Florence Nightingale School of Nursing & Midwifery King’s College London
Record of Personal Clinical Experience
BSc Midwifery Studies
with Registration
Name..........................................................
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
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Contents Page Record of personal clinical experience 3 Summary of personal details 5 Summary of placement details Year 1 6 Year 2 7 Year 3 8 Orientation to clinical placements 9
Reflective activity and meetings with supervisor of midwives
Year 1 10 Year 2 11 Year 3 12 Learning contacts and placement evaluation 14 Example of learning contract 15-16 Learning contracts Antenatal 17-22 Intrapartum 23-28 Postnatal 29-34 Community 35-40 Theatres 41-42 Gynaecology 43-44
Neonatal 45-46
Guided clinical skills Abdominal examination 47-48 Conducting a booking interview 49-50 Assessing women during pregnancy 51-52 Initial assessment of a woman in labour 53-54 Care of a woman in labour 55-56 Assessment after birth 57-58 Postnatal examination of a woman 59-60 Assessment of a baby 61-62
Infant feeding clinical skills 63 Assisting a woman breastfeed guided clinical skill 64-66 How to assess a breastfeed 67 Breastfeeding observation checklist 68 Breastfeeding observation form 69-77 Hand expressing checklist 78
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
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Clinical skills Year 1 79-80
Year 2 81-82 Year 3 83-85
European Union Midwifery Directives 86
Women cared for during the antenatal period 87-96 Spontaneous vaginal deliveries witnessed 97-98 Instrumental or operative deliveries witnessed 99-100 Women cared for in labour but not delivered by you 101-102 Women delivered by you but cannot be included in your numbers 103-104 Personal deliveries 105-120 Perineal suturing – witnessed and performed 121-122 Breech deliveries 123 Women cared for during the postnatal period 124-132 Infants cared for during the postnatal period 133-142 Newborn at risk 143-144 Women at risk 145-148 Women with pathological conditions 149 Additional personal clinical experience 150-151
Verification of mentor signatures 153-155 Tutor review Year 1 156 Year 2 157 Year 3 158
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
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RECORD OF PERSONAL CLINICAL EXPERIENCE The European Union has produced minimum standards student midwives are expected to attain by the end of their training. There are also certain experiences that are essential clinical requirements of your training and will prepare you for your role and responsibilities as set out in the Midwives’ Rules and Standards (Nursing and Midwifery Council (NMC) 2004). It is essential that you keep accurate records of all your personal clinical experience throughout your training. This document should be read in conjunction with the practice placement guidelines, programme and course handbooks. This record of personal clinical experience is part of your personal professional portfolio. It provides evidence to support links between theoretical and clinical based learning and forms an important aspect in your achievement of pre-registration proficiencies as stipulated by the NMC (2004). The following headings outline the content of this document. 1. Summary of personal details 2. Summary of placement details It is useful to keep this up to date as you will be able to show employers, on qualification, a history of your training. It also supports your transcript which is produced at the end of your training with an hourly breakdown of your placements. 3. Orientation to clinical placements In the first few days of each new clinical placement you should complete the orientation with the assistance of the staff in the unit and complete this section. Please familiarise yourself with fire alarms and exits, evacuation procedures, where emergency equipment is kept etc. 4. Summary of reflective activities and meetings with Supervisor of Midwives Opportunities will arise in your clinical placements to reflect on clinical incidents or discuss your progress with your mentor/assessor(s), Supervisors of Midwifery responsible for students and/or Clinical Practice Facilitators (CPF). Entries could comprise structured discussions using a reflective model, or group reflections with fellow students and link lecturers. This will corroborate your development as set out in the Midwifery Practice assessment Document. 5. Learning contracts and placement evaluations There are learning contracts for each area, i.e. antenatal, postnatal, intrapartum, community, gynaecology, theatres and neonatal. For each area a list of possible essential skills which may be achieved is provided for your guidance. The expectation is that you will complete: First year - the minimum of one learning contract for antenatal, intrapartum and postnatal care areas. This experience is available on the respective wards and during community/group practice placements. Second year - the minimum learning contracts are as the first year plus gynaecology and theatres. Third year - as the first year, plus neonatal. The learning contract is made prospectively with the support of your sign off mentor for that area. It is an opportunity for you to identify an area which you would like to develop. It is also an opportunity for your sign off mentor to assess you formatively. Extra copies of the learning contracts can be found on
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
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the e-learning site for placements. If your mentor is unable to sign off the final review of a learning contract discuss this with the CPF and/or your link lecturer. More guidance on learning contracts is given on page 14. Placement evaluation should be done for each placement you undertake. Please submit these electronically. Forms are available in the e-learning site for placements. We take evaluation very seriously and your feedback supports improvements/changes in the clinical area.
6. Guided clinical skills The guided skills are to support your learning towards achieving the essential skills clusters. They are not mandatory, but we strongly recommend that you complete them with the support of a mentor as they may support your learning contract and give you an opportunity to evaluate your care systematically. They are designed to be used in your first year of training. 7. Infant Feeding Clinical Skills Parts of this section are to be completed as part of the Baby Friendly training you will be undertaking during your training. The completion of these is compulsory. 8. Summary of European Union Directive Compliance with these requirements is essential for your registration as a midwife with the NMC. It is expected that you comply with guidelines of the data protection act presented in the Midwives’ Rules and Standards (NMC 2004). 9. Verification of mentor signatures Each person who signs your MPD/clinical experience document for any reason needs to sign the verification page. They only need to complete it once. 10. Personal tutor review Each time your personal tutor/CPF or link lecturer sees and reviews your MPD this will be filled in. The minimum for seeing your personal tutor is once a term. Also, you must submit your MPD on the dates given. Regular review has many advantages and is strongly recommended. References Nursing and Midwifery Council (2009) Standards of Proficiency for Pre-registration Midwifery Education, London NMC. NMC (2004) Midwives Rules and Standards. London, NMC.
Please note extra pages for this document can be printed from the KEATS e-learning site Practice Learning Environment folder. HOWEVER THE ORIGINAL PAGES MUST BE PRESENTED ALONGSIDE ANY EXTRA PAGES USED.
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
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Summary of Personal Details
Name of Student:
Contact Details:
Title of Programme
Student Cohort
Personal Lecturer Name:
Contact Details:
Date of Mid Point Tripartite Review: Date of Summative Tripartite Review:
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
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Summary of Placement Details Year 1
Name of Practice Placement Start Date End Date 1
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Summary of Placement Details Year 2
Name of Practice Placement Start Date End Date 1
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King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
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Summary of Placement Details Year 3
Name of Practice Placement Start Date End Date 1
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King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
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ORIENTATION TO PLACEMENTS (this page MUST be completed) Telephone Numbers for: Cardiac arrest …………………
Fire ………………… Security …………………
Knows how to use the Bleep system Yes…… Date shown ….…… Knows how to use the Emergency Bleep Yes…. Date shown……. Knows the location of Blood Bank Yes…… Date shown…… Knows the Fire Assembly Point Yes…… Date shown……. Tick the boxes (put N/A if not applicable) Equipment & policies Antenatal
clinic/ward Delivery Suite Postnatal
areas Community Identify location
Cardiac arrest trolley
Oxygen and suction
Fire alarms and exits
Post partum haemorrhage/obstetric emergency procedures
Neonatal resuscitation equipment
Drug administration policies
Moving and handling aids
Specialist equipment – please specify
Trust health and safety/clinical guidelines
Incident/accident reporting systems
Reporting procedure for absence
Discussion of mentorship arrangements
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
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Reflective activity and meetings with Mentor/Assessor, Supervisor of Midwives or Clinical Practice Facilitator Year 1 Date Content and summary of
meeting/reflection Reflective strategy/model used
Designation and signature of facilitator
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
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Reflective activity and meetings with Mentor/Assessor, Supervisor of Midwives or Clinical Practice Facilitator Year 2 Date Content and summary of
meeting/reflection Reflective strategy/model used
Designation and signature of facilitator
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
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Reflective activity and meetings with Mentor/Assessor, Supervisor of Midwives or Clinical Practice Facilitator Year 3 Date Content and summary of
meeting reflection Reflective strategy/model used
Designation and signature of facilitator
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
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Reflective activity and meetings with Mentor/Assessor, Supervisor of Midwives or Clinical Practice Facilitator Date Content and summary of
meeting/reflection Reflective strategy/model used
Designation and signature of facilitator
Photocopy this page if you require extra pages for any years
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
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Learning contracts and placement evaluation It is expected that you draft and discuss a learning contract for each clinical placement (see above for expectations). The content of the contract should reflect the time spent in that clinical area. A learning contract is an agreement drawn up by you and your sign off mentor. It identifies aspects of practice you would like or need to develop. The key to a successful learning contract is to make sure that goals are Specific, Measurable, Achievable, Relevant and Timed (SMART). When you have agreed a particular learning need and refined specific aim(s) and objectives it is important to establish how this will be accomplished. This may involve establishing what resources are necessary to achieve it and the timeframe over which it is to be expedited. Learning needs may relate to specific areas of knowledge, skills or professional insights that you need to develop or may relate to a particular interest e.g. teenage pregnancy. It is useful to identify how you will achieve the learning as you may need to negotiate alternative or associated opportunities such as a visit to another practice area, working with a different midwife, access to a computer to get policy documents etc. Your participation in this process gives you an opportunity to be more involved and in control of your own learning. Developing your own contract ensures that your learning takes centre stage, although it is strongly recommended that you discuss your learning contract with your sign off mentor before you write it and that it is signed and agreed by your nominated supporter. This will help you in communicating your learning needs and maximise feedback obtained during the evaluation phase. It is useful to regularly review the contract to monitor progress so that at the agreed final evaluation you are enabled to meet your outcomes. Regular review clarifies whether learning goals are being achieved and allows you to reflect on the evidence that learning has happened and to identify strategies to overcome potential constraints. The evaluation phase enables you to present evidence that you have achieved learning e.g. this may be by writing an account of care given, noting clinics attended and summarising knowledge and skills gained. Finally at the end of the placement you and your mentor will evaluate your learning to see if you have achieved your goal. If for any reason you have not then you and your sign off mentor need to write an action plan and identify if it is possible for you to carry forward to the next placement. Your mentor will sign the contract to say whether you have or have not achieved your learning goals. Placement evaluation This provides an opportunity for you to give feedback on the placement. Forms are available electronically. You should complete one for each placement attended. Anonymous data will be considered as part of the educational audit process and presented to the programme management boards to which students representative attend. It is also sent to the CPFs for the Trust and cascaded to all areas.
