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Monthly Archives: June 2018

OSCE exams part 2

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For this month’s blog post, I will be picking up where I left off on my last one and finish telling you guys about the remaining 4 of the 8 stations used to test 3rd year student midwives in their OSCEs. So far I have explained the 4 practical or ‘obstetric emergencies’ stations and therefore what remains is the 4 informative stations AKA the ‘talking’ stations.

  1. Down’s syndrome screening

All women accessing maternity care in the UK will be offered an ultrasound scan at several key points in their pregnancy to check that the baby is well inside and growing as would be expected. At a woman’s first appointment with a midwife, screening for down syndrome and other chromosomal abnormalities (such as Edwards syndrome) is offered in addition to their first dating scan. Informed choice is hugely important in midwifery and all women must be able to access the information necessary to be able to make a decision about the kind of care they want for them and their baby. Screening tests are not diagnostic- this means that these tests will not tell a woman for definite that her baby will have downs syndrome but what it will do is highlight the women that are at a higher risk of having a baby with downs syndrome so that they are able to discuss further tests that will tell them for definite if their baby has a chromosomal abnormality or not. No women have to accept the downs syndrome screening and it is a midwife’s job to ensure that the test is adequately explained- a woman should be informed of the process of the tests, the benefits but also the implications from the test (for example a woman getting a ‘high risk’ result may be offered further more invasive diagnostic testing) and that way the woman is able to make the most informed decision about what she feels is best. The aim of this OSCE station is to demonstrate both that you as a student midwife are knowledgeable in the tests available and how these are performed but also that you appreciate the importance of informed consent and are able to implement this in your practice.

  1. Delayed progress in labour

For this station, you are given a scenario whereby you are caring for a woman who has had a vaginal examination and been 4cm dilated and then 4 hours later she has a further vaginal examination and remains the same. This is not uncommon in mothers who are in labour with their first baby as although the cervix itself is not dilating, there may be other indications that labour is progressing. The idea behind this OSCE is that you must talk the woman through her options based on the NICE guidelines and the protocols of the trust you are practising under, and facilitate the woman to make a decision about the plan for her care going forward. A woman has the right to refuse any care that she doesn’t want, and this includes practices used very often in this particular scenario including breaking her waters (also known as an artificial rupture of membranes) however a woman being in labour for a long time but not progressing can be dangerous to both her and the baby so this station is all about helping to create a balance between what the woman wants and what is safe practice. In the end however, the decisions lie entirely with the mother and as her midwife you would support and advocate for her whatever decisions she chooses to make.

  1. CTG interpretation

A CTG is a device that is strapped to the woman’s abdomen and monitors her baby’s heartbeat and uterine activity (for example contractions). The fetal heart rate plots the fetal heart rate on a graph every 3 seconds and this creates a line overtime which if appropriately interpreted, can help to identify a baby in the womb that is in trouble before it is too late. Midwives and obstetricians are all taught about the correct interpretation of a CTG and work together alongside the woman to tailor their maternity care to what that particular woman and that particular baby needs. Any potential midwifery students out there, don’t worry! You will see plenty of CTGs over your training and subsequent career, however we are constantly learning and recognising new things in these CTG traces, so a midwife is responsible for maintaining the most up to date knowledge so that she can provide the best and most evidence based practice. In this OSCE, you are given a CTG and asked to interpret it using a specific guideline and following this you must make a plan as to what you would do if you had this CTG trace in front of you in real life.

  1. Breastfeeding

The recent ‘baby friendly initiative’ has highlighted the importance of midwives being adequately trained in infant feeding support to give mothers and babies the best start in life by facilitating them to establish breastfeeding earlier and promoting close relationships between the two. Not all mothers will want to or will be able to breastfeed and these women must be supported equally as much however a midwife’s stance is ‘the breast is best’ and therefore midwives must be well trained in helping women to successfully breastfeed and continue to do so ideally up to 6 months if not longer. This OSCE station uses a real actress to authenticate the scenario and the student midwife is required to support this woman through her breastfeeding difficulties to make sure the woman is able to continue to breastfeed as she wants. This may sound easy but babies can be stubborn and breastfeeding is an art that can take weeks to master therefore midwives must be heavily skilled in this area if they are to properly care and support women

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