practice and be a competent, autonomous, practitioner. I don’t need to bother other midwives for help every five minutes. I’m not ashamed, however, to still ask for help when I need it. I think that keeps me safe in my practice and I hope it ensures families are getting the best care.

Today I needed to ask for help to determine how to support a family coming for their next appointment, and I knew I was asking a senior midwife whose previous responses to my requests for help had left me crying in the toilets. But I told myself that I’ve got ten months experience behind me, and I’m feeling more settled in my practice – I’m asking her for support as my colleague, not as the “annoying newbie” I felt like in the beginning.

I didn’t expect her response to impact me as much as it did. Ultimately, she refused to help and didn’t even advise me as to how I could find the answers for myself. I completed the appointment for the family on my own. I know my actions were clinically safe, and I hope I conducted the appointment in a manner that was empathetic and kind, providing space for the family to express their needs. I was a safe practitioner. But I became a midwife to be more than just safe. It shouldn’t even be a discussion as to whether we are safe or not – that should be a guarantee

I wasn’t able to advocate and facilitate their informed-decision making because I didn’t know what the options were in that situation for that family. That’s why I asked for guidance from a senior midwife. So I hid in the toilets and cried when the appointment was over. I cried because that family didn’t have the experience in their appointment that they should have had. I cried because I wasn’t the advocate and empowerer that I really strive to be. I cried because I was made to feel helpless.

The very person whose role is to support the team as the recognised ‘experienced’ midwife simply refused to help. And it’s the family that suffers because of it.

At the beginning of the week we had a shift in which we were staffed so well that I actually got to do some admin work whilst on shift. So I worked on my revalidation in between patients.

Even though I’ve only been qualified for eighteen months as a midwife, this year marks my ninth year as a nurse. We revalidate every three years, and we have to gather together a portfolio of evidence that may or may not be selected by the NMC (Nursing and Midwifery Council) to be examined. This selection process is random and you don’t find out if you will be selected until you actually revalidate, so you have to prepare it in case you are one of the selected portfolios.

A selection of paperwork - reflective accounts.

My line manager was also doing her portfolio, and she asked me what I put for the points on practice considerations … a rookie mistake by me! I used the previous template from three years earlier. Since then the NMC have added in a whole extra section. What’s that saying about assumptions? Something about making a donkey out of me n u… or words to that effect.

Because I’m not only a midwife but a nurse, I have to provide double the evidence and relate it to both midwifery and nursing. This has helped me to see that whilst the two professions are so different, they have the same expected attributes, just worded differently. I’ve spent forever thinking “oh I’m so under qualified in midwifery and don’t know how to do this, this and this”, but I forget about all of those transferable skills that I have. Skills that not only helped me as a nurse, but as a midwife too.

A banana on a table next to a cup of tea.

That all being said, I have to revalidate every three years and it takes considerable time to gather the information and write the reflection pieces. We are not given any dedicated time for this. Most of it is done in my own time. I was blessed to have a few hours on this shift, but it’s an anomaly. Why aren’t we provided the time to do this? It is a requirement of my job, and my line manager has to sign it all off regardless of whether I’m selected or not. Having some non clinical admin time would be so beneficial. It would mean my home time is my home time. That my rest days are truly my rest days.

As I write I realise that it was on this day two years ago that I delivered that magical baby number forty, enabling me to qualify as a midwife. That’s me and the baby in the the photo below (taken and shared with consent).

A black and white photo of a midwife holding a newborn baby in a hospital. Two midwives crouching either side of a women holding a newborn baby, laying in a hospital bed.

I was instantly reminded that despite how tired I am, despite how drained I feel, I am privileged every shift to be a part of each family’s journey, and to help welcome little miracles into this world. The memory quite simply reminded me why I truly love my job.

A card with a thank you note on it. A handwritten thank you card. Thank you cards on a table. A handwritten thank you note on a yellow piece of paper. A thank you card with a photo on it.

Midwifery intuition

Midwifery intuition is something every midwife eventually gains. It’s when you have a feeling deep down that something isn’t right, for example, a feeling that you’re headed for a caesarian section, or the feeling that you have to do a certain procedure; whether that be cannulation, a vaginal examination or escalating to a doctor. It was something I thought would come with time, not something I would be forced to learn very quickly.

