Back to Basics

Early in November last year I attended a Midwife Study Day in London about pre-eclampsia (hosted

APEC

by APEC).  Sandwiched between the morning coffee break and lunch was a presentation about the importance of accurately measuring blood pressure and urinalysis.  Now, I can’t have been the only person who was internally rolling their eyes.  These are skills we master in our first year of training, and I was surrounded by a wealth of experienced midwives practicing in a range of clinical practice areas.  Why had we travelled all this way to be taught a basic skill by an obstetric physician who, by their own admission, probably had a hundredth of the practical experience of the delegates?

But as I listened, I realised that for as much confidence I had in my ability to accurately measure blood pressure and the optimum conditions under which to do it, there were a number of details I had forgotten.  It is like learning to drive; when you are under instruction you diligently check every blind spot before starting off, you mentally chant “only a fool breaks the two second rule” to ensure you are travelling at a safe distance from the vehicle in front, you tell yourself, “it’s a speed limit, not a speed target”. But soon after you pass your test, and once you get over the initial thrill of flying (well,

Being a midwifery student is a bit like learning to drive

driving) solo, you start to cut corners, although not literally hopefully!  You quickly glance in your mirrors (and maybe over your shoulder) before you pull out into traffic, you get slightly closer to the slow moving car in front of you, well, the speed limit is 60 down that road!

It dawned on me as I sat in that air conditioned basement of a conference room, that I was guilty of doing the same thing in my clinical practice.  Not on the big things of course, I’m not confessing negligence.  Nor am I suggesting that I know everything – far from it.  However, as I reflected, I realised how my confidence in practice may also be limiting me.  Skills like taking a blood pressure I now do without thinking, whereas I used to listen intently for the quiet dub dub dub of the heart beat.  I used to excitedly pull my sterile gloves over my shaking hands as soon as the women first involuntarily pushed, thinking the baby was imminent, but now, I wait until I see the hair on the

Midwifery 101

baby’s head before I open the delivery pack!  How many times have you driven home and as you park, realise you have no memory of the journey? 

Don't get me wrong, confidence and familiarity is a good thing.  I would be worried if I still had the apprehensions and hesitations I did in my first year, and so would my mentors and tutors!  But on the other hand, I need to ensure the care I give is still as diligent and considered as it was when I was mastering the skill. So, as I continue with my final year of study, I have made a promise to turn my focus back to basics.