Reflection on Midwifery Placement

Reflection on Midwifery Placement

This essay is a personal reflection on midwifery placement. Study it to gain insights on the do’s and dont’s in midwifery placement.

Introduction to Reflection on Midwifery Placement

What is the significance of the reflective cycle?

Midwifery is a complicated profession, which may lead to blunders, particularly among students on their first placement. In retrospect, based on the auscultation of the fetal heart rate in two different sessions, I will be commenting on my flaws and triumphs. Although acknowledging and dealing with errors may be tough, it is critical for midwives to observe and reflect on previous experiences in order to improve.

To do so, I’ll monitor my job as a student midwife seeking and acquiring key prenatal skills using Gibbs’ Reflective Cycle (1998). Aside from being a clear and effective model, the reflective cycle also helps you to optimize your learning opportunities and prepares you for a future job as a registered midwife. As a consequence, it helps establish “professional competence and confidence” and avoids making the same errors (The Code 2015, Share your skills, knowledge and experience for the benefit of people receiving care and your colleagues).

What are the steps in Gibb’s reflective model?

Gibbs’ reflective model is effective because it follows numerous precise procedures. Description, sentiments, assessment, analysis, conclusion, and action plans are the six phases of the model. For the purpose of reflection I’ll use a pseudonym for the first client “Jane,” the second client “Rose,” the midwife “Anne,” and the Trust “Trust A” to comply with the NMC code (2015, respect people’s rights to privacy and confidentiality). The clients, midwife and trust must respect their right to privacy and adhere to the confidentiality rules.

Reflection

Description: What Took Place?

My first job was at Trust A, where I worked in an antenatal clinic. During my job, I met Anne, one of Trust A’s working midwives. She informed me that I would be working under her direction. Anne then continued to demonstrate how a prenatal visit was arranged, allowing me to complete a 38-week session for a client named Jane (a healthy woman in her mid-twenties who was having her first baby).

Because her pregnancy was straightforward, she was covered by the NICE (2008, uncomplicated pregnancy recommendations), which specify that midwives should monitor blood pressure, collect a urine sample, measure fundal height, and talk to the client about any concerns they may have.

Soon after, I introduced myself to Jane and explained who I was and why I was attending her maternity visit, assuring her that I was under Anne’s supervision since she looked concerned about having a student. I then proceeded to start the procedures in the session, ensuring that blood pressure was precisely checked since it is a high-risk factor for catastrophic maternal and fetal issues (NICE 2008).

I measured Jane’s blood pressure and used a dipstick to test her urine sample for her 38-week visit. Jane’s pregnancy is healthy, as shown by her blood pressure (120/80 mmHg) and the absence of leukocytes, protein, ketones, and glucose in her urine sample. I conveyed her findings to her before palpating Jane’s stomach to determine her fundal height.

Jane had requested if she could hear her baby’s heart rate audibly at this time, something I had only tried on a practice model using a Pinard trumpet. According to NICE (2008, fetal growth and wellbeing), “it is not recommended to listen to the fetal heart rate as it is unlikely to have any predictive value but can be done to reassure the mother,” so Anne told me that it was fine and that I could palpate Jane’s stomach further to feel for the fetus’ position.

You must first palpate the client’s tummy to determine the baby’s location before you can hear the fetal heart rate. After you’ve determined this, take a minute to listen to the baby’s heartbeat via their shoulder. As a student midwife, you should check to see whether the heart rate is steady and within the normal range of 120-160 beats per minute (Royal College of Midwives, 2008). To comply with Trust A’s requirements, this should only be done for pregnancies that are more than 20 weeks along, and it should be documented in her notes and explained to the client.

Sentiments: What Were You Thinking and Feeling?

Despite Anne’s assistance, it was still difficult for me to discern between the fetus’s head and anus. This was partly due to the fact that the abdominal palpation models I used in practice were rigid and lacked realistic elements like amniotic fluid and varying BMI ranges. In addition, the fetus was moving about a lot and shifting positions. As a result, positioning the Pinard stethoscope over the baby’s shoulder proved challenging.

