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Here is your role as a NHS Midwife …… my suggestions

Here is your role as a Midwife in the NHS

  1. learn about the guidelines and policies at your place of work .
  2. Complete your mandatory training come hell or high water despite not being given allocated time to do so
  3. Get up in the morning / the evening travel to work be on time , report for duty .
  4. Push yourself each day to be a little better than you were the day before
  5. When you are upset about something try and soldier on because everyone else is in the same situation
  6. Support new midwives and future midwives – be a role model as everyone takes note of the way you behave at work (don’t for a minute think that they don’t !)
  7. Practice 1-5 each day now add in caring  for women families ,getting along with your colleagues , getting a break everyday and leaving your shift on time

Stick to …….

Wait a minute Wait a minute.   REWIND REWIND REWIND ……

  1. Get on Twitter and join the community of midwives there sharing evidence based practice
  2. Immerse yourself in the computer system that will give you stats for your own practice (as well as others ) and look at how to improve them.
  3. Practice a daily ritual that is kind to you – respect yourself and your body clock get fresh air and sunlight each day pre or post shift Watch this programme “The body clock- what makes us tick?” on the relevance light (measured in LUX) has on the body clock and circadian rhythm .
  4. When you are happy and /or upset about something try and reflect on it through writing or recordings and seek advice from your occupational Health dept. Team up with another midwife from a different NHS trust and see yourselves as support buddies , reflect together on what helps you at work and learn new positive ways of staying focused and compassionate in your midwifery work
  5. Be professional in all you do through the your words / deeds / behaviour towards others including the way you communicate on your break – integrity is a huge part of being a Midwife . The words you speak in the office / break room and out of work are like a fragrance upon you when you are caring / mentoring and teaching.
  6. Having a break is set into statutory employment law – it ain’t no privilege – so plan your own break and get away from your work environment eat your food in a quiet place, do three minutes of mindfulness – your break time belongs to YOU – if you can’t take the full amount at once try breaking into bite sized amounts so you can eat / / rest / reflect but perhaps on three short breaks instead of one long one -also support your colleagues to do the same
  7. If you are a manager/head of midwifery consider how you get your lunch and try to be a role model – go and eat with the staff you manage – you might find out more through this than leading meetings
  8. If you hear a group talking about another colleague in a derogatory manner then challenge them why are they discussing someone who isn’t there to defend themself, then ask them to stop – if you choose to ignore this kind of behaviour you are condoning it
  • Always remember you are not at work to socialise but to put the women and families at the heart of what you do . If you find yourself questioning a colleagues work style – ask yourself this “is that colleague putting the woman first ? “
  • You’ll probably find the answer for the style of work is because the answer is YES!! So if you have a colleague who may seems to take a little longer with women or isn’t seen in the office much try and shadow them – sometimes taking some extra time can be more cost effective – a long chat pre discharge can arm women with knowledge about how to recognise SEPSIS , help her to recognise when her baby is feeding well or not and also to pickup POSTNATAL DEPRESSION earlier .
  • These are just my thoughts and it’s my first blog for ages so I hope you enjoy it
  • Be kind ❤️
  • Yours in midwifery love
  • Jenny ❤️©️2018
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    Postnatal transfer to the ward from labour ward – my thoughts

    A DM (Direct Message) on Twitter is a message you receive from someone that no one else can see – apart from the people included in the message.

    In the past four weeks I have received 7 DMs from a mixture of midwives , future midwives and women all with the same subject matter . This subject is mainly about ‘who decides when a woman is transferred from the room she gave birth in to the postnatal ward’ This seems to be a hot topic at the moment as the variation in time from birth to transfer is huge – especially when comparing Caesarean birth transfers to other birth transfers (and it might surprise you to know that the variation in birth to transfer time to the ward for women who have Caesarean birth is also vast – some units care for these women on the labour ward until their spinal has worn off , some units transfer to ward within a short time in recovery which leads me to question that support with breastfeeding must be patchy).

    Just the other week at Salford University Midwifery Society Conference ‘Transforming Birth’ click HERE for a summary of the day – I asked a question to the audience “are you, as future midwives pressured to move women to the postnatal ward (after they have birthed their babies) faster than the women themselves would like or you as a future autonomous practitioner would like ?” The result was that over 80% said YES.