I was caring for a lady with her first baby, a spontaneous labour admitted to the delivery suite at 5cm. Four hours later I was due to examine her, but I could tell from her behaviour that she was transitioning. She was 9cm, but she was involuntarily pushing with her contractions, so I knew she’d most likely be fully dilated sometime within the next 30 minutes. Just as I was trying to do my documentation, I saw a gush out of the corner of my eye. It’s rare that a lady’s waters break with a gush. It’s a common misconception that the movies have portrayed. It’s often a small trickle, and subsequently the midwife has to squint her eyes to work out whether it’s liquor or just urine (a surprisingly common occurrence).

A lady’s waters breaking usually doesn’t catch my attention too much, but it was the colour of the liquor which I was more intrigued by – thick meconium. “Great”, I thought to myself. This is a classic sign the baby is in distress, and therefore will need observations for twelve hours following delivery. The CTG (baby heart rate monitoring) was completely normal, or rather, it was as soon as I realised I had completely lost fetal contact after the waters broke. I stopped my writing halfway through and dashed over to try to find the fetal heart rate.

“Your baby’s just wiggled away from me”. I tried to sound cheery so as no to panic the mother and her partner, but after multiple position changes and adjusting the transducer to all kinds of angles, it became evident my little loss of contact had now totalled two minutes. I buzzed for another midwife, as you usually would, for some assistance in finding the fetal heart rate. A support worker opened the door and after explaining the situation, I asked for a second midwife to attend. My heart sank when I heard the news that there was no free midwife available to help me.

Nevertheless, the support worker wandered over to offer to scribe for me. I tried to tell her what I wanted to write, but my head was filled with so many different thoughts that I couldn’t put into words what I wanted to say. Whereas I would usually look to a more experienced midwife to support my decision making, I realised that I was on my own and needed to have the confidence to make the right decisions.

I explained to the women and her partner that I couldn’t monitor their baby effectively, and therefore I would recommend a ‘clip’ to put on their baby’s head to monitor the heart rate directly. I was also obliged to say there was a tiny risk of infection near the ‘clip’ site. Fear sprang into the couple’s eyes. I tried to explain that the risk is extremely low and that I had never seen a baby gain an infection from the procedure, but the word “infection” seemed to be the only thing they could focus on.

Each second continued to tick by with no fetal heart rate, so I decided it was time to put on my stern midwifery voice; “I cannot ensure your baby’s well being if I do not apply this clip”. Some may say it’s a bit manipulative, but when you’re panicked and in the moment, and the outcome of this baby is on your PIN (personal identification number), you’ll do anything to protect it and ensure your baby is born well.

This managed to convince them enough and within a few seconds the clip was on and working. She was now fully dilated as I had predicted, and I encouraged her to push with her contractions. There was good advancement, but with this being her first baby there was no knowing how long it would take for the baby to be born.

The fetal heart rate was 75bpm according to my monitor, nearly half what it was earlier. I asked the support worker to try to find a midwife, although I was practically begging by this point. To my relief, another midwife came to assist me. She didn’t stay long before she realised what was happening and dashed to get a doctor. Meanwhile, I was taking the role of chief cheerleader, urging the woman to push with her contractions. The doctor appeared and started setting up for forceps while I continued to encourage the woman to push.

The baby started crowning, and it was at this point I must have forgotten who I was, because in the chaos I found myself pushing the doctor to the side as I dashed to support the woman’s perineum. One push later and the head was delivered smoothly, followed by the baby, which thankfully, cried beautifully at delivery. The neonatal doctor attended shortly afterwards but left quickly once they could see the baby had been delivered.

Half an hour later it was time to handover so I could go home. Suturing had only just finished, and the night shift midwife walked in. “It looks awful in here”, she whispered to me. I looked around at the blood on the floor, sheets thrown everywhere and liquor all over my scrubs. I smiled awkwardly and apologised, saying that I hadn’t had the time to clean up. I handed over and stayed past my shift to help her tidy up. I went home feeling exhausted, but also thankful that everything worked out ok.

It’s my third long day in a row

I get home and cry after work

On Call

I cried five times today

I hid in the toilets and cried today

Midwifery intuition

A true midwifery experience