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
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EXAMPLE OF A LEARNING CONTRACT LEARNING CONTRACT - ANTENATAL The possible essential skills which may be accomplished during antenatal placements are: 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 2.1, 2.2, 2.3, 2.4, 4.1, 4.2, 5.1, 5.2, 5.3, 5.4, 5.5, 5.6, 5.8, 5.9, 5.10, Skill 6, Skill 8, Skill 9, Skill 10. Clinical Area……………………… Dates from ……………..to………………. What are your learning needs? Include aims and objectives Aim To be able to undertake an abdominal examination with minimal supervision. Objectives To be able to observe the abdominal region for skin changes, previous scars and foetal movements To be able to identify gestational age, lie, presentation through palpation To be able to auscultate the foetal heart using both Pinard foetal stethoscope and Sonicaid To be able to document findings accurately Identify resources you will need to achieve your learning needs (e.g. specialist midwives, access to books) Discuss this learning need with my mentor Work with a midwife during antenatal clinics Read text books/articles about foetal growth, foetal heart sounds, maternal changes in pregnancy Anatomy and physiology Practice in the skills labs (Simulation and Interactive Learning [SaIL] Centre, Guy’s) Use Structured Clinical Guide to complement my learning experience Action plan – How you will achieve your aims and objectives using your identified resources (e.g. work with a specialist midwife, visit a clinic). Work with my mentor during antenatal clinics. Do abdominal examinations and palpations with my mentor guiding me and supporting my learning. Discuss findings with my mentor. Use Pinard stethoscope to listen to the foetal heart. Document my findings in the woman’s notes. Read and revise anatomy and physiology of pregnancy so I can apply this knowledge to the examination and palpation. Contract signatures Mentor………………………………………. Date………………………. Student…………………………………….. Date……………………….
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
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Mid review Half way through the placement you and your mentor should discuss your progress in achieving the learning contract. Review the action plan; make alterations to plans as required. Please write down the results of this meeting. This placement has allowed me to be able to practice abdominal examination and palpation. I have attended 6 clinics and seen 15 women who allowed me to do an examination and palpation. First my mentor did the examination first and told me what I was feeling and now I do it first and tell her what I think I feel and she checks me. I am getting it right a lot of the time and can now hear the foetal heart using a Pinard. Signature of mentor………………………….. Date………………………. Signature of student………………………… Date……………………… Evaluation of learning and comments This is an opportunity for the mentor to give formative feedback on your progress during this placement. It is also an opportunity for you to reflect on your learning. Mentor: Please consider learning achieved, areas of strength and areas the student may need to concentrate on in future placements. Mentor Comments: Fiona has made sufficient progress with this learning contract and has met the learning objectives identified. To continue with this she needs to practice with the Pinard at every opportunity and I have identified that this will be possible on placement in community, antenatal ward and delivery suite. When she progresses to the 2nd yr I have suggested that she takes the lead in the abdominal palpation rather than waiting for being asked to do it, and to start documenting and feeding back to her mentor. Student comments: Feel I have made sufficient progress in this learning contract and that I can undertake this skill confidently as a 1st yr student midwife. I will do as Jan (my mentor) has suggested and practice this skill at every opportunity. Signature of mentor………………………….. Date………………………. Signature of student………………………… Date………………………
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
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LEARNING CONTRACT - ANTENATAL The possible essential skills which may be accomplished during antenatal placements are: 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 2.1, 2.2, 2.3, 2.4, 4.1, 4.2, 5.1, 5.2, 5.3, 5.4, 5.5, 5.6, 5.8, 5.9, 5.10, Skill 6, Skill 8, Skill 9, Skill 10. Clinical Area……………………… Dates from ……………..to………………. What are your learning needs? Include aims and objectives Identify resources you will need to achieve your learning needs (e.g. specialist midwives, access to books) Action plan – How you will achieve your aims and objectives using your identified resources (e.g. work with a specialist midwife, visit a clinic). Contract signatures Mentor………………………………………. Date………………………. Student…………………………………….. Date……………………….
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
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Mid review Half way through the placement you and your mentor should discuss your progress in achieving the learning contract. Review the action plan; make alterations to plans as required. Please write down the results of this meeting. Signature of mentor………………………….. Date………………………. Signature of student………………………… Date……………………… Evaluation of learning and comments This is an opportunity for the mentor to give formative feedback on your progress during this placement. It is also an opportunity for you to reflect on your learning. Mentor: Please consider learning achieved, areas of strength and areas the student may need to concentrate on in future placements. Mentor Comments: Student comments: Signature of mentor………………………….. Date………………………. Signature of student………………………… Date………………………
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
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LEARNING CONTRACT - ANTENATAL The possible essential skills which may be accomplished during antenatal placements are: 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 2.1, 2.2, 2.3, 2.4, 4.1, 4.2, 5.1, 5.2, 5.3, 5.4, 5.5, 5.6, 5.8, 5.9, 5.10, Skill 6, Skill 8, Skill 9, Skill 10. Clinical Area……………………… Dates from ……………..to………………. What are your learning needs? Include aims and objectives Identify resources you will need to achieve your learning needs (e.g. specialist midwives, access to books) Action plan – How you will achieve your aims and objectives using your identified resources (e.g. work with a specialist midwife, visit a clinic). Contract signatures Mentor………………………………………. Date………………………. Student…………………………………….. Date……………………….
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
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Mid review Half way through the placement you and your mentor should discuss your progress in achieving the learning contract. Review the action plan; make alterations to plans as required. Please write down the results of this meeting. Signature of mentor………………………….. Date………………………. Signature of student………………………… Date……………………… Evaluation of learning and comments This is an opportunity for the mentor to give formative feedback on your progress during this placement. It is also an opportunity for you to reflect on your learning. Mentor: Please consider learning achieved, areas of strength and areas the student may need to concentrate on in future placements. . Mentor Comments: Student comments: Signature of mentor………………………….. Date………………………. Signature of student………………………… Date………………………
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
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LEARNING CONTRACT - ANTENATAL The possible essential skills which may be accomplished during antenatal placements are: 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 2.1, 2.2, 2.3, 2.4, 4.1, 4.2, 5.1, 5.2, 5.3, 5.4, 5.5, 5.6, 5.8, 5.9, 5.10, Skill 6, Skill 8, Skill 9, Skill 10. Clinical Area……………………… Dates from ……………..to………………. What are your learning needs? Include aims and objectives Identify resources you will need to achieve your learning needs (e.g. specialist midwives, access to books) Action plan – How you will achieve your aims and objectives using your identified resources (e.g. work with a specialist midwife, visit a clinic). Contract signatures Mentor………………………………………. Date………………………. Student…………………………………….. Date……………………….