    Do we as Midwives consider our own autonomy enough when we are working ? In order to give the woman a sense of feeling cared for and nurtured individualised, compassionate, holistic midwifery is paramount . Each woman is different- some may prefer a rapid transfer , others may not . Some women may need extra support to establish breastfeeding or be debriefed post birth or some women may want to rest in a quiet place with minimal noise before they are moved to the ward . If a birth takes place in a birth centre which doesn’t focus on time , women will stay in the same room post birth until their discharge home.

    In the NHS patient care sadly revolves around the concept of time . If a patient is not seen , admitted or discharged within a four hour time frame (see photo below ) it is considered a “breach”

    Certain procedures have a standard time frame in which so many can be done – this is how operating theatre lists are generated and how the NHS deals with waiting lists .

    However birth is and must be a positive experience – even though it has coding costs and some births are planned to the day -we must give women more than they expect – stand up for them , be their advocates. Challenging the system is one of the ways we can make change happen – if we all accept each day “this is the way we do this” we cannot be developing our roles or our practice to improve woman centred care . I’m not saying it’s easy but I want you to imagine what care you would want for your sisters and your daughters ? Then give the women THIS care – I am in the NHS as I nursed my own mother until her death at home – I see the connection between care at birth and care at death . I have been a nurse to the dying and that experience has impacted on the care I give to women in a most human way .

    Whatever care you give , whether you transfer a woman in your fastest time or not is all rather irrelevant when you focus on the bigger picture – YOU are responsible for the care you provide , or you don’t provide -if you tell a student to do something that is YOUR responsibility and I suggest referring to this NMC publication which I look at each day The NMC CODE . If advice or suggestions are not kind , caring and have a direct clash with your duty of care , if a more senior Midwife tells you to do something this should be documented in the notes and be evidence based, kind and resonate with your trust guidelines plus the NMC code.

    Sometimes we are stretched short staffed , rushed and under pressure but at no point should this be the woman’s problem.

    So the next time you are preparing a woman for transfer to a ward just think

    • Have I given her & her partner enough time alone with their newborn
    • Have I helped initiate feeding
    • Am I rushing her ?
    • Do I feel under pressure ?

    Then if necessary give her some more time – and when you arrive on the ward give continuity of care to the woman and her newborn by transferring in SkinToSkin contact , admitting them both to the ward environment yourself , taking and recording observations , checking the woman’s pad and fundus ,getting the woman a drink and this will also help your colleagues on the ward immensely.

    ❤️Be a holistic professional caring Midwife ❤️

    Thank you to the student of Salford University and those who DM’d me on Twitter – you inspired this blog

    Thank you for reading

    Yours in midwifery love

    JennyTheM

    ❤️

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    Loss of control – a reason for fear of birth ? 

    When any of us are admitted to hospital we lose control . We are unable to get a hot drink when we want one , eat what we want when we want to ,take simple pain relief , go to the toilet , sleep as well as we would at home , get up in the night or stay in bed longer . We are also unable to control what we hear , what we see . We lose our safe place of home and being surrounded by friends and family – it feels lonely and alien to us . This doesn’t mean that we are not able to adapt to new situations it’s just that more than a few things change and this throws a curveball towards us .  The fear we feel is because we feel we are handing ourselves and our bodies , our routines and home comforts over to others, they are dismissed  – this has quite a destabilising effect on our psyche . 

    A key part of NICE CG190 guidelines for care in labour encourages midwives to set the scene for women. The section I am going to focus on is COMMUNICATION – which is part of 1.2 Care throughout labour (click on the following numbers to be taken to the site)  CG190 

    I have copied and pasted the exact words and written the key words in CAPITALS below to help highlight their impact – does it make you think about them differently ? 

    COMMUNICATION 

    1.2.1 Treat ALL women in labour with RESPECT . Ensure that the woman is in CONTROL of and involved in what is happening to her, and recognise that the way in which care is given is key to this. To FACILITATE this, ESTABLISH a RAPPORT with the woman, ASK her about her WANTS  and EXPECTATIONS for labour, and be AWARE of the importance of TONE and DEMEANOUR , and of the ACTUAL WORDS used. Use this information to SUPPORT and GUIDE her through her labour.

    1.2.2 To ESTABLISH communication with the woman:

    GREET
    the woman with a SMILE and a personal WELCOME, establish her LANGUAGE NEEDS , INTRODUCE yourself   “#HelloMyNameIs”

    explain your ROLE in her CARE .
    Maintain a CALM and CONFIDENT approach so that your demeanour REASSURES the woman that all is going well.

