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July 2015

Dear Newly Qualified Midwife,

This is the time of year when many university students are completing their degrees and having graduation ceremonies. Celebrating their achievement with family and friends and looking forward to putting what they have learned into practice.

For newly qualified midwives this can be a daunting time. Often they have not been able to obtain a midwifery post in the hospital/trust where they have experience. They have had to fight with their counterparts for jobs all over the country. Often they are disappointed, as they want to work where they want to live.  Many take short term contracts in order to get a foot in the door in their local unit.

This is not a bad strategy and often results in long term employment. So if this is your only option take it and show them what you can do. Make an impression with your practice and any unit will be pleased to have you.

Others will be lost along the wayside, not able to find a job where they would like. They often seek other employment outside of Midwifery. This could be Health Visiting or something completely outside of the box. I believe this is a waste of education and is a loss to the midwifery numbers available for work across the country.  Why train midwives if we cannot use them?

But this blog is really aimed at those midwives who have found a post and are looking forward to their new role.  Thankfully the NHS has systems of preceptorship to help you through your first six months.  My advice would be to use this period well.  Don’t use it as an extension of your education. Use it to try out your wings as a new midwife.  Work on your own decision making skills.  Ask for help and others opinions but know you are making professional decisions that you want to make.

Your Team

It is very easy as a newly qualified midwife to just try and “fit in”.  Maternity units are powerful places with strong characters and often cultures that had been set over many years.  You do indeed have to work with your colleagues. My advice anticipate what they might need and do offer help.  Show yourself as a useful part of the team.  Accepting your naivety and “knowing your place” but at the same time developing your own character and the type of midwife you want to be on a daily basis.

During your education you will have worked with midwives whose work you wish to emulate. You loved the way they did this or that. You saw the effect on the woman and her family and you want to be like him/her.  But you will have also witnessed care that may have left a lot to be desired. Communication or actions that you certainly do not want to follow in your new professional practise.  This will continue to happen as you gain experience and knowledge in your qualified role. Please remember however, that all midwives have something to teach you, even if it is that you are not going to do something “like that” in your own practice.

Responsibility

Suddenly however the weight of responsibility may sit heavily on your shoulders. Yes you are right, you are now individually, professionally. responsible for what happens when you are caring for mothers and babies. The “buck” stops with you.  No more can you rely on your mentor to check what you do, be there for you when you don’t know, help you when you are struggling.  But please take heart. We have all being there and understand, so use your colleagues when you need to. Please don’t feel afraid to ask.

Often the co-ordinator of shift might not be available when you need them.  They may be busy with other women in other rooms.  Use your colleagues. They are more experienced and will give you advice.  Midwives who tend to work alone are not safe. Midwives who work with others build confidence in their practice and consistency in their approach to care, so that the whole maternity unit/birth centre benefits.

Many of you will work in units that are Obstetric Led. Team working with Obstetric/Paediatric colleagues is important to ensure the woman and her baby obtain the care that they need. This could mean surveillance during pregnancy or emergency assistance at birth. Take time to get to know them and they you.

Midwives who don’t ask for help or opinion, are judged as being mavericks and make people nervous. Even very experienced midwives will ask others to comment on how they feel about a case, a blood result, a safeguarding situation even a vaginal examination. Many midwives will have worked together for years and know who they trust and who they don’t.  Be confident in your practise, but share your skills and knowledge. Share that you know what you are doing. Try not to be influenced by gossip and judge others on your own knowledge and experience.

Litigation

Sadly this is the world we live in.  As a midwife, especially if you work for some years will inevitably be involved with loss.  These are emotional times for families and of course they need to know that everything was done to prevent that loss either fetal, maternal or neonatal.

Accept this it is part of your role, to know that your care might be investigated from time to time and others may have different opinions on what was done.  Thankfully we are moving away from identifying individuals and moving more to looking at cultures and systems that may have led to the care that was provided.  This is really the only way maternity services can move forward to ensure such events are minimised.  Please note however that your documentation needs to be as good as it can be.  This does not mean neat and tidy necessarily but should show what you thought and why you made a particular decision contemporaneously as events took place.

Loss and life

Yes, you will get to care for more women in difficult circumstances now. But providing care to families at this time can be incredibly rewarding.  Supporting them through the best pregnancy and birth that they can have, despite the outcome being a sad one.  More and more work is being done in maternity care to support women during the bereavement process.

You are correct however that mostly pregnancy, labour and birth is a happy event. Midwives are privileged to be there at the first minute of someone else’s life.

You can play a part in helping women understand their bodies as they change antenataly and help them understand the importance of fetal movements and healthy eating. You can offer support and guidance about how to plan their place of birth and the tools and actions they might use during labour.

You may work with mothers in difficult circumstances, poverty, substance abuse, mental health, domestic violence.  You can play a real part in helping them achieve as positive a pregnancy and birth as possible and enable them to access help and long term support to give them and their baby a better future.

For all those newly qualified midwives going out into the world. Remember you are the future of midwifery.  Women have been helping other women to give birth for generations. Unqualified women still attend others in all parts of the world.  We are lucky in that the United Kingdom has excellent midwifery education and excellent maternity care provided.  You are in a good place. Go out and share your knowledge and skills and help mothers and families to the best of your ability.

All my best wishes in your new role. It is good to know that the future is in good hands.

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