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
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Mid review Half way through the placement you and your mentor should discuss your progress in achieving the learning contract. Review the action plan; make alterations to plans as required. Please write down the results of this meeting. Signature of mentor………………………….. Date………………………. Signature of student………………………… Date……………………… Evaluation of learning and comments This is an opportunity for the mentor to give formative feedback on your progress during this placement. It is also an opportunity for you to reflect on your learning. Mentor: Please consider learning achieved, areas of strength and areas the student may need to concentrate on in future placements. Mentor Comments: Student comments: Signature of mentor………………………….. Date………………………. Signature of student………………………… Date………………………
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
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LEARNING CONTRACT - INTRAPARTUM The possible essential skills which may be accomplished during intrapartum placements are: 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 3.1, 3.2, 3.3, 3.4, 3.5, 3.6, 3.7, 3.8, 3.9., 3.10, 4.1, 4.2, 5.1, 5.2, 5.3, 5.4, 5.5, 5.6, 5.7 5.8, 5.9, 5.10. Clinical Area……………………… Dates from ……………..to………………. What are your learning needs? Include aims and objectives Identify resources you will need to achieve your learning needs (e.g. specialist midwives, access to books) Action plan – How you will achieve your aims and objectives using your identified resources (e.g. work with a specialist midwife, visit a clinic). Contract signatures Mentor………………………………………. Date………………………. Student…………………………………….. Date……………………….
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
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Mid review Half way through the placement you and your mentor should discuss your progress in achieving the learning contract. Review the action plan; make alterations to plans as required. Please write down the results of this meeting. Signature of mentor………………………….. Date………………………. Signature of student………………………… Date……………………… Evaluation of learning and comments This is an opportunity for the mentor to give formative feedback on your progress during this placement. It is also an opportunity for you to reflect on your learning. Mentor: Please consider learning achieved, areas of strength and areas the student may need to concentrate on in future placements. Mentor Comments: Student comments: Signature of mentor………………………….. Date………………………. Signature of student………………………… Date………………………
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
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LEARNING CONTRACT - INTRAPARTUM The possible essential skills which may be accomplished during intrapartum placements are: 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 3.1, 3.2, 3.3, 3.4, 3.5, 3.6, 3.7, 3.8, 3.9., 3.10, 4.1, 4.2, 5.1, 5.2, 5.3, 5.4, 5.5, 5.6, 5.7 5.8, 5.9, 5.10. Clinical Area……………………… Dates from ……………..to………………. What are your learning needs? Include aims and objectives Identify resources you will need to achieve your learning needs (e.g. specialist midwives, access to books) Action plan – How you will achieve your aims and objectives using your identified resources (e.g. work with a specialist midwife, visit a clinic). Contract signatures Mentor………………………………………. Date………………………. Student…………………………………….. Date……………………….
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
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Mid review Half way through the placement you and your mentor should discuss your progress in achieving the learning contract. Review the action plan; make alterations to plans as required. Please write down the results of this meeting. Signature of mentor………………………….. Date………………………. Signature of student………………………… Date……………………… Evaluation of learning and comments This is an opportunity for the mentor to give formative feedback on your progress during this placement. It is also an opportunity for you to reflect on your learning. Mentor: Please consider learning achieved, areas of strength and areas the student may need to concentrate on in future placements. . Mentor Comments: Student comments: Signature of mentor………………………….. Date………………………. Signature of student………………………… Date………………………
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
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LEARNING CONTRACT - INTRAPARTUM The possible essential skills which may be accomplished during intrapartum placements are: 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 3.1, 3.2, 3.3, 3.4, 3.5, 3.6, 3.7, 3.8, 3.9., 3.10, 4.1, 4.2, 5.1, 5.2, 5.3, 5.4, 5.5, 5.6, 5.7 5.8, 5.9, 5.10. Clinical Area……………………… Dates from ……………..to………………. What are your learning needs? Include aims and objectives Identify resources you will need to achieve your learning needs (e.g. specialist midwives, access to books) Action plan – How you will achieve your aims and objectives using your identified resources (e.g. work with a specialist midwife, visit a clinic). Contract signatures Mentor………………………………………. Date………………………. Student…………………………………….. Date……………………….
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
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Mid review Half way through the placement you and your mentor should discuss your progress in achieving the learning contract. Review the action plan; make alterations to plans as required. Please write down the results of this meeting. Signature of mentor………………………….. Date………………………. Signature of student………………………… Date……………………… Evaluation of learning and comments This is an opportunity for the mentor to give formative feedback on your progress during this placement. It is also an opportunity for you to reflect on your learning. Mentor: Please consider learning achieved, areas of strength and areas the student may need to concentrate on in future placements. Mentor Comments: Student comments: Signature of mentor………………………….. Date………………………. Signature of student………………………… Date………………………
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
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LEARNING CONTRACT - POSTNATAL The possible essential skills which may be accomplished during postnatal placements are: 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 4.1, 4.2, 4.3, 4.4, 4.5, 4.6, 5.1, 5.2, 5.3, 5.4, 5.5, 5.6, 5.7 5.8, 5.9, 5.10, Skill 7, Skill 8, Skill 9, Skill 10. Clinical Area……………………… Dates from ……………..to………………. What are your learning needs? Include aims and objectives Identify resources you will need to achieve your learning needs (e.g. specialist midwives, access to books) Action plan – How you will achieve your aims and objectives using your identified resources (e.g. work with a specialist midwife, visit a clinic). Contract signatures Mentor………………………………………. Date………………………. Student…………………………………….. Date……………………….
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
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Mid review Half way through the placement you and your mentor should discuss your progress in achieving the learning contract. Review the action plan; make alterations to plans as required. Please write down the results of this meeting. Signature of mentor………………………….. Date………………………. Signature of student………………………… Date……………………… Evaluation of learning and comments This is an opportunity for the mentor to give formative feedback on your progress during this placement. It is also an opportunity for you to reflect on your learning. Mentor: Please consider learning achieved, areas of strength and areas the student may need to concentrate on in future placements. Mentor Comments: Student comments: Signature of mentor………………………….. Date………………………. Signature of student………………………… Date………………………
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
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LEARNING CONTRACT - POSTNATAL The possible essential skills which may be accomplished during postnatal placements are: 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 4.1, 4.2, 4.3, 4.4, 4.5, 5.6, 5.1, 5.2, 5.3, 5.4, 5.5, 5.6, 5.7 5.8, 5.9, 5.10, Skill 7, Skill 8, Skill 9, Skill 10, Clinical Area……………………… Dates from ……………..to………………. What are your learning needs? Include aims and objectives Identify resources you will need to achieve your learning needs (e.g. specialist midwives, access to books) Action plan – How you will achieve your aims and objectives using your identified resources (e.g. work with a specialist midwife, visit a clinic). Contract signatures Mentor………………………………………. Date………………………. Student…………………………………….. Date……………………….
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
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Mid review Half way through the placement you and your mentor should discuss your progress in achieving the learning contract. Review the action plan; make alterations to plans as required. Please write down the results of this meeting. Signature of mentor………………………….. Date………………………. Signature of student………………………… Date……………………… Evaluation of learning and comments This is an opportunity for the mentor to give formative feedback on your progress during this placement. It is also an opportunity for you to reflect on your learning. Mentor: Please consider learning achieved, areas of strength and areas the student may need to concentrate on in future placements. Mentor Comments: Student comments: Signature of mentor………………………….. Date………………………. Signature of student………………………… Date………………………
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
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LEARNING CONTRACT - POSTNATAL The possible essential skills which may be accomplished during postnatal placements are: 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 4.1, 4.2, 4.3, 4.4, 4.5, 4.6, 5.1, 5.2, 5.3, 5.4, 5.5, 5.6, 5.7 5.8, 5.9, 5.10, Skill 7, Skill 8, Skill 9, Skill 10 Clinical Area……………………… Dates from ……………..to………………. What are your learning needs? Include aims and objectives Identify resources you will need to achieve your learning needs (e.g. specialist midwives, access to books) Action plan – How you will achieve your aims and objectives using your identified resources (e.g. work with a specialist midwife, visit a clinic). Contract signatures Mentor………………………………………. Date………………………. Student…………………………………….. Date……………………….
