I have chosen Gibb's (1988) model of reflective practice to make sense of an emergency I experienced while on my first clinical placement in maternity care. For the purposes of this article and to maintain patient confidentiality, I will use the pseudonym Ann for the woman and the pseudonym Bill for her partner.
Description
Early in my first clinical placement as a student midwife, Ann presented to the labour ward for removal of a cervical cerclage. She was at 37 weeks' gestation and healthy. Bill did not accompany her. I introduced myself as a student midwife and we chatted. I also obtained her consent to observe the procedure. Ann had a relaxed demeanour and did not appear anxious.
Ann's vital signs were within the normal ranges, and she was therefore prepared for the procedure. After the procedure, Ann said that she felt weak and began to experience pains. Although she was unsure what was happening, Ann contacted Bill, as she felt that he should be present if she was in labour. Following an assessment by my preceptor midwife, assistance was summoned as it appeared that Ann's condition was deteriorating. When the clinical midwife manager, obstetrician and anaesthetist arrived, it was concluded that Ann required an emergency caesarean section.
When it was indicated that Ann's situation was serious and required emergency intervention, I felt immediate concern for her and her baby. I felt inadequate, unprepared and I didn't understand what was happening.
Ann was being prepared for immediate transfer to theatre when Bill arrived. The team was concentrating on Ann and after she was rushed into theatre, it fell to me to attend to Bill, who was worried and visibly shocked by his partner's situation. He began asking questions and wanted to know if he could be with Ann in theatre.
Wanting to assist Bill, I invited him to sit down. I introduced myself as a student midwife and explained I would find a senior midwife to come and talk to him. Although I felt shocked by the situation, I wanted to help Bill as much as I could and keep him informed. I was unfamiliar with the protocol in relation to the attendance of a partner in theatre in an emergency, so I sought out a senior midwife to talk to him. Once I knew Bill was being looked after and the situation explained to him, I began to focus on my own emotions.
I went to the staff bathroom and cried. I felt overwhelmed and worried for Ann and her baby, as I did not know the outcome for either of them and feared the worst.
After emerging from the bathroom, a senior midwife recognised I was upset and offered to help by finding out if she could get an update on Ann and her baby.
When Ann and her baby were stable, my preceptor midwife came to talk to me. Ann was in recovery and her baby had been transferred to the neonatal unit. I felt such relief, and my preceptor midwife stayed with me to make me feel supported.
As I drove home, I reflected on how quickly Ann's situation had deteriorated. Ann and her baby were in a stable condition and indications were good that they were going to be fine; however, this experience made me doubt if I was capable of coping with the expectation and responsibility of becoming a midwife.
The next day, I was fortunate enough to see Ann and observe her postnatal care. It was so wonderful to see that she was doing well and hear that she had been to visit her baby in the neonatal unit. Having expressed colostrum for her baby during the night, Ann was determined to continue, and I was entrusted with the task of delivering this to the neonatal unit.
This made me realise how dedicated and resilient Ann was, even though she herself had sustained a shock, and it must have been quite frightening and worrying for Ann when she was rushed unexpectedly into theatre. Observing Ann recovering from her difficult experience helped me to overcome the shock I experienced the previous day. It has made me think about birth trauma and the longer effect on women and their babies.
Evaluation
I now feel this incident was significant for several reasons.
Firstly, it reinforced fundamental aspects of care that had been addressed in my midwifery education: continuous observation of mother and baby; and that midwives should always hear, take note, and never ignore or underestimate what the mother says about how she feels. Ann said she felt weak, so something was happening to Ann and possibly her baby.
Secondly, I seriously questioned myself and my ability to look after the health and welfare of mother and baby. While understanding that I had much to learn, I was overwhelmed by the enormity of the responsibility that comes with becoming a midwife. I considered giving up, and the only thing that brought me back the next day was the urge to see that Ann and her baby were well.
I also saw how crucial support from midwives and preceptors is in ensuring the psychological safety of student midwives during clinical practice placements. The support offered by colleagues and family was important to me after this difficult experience. I was reminded by loved ones never to make rash decisions when you are feeling stressed or feeling vulnerable.
When I delivered the colostrum to the neonatal unit, I should have enquired about Ann's baby. I was so focused on myself and the task that I did not remember how important it was to let Ann know how her baby was doing. This should have taken priority over how I was feeling.
Looking back, I feel I handled the situation well when dealing with Bill. I sought guidance and operated within my scope of practice, and withheld my own emotions until Bill's needs were addressed.
Finally, I learnt that my lack of knowledge and understanding prevented me from making sense of the situation. I now feel I should have been more assertive and asked what was happening. As I did not, I was shocked by the situation and how quickly it had changed from normal to warranting emergency intervention.
Conclusion
My action plan involves being mindful of what I have learnt and implementing it in future. I learnt that you should always be ready for the unexpected: a woman's condition can change and deteriorate rapidly and unexpectedly. If faced with a similar situation, I hope I would feel more assertive and confident, and have the courage to ask more questions when appropriate. I hope to develop my communication in the future, so I can advocate for women.
I have learnt that the importance of observations for identifying the wellbeing of a woman and her baby cannot be overstated. I have also learnt that it is key to listen when a woman tells you how she feels. I saw how important it was not to neglect the needs of the partner in an emergency, and to learn the protocol on their attendance in theatre. I now know that negative experiences can teach us as much as positive experiences. Finally, I have learnt the importance of not giving up before you even begin.
Writing this article has been therapeutic and this is something I shall continue to do in my future practice.
According to Robb-Nicholson (2018) ‘Writing about thoughts and feelings that arise from a traumatic or stressful life experience — called expressive writing — may help some people cope with the emotional fallout of such events.’
With this knowledge and a more peaceful state of mind, I now sincerely hope to graduate as a midwife.