    KNOCK
    and WAIT before entering the WOMAN’S ROOM , respecting it as her PERSONAL SPACE , and ask others to do the same.

    ASK
    how the woman is FEELING and whether there is anything in particular she is WORRIED about.
    If the woman has a written BIRTH PLAN , READ  and DISCUSS it with her.

    ASSESS
    the woman’s KNOWLEDGE of strategies for coping with pain –PROVIDE  BALANCED INFORMATION to find out which available approaches are ACCEPTABLE to her.

    ENCOURAGE the woman to ADAPT to the environment to meet her INDIVIDUAL needs.
    Ask her PERMISSION before all PROCEDURES and OBSERVATIONS, FOCUSING  on the WOMAN  rather than the TECHNOLOGY or the DOCUMENTATION .

    SHOW the woman and her birth companion(s) how to summon HELP and REASSURE her that she may do so WHENEVER  and as OFTEN  as SHE NEEDS to. When LEAVING  the ROOM, LET her know when you WILL return.

    INVOLVE
    the woman in any HANDOVER OF CARE  to another professional, EITHER when ADDITIONAL EXPERTISE has been brought in or at THE END OF THE SHIFT. 

    Every person who cares for (no matter how short a time ) a woman in labour should follow this guidance and I feel there should be posters up on maternity units in all languages which emphasise that this will happen . 

    There are many barriers to communication and one that most midwives, student midwives , maternity health care assistants , obstetricians and anaesthetists agree on is that time, pressure and NHS systems restricts our practice. I want to have laminated cards that go with the analgesia cards to explain why kindness and compassion will also help ease women’s pain . Fear is a huge factor in the perception of pain and if we try to reduce fear we might help reduce not only  pain but also anxiety and then by this we will gain trust and build on positive care. 

    As the  midwifery workforce we must start to say to ourselves “how would I feel ? ” another question which is used on the Nye Bevan leadership module is this …. 

    Lets keep sharing our ideas and thoughts and if you have any more relating to CG190 – tweet using #CG190 or why not write a blog or design a poster ? 
    Thank you for reading and please leave comments , I always value them and they help me to reflect and grow . 


    Yours in midwifery love 

    Jenny ❤️

    Babies, Being busy as a midwife, Birth, Compassion, Courage, Giving information, Helping others, Hospital, Human kindness, Kindness, Labour , birth, Labour and birth, Learning, MatExp, Midwife, Midwifery, Midwifery and birth, Motherhood, New parents, Newborn, NHS, NHS Systems and processes, Obstetrics, Patient care, Respect, Uncategorized, Women's health, Women's rights, Working from the heart

    With woman midwifery 

    ❤️Before I start I’d like to thank Soo Downe for using this photo of me with my pinards in her slides during this years EMA ❤️ &  thanks to Jacque Gerrard RCM for letting me know. 

    Hello , are you a midwife ? Have you ever heard or said any of the following sentences ? 

    “I’m coming in the office for a few minutes , they don’t want me in there all the time” 

    “I’ll leave you in peace for a while – you don’t need me here all the time” 

    “I’m giving them some time to themselves whilst she’s in the early stages” 

    There is evidence and research to prove unanimously that women who have continuous one to one care have less pain relief , more incidence of normal birth , less perineal trauma and feel more positive about their birth process . As midwives there’s always information to share and explain that the woman may not know about . I also view my role as a guardian to the partner making sure he or she feels involved and free to ask questions . So the next time you hear yourself or a colleague say “I’m leaving the couple I’m caring for as they don’t need me in their birth room all the time” just remember leaving them  isn’t evidence based practice – staying with them totally is 

    Resources on continuity 

    http://onlinelibrary.wiley.com/store/10.1002/14651858.CD004667.pub5/asset/CD004667.pdf?v=1&t=iwl6t8eo&s=72d734e7de6a3665a8d183e2d5df1492e37dc2ec

    http://www.sciencedirect.com/science/article/pii/S0140673616314726

    http://www.sciencedirect.com/science/article/pii/S0266613816300572 

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    #LeadToAdd 

    LeadToAdd click HERE to learn more is the latest NHS England campaign # is #LeadToAdd. As a Caremaker I will be linking this on Twitter with my work on #skinToskin , #futuremidwives and #couragebutter to inspire others to see themselves as leaders regardless of their role . Patients, women, families and non-clinical staff are also leaders .  
    I feel this will inspire/activate different meanings to different people

