Reflections: 3 Months as a Caseload Midwife

So 3 months in to my new job as a caseload midwife (I can’t believe how quickly that’s gone) and I can say without a doubt this is the best decision I have ever made. Not only being a caseload midwife, that was always a given for me after my experience as a student, but also being one in a team whose values are ones that speak to my midwifery soul.

It has not been without its bumps, however the way in which these have been dealt with demonstrate what a forward thinking and innovative organisation Neighbourhood Midwives is. I am inspired on a daily basis by the kindness, support and general ethos of my colleagues when it comes to their view on midwifery and the care they provide not just to the women, but to each other, throughout the entire organisation.

After 3 months I thought that looking back on what I have done, what my appointments and call outs have been like and general reflections might be interesting for anyone who is thinking about this way of working and wanting to know what it’s really like. I have worked differently, I have done the 12 hour shifts on labour ward, I have done traditional community with the on calls, I have experienced all of that. So when I say this way of working is a vast improvement to my life in terms of having more time for the things and people I love, I say so with the prior experience of working the way that the majority of the midwifery workforce do.

The last couple of weeks has been the first time I’ve found it a little bit overwhelming, however that is actually entirely my own doing as I chose to work on days off multiple times and just generally knackered myself out. This COULD have been avoided of course, but actually I wouldn’t change it, absolutely not. Who knows, I might have found it difficult for other reasons had a not been able to be there for women I had built relationships with. I think this is especially the case if a woman ends up having a more challenging experience. I’m embracing the peaks and troughs of this model of care as after a busy few weeks I’m now entering a period which, for me, is due to be a bit Q…. Well you know the word, I can’t say it out loud though haha!!

My first month was quiet as I had that month to settle, get used to systems, contact my caseload of women, arrange my diary, book appointments and get used to the on call. It was a really important time for me to really get used to boundaries to look after myself, such as getting used to just getting on with life with a phone. It really wasn’t that hard to do either, as you might have read in my last post. But having this settling in period was so vital. Shortly after I joined it was decided we should set up a working group to look at creating an induction programme created by midwives for midwives, which I am really excited to be a part of, as its something I’m passionate about. If we look after our colleagues when they first start, particularly if they’ve never worked in caseloading before, then I think they are more likely to have a positive experience and flourish.

In September I attended one birth with colleagues to help me see how they worked and get used to the paperwork, I had my first two weeks off call to settle in then was on call for the rest, with rest days, although not really needed when I only got called out once (other than to enjoy a glass of wine or two).

October was when things picked up, which was great timing as it was October that I moved to the patch I work in (although sad too as I’d been living with my friend and her son and still miss them). The on call part of caseloading seems to be the biggest sticking point for so many people but in reality you really don’t get called out that much. I had four births in October and three in November, during which time I was on call for 35 days with the rest being annual leave and protected off call time, if you work that out the ratio for number of call outs compared to the number of days on call is approximately 1:5

Half of the births I’ve been too I was actually out and home within 4 hours and one of those I was 2nd midwife and arrived after the baby and was only there for a couple of hours. I have only worked long hours (as in 12 hours, as is standard for many) 3 times, 2 of those being overnight, which is hugely beneficial to me as the 12 hour night shifts I used to do really affected my sleep which in turn impacted my mental health.

What we do with our protected off call time is entirely up to us, as you can see from the figures, call outs are minimal so sometimes I would work on off calls days, whether that be doing appointments (but with my phone still diverted) going back on call completely for a woman in my caseload, or offering support to my colleagues who may need it. It would entirely depend how I felt, today I am off call and apart from looking at my phone to divert it and send a message to my colleagues, it has stayed off, because at this moment in time, that is what I need.

Appointment wise, not including births and home assessments, I have had exactly 80 appointments in 2 months, which I will be honest actually surprised me. I was looking at the RCM Continuity Counts game last week and one of the things mentioned in there is around the number of appointments caseload midwives should be able to achieve sustainably monthly (including bookings) when holding a caseload of 35 a year; it stated 40, which I felt I was doing more as this works out 2 a day if you do your appointments Monday- Friday. However we never do them that way, we have annual leave to account for, as well as births and home assessments and for those working in a team midwifery model, the way that is recommended by NHS England and RCM, the working days are less so you fit those appointments into longer days, very rarely 2 a day. So this figure is spot on in terms of what I have achieved!! Again I think my view on feeling that I had been doing more was actually because I was overwhelmed after pushing my own boundaries, not being forced to, not because anyone expected me to, but because I wanted to. So that’s a really important reflection on my part and one I need to remind myself of!

So in summary, I think the biggest points to take away from the last 3 months personally are around support, flexibility and understanding your boundaries. The support we receive and accept as midwives new to this way of working is so important and if you are going to work this way you really need to find people who you connect with and a team where everyone shares similar values. Flexibility is also an important learning point as I’ve learnt that to be there for my caseload and my colleagues whilst also maintaining my own personal life requires flexibility, not just from me but also from my colleagues and the families we care for too. Setting and maintaining my boundaries follows on from that, if I know I really do need my rest day then I should keep my phone off. Maintaining these boundaries is also about not being glued to my phone out of hours, because it is always tempting to have a little peak, when actually for our own preservation we should be enjoying our evenings and weekends even if we are on call, if the phone rings we answer but anything else can wait until normal working hours.

So after 3 months, I’m really pleased I am now a permanent member of the NM family and very proud to be so. I hope this post will help people to understand how continuity works and how being a caseload midwife, where ever that is, can be a hugely positive experience.

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