A Reflection of My Caseholding

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A reflection about my experience of caseloading

For this essay I will be using the John’s (2000) structured model of reflection, as I find it guides me through my thoughts in a clear and structured format. I will be reflecting on a caseloading experience mainly in relation to the labour and birth, as this was a key time in meeting many of the objectives of the module and as a result has been a great benefit to myself not only as a student midwife but for my future career. The particular woman in this case will be referred to as Claire in order to maintain confidentiality. She was a low risk multiparous woman (National Institute for Health and Clinical Excellence 2008).

It was clear from the booking that Claire had not had a very positive experience with her first delivery and therefore I felt that she would be an ideal candidate to approach about caseloading, as the additional support and continuity could benefit her greatly (Rogers 2009; Van der Kooy 2009). Claire was very keen to be involved and I saw her at almost every scheduled appointment of care.

As the due date approached it became extremely clear to me that Claire’s fears surrounding the birth were increasing, which has been found to be a common theme (Maier 2010). I discussed these fears with her in an attempt to help alleviate them and make this birth a positive experience for her. Her main fears were having another instrumental delivery and an episiotomy as the last healed poorly. Claire was aware herself that there was a higher chance of an episiotomy with an instrumental delivery (Raisanen, Vehvilainen-Julkunen and Heinonen 2008) and I reassured her as much as I could in relation to current research but knew myself that the outcome of this birth could not be predicted. Research has found this to be a common fear for women with a previous instrumental delivery (Goyder, Bahi, Ford and Strachan 2010). As an autonomous midwife I will face many challenges and responsibilities in my role and this I saw as a great opportunity to gain experience and develop my skills and ability. Striving for positive outcomes I feel is a major part of this autonomous role.

The birth unfortunately was everything Claire had feared. She had an episiotomy, instrumental delivery, and a major obstetric haemorrhage. A de brief was organised this time and Claire was able to talk through any unanswered questions she had. As stated by the Nursing Midwifery Council (2004) “midwives must act to identify and minimise risks to patients and clients”. This is exactly what was done in Claire’s care. I feel the key issues were how the whole experience was perceived by Claire in relation to how she felt and how as autonomous midwives we play a role in that through our ability, skills and knowledge.

Due to her previous experience I wanted her to feel as though it was now at the back of her mind and no longer such an issue. I wanted Claire and her husband to feel supported in their decisions and fully informed (Bick 2010; Midirs 2008). I felt that by doing this I could help her to feel more relaxed about the birth (Maier 2010). I acted upon this as I wanted everything to be perfect for Claire and feel that if you don’t strive for this and normality in the care you provide then you should not be in this role. Obviously you will not always achieve it but you should aim to (Stephens 2010).

Although the final outcome may not be what you hoped for, the care you provide and the decisions you make can still make it positive. By listening to Claire and keeping her fully informed I really feel I did all that was possible to reduce the impact of the situation. Being capable of making autonomous and informed decisions whilst empowering parents to do the same is part of our role (Sullivan 2005).

Communication is a vital skill of being an autonomous practitioner (Bick 2010) and one I feel is a great strength of mine. I feel that had communication been poor, Claire would have felt very...
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