DAY 2 WORKSHOPS
Day 2 arrived quickly, and we all felt much more at ease following the success of day 1! The midwives were all slightly more on time and were very excited to arrive to a polo t-shirt each (donated by Muntada Aid) and some lovely hand creams donated from the UK (thanks to those that donated!) A few of the midwives who attended day 1 could not make day 2, so we had a few new faces come in their place including our first male midwife- James!
Following another great breakfast from MamaBox, Alison promptly started the day with a look back on day 1 and a recap on respectful care. She then moved into another key theme of the workshops, which was the importance of research in midwifery. This then progressed to Dr Scovia Nmbalinda of Makerere University providing a fantastic talk on her journey in research and the importance of making changes in midwifery practice to improve outcomes.
To lead us gently into the teaching on neonatal resuscitation, we decided to take the issue back a step to respectful care in labour and the issues of evidenced based care which will reduce the likelihood of the need for resuscitation for some babies. The MUMSIE made another dramatic appearance as the topic was introduced by Mollie and Jenny entered the room in the throes of the 2nd stage of labour with her Midwife Nicola.
The acting was amazingly real, and the whole room of midwives became attentive, and you could feel the buzz, as they all wanted to be involved with the pending birth. As labour progressed, Jenny became distressed on her back, so was encouraged to move to her side, and then onto ‘all fours’. This position was more comfortable for labour, and slowly and with dramatic effect, Jenny’s baby was born. Baby was placed on Jenny chest skin to skin and the scene frozen. During the freeze, the benefits of skin to skin were addressed and discussed, thermoregulation, hormone release, regulation of heartbeat, and stimulation of digestion and an interest in breastfeeding.
The scenario was further played out, as Nicola assessed baby on the chest, and dried and stimulated baby, while noticing that she was not yet actively breathing. Jenny was assured that baby was safe there, and getting a further blood supply from the placenta, and that the cord would be cut at one minute post-delivery. A hat and towel were placed on the baby and delayed cord clamping was perused. The scenario was again frozen as Mollie undertook further teaching, and Jenny and Nicola were made comfortable in the scene as a video of the physiology was delayed cord clamping was played.
Following this, the acting re-commenced, as Nicola called for help, and at a minute post birth, clamped and cut the cord, and took the baby to the resuscitation table to meet with Mollie. Baby was further assessed, and given inflation breaths, followed by ventilation breaths. Further support was needed, but soon, baby was crying and returned to Mummy Jenny, to have a further calming period of skin to skin and a breastfeed. This session generated hearty debate on the variations of resuscitation methods, which were taken back to the latest evidence and would be further taught and demonstrated in stations in the afternoon.
Another unexpected outcome was the discussion of birth position which had been modelled during the birth. Jenny had laboured on her back and left lateral but had chosen to deliver baby on ‘all fours’ using the birthing ball. This sparked discussion and debate among the midwives, the President was keen to ‘have a go’. Her insightful leadership empowered the midwives to join the debate, and Jenny became pregnant for a second and third time, as her baby was delivered in the left lateral and all fours position. This impromptu session led to further discussion in the reflection practice session later in the afternoon.
We soon realised the difference in practice between the UK and Uganda regarding resuscitation when the next activity required the midwives to work in their groups to order picture diagrams of a neonatal resuscitation. From the difficulty with this task, it was soon realised we would need to work on the basics in the neonatal resuscitation practice element of the scenarios.
Following lunch, we commenced day 2 scenario stations. Mollie ran the station on neonatal resuscitation. Luckily, the university was able to provide us with 3 NeoNatalie simulation dolls for resuscitation practice, so the groups were split up into twos and threes to all get a chance to demonstrate a resuscitation. Mollie started with running through checking equipment worked effectively, and the importance of correctly sized masks. The biggest challenge was that the midwives didn’t complete inflation breaths, they were used to moving into quick ventilation breaths. It took some time to relay the importance of the 5 inflation breaths to displace the fluid on the neonate’s lungs, but by the end of each sessions every midwife was able to demonstrate 5 inflation breaths, 15 ventilation breaths, 30 second re-assessments and basic CPR.