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
34
Mid review Half way through the placement you and your mentor should discuss your progress in achieving the learning contract. Review the action plan; make alterations to plans as required. Please write down the results of this meeting. Signature of mentor………………………….. Date………………………. Signature of student………………………… Date……………………… Evaluation of learning and comments This is an opportunity for the mentor to give formative feedback on your progress during this placement. It is also an opportunity for you to reflect on your learning. Mentor: Please consider learning achieved, areas of strength and areas the student may need to concentrate on in future placements. . Mentor Comments: Student comments: Signature of mentor………………………….. Date………………………. Signature of student………………………… Date………………………
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
35
LEARNING CONTRACT - COMMUNITY The possible essential skills which may be accomplished during community placements are: 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 2.1, 2.2, 2.3, 2.4, 3.1, 3.2, 3.3, 3.4, 3.5, 3.6, 3.7, 3.8, 3.9, 3.10, 4.1, 4.2, 5.1, 5.2, 5.3, 5.4, 5.5, 5.6, 5.7 5.8, 5.9, 5.10, Skill 6, Skill 7, Skill 8, Skill 9, Skill 10. Clinical Area……………………… Dates from ……………..to………………. What are your learning needs? Include aims and objectives Identify resources you will need to achieve your learning needs (e.g. specialist midwives, access to books) Action plan – How you will achieve your aims and objectives using your identified resources (e.g. work with a specialist midwife, visit a clinic). Contract signatures Mentor………………………………………. Date………………………. Student…………………………………….. Date……………………….
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
36
Mid review Half way through the placement you and your mentor should discuss your progress in achieving the learning contract. Review the action plan; make alterations to plans as required. Please write down the results of this meeting. Signature of mentor………………………….. Date………………………. Signature of student………………………… Date……………………… Evaluation of learning and comments This is an opportunity for the mentor to give formative feedback on your progress during this placement. It is also an opportunity for you to reflect on your learning. Mentor: Please consider learning achieved, areas of strength and areas the student may need to concentrate on in future placements. Mentor Comments: Student comments: Signature of mentor………………………….. Date………………………. Signature of student………………………… Date………………………
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
37
LEARNING CONTRACT - COMMUNITY The possible essential skills which may be accomplished during community placements are: 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 2.1, 2.2, 2.3, 2.4, 3.1, 3.2, 3.3, 3.4, 3.5, 3.6, 3.7, 3.8, 3.9, 3.10, 4.1, 4.2, 5.1, 5.2, 5.3, 5.4, 5.5, 5.6, 5.7 5.8, 5.9, 5.10, Skill 6, Skill 7, Skill 8, Skill 9, Skill 10. Clinical Area……………………… Dates from ……………..to………………. What are your learning needs? Include aims and objectives Identify resources you will need to achieve your learning needs (e.g. specialist midwives, access to books) Action plan – How you will achieve your aims and objectives using your identified resources (e.g. work with a specialist midwife, visit a clinic). Contract signatures Mentor………………………………………. Date………………………. Student…………………………………….. Date……………………….
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
38
Mid review Half way through the placement you and your mentor should discuss your progress in achieving the learning contract. Review the action plan; make alterations to plans as required. Please write down the results of this meeting. Signature of mentor………………………….. Date………………………. Signature of student………………………… Date……………………… Evaluation of learning and comments This is an opportunity for the mentor to give formative feedback on your progress during this placement. It is also an opportunity for you to reflect on your learning. Mentor: Please consider learning achieved, areas of strength and areas the student may need to concentrate on in future placements. Mentor Comments: Student comments: Signature of mentor………………………….. Date………………………. Signature of student………………………… Date………………………
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
39
LEARNING CONTRACT - COMMUNITY The possible essential skills which may be accomplished during community placements are: 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 2.1, 2.2, 2.3, 2.4, 3.1, 3.2, 3.3, 3.4, 3.5, 3.6, 3.7, 3.8, 3.9, 3.10, 4.1, 4.2, 5.1, 5.2, 5.3, 5.4, 5.5, 5.6, 5.7 5.8, 5.9, 5.10, Skill 6, Skill 7, Skill 8, Skill 9, Skill 10. Clinical Area……………………… Dates from ……………..to………………. What are your learning needs? Include aims and objectives Identify resources you will need to achieve your learning needs (e.g. specialist midwives, access to books) Action plan – How you will achieve your aims and objectives using your identified resources (e.g. work with a specialist midwife, visit a clinic). Contract signatures Mentor………………………………………. Date………………………. Student…………………………………….. Date……………………….
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
40
Mid review Half way through the placement you and your mentor should discuss your progress in achieving the learning contract. Review the action plan; make alterations to plans as required. Please write down the results of this meeting. Signature of mentor………………………….. Date………………………. Signature of student………………………… Date……………………… Evaluation of learning and comments This is an opportunity for the mentor to give formative feedback on your progress during this placement. It is also an opportunity for you to reflect on your learning. Mentor: Please consider learning achieved, areas of strength and areas the student may need to concentrate on in future placements. Mentor Comments: Student comments: Signature of mentor………………………….. Date………………………. Signature of student………………………… Date………………………
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
41
LEARNING CONTRACT - THEATRES The possible essential skills which may be accomplished during neonatal placements are: 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 5.1, 5.2, 5.3, 5.4, 5.5, 5.6, 5.7, 5.8, 5.9. Clinical Area……………………… Dates from ……………..to………………. What are your learning needs? Include aims and objectives Identify resources you will need to achieve your learning needs (e.g. specialist midwives, access to books) Action plan – How you will achieve your aims and objectives using your identified resources (e.g. work with a specialist midwife, visit a clinic). Contract signatures Mentor………………………………………. Date………………………. Student…………………………………….. Date……………………….
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
42
Mid review Half way through the placement you and your mentor should discuss your progress in achieving the learning contract. Review the action plan; make alterations to plans as required. Please write down the results of this meeting. Signature of mentor………………………….. Date………………………. Signature of student………………………… Date……………………… Evaluation of learning and comments This is an opportunity for the mentor to give formative feedback on your progress during this placement. It is also an opportunity for you to reflect on your learning. Mentor: Please consider learning achieved, areas of strength and areas the student may need to concentrate on in future placements. Mentor Comments: Student comments: Signature of mentor………………………….. Date………………………. Signature of student………………………… Date………………………
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
43
LEARNING CONTRACT - GYNAECOLOGY The possible essential skills which may be accomplished during neonatal placements are: 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 5.1, 5.2, 5.3, 5.4, 5.5, 5.6, 5.7, 5.8, 5.9. Clinical Area……………………… Dates from ……………..to………………. What are your learning needs? Include aims and objectives Identify resources you will need to achieve your learning needs (e.g. specialist midwives, access to books) Action plan – How you will achieve your aims and objectives using your identified resources (e.g. work with a specialist midwife, visit a clinic). Contract signatures Mentor………………………………………. Date………………………. Student…………………………………….. Date……………………….
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
44
Mid review Half way through the placement you and your mentor should discuss your progress in achieving the learning contract. Review the action plan; make alterations to plans as required. Please write down the results of this meeting. Signature of mentor………………………….. Date………………………. Signature of student………………………… Date……………………… Evaluation of learning and comments This is an opportunity for the mentor to give formative feedback on your progress during this placement. It is also an opportunity for you to reflect on your learning. Mentor: Please consider learning achieved, areas of strength and areas the student may need to concentrate on in future placements. Mentor Comments: Student comments: Signature of mentor………………………….. Date………………………. Signature of student………………………… Date………………………
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
45
LEARNING CONTRACT - NEONATAL The possible essential skills which may be accomplished during neonatal placements are: 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 3.1, 3.2, 4.1, 4.2, 4.3, 4.4, 4.5, 4.6, 5.1, 5.2, 5.4, 5.5, 5.8, 5.9, Skill 10. Clinical Area……………………… Dates from ……………..to………………. What are your learning needs? Include aims and objectives Identify resources you will need to achieve your learning needs (e.g. specialist midwives, access to books) Action plan – How you will achieve your aims and objectives using your identified resources (e.g. work with a specialist midwife, visit a clinic). Contract signatures Mentor………………………………………. Date………………………. Student…………………………………….. Date……………………….