    Here are some of my thoughts around it

    What does to lead mean ? 
    To take charge , to be at the front , to inspire , to educate, to be diverse 
    Leading is about being at the front and CONSTANTLY looking back to bring others with you

    Leading is about being the first to begin something but not necessarily holding onto that but looking at how your actions impact on the way others fulfil their role. Leading is being a positive role model, leading is about looking inwards at your own behaviour and also looking outwards at the behaviour of others . 

    In the NHS all staff need encouragement to recognise themselves as leaders and also to see that some behaviours do not embody leadership. We are all learning each day, so don’t stay still – question yourself and the way you speak to others . Ask a colleague to listen to you talking to patients and staff and to give you feedback -what could you change ? Integrate telephone conversations into drills training-  talk to your practice development team – think outside the box . 

    Someone who leads others into poor practice is a poor leader but a leader non the less so be aware of your own commitment to pass the positive leadership baton . We are human and it’s ok to make mistakes , however we must learn, evolve and change .

    The other day I had a car journey with Joan Pons Laplana (@ThebestJoan on twitter) and once again he made me think hard about how the 6Cs are integrated into practice . Joan said to me that as a health care professional all tasks and procedures must embody the 6Cs – even answering a telephone call. 
    As a form of reflection I’d like you to read passage one and then passage two
    Passage One 
    Busy labour ward – phone ringing , midwife answered the phone – we will call the person making the call Tony and his partner who is having a baby is called Dolores. The midwives name will be Darcy . 
    Midwife ( confident and cheery) ” hello labour ward , midwife speaking how can I help you?”
    Tony (nervous voice) ” oh hi – err my partner thinks she’s in labour , it’s our first baby and we are a bit nervous . Could I ask you some questions , she’s here but having a contraction right now and then she feels sick for a few minutes after its gone. 
    Midwife “oh right well I need to talk to her please and decide what’s happening’  
    I’m not going to continue this but could the midwife change her approach ? Is this midwife you ? A colleague? This approach has been learnt from a peer
    Passage Two 

    Busy labour ward – phone ringing , midwife answered the phone – we will call the person making the call Tony and his partner who is having a baby is called Dolores. The midwives name will be Darcy . ….

    Midwife ( confident and cheery) ” hello labour ward , my name is Darcy Jones I’m a midwife and how can I help you?”
    Tony (nervous voice) ” oh hi Darcy – I’m Tony – err my partner Dolores thinks she’s in labour , it’s our first baby and we are a bit nervous . Could I ask you some questions , she’s here but having a contraction right now and then she feels sick for a few minutes after its gone. 
    Midwife “ok well I would like to take some details first whilst Dolores has a contraction . Thank you so much for ringing us . How are you feeling ? This is your first baby ? How exciting for you both!” 
    I’m not going to continue this but could the midwife change her approach In either scenario – which is the best one in your opinion ?  ? Is either of these scenarios you ? A colleague? This approach has been learnt from a peer. 
    So you see two examples each one leaving the person contacting  the service with different emotions . 
    Start your journey as a #LeadToAdd leader today  ❤️
    Thank you for reading 
    Love , Jenny ❤️

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    The natural caesarean / the gentle caesarean 

    There’s a debate on Twitter this morning about the ‘natural caesarean’ as a term that promotes a positive experience of birth by caesarean. I don’t agree with the term and I think as health care professionals working in the area of birth we should ensure that every birth is a positive birth . Milli Hill started the The Positive Birth Movement  with this goal in mind (@birthpositive on Twitter ) 

    Bearing this in mind I’d like to ask the following questions for you to consider and share with with your colleagues, family , friends , midwives and obstetricians . 
    1. How many women who have an emergency caeserean and/or instrumental birth (forceps or ventouse) are given information in the antenatal period about the far reaching health and psychological benefits of skin to skin contact in this setting to both mother and baby ? 

    2. Compare the above with how many women are given information about  skin to skin contact around normal birth ? 

    3. Compare both to how many woman are informed that skin to skin is possible during manual removal of placenta and repair of any perineal trauma in the theatre setting ? 

