...and now back to work.

Okay the OSCEs could have been worse. Most of them I felt I did well in and will have passed - one or two I was even told as much by the examiner. There are 3 or 4 that are in question - I made a silly minor error here, blanked on what they were trying to get at there, but I think it's all down to the individual examiner as to how harsh they are. I imagine I'll be back for retakes in the Spring, mainly because most people have to retake on or two sections. But I'll know where I went wrong and I'll damn well not make the same mistake again!

In the meantime, word has got out that there's a new midwife in town (we're a rare commodity!) and, following a flurry of activity, I now have a fairly decent caseload going on. Hurray!

Being practical

Hello! As I write I am sat in the Super8 in Calgary (which I don't recommend one little bit incidentally) revising for my OSCEs - Objective Simulated Clinical Examinations - tomorrow. This is basically a whole day of being shoved into a room with a clinical scenario and having to deal with it, just to prove that you can. Some of them are emergency situations - I'm anticipating shoulder dystocia, post-partum haemorrhage, undiagnosed breech and neonatal resuscitation - and the others are likely to be normal clinical skills, such as an abdominal palpation, suturing or a neonatal examination, and yet others will be discussions on subjects such as vitamin K administration, metabolic screening and circumcision. They use real women where possible/appropriate (I assume shoulder dystocia would be on a model!) so that does help a bit I suppose, but I HATE doing these kind of exams. It's funny, the actual clinic skills I have no problem with and feel confident when I'm in a real situation, but having someone in a room watching, and critiquing, your every move is horrible. My tendency is to try to rush through things and in the process to forget something important, so I'm going to focus on breathing deeply and relaxing wherever possible. I did a practice session yesterday and was relieved to find that I did generally remember things - I was also relieved that everyone else was as nervous, and some were less experienced, than me. Anyway, we get 10 scenarios and have to pass at least 8 of them, 6 of which are mandatory. I can retake individual scenarios if I do fall to pieces ;-)

Wish me luck!

The great confessional

Much has happened since my last post and I make no apologies for not prioritising writing about it, since I've been too busy living it.

I mentioned, almost in passing, a while back that I'd been accepted into the International Midwifery Preregistration Programme (IMPP) in Toronto. I went to the orientation day back in July and began work on a series of distance modules prior to the official start in September. However, I was chatting to my lovely friend Megan, who you may or may not remember had been my student back in London when she was training to be a midwife before coming home to Canada, and she told me that her midwifery partner Gaelyn and her had decided that I should come and work with them in Edmonton, Alberta. For those of you unfamiliar with Canadian geography, that's around 3,500kms away from where we live in Ontario. The idea of working with Megan certainly appealed to me (as did living only a 3 hour drive from Banff) I looked into what would happen if I completed the IMPP and then moved - long story short it was a bureaucratic nightmare. The Ontario system is set up so that you don't become a fully fledged midwife until at least 6-12 months after you finish your training and so you're effectively tied to the province until then. Since it was going to take 6-9 months to complete the course itself, this would delay any move for at least a year and quite possibly more. Hmmm.

I decided to look at what the requirements for registering directly in Alberta were instead. It turns out the only things that Alberta required was a midwifery qualification (a UK one would do) minimum of 60 births in the past 5 years and to take, and pass, a practical and written exam. As luck would have it, despite not having practised for 3 years, I still had over 60 births in the previous 2 under my belt. This wouldn't be the case for long so I had to get on it asap. I got all the required paperwork together - oh it sounds so easy but really it wasn't! - and applied: I was accepted to sit the exams. A quirk of the system meant that if you are judged eligible to sit the exams, you can actually begin practising on a restricted licence with a named Supervisor straight away. Crazy but true.

Having by now dropped out of the IMPP, I packed up all my stuff and Isaac and I drove across Canada - staying, by some miracle, ahead of the winter weather - we arrived in Edmonton two weeks ago. We actually had a brief stop off in Banff, which was a fabulous trip down memory lane and even included meeting up with friends, Andrew and JK, who were back for another ski season working at Lake Louise. We made a quick stop at Sunshine Village, which was not yet open, to pay homage to where it all began for us. It was a lovely interlude, but sadly I got ill on the second day there and spent a rather hellish couple of days shivering and puking while we headed north via Calgary.

