Hi all!
For the last 6 months my job has been a little different. No, I’ve not become a Rock Star, sadly. I’ve been a Community Midwife! I know, cue the “Oos” and “Ahhhs”. For those who don’t have experience in the world of Midwifery, that means that I’ve stepped out of the Hospital and have been out in the community (would you believe it), running antenatal clinics for pregnant women, postnatal clinics for parents and babies, driving around doing home visits and much, much, MUCH more. I’m now back in the Hospital, but since I’ve been back I’ve had A LOT of questions about my experience, so here it is!
When I first found out I’d be going out on the “Mean Streets” as I’ve heard some call it, I pretty much pooped myself (in less angelic words). I hadn’t experienced community midwifery since I was a student, meaning I’d done a maximum of 4 weeks of Community Midwifery, 3 years ago, in Manchester. I was aware of how much Community practice varied across different areas within Manchester, never mind in a whole new area of the UK. Not cool. I was familiar with the notes that the Community Midwives wrote in, but beyond that, I was clueless.
So the dreaded day arrived. Thankfully I was warmly welcomed by the wonderful team headed by Cathy and Joan and my initial fears of being made to feel unwelcome were well and truly squashed. A huge relief! I was definitely in a state of denial until I physically got through the door on that first day so was wholly unprepared. I didn’t take a notebook. IDIOT. First tip to anyone moving out to Community- you will definitely need a notebook. On that first day I filled endless scraps of paper with information I’d need to know to function. It was a lot. The first two weeks were spent shadowing Cathy and Joan, scribbling down every bit of information I could, in the desperate hope that it would help me when the time would inevitably come that I’d be left to my own devices.
To my initial dismay, that dreaded day did arrive! I was on my own. The day was a quiet one, as orchestrated by Joan and Cathy to ease me in (thank you, thank you, thank you). I only had a few home visits. Easy right? Nah. Well, I managed to find a reason to ring Joan at every visit I had just to clarify that what I was doing was right. It was her day off but she’d made the utterly kind, but no doubt regretful mistake of telling me I could call her should I need anything. She answered every call and reassured me every time. My hero! I’m so grateful, and equally sorry for that first day. Every day from then on presented new challenges and learning curves but, mostly driven by guilt for being such a pest, I put down my phone and started to trust myself. Most of the time I had Joan or Cathy not far away for guidance should I have needed it, which made it all a much more manageable prospect. Despite this, some things were easier to adjust to than others.
Running my own clinic was always going to be daunting. For anyone unsure of what that involves, there is a Midwife employed by Blackpool Hospital linked to most GP practices in the area. The Midwives look after all of the women who present as pregnant at that GP practice. The caseload of women at my GP practice was around 30-40 women. Initially, I found it a little awkward taking over from Cathy. Some of the women had seen her throughout their pregnancy and suddenly they were lumped with me. I could understand their disappointment! I was slower and less experienced so it must have been a shock to the system for them as well as me, but as weeks passed, I got to know the women, and the women me. I realised I wasn’t as useless as I thought (hopefully they did too) and I became more efficient, confident and built some really close, positive relationships with the women in my care. That was one of my main loves of the Community Midwife experience. When working in the hospital, you rarely see women more than once in their pregnancy. The contact you have with families at the Hospital, during labour for example, although intense, is short when you compare it to the months and months of interaction you have with women on Community. Not only do you have face to face contact every so often, you’re also their first port of call if they have any questions or concerns, so phone conversations were also regular. I enjoyed recognising women and having knowledge of what had happened in their lives and pregnancies. It felt like old school, “Call the Midwife” Midwifery in some respects, which I loved.
Keeping an eye on 30-40 pregnant women however, was a challenge. Making sure that they turned up to their appointments and chasing them up when they dropped off the radar was one of the more frustrating, and particularly challenging parts of the job. I soon picked up tricks of the trade and found myself exercising surprising skills in respect of tracking people down. I didn’t realise being a midwife also entailed turning into Sherlock at least once a week.
Another task it took time to get my head around was “Consultant Antenatal Clinic” and my role in that. If women have any risk factors in their pregnancy we refer them to see a Consultant Obstetrician. They work weekly out of either the Hospital or outreach clinics. Every week around 20-25 (give or take) women would come to be seen by the Consultant at our outreach clinic. My role was to see them before I passed the notes on to the Doctor who would then call them in. Often there would be one Midwife, a Healthcare Assistant and two Doctors (a Registrar and a Consultant). I soon learned that these mornings would be both physically and mentally, very demanding. On paper I only had 5 minutes to see every woman to check their blood pressure and urine, take any bloods required, palpate her tum, have a listen to baby, measure bump and answer any questions. It’s safe to say that it took longer than 5 minutes.