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
46
Mid review Half way through the placement you and your mentor should discuss your progress in achieving the learning contract. Review the action plan; make alterations to plans as required. Please write down the results of this meeting. Signature of mentor………………………….. Date………………………. Signature of student………………………… Date……………………… Evaluation of learning and comments This is an opportunity for the mentor to give formative feedback on your progress during this placement. It is also an opportunity for you to reflect on your learning. Mentor: Please consider learning achieved, areas of strength and areas the student may need to concentrate on in future placements. Mentor Comments: Student comments: Signature of mentor………………………….. Date………………………. Signature of student………………………… Date………………………
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
47
GUIDED CLINICAL SKILLS These guided skills are to support your learning. They are not mandatory, but it is recommended that
you use them to generate discussion and review of your practice with your mentor. Abdominal Examination
General elements of this skill will include introducing yourself to the woman; explaining what you are going to do and why; ensuring the woman has emptied her bladder and gaining consent to perform the examination.
Gravida….. Parity…… Gestation…….. Reason for antenatal visit Observation of abdomen Shape Scars Skin changes Foetal movements Palpation Fundal height cm……. = …….. weeks Does this equal dates? Fundal palpation finding Lateral palpation findings… Pelvic palpation findings… Auscultation findings… NOTES
Linked to essential skills 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 2.2, 3.3, 3.5.
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
48
Abdominal Examination General elements of this skill will include introducing yourself to the woman; explaining what you are going to do and why; ensuring the woman has emptied her bladder and gaining consent to perform the examination.
Gravida….. Parity…… Gestation…….. Reason for antenatal visit Observation of abdomen Shape Scars Skin changes Foetal movements Palpation Fundal height cm……. = …….. weeks Does this equal dates? Fundal palpation finding Lateral palpation findings… Pelvic palpation findings… Auscultation findings… NOTES
Linked to essential skills 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 2.2, 3.3, 3.5.
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
49
Conducting a booking interview General elements of this skill will include; reading the notes before you see the woman; introducing yourself and anyone else present; ensuring you check personal details such as address & GP with the woman; explain the purpose of the interview. Give the woman opportunities to ask questions and ensure she is given information about diet, exercise and general health issues. Gravida…………. Parity …………. ………LMP and EDD…………………………… Gestation………………………….. Obstetric history Medical and surgical history Family history Sexual health Mental health history Social services support arranged Physical examination BP Urinalysis Other Abdominal palpation (if appropriate) Auscultation (if appropriate) Blood tests Organized scans Organized follow up visits Reflect on how you felt the interview went and what you may do differently next time. Linked to essential skills 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 2.1, 2.2, 2.3, 2.4, 4.1, Skill 6, Skill 9, Skill 10.
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
50
Conducting a booking interview General elements of this skill will include; reading the notes before you see the woman; introducing yourself and anyone else present; ensuring you check personal details such as address & GP with the woman; explaining the purpose of the interview. Give the woman opportunities to ask questions and ensure she is given information about diet, exercise and general health issues. Gravida…………. Parity …………. ………LMP and EDD…………………………… Gestation………………………….. Obstetric history Medical and surgical history Family history Sexual health Mental health history Social services support arranged Physical examination BP Urinalysis Other Abdominal palpation (if appropriate) Auscultation (if appropriate) Blood tests Organized scans Organized follow up visits Reflect on how you felt the interview went and what you may do differently next time. Linked to essential skills 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 2.1, 2.2, 2.3, 2.4, 4.1, Skill 6, Skill 9, Skill 10.
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
51
Assessing women during pregnancy
General element of this skill will include introducing yourself to the woman; explaining what you are going to do and why; ensuring the woman has emptied her bladder and you have gained consent to perform the examination. Gravida………. Parity…….. Gestation…. Why the woman is attending clinic… Ask the woman general questions about herself Problems identified (with mentor’s support) Actions to be taken (e.g. who referred to, scan ordered)
Physical examination BP… Urinalysis…. Assess oedma… Palpation findings… Auscultation Blood tests Which ones and why taken…. NOTES Linked to essential skills 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 2.2, 3.3, 3.5, 4.1.
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
52
Assessing women during pregnancy
General element of this skill will include introducing yourself to the woman; explaining what you are going to do and why; ensuring the woman has emptied her bladder and you have gained consent to perform the examination. Gravida….. Parity…… Gestation…….. Why the woman is attending clinic… Ask the woman general questions about herself Problems identified (with mentor’s support) Actions to be taken (e.g. who referred to, scan ordered)
Physical examination BP… Urinalysis…. Assess oedma… Palpation findings… Auscultation Blood tests Which ones and why taken…. NOTES Linked to essential skills 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 2.2, 3.3, 3.5, 4.1.
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
53
Initial assessment of woman in labour History The woman’s health throughout pregnancy Medical conditions or significant history Past obstetric history Assessment Parity Gestation Risk factors Onset of contractions; Length & Frequency Frequency from beginning of one contraction to the beginning of the next contraction measured over ten minutes (To accommodate irregularity) Strength Objective assessment by you Women’s subjective opinion
Show observed Yes / No Comments Membranes Intact Ruptured (Spontaneous or artificial rupture of membranes)
Amount Colour of liquor; clear bloodstained meconium
Observations
Blood pressure (check similarity with last ante natal B/P) Pulse Temperature Urine; proteinurea ketones
Abdominal examination Inspection Size Shape Scars Straie gravidarum Examination
Fundal height Lie Presentation Position Descent of head Amount of amniotic fluid
Listen; Foetal heart rate ………….. How you listened Pinard/sonicaid/CTG Also ask the women about foetal movements Vaginal examination
External genitalia Vagina Cervical dilation Effacement Thickness of cervix Consistency of cervix
Position of os Foetal Position please draw sutures and fontanelles Linked to essential skills 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 3.1, 3.2, 3.3, 3.4, 3.5, 3.6, 3.9, 3.10.
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
54
Initial assessment of woman in labour History The woman’s health throughout pregnancy Medical conditions or significant history Past obstetric history Assessment Parity Gestation Risk factors Onset of contractions; Length & Frequency Frequency from beginning of one contraction to the beginning of the next contraction measured over ten minutes (To accommodate irregularity) Strength Objective assessment by you Women’s subjective opinion
Show observed Yes / No Comments Membranes Intact Ruptured (Spontaneous or artificial rupture of membranes)
Amount Colour of liquor; clear bloodstained meconium
Observations
Blood pressure (check similarity with last ante natal B/P) Pulse Temperature Urine; proteinurea ketones
Abdominal examination Inspection Size Shape Scars Straie gravidarum Examination
Fundal height Lie Presentation Position Descent of head Amount of amniotic fluid
Listen; Foetal heart rate ………….. How you listened Pinard/sonicaid/CTG Also ask the women about foetal movements Vaginal examination
External genitalia Vagina Cervical dilation Effacement Thickness of cervix Consistency of cervix
Position of os Foetal Position please draw sutures and fontanelles Linked to essential skills 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 3.1, 3.2, 3.3, 3.4, 3.5, 3.6, 3.9, 3.10.
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
55
Care of a woman in labour
Maternal wellbeing Temperature Pulse B/P Urine Intake Oral IV Coping with Pain What strategies were used to help the woman cope with pain? Distraction Focussing Water Heat Massage Tens
Pethidine Entonox Epidural Other
Foetal Wellbeing Gestation Size = to gestation Amount of amniotic fluid Foetal heart monitoring Normal baby/labour; Intermittent auscultation Abnormal baby/labour; Continuous CTG Interpretation
(DR C. BRAVDO)
Determine Risk
Contractions Baseline Rate Accelerations
Variability Decelerations
Overall
Progress in Labour Contractions; Length Strength Frequency Compare contraction pattern with what it was earlier (may get less intense as well as more intense) Palpation to determine descent of head Vaginal examination Notes Linked to essential skills 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 3.1, 3.2, 3.3, 3.4, 3.5, 3.6, 3.9, 3.10, 5.1, 5.2, 5.3, 5.4, 5.5, 5.6, 5.7, 5.8, 5.9, 5.10.
