Denise and her blog
Driving Forwards - Transition From Student To Midwife
Congratulations to all our newly qualified midwives!
You did it! After all the effort, stress and challenges you may have experienced along the way, you should be proud of yourselves. Some of you may have been lucky enough to find a midwifery post; others may still be waiting for that elusive job – but you ARE now a midwife.
The transition from student to midwife is exciting even though it can be nerve wracking. I well remember how I felt when I stepped on to the labour ward the day after qualifying – proud yet nervous, frightened even. You have a different role, a different title and colleagues view you differently. There are greater responsibilities, greater challenges and greater fears now the buck stops with you. And yet, there can be awe-inspiring moments of emotion, success and knowing you are doing the right thing.
Stepping over that line from student to midwife is a bit like driving a car. You’ve passed your test and have the certificate allowing you to practice. But now you have to really learn to drive: to consolidate your learning to increase your confidence and competence in midwifery. You know how to drive but you now need to be able to drive safely without thinking about it; you can then concentrate on becoming confident at driving in the dark, looking for directions and dodging all the other cars on the road.
For NQMs, this means first consolidating your basic skills and knowledge and then learning to add in the other aspects that contribute to becoming a wonderful, caring, compassionate, confident midwife whilst still adhering to the “rules of the road” in terms of safety, such as the NMC Code and local clinical guidelines.
If you feel more senior midwives are ignoring or bullying you, think of them as road users who push cars around and endanger others with their fast, aggressive or incompetent driving.
If you are overwhelmed by all the rules and regulations, local and national guidelines and institutional requirements, learn your “highway code” – the NMC Code is your friend, not your enemy – but don’t be prepared to challenge the system if you think something is incorrect, unsafe or inappropriate.
It is absolutely normal to feel anxious, overwhelmed, lacking in confidence and fearful of doing something wrong. Every single midwife before you has felt like this as they step over the threshold into their midwifery career – and those who tell you otherwise are hiding the truth. So how can you help yourself and others to deal with this transition phase?
Tips to cope as a NQM:
- Review each day – think about what you have learned today and what caused you difficulty; identify at least one success from the day – such as a thank you from the parents or a student whose questions you were able to answer. Value the small things and don’t get put off by those issues that seem insurmountable – they are not.
- Don’t beat yourself up when things don’t go right or feel difficult – if you miscalculated a woman’s cervical dilatation on VE, it doesn’t matter, there’ll be others from which you can improve your skill.
- Don’t be afraid to ask for help or for someone to explain something – even if you feel silly or embarrassed; this could be a midwife who you get on well with or an obstetrician
- Don’t feel intimidated – remember ALL midwives and doctors have been in your position – some may have forgotten what it felt like, but be prepared to stand up and ask or challenge those more experienced
- Keep a diary about how you feel each day – you will be surprised when you look back after a few weeks or months how differently you feel.
- Find someone you can confide in – a midwife you trust, another NQM or a friend unconnected to midwifery
- Make sure you have at least one day where you do something for YOU – not just family commitments, shopping or sleeping – go for a nice walk or swimming, have coffee with a friend, treat yourself to a spa treatment
- if things really challenge you, learn self-hypnosis or, in extreme cases, seek counselling – but remember, prevention is better than cure, so try not to let your sense of inadequacy, anxiety or demoralisation get out of hand – deal with it earlier rather than later
- Most of all - believe in yourself! You have spent over three years working towards your goal of becoming a midwife; you have passed the exams, you’ve got the certificate – and you CAN do this.
SPECIAL 60% DISCOUNT FOR NEWLY QUALIFIED MIDWIVES!
We’re offering a six-month ten-day online Certificate in Midwifery Complementary Therapies, specifically for NQMs and senior students at almost 60% reduction on the normal price! You’ll study several complementary therapies relevant to midwifery: aromatherapy, self-hypnosis, moxibustion, acupressure for postdates pregnancy, natural remedies and more. There are five set study days and five option online study days plus optional extra monthly webinars, self-hypnosis and relaxation sessions and access to our online members’ resource site of articles, videos etc. £1250 including VAT (normally £2964) - £250 non-returnable deposit to be paid by 31st December 2026 plus ten payments of £100 per month. 10% surcharge for payments from a non-UK bank account. Why not ask for the fees as a Christmas present?!
Traditional Medicine Approval
I was pleased to read recently that Burkina Faso in central Africa has approved an additional eighteen traditional medicines for use within healthcare, to supplement the 53 products already approved. These are herbal remedies long used as local family medicines that have been validated through a range of formal processes and now legitimised in law. As with other countries in which traditional herbal remedies play a prominent part in healthcare, regulating specific plants in law prevents the plundering of locally grown plants for development as medicines by the largely European pharmaceutical industry; plants known to have therapeutic properties in Burkina Faso and elsewhere can not be harvested by external industry without formal governmental permission.
There is a wealth of indigenous knowledge and power in people using natural remedies to help themselves. Whilst modern medicine (pharmaceuticals) has its place, so does traditional medicine. It empowers the population to help itself rather than relying on the disempowering state system (such as the UK's NHS). Traditional medicine uses freely available plants to encourage good health at a fraction of the cost of sometimes unnecessary drugs. It also treats holistically (whole person care) rather than systemically (seeing an individual as an engine with different parts). On the other hand, many developed countries have a growing interest in alternative systems of medicine, and the international trade in herbal medicines and other types of traditional remedies has grown exponentially.
