After all, Nepal has STUDENT MIDWIVES (Wahoo!). Independent midwifery still has a very unpredictable future. NHS has ever decreasing resources. I have ever increasing age. My parents are older, too. My grandchildren are frustratingly yet to manifest.... and so it felt time to place a few eggs in another basket. Best thing to do was to chill out, smell the coffee, plant nasturtiums, and make undies during lazy sunny mornings and candlelit tucked up nights, so that I might have more flexibility for the things I love....One of them being midwifery.
I’ve been scrolling through a dusty notepad for scant scribblings, and spending time over the photos I uploaded and then ignored. The memories aren’t quite ‘flooding back’, but I am piecing together events from March, and themes that now have a repeated importance.
|The very necessary midwifery art |
of 'eating cake'.
During the workshop, small groups considered how they would care and react in certain scenarios, decided when obstetric help was (and wasn’t) required and how they would make the transfers smooth. As a team, we then reviewed, discussed, and agreed changes to the Birth Centre admission criteria and guidelines. We also explored ways of encouraging women to birth in the new centre. Identifying a woman as ‘low risk’ in the antenatal period, and having midwives perform their antenatal checks, were just two suggestions.
|Stevie's fantastic homemade dungarees.|
As much as we try to organise our time BEFORE the trip, there is easily as much ‘ad hock’, and this has to be anticipated so that we can best provide materials for learning. Several evenings were spent in our ‘@home’ guest house in Jhamsikhel (fantastic place, great breakfast, comfy beds, lovely hosts), preparing for our next day, while delving into whatever savoury nibbles we’d harvested from the local ex-pat mini supermarket, and enjoying the ‘winding down’ hastened by a not-so-chilled gin and tonic.
We even took time for a day out. We were tired and although we were ten times more tired after hiking for hours from Nagarkot, our spirits were lifted by the fresh air, amazing views and sense of freedom. How could we not feel a spiritual over flow, when we had a guide called 'Santa'.
We all had lunch and drinks in the cafe close to the hospital, and we asked the students and teachers for their thoughts of how the birth had gone. We asked how they felt, what they thought could have been better, how the drummed-in practice of delayed cord clamping doesn’t sit alongside cutting a nuchal cord before the baby is born. We were thrilled when the students began to ask questions about not just nuchal cord, but the lack of mobility for the woman, about how the woman herself might have felt about the experience (having had two home births already), and about how she might have felt when they took her limp baby out of the room.
- · One student arrived on labour ward for her next shift, and told ALL of the staff she would be closing any curtains she found open, and explained why she felt this was important. We were pleased to hear she had the support to carry this plan out.
- · A nurse midwife admitted that our discussions prompted her to introduce herself, for the first time ever, to a woman she supported in labour.
- · A reading list was provided, along with a varied list of research sites. A NAMS student Facebook page was also set up to held share useful links and experiences.
- · During role play, we explored the thoughts and feeling of mother, student midwife, and staff nurse. This was an interesting and extremely valuable exercise. Fear, embarrassment, coercion and sometimes bullying felt by all three for different reasons, and all too negative for what should be a nurturing, ‘with woman’ space. But it created some understanding of the different challenges.
- · Individual research topics chosen by each student, to explore evidence and choices for clinical practice. Management of.......suturing and perineal repair, normal progress and latent phase, nuchal cord, delayed clamping, mobilisation,.....were all topics the students chose to question and research. These findings were printed, and shared with the group. It was the plan to hijack a small part of labour room wall, or provide a folder, so that this information could be shared with the staff and obstetric team. How else are these students going to respectfully, and healthily, challenge current practice? Essential reflection was encouraged by Maya, who bought each student a reflective journal.
- · How to research, and developing curiosity for evidence based practice.
- · Leadership and communication skills.
- · Decision making, and work place dynamics
- · Reflection
- · What it means to be a midwife, and identifying barriers to successfully moving student midwives into midwifery practice.
|The art of communication!|
It appears that varied placements would be beneficial to the students. The APS Birth Centre in Kalanki, although not having many births, has an immeasurable wealth of support and expertise in the nurse midwives working there. Asha, Amala, and not least Rashmi Rajopadhyaya are as close to my kind of midwifery as I have ever known in Nepal.They have a beautiful 'way' about them, and could provide valuable training to the students. They are perfect role models.