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
56
Care of a woman in labour Maternal wellbeing Temperature Pulse B/P Urine Intake Oral IV Coping with Pain What strategies were used to help the woman cope with pain? Distraction Focussing Water Heat Massage Tens
Pethidine Entonox Epidural Other
Foetal Wellbeing Gestation Size = to gestation Amount of amniotic fluid Foetal heart monitoring Normal baby/labour; Intermittent auscultation Abnormal baby/labour; Continuous CTG Interpretation
(DR C. BRAVDO)
Determine Risk
Contractions Baseline Rate Accelerations
Variability Decelerations
Overall
Progress in Labour Contractions; Length Strength Frequency Compare contraction pattern with what it was earlier (may get less intense as well as more intense) Palpation to determine descent of head Vaginal examination Notes Linked to essential skills 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 3.1, 3.2, 3.3, 3.4, 3.5, 3.6, 3.9, 3.10, 5.1, 5.2, 5.3, 5.4, 5.5, 5.6, 5.7, 5.8, 5.9, 5.10.
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
57
Assessment after birth
Assessment of the woman Fundus
Height Consistency Reasons for deviation Uterus Relaxed Full of blood Full bladder Passed urine Catheter draining
Perineum Intact Degree of tear Type of repair if any Blood loss Temperature Pulse BP How is the mother feeling after birth? Assessment of baby immediately after the birth Type of delivery Gestation Apgar score Weight Skin to skin contact
1st breastfeed occurred within an hour of birth? If not – comment on why (baby sleepy / not interested etc)
Passed Urine Passed Meconium Cord Temperature Identification tags x2 Notes Linked to essential skills 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 3.7, 3.8, 3.9, 3.10, 4.1, 4.6.
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
58
Assessment after birth
Assessment of the woman Fundus
Height Consistency Reasons for deviation Uterus Relaxed Full of blood Full bladder Passed urine Catheter draining
Perineum Intact Degree of tear Type of repair if any Blood loss Temperature Pulse BP How is the mother feeling after birth? Assessment of baby immediately after the birth Type of delivery Gestation Apgar score Weight Skin to skin contact
1st breastfeed occurred within an hour of birth? If not – comment on why (baby sleepy / not interested etc)
Passed Urine Passed Meconium Cord Temperature Identification tags x2 Notes Linked to essential skills 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 3.7, 3.8, 3.9, 3.10, 4.1, 4.6.
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
59
Postnatal examination of a woman General elements of this skill will include reading the notes before you see the woman and introduce yourself. You should ask her how she is feeling and ensure she is comfortable. Ask if she requires analgesia and also if she is passing urine and stool. Give the woman opportunities to ask questions.
Gravida……………………. Parity Gestation baby was born
Mode of delivery
Days Postnatal
Method of feeding baby breast / bottle / both
Assessment of breastfeeding including attachment and positioning Any other strategies undertaken to help?
Physical examination Pulse, BP & temperature (if applicable) Breasts- ask the woman how her breasts are feeling and observe. Uterus and involution (not palpated if C/S, not all midwives palpate the uterus to check involution after normal delivery, discuss with your mentor and make notes relevant to this woman) Perineal wound (ask if not observed) or C/S scar Lochia (ask if not observed) Assess for DVT Problems identified (with the support of mentor) Actions to be taken (with the support of mentor) Psychological assessment (with the support of mentor) Sleep pattern NOTES Linked to essential skills 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 4.1, 4.2, 4.3, 4.4, 4.5, 4.6, 5.1, 5.2, 5.3, 5.4, 5.5, 5.6, 5.7, 5.8, 5.9, 5.10, Skill 7, Skill 9, Skill 10.
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
60
Postnatal examination of a woman General elements of this skill will include reading the notes before you see the woman and introduce yourself. You should ask her how she is feeling and ensure she is comfortable. Ask if she requires analgesia and also if she is passing urine and stool Give the woman opportunities to ask questions.
Gravida……………………. Parity Gestation baby was born
Mode of delivery
Days Postnatal
Method of feeding baby breast / bottle / both
Assessment of breastfeeding including attachment and positioning Any other strategies undertaken to help?
Physical examination Pulse, BP & temperature (if applicable) Breasts- ask the woman how her breasts are feeling and observe. Uterus and involution (not palpated if C/S, not all midwives palpate the uterus to check involution after normal delivery, discuss with your mentor and make notes relevant to this woman) Perineal wound (ask if not observed) or C/S scar Lochia (ask if not observed) Assess for DVT Problems identified (with the support of mentor) Actions to be taken (with the support of mentor) Psychological assessment (with the support of mentor) Sleep pattern NOTES Linked to essential skills 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 4.1, 4.2, 4.3, 4.4, 4.5, 4.6, 5.1, 5.2, 5.3, 5.4, 5.5, 5.6, 5.7, 5.8, 5.9, 5.10, Skill 7, Skill 9, Skill 10.
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
61
Assessment of a baby General elements of this skill will include reading the notes before you examine the baby; introduce yourself to the mother and gain maternal consent. Ask her about how she feels the baby is generally and how the baby is feeding and ensure you give the woman opportunities to ask questions. Gestation of baby Mode of birth How many days old Baby able to attach correctly to the breast? Comment of on feeding Vomit General appearance Colour Muscle tone and movement Skin e.g. rashes Examination Fontanelles
Eyes Mouth and nose Temperature (if applicable take temperature with thermometer) Breathing pattern Umbilical cord Baby passing urine meconium/stool Any problems identified (with the support of mentor) Actions to be taken (with the support of mentor)
Screening / blood tests (if any taken) NOTES Linked to essential skills 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 4.4.
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
62
Assessment of a baby General elements of this skill will include reading the notes before you examine the baby; introduce yourself to the mother and gain maternal consent. Ask her about how she feels the baby is generally and how the baby is feeding and ensure you give the woman opportunities to ask questions. Gestation of baby Mode of birth How many days old Baby able to attach correctly to the breast? Comment of on feeding Vomit General appearance Colour Muscle tone and movement Skin e.g. rashes Examination Fontanelles
Eyes Mouth and nose Temperature (if applicable take temperature with thermometer) Breathing pattern Umbilical cord Baby passing urine meconium/stool Any problems identified (with the support of mentor) Actions to be taken (with the support of mentor)
Screening / blood tests (if any taken) NOTES Linked to essential skills 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 4.4.
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
63
Infant Feeding Clinical Skills
Contents
• Guided skill worksheets (3) – compulsory • How to assess a breastfeed information sheet • Breastfeeding Observation Checklist (3) • Breastfeeding Observation Forms (3) – compulsory
• Hand expressing Checklist (1)
How to use this section
The parts which need to be completed in this section are the:
• 3 guided Skill Worksheets – Assisting a woman with breastfeeding • 3 Breastfeeding Observation Forms.
The other parts are for help and information only. You have 3 years to complete this section and you are advised to do one each year. The Guided Skill Worksheets are to help you develop the skills needed to support a mother and baby with successful position and attachment. The Breastfeeding Observation Forms are to help you develop your ability to observe the process of breastfeeding undisturbed without giving your input to the mother. It is therefore suggested that you select a mother and baby pair who are more confident with breastfeeding rather than one that still needs your help. The baby can be any age. Your mentor will help you with choice and give you support if needed. Please ensure that you get the mother to sign the observation sheet at the end.
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
64
Assisting a woman with breastfeeding General elements of this skill will include reading the notes before you see the woman and introducing yourself. Give the woman opportunities to explain the problems, how she feels, and time to ask questions. Parity …………. Days postnatal Mode of delivery Birth weight Can this baby lead his/her own feeding (demand feeding)? Yes / Maybe / No If maybe or no, what are the significant factors? E.g. low birth weight premature etc. How is the mother positioning herself and her baby for feeding? Does the baby attach well to the breast (assess signs of correct attachment no pain, chin against breast, more areola visible at baby’s nose than chin, wide open mouth) Comment on feeding and strategies undertaken to help Notes Linked to essential skills 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 4.1, 4.2, 4.3, 4.4, 4.5, 4.6.
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
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Assisting a woman with breastfeeding General elements of this skill will include reading the notes before you see the woman and introduce yourself. Give the woman opportunities to explain the problems, how she feels, and time to ask questions. Parity …………. Days postnatal Mode of delivery Birth weight Can this baby lead his/her own feeding (demand feeding)? Yes / Maybe / No If maybe or no, what are the significant factors? E.g. low birth weight premature etc. How is the mother positioning herself and her baby for feeding? Does the baby attach well to the breast (assess signs of correct attachment no pain, chin against breast, more areola visible at baby’s nose than chin, wide open mouth) Comment on feeding and strategies undertaken to help Notes Linked to essential skills 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 4.1, 4.2, 4.3, 4.4, 4.5, 4.6.