The second station covered Reflection as a topic, to help midwives gain a deeper understanding of the process; this helps to reflect on practice both positive and negative, gives them a chance to take some time out, and improve actions if the situation occurs again.
This was a new topic for some, although some of the younger Intern Midwives had a basic knowledge of the process, so we began with a gentle introduction or revision of the key themes. To help the midwives own their own situations, Nicola placed thought processes in a clock circle on the floor, and asked them to move in pairs around the clock face to complete a reflection. This included a short description of what happened, what did they feel about it, evaluation of the incident, analysis and conclusion and next steps. They were asked to identify a critical incident in their career and reflect on this together. If they did not want to share, they were invited to reflect on the incident that we had just acted out which resulted in a neonatal resuscitation.
Although this technique was new to most of the midwives, it produced some really in-depth discussions and really pulled on the learning over the previous days of respectful care, and how that can be incorporated into practice, with our women, but also between each other. One midwife described how her staff were stressed and anxious due to the volume of work. She reflected that as a manager, she may be able to do more to support, and as a next step, was going to investigate a staff support WhatsApp group. She also identified that daily ‘huddles’ would help, and more praise towards each other during a difficult shift. This idea of respect between ourselves became a theme in all of the groups; many identifying that respectful care really starts with respect and care of ourselves, then replicated towards those we care for.
Many other experiences emerged in these discussions and while hearing the learning and joy from the other groups, the reflective practice workspace gave a quiet time and space to value each other, acknowledge that sometimes things are difficult at work, and to take time out to look back and learn. This quiet time was valued by the team and helped them make a conscious effort to look at clinical situations and examine own beliefs and values within the situation and to learn from the experiences.
The final station focused on respectful care. This centred around a scenario of a young woman attending for her first antenatal appointment, played by Alison. Jenny played the role of an exhausted midwife who had more than 40 people in the waiting area to be seen. Understaffed and fatigued, core aspects of respect became neglected from the midwife’s care. The team watched this scenario and then came together to reflect on what they had seen, and what could have been improved or changed. Themes of consent, privacy, dignity, and good communication were discussed. The midwives then selected one person from each team to act out the scenario again, this time ensuring respectful care. Before moving on to the next station the teams reflected on what ‘respectful care’ meant to them and wrote these ideas down on post it notes to add to our Respect wall later.
Following the scenario’s, the last group session of the day was on the theme of research in maternity. The idea of this session was to get the midwives thinking about what research questions or priorities they had, or more simply, what changes they would like to see in their place of work. We heard from Betty Jajuuko, an incredibly inspiring research midwife working in Kampala. Betty’s breadth of knowledge and experience coupled with her enthusiasm for the role of midwives in research was the perfect starting point to get the midwives thinking about how they could be involved in research themselves. We split in to three groups and heard from the midwives about what problems or difficulties they face at work, and what they would like to see changed. Suggestions varied from reducing long waiting times in antenatal clinics, to understanding and tackling negative perceptions of midwives in the community. Through thinking about what questions they would like answered or what changes they would like to see, we opened up discussions about how small research projects could be done and lead by the midwives that could generate these changes and lead to real improvements.
We had now reached the end of day 2, and with that Annette (President of the Ugandan Association of Midwives) closed the workshops with many thanks and take-home points for the midwives. We then moved on to the certification ceremony. Ugandan culture involves a lot of formality, so we knew the midwives would really appreciate a formal ceremony (with Arethra’s respect playing in the background of course!) They were all gifted with a certificate, baby’s knitted hat and a fob watch (thanks to a donation from Mollie’s Nan!)
This then led to group photos, emotional thanks, and goodbyes, along with a little dancing to respect to celebrate the midwife’s achievements!
We were all on a high by the end, so after some packing up and cleaning up we made our way to a rooftop terrace in central Kampala for a celebratory dinner, some emotional debriefing and a sense of great pride in the beginning of HER Workshops journey.
Author : Mollie Haskey
The blog first appeared in Midwifery Twinning Project- Uganda.
