Birth Centres are cool
So i've officially finished my shifts at the birth centre 😔 i'm gutted! I've had such a fantastic experience and learnt so much, the incredible midwives have taught me so much, i'm in awe of the women and saw true calm, physiological, undisturbed births.
The birth centre is entirely different to anything i've ever experienced, and it's not till you go, you realise how birth CAN be. The births I had the privilege of being part of were some of the calmest i'd ever seen, no mad rush, no big trolleys with sterile delivery packs, and genuinely undisturbed first golden hours. No pressure for vitamin K or a weight and most stay over night in the birth centre, with partners!
Around half of the rooms have pools in, and generally families are moved into the room directly opposite postnatally if they opted for a pool room for labour/birth. NONE, I repeat, NONE have beds! They have sofas with pull out beds for postnatal stays, but no 'labour' beds at all in the room. One (maybe 2?) has a bunch of apparatus like a birth stool, with a seat behind for support and a birth rope etc etc and they also have an assessment room for labourers wishing to be assessed, or who think their membranes have ruptured. As a caveat, they do have a transfer trolley for emergencies and a labour bed thats brought in if a woman opts for perineal suturing.
All equipment is as a 'normal' labour room, but is hidden behind doors along the wall. There's resuscitaire's that fold into the wall and the usual, suction, entonox sockets etc but the doors open out and then can be pushed in so if you needed, all equipment can be accessed without the hassle of the doors.
Dare I say, there were 'Q' parts of my shift so I did manage to find out a lot about their policies and procedures, look at feedback from families, and find out how the midwives enjoyed working there. Most of their policies are similar to what i'm familiar with, but with some big differences. The biggest difference is probably their inductions, women are offered induction at 41 weeks and if they don't need a syntocinon drip can still access the facilities there. Their paperwork is also really different, I expected it to be much more informal but actually they have to fill out a braden score and nutrition scoring etc which is...odd?
Perhaps the most interesting is the birth centre offer water papules for pain relief! The indication is back pain, most often seen in latent labour with an OP (back to back) babe, and can be used in labour as well. I was fortunate to see the procedure a few times, while there were some screams for a few seconds, the women reported instant relief from their back pain. There is no good quality evidence for water papules, but the midwives have good anecdotal evidence and the few I saw all worked well. If you're interested in the procedure, its basically the same as this, the diagram is particularly useful on this to visualise where the injections go. They explained to me to locate the rhombus of michaelis which is a diamond shape and do the injections in a square over that with the 'top' two slightly out. The juries still out on why water papules seem to work, but is thought to be either the gate theory of pain, or just distraction/placebo.
I'm really keen to do a blog post on the evidence for this!
I had some spare time to chat to the midwives about the what the training is like and was really surprised by how different it is. Mostly as the students training at this hospital don't have as much in their programme, which stresses me the thought of doing it all as a preceptor! As part of our training we do phlebotomy, cannulation, giving drugs, IV fluids and management, blood transfusion training (for anti D), perineal suturing, and the NIPE. The students aren't able to do any of those things and its all part of the preceptor package at the trust. Interestingly (I think i'm overusing that now), their band 5 training is very detailed with midwives expected to and trained to do presentation scans which are done as part of every induction, and also bladder scanning to assess urine in the bladder. I've never came across this before, and would be interested in hearing and looking for different perspectives. On the one hand it allows for better continuity of carer and less 'new' people to meet, but is it really part of the midwives role? How much else will the midwife expand into, there's also talk of growth scans being done by midwives...
On the whole, I had a fantastic week and felt I got some of my midwifery juju faith back. Onto labour ward this week and will report back!
The birth centre is entirely different to anything i've ever experienced, and it's not till you go, you realise how birth CAN be. The births I had the privilege of being part of were some of the calmest i'd ever seen, no mad rush, no big trolleys with sterile delivery packs, and genuinely undisturbed first golden hours. No pressure for vitamin K or a weight and most stay over night in the birth centre, with partners!
Around half of the rooms have pools in, and generally families are moved into the room directly opposite postnatally if they opted for a pool room for labour/birth. NONE, I repeat, NONE have beds! They have sofas with pull out beds for postnatal stays, but no 'labour' beds at all in the room. One (maybe 2?) has a bunch of apparatus like a birth stool, with a seat behind for support and a birth rope etc etc and they also have an assessment room for labourers wishing to be assessed, or who think their membranes have ruptured. As a caveat, they do have a transfer trolley for emergencies and a labour bed thats brought in if a woman opts for perineal suturing.
All equipment is as a 'normal' labour room, but is hidden behind doors along the wall. There's resuscitaire's that fold into the wall and the usual, suction, entonox sockets etc but the doors open out and then can be pushed in so if you needed, all equipment can be accessed without the hassle of the doors.
Dare I say, there were 'Q' parts of my shift so I did manage to find out a lot about their policies and procedures, look at feedback from families, and find out how the midwives enjoyed working there. Most of their policies are similar to what i'm familiar with, but with some big differences. The biggest difference is probably their inductions, women are offered induction at 41 weeks and if they don't need a syntocinon drip can still access the facilities there. Their paperwork is also really different, I expected it to be much more informal but actually they have to fill out a braden score and nutrition scoring etc which is...odd?
Perhaps the most interesting is the birth centre offer water papules for pain relief! The indication is back pain, most often seen in latent labour with an OP (back to back) babe, and can be used in labour as well. I was fortunate to see the procedure a few times, while there were some screams for a few seconds, the women reported instant relief from their back pain. There is no good quality evidence for water papules, but the midwives have good anecdotal evidence and the few I saw all worked well. If you're interested in the procedure, its basically the same as this, the diagram is particularly useful on this to visualise where the injections go. They explained to me to locate the rhombus of michaelis which is a diamond shape and do the injections in a square over that with the 'top' two slightly out. The juries still out on why water papules seem to work, but is thought to be either the gate theory of pain, or just distraction/placebo.
I'm really keen to do a blog post on the evidence for this!
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| Visual of location for water papules source |
I had some spare time to chat to the midwives about the what the training is like and was really surprised by how different it is. Mostly as the students training at this hospital don't have as much in their programme, which stresses me the thought of doing it all as a preceptor! As part of our training we do phlebotomy, cannulation, giving drugs, IV fluids and management, blood transfusion training (for anti D), perineal suturing, and the NIPE. The students aren't able to do any of those things and its all part of the preceptor package at the trust. Interestingly (I think i'm overusing that now), their band 5 training is very detailed with midwives expected to and trained to do presentation scans which are done as part of every induction, and also bladder scanning to assess urine in the bladder. I've never came across this before, and would be interested in hearing and looking for different perspectives. On the one hand it allows for better continuity of carer and less 'new' people to meet, but is it really part of the midwives role? How much else will the midwife expand into, there's also talk of growth scans being done by midwives...
On the whole, I had a fantastic week and felt I got some of my midwifery juju faith back. Onto labour ward this week and will report back!
Well done Charlotte for getting all your experiences into print, it sounds like your elective has been amazing. What a variety of experiences you have had, so good that you have shared this with others too. I know you will be able to take on all of this new information and use it to shape your future journey. Sheona ��
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