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Assisting a woman with breastfeeding General elements of this skill will include reading the notes before you see the woman and introduce yourself. Give the woman opportunities to explain the problems, how she feels, and time to ask questions. Parity …………. Days postnatal Mode of delivery Birth weight Can this baby lead his/her own feeding (demand feeding)? Yes / Maybe / No If maybe or no, what are the significant factors? E.g. low birth weight premature etc. How is the mother positioning herself and her baby for feeding? Does the baby attach well to the breast (assess signs of correct attachment no pain, chin against breast, more areola visible at baby’s nose than chin, wide open mouth) Comment on feeding and strategies undertaken to help Notes Linked to essential skills 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 4.1, 4.2, 4.3, 4.4, 4.5, 4.6.
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Information Sheet 6 How to assess a breastfeed 1. What do you notice about the mother? 2. How does the mother hold her baby? 3. What do you notice about the baby? 4. How does the baby respond? 5. How does the mother put her baby to her breast? 6. How does the mother hold her breast during a feed? 7. Does the baby look well attached to the breast? 8. Is the baby suckling effectively? 9. How does the breastfeed finish? 10. Does the baby seem satisfied? 11. What is the condition of the mother’s breasts? 12. How does breastfeeding feel to the mother? Copyright BFI
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The Breastfeed Observation Checklist This form summarises the key points for assessing a breastfeed. It is a useful learning tool for healthcare workers to use to practise observing breastfeeds with mothers and babies. It is also helpful where problems related to feeding are suspected, to identify where changes can be made to improve the breastfeeding experience for either mother or baby. Simply put a tick next to each sign observed during the breastfeed. Signs that breastfeeding is going well are listed on the left hand side; signs of possible difficulty are listed on the right hand side. Before attachment: Mother’s position __ Mother relaxed and comfortable __ Mother not relaxed, e.g. shoulders tense __ Breast hanging or lying naturally1 __ Breast squashed or restricted __ Easy access to nipple/areola __ Access to nipple/areola restricted __ Hair/clothing do not restrict mother’s view __ Mother’s view restricted by hair/clothing Baby’s position __ Baby’s head and body in line __ Baby has to twist head and neck to feed __ Baby held close to mother’s body __ Baby not held close to mother’s body __ [Baby’s whole body supported]2 __ [Only shoulders or head supported] __ Baby’s nose opposite nipple __ Baby’s lower lip/chin opposite nipple Attaching to the breast: __ Baby reaches or roots for the breast __ No response to the breast __ Mother waits for baby to open mouth wide __ Mother does not wait for baby to ‘gape’ __ Baby opens mouth wide __ Baby’s does not open mouth wide __ Mother brings baby swiftly towards breast __ Mother does not move baby in swiftly __ Baby’s chin/lower lip/tongue touches breast first __ Baby’s top lip touches the breast first During the feed: Observations __ Baby’s chin touches the breast __ Baby’s chin does not touch the breast __ Baby’s mouth wide open __ Baby’s mouth pursed, lips point forward __ Baby’s cheeks soft and rounded __ Baby’s cheeks tense or pulled in __ Baby’s lower lip turned outwards __ Baby’s lower lip turned in __ If visible, more areola above baby’s top lip3 __ More areola seen below bottom lip (or equal) __ Breasts remain round during a feed __ Breasts look stretched or pulled __ Signs of milk release (e.g. leaking) __ No signs of milk release Baby’s behaviour __ Baby stays attached to the breast __ Baby slips off the breast __ Baby calm and alert at the breast __ Baby restless or fussy __ Slow, deep sucking bursts with pauses __ Rapid shallow sucks __ No noise other than swallowing __ Smacking or clicking sounds __ Rhythmic swallowing seen __ Occasional or no swallowing seen At the end of the feed: __ Baby releases the breast spontaneously __ Mother takes baby off the breast __ Breasts appear soft __ Breasts are hard or inflamed __ Nipple is same shape as before feed __ Nipple is wedge-shaped or squashed __ Skin of nipple/areola appears healthy __ Nipple/areola is sore or cracked Copyright BFI 1 If the mother prefers her breast to be supported, this should not move it from its natural lie. 2 The observations in square brackets [ ] are less important in older babies than in the newborn. 3 This may not be significant if the mother’s nipple is not in the centre of her areola.
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Breastfeed Observation Form (1) Observing a breastfeed The aim of this form is to facilitate accurate, close observation of a breastfeed, as a learning exercise. It is important to allow plenty of time to carry out the exercise. You should aim to observe a complete breastfeed, from before the start of the feed until after it is concluded. Beginning of the feed 1. Describe the appearance of the nipple(s) and areola(e) before the start of the feed. (Note particularly the shape of the nipple and areola and whether the nipple is centrally positioned). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. How does the mother hold the baby to bring her/him to the breast? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. How does she encourage the baby to turn towards the breast? Is it by turning: Her/his head □ or her/his body □ towards her? 4. Describe what the baby does when approaching the breast. What do you notice about: Her/his arms and hands . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The angle of her/his head . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Her/his mouth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Her/his tongue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Her/his mood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . During the feed 5. Describe the mother’s body posture. Do any areas appear tense? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. Which parts of the baby’s body are touching the mother’s body (i.e. her trunk)? Chest? □ Hips/tummy? □ Thighs/knees? □ Other? □ 7. Do the baby’s knees point in the same direction as her/his nose? Yes □ No □
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If not, where is her/his body twisted? At the neck? □ At the waist? □ Somewhere else? □ 8. Which parts of the baby’s face are touching her/his mother’s breast during the feed? Nose? □ Lips? □ Chin? □ 9. Describe the appearance of the baby’s: top lip . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . lower lip . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . cheeks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10. Is any of the mother’s areola visible? Yes □ No □ If so, where do you see more of it? More by the baby’s top lip □ More by the bottom lip □ None is visible □ 11. Does the baby appear to let go or pull away during the feed? Yes □ No □ 12. Is there any movement of the mother’s breast tissue or skin during the feed? Yes □ No □ If so, please describe it. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13. How does the mother interact with her baby during the feed (e.g. eye contact, talking, stroking)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14. Does the baby suck: constantly? □ in bursts? □ If in bursts, are the gaps between bursts short (i.e. a few seconds)? □ long (15 secs+)? □ 15. How would you describe the baby’s sucks? Rapid/short? □ slow/long? □ Does this pattern change during the feed? Yes □ No □ If yes, how? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . End of the feed 16. Who ends the feed? The mother □ The baby □ How? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17. Describe the appearance of the nipple(s) and areola(e) immediately after the feed. Note particularly any changes in colour or shape. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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18. How does the mother feel about the feed? Does she report any discomfort? What is her impression of how the baby experienced the feed? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Additional notes: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Mother’s signature:…………………………. Student’s signature…………………Date………… Copyright BFI
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Breastfeed Observation Form (2) Observing a breastfeed The aim of this form is to facilitate accurate, close observation of a breastfeed, as a learning exercise. It is important to allow plenty of time to carry out the exercise. You should aim to observe a complete breastfeed, from before the start of the feed until after it is concluded. Beginning of the feed 1. Describe the appearance of the nipple(s) and areola(e) before the start of the feed. (Note particularly the shape of the nipple and areola and whether the nipple is centrally positioned). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. How does the mother hold the baby to bring her/him to the breast? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. How does she encourage the baby to turn towards the breast? Is it by turning: Her/his head □ or her/his body □ towards her? 4. Describe what the baby does when approaching the breast. What do you notice about: Her/his arms and hands . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The angle of her/his head . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Her/his mouth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Her/his tongue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Her/his mood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . During the feed 5. Describe the mother’s body posture. Do any areas appear tense? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. Which parts of the baby’s body are touching the mother’s body (i.e. her trunk)? Chest? □ Hips/tummy? □ Thighs/knees? □ Other? □ 7. Do the baby’s knees point in the same direction as her/his nose? Yes □ No □