    4. Are women informed 

    • They can TELL midwives to defer the weighing of their newborn in order to enjoy the benefits of prolonged skin to skin contact 
    • That they should never be separated from their baby unless a clinical situation becomes apparent or they themselves choose not to have skin to skin contact despite being FULLY informed
    • That their baby could ‘self latch’ at the breast without any handling by staff and also correct its own acidosis and stabilise its own breathing because of skin to skin contact ? 
    • That skin to skin and early breastfeeding “Pronurturance ” is linked to a reduction in the incidence of  postpartum haemorrhage?  CLICK RIGHT HERE for the Pronurturance paper 
    • That if babies could talk they would choose skin to skin contact despite their birth environment 
    • That skin to skin contact is the building block for a persons social and psychological development 

    The midwives and staff on social media who talk about caesarean are not promoters of it , they are giving women information about choice – so that if the operation (which is major surgery) does take place then these women are able to not only enjoy their birth experience but give their relationship with their baby the best possible start . 

    I suppose it’s similar to the question “does having a teenage pregnancy strategy increase teenage pregnancy rates ?  (and I much prefer the term  “young women”to ‘teenage pregnancy’) 

    Does having full information about your choices if you do go on to have a caeserean increase caesarean rates ? I don’t know the answer to either of these questions but I do know that the women I have assisted and sometimes fought for to have skin to skin contact with their newborns in different birth situations have all told me this 

     
    -that they never realised the positive impact it had on them as a successful mother

    To me this is enough .   
    Thank you for reading 

    With love , Jenny ❤️

    I am also promoting #MatExp as a platform which enables and encourages discussion between women, families and health care professionals . 

    Being busy as a midwife, Birth, Courage, Discharge from hospital, Kindness, Learning, Midwifery and birth, Newborn, NHS, Patient care, Postnatal care, Skin to skin contact, Teaching, UK Blog Awards 2016, Women's rights

    The UK Blog Awards 

    I have entered this years UK Blog Awards in the Health Category to raise the public profile of midwifery in a positive light . 

    Compassion is a crucial part of any midwife’s role and I find that blogging helps me to open the window of my midwifery soul through the written word.

    It’s crucial that women and families have access to midwifery support now and in the future . Social media is a great way to connect to others and also to learn , inspire and lead. 

    You can vote for me BY CLICKING HERE

    Thank you for your ongoing support and for reading and sharing my blog . 

    With love from Jenny 💛 

     

    Being busy as a midwife, Birth, Courage, Kindness, Learning, NHS, Nursing, Teaching, Women's rights

    Dashing here to where ? 

    A few months ago I was on a break  with a #FutureMidwife – we were eating a meal at work . The staff room door flew open and a midwife in charge said “I need an observations machine in room 2 right now” the future midwife was up & out of the room before I had chance to think – err she is a lot younger than me : ) 

    When she returned I said “did you go into automatic pilot ?” She agreed that she had so here’s what we discussed . 

    1.When someone asks you for help ask why -is it an emergency?

    2. Allow the process time to reach your brain 

    3. If sitting stand up slowly to prepare yourself – if standing think before you start to walk 

    4. Respect yourself and your mindfulness as much as the other person – you are equals 

    5. Consider your age / fitness / mental well being and why you feel the need to dash 

    6. Slow down – put yourself first – if you are young you have a long time to be working – probably into your 60s – each stressful situation shortens your life slightly 

    7. If it’s an emergency it’s ok to go into autopilot but realise that you are a valuable so your focus and calm will lead others to be the same . 

    Last week I almost bumped into a newly qualified midwife who was ruining out of a room . I said stop ! Are you ok what’s wrong ? “I have to tell shift leader how many cm’s dilated the woman I am with is ” I said “but that’s no emergency – you are 22 you have probably another 44 years to work . So if you continually dash you will eventually burn out . Leaving a room calmly will impact on yourself and the woman you are with – be mindful of yourself”  

    The midwife agreed with me and I said don’t promise me – promise yourself to think first then walk – dash only in an emergency situation and running ? Should we be running ? Consider your own safety first . 

    Here’s some points  for you all to consider 

    Do you dash here & there not stopping to think ? 

    Consider your mind and body – slow down a little – be calm – take your time . There are plenty of opportunities to speed up in emergency situations . Don’t put yourself under unnecessary stress if you don’t need to – there is an implication on your health . 

