One year in... 'P' plates are off
In the middle of a night shift a couple of weeks ago a doctor asked me a question that seemed far beyond my reach. I grabbed my badge, ensconsed in its yellow holder, and waved it around, professing that I was far too junior to even guess at the answer. The doctor thought I was cuckoo and, in my defence, it was 4am and I'd been presented with an emergency situation and had had a scant handover.
Fast forward a few weeks and I've had the yelllow badge holder replaced by a red one. In our Trust, this is the equivalent of pulling up your big girl pants. NQMs and others who are new to the Trust are given a yellow badge holder to mark us out as newbies. It's a great safety net in a sea of experienced professionals who may otherwise not know you're new and terrified, and may instead assume you're just slow and incompetent. The yellow badge holder is akin to having a set of 'P' plates on your first car as you realise that you've been deemed adequately qualified to go it alone (ish).
My terror at being given the red badge is matched by the pride I'm feeling at having survived this year with fewer tears than I'd anticipated. There's also relief and disbelief that another year has passed and there's happiness, actual genuine happiness at my lot in life. The mental health demons are lurking in the shadows, and the bad days are still petrifying, but now they are even fewer and farther between than a year ago. There's also excitement at the seemingly endless opportunities at work.
The absolute highlight of my year, and the backdrop to the last twelve months, have been the women I've met. They've all made an impact on my first year, but two have stood out even more than the rest. Both had had babies before and had had traumatic births. I got to look after both of these women throughout their pregnancy, I looked after them in labour and, for various reasons, I literally caught their babies as they were born. I got to wrap both women in a gigantic hug when they had a wobble during labour, and I was supported by midwife colleagues that I consider close personal friends as those babies entered the world. The first woman had sailed through pregnancy, but her baby had harboured a secret that caused a shift in everyone's perception of 'normal'. I got to see both of these women and babies at home to discharge them. Continuity of carer was hugely positive for both women, and it made the buzz I felt deeper and even more heartfelt.
Apart from the incredible women I've cared for, I think I can probably break down most of my year into four sections: decision-making; team; tribe; self. In no particular order.
Decision-making
This year I've revisited the work I did as a third-year student midwife on decision-making. I split my essay in two, revised and reworked it until I felt I knew it off by heart. I had it published in The Practising Midwife, and I looked back at the model for decision-making that I'd proposed as a student. I try to keep that in my mind when I'm at work, bringing together evidence from all available sources: me, other healthcare professionals, guidelines, research and (most importantly) the woman herself. I also try to think about what's going on in the background: how busy is the ward, who's working, what's the bed status? What are the perceived benefits and risks of the available options, does the women know all of the options? What does the woman want? Thinking like this means decision-making is far less clear cut than it might otherwise be, but it's more realistic and places the woman at the centre, which is how it should be.
Team
The team's impact has been huge and has determined, on occasion, whether I've had a positive shift, or not. There's always a senior midwife on shift, and the way in which they practise, and their confidence in you, can affect the workload you're given. The team is everything. I've had awful shifts that have threatened to destroy me, but at the end there's been a hug or a shoulder to cry on. A horrendous shift can be salvaged by a cracking team that's right beside you all the way. Similarly, one destructive person who utters something derisory (or just plain mean) in your direction can ruin a perfectly good day. As a group of NQMs, we have a WhatsApp group and all bounce ideas and queries off of each other, some days it's nice to know you're not completely alone and there's someone as scared as you are.
Tribe
Oh my goodness, the tribe of absolute goddesses who have got me to this point all deserve medals. I may in fact make them medals because they truly deserve them. I've got the most incredible safety net of life gurus who listen to me rant, encourage me to keep going with whatever crazy project I've got under way, who challenge me daily and make me think outside the box. These women unleash my love for midwifery, my determination to be better and do better, my sense of injustice at certain wrongs. Without the tribe of women who have now spent years wiping my tears away and hugging away the pain, I'd be in a very different place to where I am now. Without them, I'd probably have cried a lot more, been a lot more lonely, and felt a lot less supported this year.
Self
I've spent a lot of this year wondering who the hell I am, what type of midwife I am, and what I value. I question what I would sacrifice in my work, if I had to. The answer is usually lunch and/or passing urine. I won't sacrifice kindness or informed decision-making or woman-centred care that is full of warmth and love. At various points this year, I've felt as though I might drown in the system. I've spent some shifts feeling as though I've got lost, forced to go with the flow at the risk of compromising the care I give and my integrity. As students, values-based education kept us on track and made us reflect on who we were and what type of midwife we were becoming. There's not the same compulsion to do this as an NQM as we don't have regular study sessions that shine a light on our own practice. We have to do it ourselves and keep ourselves on track. Today I've had my annual review, and I've come away thinking about whether I'm anywhere near the midwife I wanted to be. We also talked about achievement and ambition, both of which I am reluctant to admit to. If I admit to ambition, and voice all the weird and wonderful aspirations I've got swimming around in my head, I wonder whether I'll be laughed at or if someone will raise their eyebrows and tell me I'm not good enough. In terms of achievement, it can be difficult to see your own successes when some days you still feel as though you're drowning and your biggest achievement is managing to get out the door with everyone in one piece. I don't have a five-year plan, I'm not even sure what I hope to achieve beyond being a really good midwife. When I think back over the past year, some of the best times I've had were when I've felt like the midwife I aspired to become, and some of the worst times were when I felt like I was so far from that midwife that I didn't recognise myself. Hopefully with experience I will become even more confident in being that midwife I wanted to be, and will be bold in fighting against anything that compromises that. I am constantly asking whether this is who I wanted to become, and I've had some lovely feedback from women and colleagues so maybe this is OK.
I've absolutely loved the past year, I've laughed more than I've cried, I've got a tribe of brilliant women around me that I definitely couldn't do without, I've had a couple of papers published, I've been to some amazing study days, I know more than I knew last year and I've refined my skills. Honestly, what more could I ask for?