In addition to Burkina Faso, other countries that have legalised indigenous plants include China, India and several South American countries which facilitate holistic medicine alongside orthodox medicine. indeed, the World Health Organisation has a traditional medicines programme to facilitate the expansion, where appropriate, of herbal medicine use. In other countries, such as Canada, herbal medicines are regulated as drugs; in the UK the post-Brexit Traditional Medicines Regulations tacitly approve remedies that have been in common use for thirty years or more, although these remedies continue to sit outside the legislature pertaining to drugs.Unfortunately, this lack of formal recognition contributes to a general disparagement of herbal medicines by the establishment – government, the healthcare regulatory organisation and the medical profession, ably reinforced by the media. This leads to those who wish to explore alternatives to drugs doing so surreptitiously, either through a sense of embarrassment or fear of reprimand.
Pregnancy and birth are of particular concern when it comes to self-administration of active herbal medicines – not because they don’t work but because, in fact, they DO. All herbal medicines act pharmacologically and have the power to be therapeutic when used appropriately. However, anything that has the power to do good also has the potential to do harm when not used appropriately. Herbal remedies may cause adverse effects if taken in too high a dose or for too long, and may interact with prescribed conventional medication. Many herbal remedies contain chemicals which have anticoagulant properties, or which have anti-diabetic effects or which impact on the liver.
Expectant parents’ use of raspberry leaf tea for birth preparation, ginger for nausea, clary sage to enhance contractions, evening primrose oil to encourage cervical ripening and many more remedies must be sued appropriately in order to be safe. Midwives, doulas, obstetricians and GPs must take account of the fact that many women choose to self-administer natural remedies in the belief that, because they know drugs should generally be avoided and because herbal medicines are “natural” they must obviously be safe (or safer). Maternity care professionals should:
- ask women at booking about their use of herbal medicines and aromatherapy oils and document their answers
- ask again towards the end of the third trimester as they prepare for birth and in early labour to determine if they wish to use any natural remedies
- advise women on any other medication NOT to take herbal remedies unless prescribed by a fully qualified medical herbalist practitioner, to avoid interactions which may potentiate or inhibit conventional medicines
- advise women booked for elective Caesarean to DISCONTINUE all herbal remedies at least two weeks before surgery to minimise the risk of bleeding.
Caesarean Birth Is Not A Lifestyle Choice!
The alarming rate of Caesareans, not just in the UK but in other countries too, is of grave concern. There is, of course, a multitude of reasons, not least the incidence of greater pathology in many women, lack of midwives to help maintain physiological birth, obstetric and managerial fear of litigation from failure to act when labour deviates from physiological progress and changing social trends in relation to childbirth and parenting. In the UK we are fast approaching a 50% Caesarean rate; in private care in South Africa, it can be as high as 90%. I cannot believe that almost 100% of the birthing population has so many issues that operative delivery is the only answer. However, with induction of labour rates at 60% or more in some UK units, it is hardly surprising that the “cascade of intervention” leads to increasing indications to manage and control birth.
Sadly, as I’ve mentioned before, Caesarean has become so normalised that young couples accept it as something that is, without challenge, part of their childbearing journey. My almost-daughter-in-law said she hadn’t made her mind up yet about the possibility of having a Caesarean, as if it is a lifestyle choice (no criticism intended, Ninka – and having twins in South Africa definitely increases the possibility of needing one). But Caesarean is not something on which you can make a decision until the time comes, usually shortly before or during labour, that indicates its necessity. It’s not like choosing whether to buy a new car or become vegetarian or change jobs.
Many expectant parents seem to take it in their stride that Caesarean may be needed, but I doubt they fully understand its implications. Caesarean is a major operation, the risks of which have been belittled by its frequency. It carries risks for both mother and baby that are rarely discussed at length with parents, just that it is “necessary”, with little opportunity to opt out. It has long-term sequelae that are almost never mentioned, not least a longer postnatal recovery time and the possibility of poor parent-infant bonding. Having a Caesarean is like having your appendix out – and having a baby as well. It is difficult enough recovering from physiological vaginal birth and caring for a newborn baby which, for most, is a completely alien concept until it happens. There is no rule book for caring for newborns – you are just expected to get on with it, deal with the sleepless nights, the difficulties of learning to breastfeed, the change in relationships between partners and sometimes the loss of identity for those who may, even temporarily, be stay-at-home parents rather than the competent professionals they were before pregnancy.
Caesarean birth – and its little sidekick, induction – are at risk of changing the microbiome of the human race. Will women evolve with zips down their abdomens that can conveniently be opened to lift the baby out? Women’s bodies are intended to become pregnant and to give birth – billions of people for thousands of years have been doing just that. Yes, there are some who experience difficulties or even die in childbirth, but that is not usually dependent on operative delivery – of course, in some cases, surgery can be a lifesaver for either or both mother and baby. But whilst we continue to normalise such deplorable and increasing rates of what can only be termed operative assault on women’s bodies, the higher the rates will rise.
Expectant parents need the facts, applied to their individual situations rather than a blanket policy of reaching for the scalpel as if all other avenues have failed. They need to know the benefits and the risks of both having or not having a Caesarean. As a society we need to stop treating major surgery as a minor inconvenience. And professionally, we need to acknowledge that childbirth is a normal biopsychosocial life event that, in the main, progresses without complications and brings a baby into the world without drama or trauma. Caesarean is NOT a lifestyle choice!
Previous articles
Driving Forwards - Transition From Student To Midwife
Traditional Medicine Approval
Caesarean Birth Is Not A Lifestyle Choice!
Birth Of My Son
Paternalism in Maternity Care: The “Just In Case Syndrome”
Transitioning Role From Midwife To Grandmother
Midwifery, Aromatherapy and Natural Birth Under Attack Again
About Midwifery
Quality Of Education In Midwifery Complementary Therapies
Safe Maternity Care
