Feedback: December 2009/January 2010

Want to be a general nurse?

Dear editor

I am wondering how my colleagues feel about losing the right to practise as a registered general nurse, despite continued practice within the clinical setting of midwifery – that is for those of us who were not direct entry.

I entered midwifery in 1991, after three years working as a qualified general nurse. It’s not that I felt I needed to leave general nursing never to return, I just wished to be a midwife and I have stayed as one and loved it ever since. But it saddens me to have that door now completely closed to me, unless I complete five nursing study days – all a little difficult if you are already employed.

I had a conversation with the NMC, who stated that midwives view all things from a midwifery perspective and if having been a midwife for 16 years I felt I could return to a general ward, then why could a direct-entry midwife not do the same? The answer to me is simple – because they have never completed three years’ training for nursing! The NMC said I would be unfamiliar with the drugs used and procedures carried out. But it is strange that a nurse who specialises in one area, such as medicine can move to a surgical unit, or a nurse caring for the elderly can move to paediatrics.

Recently, I cared for a woman who was 38 weeks’ pregnant. She was admitted unwell and found to have bacterial meningitis. She remained on the delivery suite, because it was felt that obstetric/midwifery input would need to be extensive. I did not know of the intravenous (IV) antibiotics, or the procedures for lumber puncture, but I had to find out.

I have also cared for a lady post caesarean with a paralytic ileus requiring two-hourly nasal gastric aspiration. Is this wholly midwifery? As with many of my colleagues, I also scrub, cannulate, take blood, suture, catheterise, prevent pressure sore development, give IV medicines and so the list goes on – all those skills, which we incorporate within our role, and with Nancy Roper’s (Roper et al, 2000) activities of daily living never far from our minds. This is being clinically up to date and to me, not so far removed from care given on general wards.

I recently completed a diabetic course on which there was a nurse from overseas. Her knowledge base was shockingly poor and yet she is able to be employed. I, however, who trained in this country and whose only break from practice was six months’ maternity leave nine years ago cannot be employed as a nurse.

I think it shows a lack of respect for us.

The future is direct entry and those of us who did nursing first will die out of the system eventually, but for now, we are still here and deserve the choice.

My long-term plan was always to have a local practice nurse post. Would I actually ever leave midwifery? Well, see me after a night shift when for the third night that week I’ve had no break and it feels like my life force is draining out of me, then yes I could move on. Then see me at the point of delivery as you say, ‘Look down, what have you got?’ Then no, a midwife is what I want to be. I would just like the choice. I worked hard for it. Does anyone feel the same?

From
Jayne Elstone, midwife


Reference

Roper N, Logan WW, Tierney AJ. (2000) The Roper-Logan-Tierney model of nursing: based on activities of living. Elsevier: Edinburgh.




Horror and disgust... Traumatic...

Dear editor

I recently read The red tent by Anita Diamant and I was enthralled as to how wonderfully the power of women giving birth in ancient times is described and how childbirth is portrayed as a defining experience for women. I felt many themes in the book resonated strongly in my work today as a community midwife and I was moved by the way the author acknowledged the power of having a skilled midwife to support and encourage a woman during the trial of her labour.

I chose The red tent for my book club to read. A group of friends – all of us mothers and several are grandmothers. I introduced the book and I got to hear what the others’ thought. A couple of them really liked it, but the overall opinion was one of horror and disgust. One friend said she found reading it traumatic and it made her feel physically sick. At the
end of the discussion, another group member offered up her thought that ‘it was terrible that the government wants to increase the number of babies born at home’. For me, this was a seminal moment. Of the eight women in the room, six had had caesarean sections or negative birth experiences. Only one of my friends talked positively about childbirth.

At first I was very upset and disappointed with my friends, but having reflected on their reaction, however, I am beginning to realise that this is probably a good representation of how childbirth is viewed today by many women. I was shocked when I was talked over by a group who answered my challenges supporting choice and normal birth with – ‘it’s alright you saying that, but my baby would have died if I had given birth at home’. There appeared to be no appreciation of the skill and care that a midwife can give. No thought that women should have a choice and that many would be exposed to less risk if they gave birth in their own safe and familiar surroundings. Could this be an example of women disengaging from the facts about childbirth and reverting to the comfort zone of what they have been led to believe? Are women only interested in childbirth when it is happening to them? One conclusion is indisputable – it is not obvious to everyone that normal, midwifery-led care is a safe birth option for the majority of women.

Having conducted my own piece of impromptu, qualitative research, my
findings have caused me to dig deep and to strengthen my resolve. Although this was a small sample, the conclusions I have drawn have confirmed what, deep down, I already believed – that the campaign for keeping birth normal needs to be a strong one. We have a whole culture to change and a new generation of childbearing women to inform, but I for one am up for the challenge.

From
A Buckinghamshire community midwife

There's more

Want more views? Then please visit: www.rcm.org.uk/midwives/your-views for more letters and opinions. Topics include:

✲ Domestic violence
✲ Community midwifery
✲ A response to June/July’s Disillusioned and disgruntled too.