Furthermore, I did not want to upset Jane during palpating, therefore I did not apply enough pressure to the stomach to distinguish the distinctions between the head and anus. These variables together made me feel quite ashamed since I didn’t feel like I knew what I was doing. Furthermore, I noticed myself shifting and altering my perspective about the location of the fetus on a regular basis.

As a consequence, I positioned the Pinard incorrectly, and when asked whether I could hear the fetal heart rate, I couldn’t since I positioned the Pinard incorrectly. I then proceeded to inform Anne that the heart rate had been detected. As a result, I positioned the sonic aid incorrectly and picked up the placenta instead. As a result, Anne made the decision to take over.

She highlighted the variations in sound and how to tell the difference between the placenta and heart rate during this time. She also put my hands on the fetus’s head and anus to assist me to understand the anatomical changes. As a result, I met with RCN Guidance for Mentors of Nursing and Midwifery Students (2017), who provided me with “positive criticism, with ideas on how to improve to encourage development.”

Assessment: What Was Good and Bad about the Experience?

Anne wanted me to get more experience as a result, so she invited me to join her second meeting with a customer named Rose (gravida 3). Rose, too, was in good health, with a BMI of 24 and normal blood pressure. Anne had informed her that the auscultation would be performed by me. I was originally worried, but thanks to Anne’s lesson and advice, I was able to quickly detect the fetal heart rate using the sonic aid doppler. This gave me greater confidence and made me more willing to participate in additional auscultations.

This experience has proven to be useful in a variety of ways. One is demonstrating that as a student, I will not always know the answer, but I must always ensure that I learn from my failures and utilize these experiences for educational reasons. Moreover, this experience has taught me what is considered typical throughout pregnancy. As a result, I’m able to tell what’s healthy during pregnancy. For example, in Rose’s case, I was able to participate in and listen to a healthy fetal heart rate, which taught me that a healthy heart rate is between 120 and 160 beats per minute.

In Jane’s instance, the fetus’s movement in response to my action of palpating the stomach suggested that the baby was conscious and active. However, there are certain disadvantages. To begin with, I was disappointed in myself for failing to finish the visit and personally satisfy Jane’s desire to listen to the fetal heart rate. In addition, I was concerned that I may have increased Jane’s tension and anxiety by requiring Anne to intervene and assist me. As a first-time mother, this may have caused her to assume that anything was wrong with her child.

Analysis: What Sense Can You Make of the Situation?

My experiences taught me that in order to develop my student abilities, I will need to attend more prenatal checkups in order to learn and obtain a broader range of skills. When understanding what to anticipate during appointments, this is very crucial. For example, the NHS dedicates the breakdown of prenatal sessions to their patients in order to satisfy the NHS ideals of “committing quality of care” (NHS England values).

Cooperation and Collaboration in Practice
Reflection on Midwifery Placement

Pregnant women and their families should be informed about the care they will get. Furthermore, these experiences have taught me the value of communication and collaboration in delivering care. This may be useful if Anne worked with me to teach me how to do auscultation correctly. In Jane’s scenario, I might have utilized communication by explaining why Anne had to have the auscultation instead of me; alternatively, I believed she would understand that as a student, I could want assistance. This may have made Jane feel more at ease and reduced the amount of misunderstanding.

Conclusion: What Else Could you Have Done?

After doing some research on auscultation, I discovered that home dopplers are not advised by midwives. This is because they may add to the stress by failing to detect the fetus’ heart rate or mistaking it for their own. This is owing to their lack of professional training on how to utilize them. Additionally, the client may assume they do not need medical assistance as a result of this.

Present moms, on the other hand, trust dopplers as a way of assuming fetus’s well-being when usual movements aren’t noticed, according to accounts published on Kicks. As a prospective registered midwife, I’ll have to teach clients the dangers of using home sonic aid. In addition, the Nursing and Midwifery Council requires that I “practice in accordance with the greatest available evidence” (The code,2015).

Action Plan: If it arose again, what would you do?

To sum up, I feel I would have treated things differently if the same situation arose. One aspect of this situation that I would modify is to make sure I properly explain to the client that if I needed any assistance, I would notify the midwife who was working with me. This may have been partially accomplished by providing a booklet outlining the function of a student midwife since I believe Jane felt compelled to attend her appointment with me as a student midwife by both myself and Anne. In addition, I would have like to meet with Jane for a longer period of time. This would have enabled me to read through her pregnancy records in more detail and obtain further insight during her pregnancy.