    Try this for one day then one week and see how you feel – share your feelings with others , spread the word. 

    Here’s my poem 

    Dashing About 

    When we dash out of a room -we leave no time to think

    So thoughts are given less worth than deeds and this might make us sink 

    Walk slowly as you think to yourself  and slow your pace right down

    Be mindful of your own well being and you’ll never wear a frown x ❤️

    Thankyou for reading 

    Jenny ❤️ 

    Being busy as a midwife, Courage, Kindness, Learning, Midwifery and birth, Skin to skin contact, Teaching, Women's rights

    If you are a midwife – I am just like you ❤️  

    I am two people sometimes my identities merge into one sometimes they separate. First and foremost I am a mother who is a writer and expresses her work through writing, art  and social media. Then I am a midwife I work full time clinically and I do shift work. This realisation hit me after seeing the film ‘The Lady In The Van’ where Alan Bennett is portrayed by two actors  showing his two roles – one as the writer Alan Bennet and the other Alan Bennett the man with the house and life to live 

    In addition to my NHS role  I also present regularly usually to NHS trusts Midwifery Societies and to other NHS Departments usually around skin to skin contact at birth – I also include discussion around  courage and challenges within the workplace .  Sometimes my  two ‘lives’ meet sometimes they go their separate ways however I am the conduit of my own story . I say this because I blog about some of the experiences I have had within my own work and also talk about them in my presentations . By using these experiences my aim is help others to gain confidence or consider their own approach to colleagues and to women. 

    I reflect on each occurrence and then I depersonalise it to write in the third person – the aim of my stories is to give the reader hope for themselves and for others . I want midwives to realise that I am just like them – I get up I go to work I come home and then I work some more .  I work shifts and weekends . There are occasions when I have beans on toast or cereal for dinner and I have even been known to spend a full day in my pyjamas if I need a good rest . There are times on a shift when I may not get a break and / or go home late. 

    I have had feedback that some of my blogs hit a nerve – my main passion is to promote skin to skin contact for all birth settings where possible , however if my platform enables me to speak out for others who are unable to speak out for themselves , then I will do it .  I would like to pose a question to you all – 

    Are you aware of why some midwives do not rejoice in the work that other midwives do? 

    Why is this ? As far as I am concerned it is stopping us from moving forwards as a profession. The midwives that do extra mural work are not trying to glorify themselves but they are simply filled with passion. Their drive is not something they find easy and they get tired and disheartened but they keep going – that does not mean they are any better, wiser or more respected than those doing their role and nothing extra – it just means they want to help the profession to be recognised and all of us to be equally valued. We are all relevant voices so try to respect one another and be professional , compassionate and kind to one another – this will then drip onto the women and families we care for . Consider how you react to a midwife who might be in the public eye and realise that you are equal partners in midwifery . 

    Reflect back to your last month at work – have you been in any situation that you felt uncomfortable in ? Did you witness a colleague being upset? Did you see or hear something that concerned you ? How did you feel ? What did you do ? Did you regret not saying anything either because the time was not right or just because you felt scared? How do you think the other person felt ? Who did you talk to about it ? Your supervisor of midwives ? Your colleague ? Your manager ? Your family ? The NMC? Your union representative or steward? Your friends or no one ? It’s really important that when something emotional happens in your life that you can debrief about it . Personal or joint reflection helps us all to  gain feedback from ourselves  and from others and it’s SO important that this feedback includes positivity as well as critical analysis . Why ? There is a plethora of research available  ON FEEDBACK  including the article you’ve just read . Search google scholar for research and articles on how nurses and / or doctors reflect

    Keeping a diary each day will help you to reflect back with better clarity – time moves fast and soon the next week is upon us – the incident or situation will pass you by . Unbeknown to you stressful situations,  scenarios , whether they are large or small will slowly and gradually affect your physical and mental health . Things like weight gain , anxiety and depression are directly  to linked to stress in the workplace and can impact negatively  on safety , staffing levels , good care and achievements  for midwifery . 

    I suggest you buddy up with someone you trust , someone you can reflect with , plan with and rejoice with. Try to remember why you chose midwifery and the massive impact that your care will  have on a woman and her family . 

    We all have the same dreams 

    Thank you for reading please leave comments as this helps me to learn and reflect 

    Jenny ❤️