We immediately launched into looking for a place to live and found a lovely 3 bed house very close to Megan and her husband Craig in Leduc, just south of Edmonton. Isaac flew back a week ago to Ontario where he'll remain, looking after our house and Tiger the cat, until after Christmas. I've remained in Edmonton, staying with Megan and Craig, preparing to move into our new house in a week's time. I've spent the last week calling and arranging to meet my new clients, and even attended my first birth in over 3 years as back up for Gaelyn. It was a home waterbirth, which will happily be the large majority of my work here. I'm flying back to Ontario to spend Christmas with Isaac's family and my sister Jenny and her boyfriend James, who are flying out from the UK to visit. I'm flying back here at the beginning of January and Isaac will drive back out with his friend Matt and his brother Reilly, so we have both our cars out here in Alberta, then Isaac will be joining me here permanently.

So that's pretty much where we are up to now. I'm loving living in Alberta again - I like living out in what amounts to suburbia but close enough to a city to have access to all a city has to offer: I'm 15 minutes from Ikea and the South Edmonton Common retail park, including the Gap Factory Store (where I indulged in a spending spree when I got my first paycheque the other day). I'm really enjoying being back in midwifery (bit nervous too) and I'm excited about our new house! I can't wait to see Jen & James at Christmas and I'm really looking forward to having real money to spend on people's presents for the first time since 2006. Such a relief.

So apologies for once again just having a 'I did this, then I did this, then I'm doing this' kinda post. I'd rather just be musing on ideas and throwing around the one liners, but I don't get to do this as often as I'd like and blah de blah de blah. Which brings me on to...

While I'm spilling my guts about things I would also like to admit a rather shameful secret: I've been Twittering for a few weeks. At first I told no one and happily tweeted just to myself. Then, the other day, my nephew Benj found me - not sure how - and began 'following' me. A few more people (strangers!) followed suit. So I thought I'd come clean and if you feel like following my random thoughts then look for @midwifemia. No obligation though, it is of course merely the whitterings of a madwife.

Bang to rights?

Just watched the Panorama programme 'Midwives Undercover', which aimed to highlight the problems in Britain's maternity units using secret filming by a journalist working as a volunteer. It was alarming stuff, but one of the problems with having a lay person looking for problem areas is that, unless you know what you're looking for, you run the risk of making an issue out of something that really isn't that big a deal and, as a result, missing the really important things.

Certainly there was a big fuss made over the fact that the journalist was asked to hold a baby's heart monitor transducer in place for a 20 minute period "without having any training at all". Now, it is certainly the case that interpreting a CTG (cardiotocograph) trace takes training and if mistakes are made, they have the potential to be catastrophic. BUT holding the transducer in place is a job more usually done by an elasticated strap. Only if the baby is in an awkward position, as presumably was the case here, do you have to angle it a bit by hand. The woman was not in labour, so it was highly unlikely that the trace would show anything requiring immediate action and the midwives were popping in to look at the trace every 10 mins or so, as they would normally have done. So is it really a major story that the volunteer was acting as an glorified bit of elastane? To my mind, it's far more appropriate that the volunteer was doing this, than the midwife who had plenty of better things to be getting on with.

The other thing that crops up time and time again, whenever anything is reported about maternity services, is the inevitable 'my baby died/had brain damage because of what they did' story. I apologise if that comes across as heartless, it's not intended to be. The fact is however that babies do die, they do get brain damaged, and whilst we should never become complacent about it, and we should of course do everything we can to prevent it, we will never be able to save every baby. I cannot comment on the two cases discussed on tonight's programme, for the obvious reason that I wasn't there and I don't have any of the details, but warning bells always ring for me when phrases such as "So & so was already having problems before they arrived on the ward" are heard. Many - if not most - cases of brain damage are due to antenatal insults, meaning that the care in labour does not directly contribute to the outcome, the damage has already been done before you get there without anyone being able to do anything about it. Proving it one way or another is often impossible though and often results in hospitals offering (substantial) out-of-court settlements to parents. Whilst I have a lot of sympathy for parents who are naturally devastated and seek to apportion blame in someone's quarter, but I also have a lot of sympathy for those involved in the care, who often did their best, with an outcome that was inevitable.

It is definitely beyond question that there is a shortage of midwives in most units though and, yes, this can contribute to the kind of problems detailed above. Much much more often, however, it contributes instead to women - or whole families - having a thoroughly miserable and rather crap experience. This may be the poor cousin of the catastrophic events we love to hear about, but if you ask me, it's a much bigger problem. Women who've had crap care are more likely to have had unnecessary interventions (expensive to the NHS, detrimental to women's bodies), develop postnatal depression, be overly anxious about subsequent pregnancies which results in more unnecessary interventions - if they go on to have any more children that is. I often wonder how many women never go on to have the families they would have wanted because they were badly treated the first time; I have a friend who is finally having her second baby now, 14 years after her first, because it's taken her this long to pick up the courage after having such a horrible time with her first.

Ah well. It's only a job, eh?