Reflection on Midwifery Placement
Action Plan

Looking at Jane’s ethnic origin, for example, the Black Caribbean race had the greatest rate of preterm deliveries (10%). (national office of statistics,2013). This would have given me a better understanding of how midwives prepare for women in these categories like Jane. For example, talking about the phases of labour and how the trust works. Furthermore, I have learned that in future prenatal sessions, I should be more confident and prepared so that patients feel at ease and that I am aware of my responsibilities as a student. Finally, meeting the professional criteria of the Nursing and Midwifery Council to operate “as a role model of professional conduct” (The Code, 2015).

Frequently Asked Questions (FAQs)

1. Why is the reflective cycle important?

Aside from being a clear and effective model, the reflective cycle also helps you to optimize your learning opportunities and prepares you for a future job as a registered midwife. As a consequence, it helps establish “professional competence and confidence” and avoids making the same errors (The Code 2015, Share your skills, knowledge and experience for the benefit of people receiving care and your colleagues).

2. What are the stages of Gibbs’s reflective cycle?

Gibbs’ reflective model is effective because it follows numerous precise procedures. Description, sentiments, assessment, analysis, conclusion, and action plans are the six phases of the model.

3. How does a nurse measure heart rate?

You must first palpate the client’s tummy to determine the baby’s location before you can hear the fetal heart rate. After you’ve determined this, take a minute to listen to the baby’s heartbeat via their shoulder. As a student midwife, you should check to see whether the heart rate is steady and within the normal range of 120-160 beats per minute (Royal College of Midwives, 2008). To comply with Trust A’s requirements, this should only be done for pregnancies that are more than 20 weeks along, and it should be documented in her notes and explained to the client.

References

  • [i] Gibbs, G. (1998). Learning by doing: a guide to teaching and learning methods. Oxford: Further Education Unit, Oxford Polytechnic.
  • The Code professional standards practice and behaviour for nurses, midwives and nursing associates (2015), Practice effectively, share your skills, knowledge and experience for the benefit of people receiving care and your colleagues.
  • The Code professional standards practice and behaviour for nurses, midwives and nursing associates (2015), Priorities People, Respect people’s rights to privacy and confidentiality.
  • National Institute for Health and Care Excellence (2008) Antenatal care for uncomplicated pregnancies, 38 weeks, Accessible on- https://www.nice.org.uk/guidance/cg62 Date retrieved (16/22).
  • National Institute for Health and Care Excellence (2008), Routine care for the healthy pregnant woman.
  • National Institute for Health and Care Excellence (2008), Antenatal care for uncomplicated pregnancies, Fetal growth and well-being 1.10.7.
  • Royal College of Midwives (2008). How to perform an abdominal examination, Accessible on- https://www.rcm.org.uk/news-views-and-analysis/analysis/how-to%E2%80%A6-perform-an-abdominal-examination, Date retrieved (16/22).
  • The Royal Nursing Guidance for Mentors of Nursing and Midwifery Students (2017), The Role of mentor.
  • NHS England (2016), Your pregnancy and baby guide, 38 weeks, Accessible on- https://www.nhs.uk/conditions/pregnancy-and-baby/, Date retrieved (16/22)
  • The NHS Constitution for England, NHS Values, Commitment to quality of care, Accessible on- https://www.hee.nhs.uk/about/our-values, Date retrieved (16/22).
  • The Code professional standards practice and behaviour for nurses, midwives and nursing associates (2015), Practice effectively, always practice in line with the best available evidence.
  • The National Office of Statistics (2013), Births by term and ethnicity, England and Wales, Accessible on- https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/livebirths/bulletins/birthsummarytablesenglandandwales/2015-07-15, Date retrieved (16/22)
  • The Code professional standards practice and behaviour for nurses, midwives and nursing associates (2015), Promote professionalism and trust, 20.8, Act as a role model of professional behaviour.

Reflection on Midwifery Placement

 

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