Time pressure was HUGE. Efficiency was vital, and missing something? Not an option. On top of that I also needed to keep an eye on what the Doctors needed, making sure to book women in for follow up appointments for example. I would often have to tell myself to “just keep going”, as the notes of waiting women piled up. When there were two Midwives, the pressure was somewhat less, but a lack of space at the clinic meant that progress was still slow as with only one room, we could still only see one woman at a time. The “luxury” in this case was that while one Midwife checked urine, the other could check blood pressure. Every week, we got there, but more often than not, running way over time. Women were thankfully incredibly understanding, and dear Diane and Vicky kept me going with tea and biscuits (even the odd sip and nibble was a god send) and sat in with the Doctors for me so I was less divided. We got through it. It upsets me that I came away with that thought after seeing the women. I know they will have felt rushed through and frustrated with having been waiting for long periods, and all I could do at the time was apologise and explain the situation the best I could. This weekly experience really opened my eyes to the reality of the lack of time and resources we have. A team of what used to be eight Midwives years ago, is now down to two. Clinics for 20- 25 women, sometimes more, squeezed into one morning is really stretching the band. On top of this, visits and appointments would continue on into the afternoon.
On days like that, team work across areas was so valuable. Day to day, teams with less of a workload than others would often offer to take on visits from other teams and Midwives from other areas would come and offer a helping hand as able. But what happens when everyone is busy? It is often that I think that teamwork and individual dedication are the only things keeping the NHS going. If it wasn’t for Midwives staying behind later than expected, working through lunch, turning up early I really dread to think what would become of maternity care overall. I digress. That’s a topic for another day.
Beyond this, what came to be the most demanding part of the role for me personally was the social aspect of the work. I live and work in an area where like all areas, affluence and deprivation live side by side. Every family I come into contact with has their own set of individual circumstances. Women walk through the door, not just a body with a bump, but women with a life and we need to consider all aspects of that life. Yes, physical health is important and we ask all of those questions to ensure that we provide appropriate care to ensure a safe mum and baby, in the physical sense, but women also walk in with a social and emotional status and individual needs that we must recognise. A family dynamic, a housing situation, a financial situation, a level of education, mental health needs, previous pregnancies, previous partners, social service involvement, police involvement, experience of domestic abuse, addiction, to name but a few. From a holistic perspective, the potential vulnerabilities and needs of families is endless. The questions we are prompted to ask as standard ensure that these needs are highlighted, but taking action to safeguard vulnerable families was a responsibility I struggled with.
We have a specialist team of Safeguarding Midwives for the most vulnerable families. They were a saving grace in terms of their vast experience and knowledge, but they are very unfortunately, massively overstretched. It’s impossible to ensure that every vulnerable woman is seen by a Safeguarding Midwife, so, where possible, women with lesser levels of vulnerability are managed by Community Midwives with the input of Safeguarding Team as required.
I was naive as to how much time goes into managing the social needs of families in Community Midwifery before I experienced it for myself. I spent a great majority of my time, between visits and clinics on the phone to social services and probation, gathering histories, compiling information and actioning referrals to ensure the right support and management plans were initiated to meet individual needs. I found that I took a lot of my concerns home with me. On reflection, I recognise that I wore the responsibility of keeping vulnerable families safe, too heavily. I spoke to my manager (Sorry, and thank you Angie!) one morning and broke down due to weight of the responsibility I was carrying. This has been my biggest lesson, and the recognition that I need to work on my resilience and work/ life compartmentalisation has been valuable for my personal growth. I learned that I could only do everything I could do, within my scope of practice, and having done that, I had to let it go. Recognising, and meeting the holistic individual needs of a family over a period of 14 hours is much different to recognising and meeting those needs over a period of nine months. I have a huge amount of respect for community midwives, and safeguarding Midwives in that respect.
So! Am I glad I did it? Extremely. Would I do it again? Maybe. But for now I’m ready to be back in the Hospital, rebuilding my confidence in that environment and facing different challenges that will no doubt present themselves. It’ll be interesting to see how this bucket load of new knowledge and experience will impact on my practice within the Hospital. I’m hopeful that it will help me to be a better Midwife overall.
To my Community team (especially Cathy and Joan), thank you, endlessly, for your patience, kindness and support over the last 6 months. Thank you for the much needed hugs and kind words of reassurance. I couldn’t have done it without you, well, not with as many laughs/with my sanity intact anyway. I will miss you all. And good luck in your new ventures!️
For anyone about to face the “Mean Streets”, they’re not so mean. Enjoy getting to know Women and their families, I did, and it really is a privilege you rarely get to experience working within the hospital. Soak up every bit of knowledge you can from the more experienced bunch. They are incredible and their lessons, so valuable. For the more complex stuff, seek support and advise from your safeguarding supervisor (you will have one) speak to the vulnerables team; again, incredible sources of knowledge, or speak to a Manager. Ask questions, lots of them, take a notebook, you’ll need it, keep a phone charger in your car (Google Maps is life). The on-calls are fine. You eventually learn to sleep ensuring your phone is on LOUD and your partner has called you fifteen times just to check you’ve got signal, it’s on and it’s loud enough. Mileage is very worthwhile keeping on top of. The extra money will help cover your petrol. I could go on forever, but I wont, but do ask me if you have any questions. I’m not the most experienced by a long shot, but I’ve been in your shoes recently. I might be able to help somehow. For the experienced super hero Community Midwives out there, be patient and kind with the newbies. It’s a scary prospect at first.
Lots of love, as always.
Chelsey Turner 