Welcome to practice: A guide for the first labour ward placement
Depending on the structure of their curriculum, some first-year midwifery students will already be preparing for their first clinical placements. Each clinical area has its particular demands; however, for many, it is the labour ward that causes the most trepidation as it is a dynamic and unpredictable environment. Theoretical training in the first year focuses on normal birth, but things do not always go to plan and sometimes student midwives are involved in obstetric emergencies that demand prompt, effective management. This guide provides basic information on two common obstetric emergencies: shoulder dystocia and postpartum haemorrhage.
Student midwives must be able to demonstrate that they have the competence, knowledge and skills to be deemed fit to practise at the point of registration, not only in the performance of routine clinical skills but also in ‘managing obstetric and neonatal emergencies, underpinned by appropriate knowledge’ (Nursing and Midwifery Council (NMC), 2009: 4). The labour ward environment is dynamic and unpredictable in nature and, as a consequence, learning opportunities in relation to the management of obstetric emergencies cannot be anticipated. In such an environment the safety of women and babies is paramount, with the student's learning needs being a secondary consideration (Haigh, 2007).
Theoretical input at the start of a 3-year midwifery programme focuses on normality and typically students will study: anatomy and physiology; physiological changes as a result of pregnancy; low-risk antenatal, intrapartum and postnatal care; and care of the newborn. The rationale for this approach is that if you have a thorough underpinning knowledge of normality, you will be able to recognise the ‘abnormal’ and act appropriately, thereby demonstrating safe practice. Despite our best efforts to focus on normality, the reality of the labour ward environment does not match theoretical input, so it is not uncommon for students in their first placement to be exposed to complex clinical situations and obstetric emergencies for which they have received no formal theoretical education.
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