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Caroline Flint explains how the midwives who work at her clinic have gained in confidence because they have been involved in improvements to the antenatal service Midwives who choose to work in an antenatal clinic usually do so for a variety of reasons. Many midwives have small children or family commitments and work part-time. Some of the midwives are not physically strong enough to cope with the lifting that has to be done on the labour ward or postnatal ward. Some have been inspired and interested by the challenge pregnant women bring them, others are there because they `have been sent': Because part-time staff arrive on duty at different times and because, unlike working in a ward, there is no report when all the staff gather together a special effort has to be made to encourage antenatal clinic staff to relate to each other and form a cohesive team. In our clinic we have a weekly 'working lunch'. We all bring sandwiches and discuss and explore different topics together. Sometimes we see a film or a video, or preview one of the visual aids for the clinic. On other occasions we discuss ways of improving the service we are providing. Each member of the team has a different point of view and we try to encourage everyone to participate. The student nurses see things that some of us, who have been around for a long time, stopped seeing years ago. Sometimes we try to analyse why a particular clinic went so well, and sometimes why a particular clinic went so badly. We tried role play when we first brought in the assessment for the nursing process and we plan to use it again. It is such a useful educational tool and it is such fun to do. We air grievances and try to smooth out hitches, we allocate or volunteer for specific jobs. One of the most useful ventures is when we visit another antenatal clinic to see how they organise themselves - this has many benefits. It means that we all, or a group of us, go out together; this is refreshing and enjoyable and helps us all to get to know each other better. Seeing another clinic functioning opens our eyes to different ways of approaching antenatal care. Some of the ideas we can utilize, others we regretfully discard. One great benefit we gain from these outings is that we appreciate the benefits we have, for example we have remarked `I wouldn't like to work with that consultant, would you? I've never met anyone so grumpy. Thank goodness for our lovely ones.' `Have you ever seen anything as poky as those consulting rooms, ours are so much better.' ,I'd hate to be a midwife there, they don't do anything except weigh patients.' We all work together keeping statistics for our clinic - this involves no more than a tatty piece of paper outside each consulting room on which we jot down how many patients were seen by each person. These figures are helpful for the sister/hostess allocating women to different medical attendants and they encourage us when we find that last week, out of a total of 296 follow-on patients seen, 113 were seen by midwives, or the week before - when a total of 283 follow-on patients were seen in our clinic - 70 of them by midwives. We try to use each team member's special skills: one midwife is quiet and reliable, she does all the ordering of pharmacy and stocks; one midwife is an early bird and she prepares the clinics; one is more mechanical than most, she threads the projector; and one is very tidy, she keeps an eye on the posters and leaflets which tend to straggle.Our auxiliary nurse has a great clerical aptitude, she is also a very warm and welcoming person - she looks after all the clerical work attached to the booking clinic and welcomes new patients. Some of the midwives see their role as hostesses to frightened, nervous mothers-to-be. The midwives give welcoming talks to women when they first arrive, or go round and talk to women waiting in the clinic, or they stand in for sister on a Friday when there is `open house' for anyone who has a worry or problem to come and discuss it over a cup of coffee. Some midwives love seeing pregnant women for the complete consultation and some prefer to chaperone doctors. As our midwives' clinic progresses, so the confidence of the midwives who run it, grows. Seeing the same women month by month, and then week by week, shows the midwife that she is perfectly capable of giving antenatal care. And this makes her more alert to signs that all is not going well because she knows the women so well. Her confidence is increased by the attitude of the women she sees - they respect and trust her, and they look forward to seeing her. As the doctors see the quality of care their patients receive they become happier with the midwives' clinic and more aware of its benefits, to the women, to the midwives, to the doctors. Our next step at either midwives' or consultants' clinics will be to discuss cases as they crop up, after the clinic. This is done at Sighthill Health Centre. `At the end of each clinic all members of the [community] team gather to review management decisions. Each member who has seen patients relates risk factors which have arisen and decisions which have been taken.' More than ever, this will help us all to feel like a team and will make us more responsive and sensitive to the women. Thank you for all your letters - next week I shall be quoting from many of them with some really interesting ideas on improving our service. January 19 1983 |
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