So whilst writing this blog post I must admit that I am on a bit of a high as I have finished all of my exams as a student midwife!! Yesterday was one of the most stressful experiences of my life- worse than my driving test, worse than my university interview and worse than all of my a-level exams put together. The dreaded moment of any student midwife’s career… third year OSCEs (duh duh duh). I have talked briefly about what an OSCE is before in my previous blog posts but for those of you who may have skipped that one, an OSCE is the most effective way to assess a student midwife’s ability to preform skills used frequently by midwives. These are conducted in City’s clinical skills labs and you have 15 minutes to talk through your given scenario and then 5 minutes to reflect on your performance. In total this year we had 8 stations to learn; 4 practical skills and 4 “talking” stations and we were tested on 2 of them on the day. I thought it might be useful for you guys if I briefly outlined each station so you can get an idea of the kind of things you’re capable of doing after 3 intensive years of training.

Station 1- Shoulder Dystocia

Shoulder dystocia is an obstetric emergency that occurs with 0.1-0.3% of all births and it occurs when “the anterior shoulder of the baby comes in to contact with the symphysis pubis and requires additional obstetric manoeuvres to deliver the baby”- basically the baby’s head comes out fine but the one of the shoulders gets stuck in the pelvis and the longer baby is stuck like this, the higher the risk of baby suffering life changing injures becomes. There are some risk factors that have been identified that increased a woman’s chances of suffering a shoulder dystocia in labour such as maternal obesity or macrosomia (essentially a big baby) however these risk factors are only predictive of about 16% of recorded shoulder dystocia’s therefore it remains a very unpredictable event so all midwives have to be trained in dealing with this emergency should it present in practice.

Station 2- Breech delivery

A breech delivery according to the textbooks is “a birth where the presenting part is the buttocks or feet”- in essence, most babies come out head first, but 3-4% of babies will be the other way up and this can complicate things slightly in labour. Although it is physiologically possible for babies to be born naturally this way, there are risks to the baby and we make sure all women with breech babies are informed of these so that they can make a chance to make a decision about whether to go for a natural birth or have a caesarean section (deliver the baby through an incision in the abdomen). There is a special way that these babies have to be delivered safely and that’s what we get tested on at this station.

Station 3- Postpartum haemorrhage (PPH)

Managing a PPH well is an incredibly important skill in a midwife’s repertoire as bleeding excessively after giving birth is the leading cause of women dying during childbirth worldwide. All women who give birth will bleed and this is completely normal however women who loose over 500mls of blood are at risk of their bodies not being able to continue with normal function after loosing this volume of blood. A major obstetric haemorrhage is when women loose over 1L of blood and as you can imagine this can have a huge impact on a woman’s health. Therefore midwives use a range of physical skills and different drugs to stop the bleeding before it has a lasting impact on the woman’s life.

Station 4- Neonatal resuscitation

A midwife’s job doesn’t end once the baby is delivered and some baby’s will be born requiring extra help to breath on their own. For some of these babies we can predict that they are at risk antenatally (in the pregnancy)- babies may have existing conditions identified through scans, they may be born early (before 37 weeks) or they may be SGA (small for gestational age- basically their scans have shown they aren’t growing as much as you would expect for their age) and some babies may be totally fine in pregnancy but then are unable to tolerate labour and when they are born they need an extra hand from a neonatologist (baby doctor) or if they are not available, a midwife. Therefore we are taught the initial skills needed to keep a new born baby alive until further help arrives. At this station we must commence the resuscitation and are given regular updates as to the condition of the baby which we must use to adapt our technique to suit that particular baby.

This may seem overwhelming to read however let me assure you that we get taught through all of the skills and are given plenty of time to practice before the exam date. My best advice for these types of exams is to purchase the PROMPT books- they are written by experienced obstetric staff and are updated regularly using the most up to date evidence available. I bought mine from amazon for £30 and it was the best investment in my degree so far as I am sure it will continue to be as I start my career as a midwife.

Tune in to next months blog to find out all about the 4 talking stations of third year OSCE’s. and wherever you are reading this from, I hope you are enjoying the sun!