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If not, where is her/his body twisted? At the neck? □ At the waist? □ Somewhere else? □ 8. Which parts of the baby’s face are touching her/his mother’s breast during the feed? Nose? □ Lips? □ Chin? □ 9. Describe the appearance of the baby’s: top lip . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . lower lip . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . cheeks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10. Is any of the mother’s areola visible? Yes □ No □ If so, where do you see more of it? More by the baby’s top lip □ More by the bottom lip □ None is visible □ 11. Does the baby appear to let go or pull away during the feed? Yes □ No □ 12. Is there any movement of the mother’s breast tissue or skin during the feed? Yes □ No □ If so, please describe it. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13. How does the mother interact with her baby during the feed (e.g. eye contact, talking, stroking)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14. Does the baby suck: constantly? □ in bursts? □ If in bursts, are the gaps between bursts short (i.e. a few seconds)? □ long (15 secs+)? □ 15. How would you describe the baby’s sucks? Rapid/short? □ slow/long? □ Does this pattern change during the feed? Yes □ No □ If yes, how? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . End of the feed 16. Who ends the feed? The mother □ The baby □ How? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17. Describe the appearance of the nipple(s) and areola(e) immediately after the feed. Note particularly any changes in colour or shape. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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18. How does the mother feel about the feed? Does she report any discomfort? What is her impression of how the baby experienced the feed? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Additional notes: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Mother’s signature:…………………………. Student’s signature…………………Date………… Copyright BFI
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Breastfeed Observation Form (3) Observing a breastfeed The aim of this form is to facilitate accurate, close observation of a breastfeed, as a learning exercise prior to attending teaching on Modules 3 and 4 of this course. It is important to allow plenty of time to carry out the exercise. You should aim to observe a complete breastfeed, from before the start of the feed until after it is concluded. Beginning of the feed 1. Describe the appearance of the nipple(s) and areola(e) before the start of the feed. (Note particularly the shape of the nipple and areola and whether the nipple is centrally positioned). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. How does the mother hold the baby to bring her/him to the breast? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. How does she encourage the baby to turn towards the breast? Is it by turning: Her/his head □ or her/his body □ towards her? 4. Describe what the baby does when approaching the breast. What do you notice about: Her/his arms and hands . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The angle of her/his head . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Her/his mouth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Her/his tongue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Her/his mood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . During the feed 5. Describe the mother’s body posture. Do any areas appear tense? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. Which parts of the baby’s body are touching the mother’s body (i.e. her trunk)? Chest? □ Hips/tummy? □ Thighs/knees? □ Other? □
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7. Do the baby’s knees point in the same direction as her/his nose? Yes □ No □ If not, where is her/his body twisted? At the neck? □ At the waist? □ Somewhere else? □ 8. Which parts of the baby’s face are touching her/his mother’s breast during the feed? Nose? □ Lips? □ Chin? □ 9. Describe the appearance of the baby’s: top lip . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . lower lip . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . cheeks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10. Is any of the mother’s areola visible? Yes □ No □ If so, where do you see more of it? More by the baby’s top lip □ More by the bottom lip □ None is visible □ 11. Does the baby appear to let go or pull away during the feed? Yes □ No □ 12. Is there any movement of the mother’s breast tissue or skin during the feed? Yes □ No □ If so, please describe it. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13. How does the mother interact with her baby during the feed (e.g. eye contact, talking, stroking)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14. Does the baby suck: constantly? □ in bursts? □ If in bursts, are the gaps between bursts short (i.e. a few seconds)? □ long (15 secs+)? □ 15. How would you describe the baby’s sucks? Rapid/short? □ slow/long? □ Does this pattern change during the feed? Yes □ No □ If yes, how? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . End of the feed 16. Who ends the feed? The mother □ The baby □ How? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17. Describe the appearance of the nipple(s) and areola(e) immediately after the feed. Note particularly any changes in colour or shape. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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18. How does the mother feel about the feed? Does she report any discomfort? What is her impression of how the baby experienced the feed? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Additional notes: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Mother’s signature:…………………………. Student’s signature…………………Date………… Copyright BFI
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Hand Expression Checklist Below is a checklist summarising the practical technique involved in teaching hand expression. This is what all breastfeeding mothers should be shown, whether or not it is expected that they will need to use it. Extra information, depending on the mother’s situation (e.g. how to assist the oxytocin reflex when the mother and baby are separated, how much milk needs to be expressed and how [if at all] to collect and store it) is not covered here, but should be provided in addition to the information below. Tick the box to confirm that you have given the mother this information.
Stages of the technique of hand expression Tick
A: STIMULATING THE HORMONAL REFLEXES • Breast massage assists the release of oxytocin. Several methods are possible: – The fist may be gently rolled over the breast. □ – The flat of the hand (or fingers) may be used to press or stroke gently. □ – There should be no rubbing, or pulling of the skin. □ – The technique should feel pleasant to the mother. □ • Rolling the nipple gently between thumb and forefinger stimulates prolactin release. □ B: LOCATING THE LACTIFEROUS SINUSES (Note: This usually needs to be taught only once) The mother needs to: 1. Cup the breast with the palm of her hand and fingers; □ 2. Use her thumb to ‘walk’ down the breast, feeling the underlying tissue; □ 3. Stop at the place where she notices a difference in texture; □ 4. Describe to you what she feels. □ C: EXPRESSING THE MILK The mother needs to: 1. Compress the lactiferous sinuses, if necessary pressing backwards □ slightly before she does so; 2. Avoid sliding her fingers on the skin; □ 3. Release and repeat as often as wished, or until the milk flow subsides; □ 4. Rotate her fingers and thumb to a new position around the areola and □ repeat the process. Copyright BFI
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CLINICAL SKILLS Year 1
These skills are to support your learning. It is recommended that you use them to support your learning in the clinical area. It is recommended that you work towards getting them signed off by a Sign Off Mentor, a Mentor or Co-mentor. These skills can be achieved in any suitable clinical placement. By achieving these you will be adding to your portfolio and you can use them as a discussion point and to support achieving the essential skills in the Midwifery Practice assessment Document.
Signature and date Comments
1. Accurately explain the procedure to obtain a MSU specimen from a woman
2. Is able to auscultate the foetal heart using a Pinard Stethoscope
3. Is able to auscultate foetal heart using a Sonicaid
4. Discuss physiological changes of pregnancy and symptomatic relief with women
5. Perform venepuncture under direct supervision
6. Giving advise on diet and exercise
7. Apply CTG
8. Accurately weigh Baby
9. Give advice on perineal healing and hygiene
10. Undertake perineal assessment including healing
11. Provide pain management in the post-natal period with support from mentor
12. Is able to record fluid input and output accurately
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Signature and date
Comments
13. Teach others baby bathing
14. Teach others to top and tail
15.Demonstrate good telephone skills
16. Use universal precautions at all times
17. Demonstrate understanding of security procedures e.g. labelling women and babies
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CLINICAL SKILLS Year 2
Signature and date Comment
1. Determine when to give Anti D
2. Identify correct sample bottles
3. Complete the correct forms Bloods, MSU
4. Identify deviation from the norm in blood results
5. Administration of Vitamin K to a baby (if prescribed on a drug sheet & under supervision of a qualified mentor)
6. Assess normal/abnormal foetal movement
7. Is able to give an accurate verbal handover
Some of the skills below you may achieve in theatres or gynaecology ward
8. Undertake the admission of a woman to the hospital ward
9. Undertake pre operative preparation of a woman for surgery
10. Receive a woman back from recovery or theatre staff
11. Manage IV regime (under supervision of a qualified mentor)
12. Demonstrate knowledge of fluid balance management
13. Care and removal of urinary catheter
14. Determine urine output satisfactory after removal of urinary catheter
15. Identify signs of infection in the post operative patient
16. Identify normal wound healing
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Signature and date Comments
17. Care of an immobile client Mouth care
Catheter care
Pressure area care
Hygiene needs
18. Aseptic techniques Remove redivac/drain
Remove sutures/clips
Perform sterile dressing
19. Demonstrate awareness of the importance of patient identification and consent
20. Provide care for a patient in the anaesthetic room with support
21. Show awareness of operating theatre technique e.g. swab counts, sterile field etc.
22. Provide care to clients in the recovery room with support
23. Monitor an unconscious patient with support
24. Care for an unconscious patient with support e.g. airway, pressure area care, and patient safety
25. Assess clients’ level of consciousness
26. Assess clients’ pain
27. Demonstrate an understanding of managing post operative pain
28. Undertake cannulation
29. Provide care for a patient receiving 02 therapy with support
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CLINICAL SKILLS Year 3
Signature and date Comments
1. Assess and care for high risk women in the AN Ward/day assessment unit
2. Assess and care for women with PIH
3. Interpret: Antenatal CTG
PIH blood results
4. Undertake speculum examination for HVS and SROM only
5. Undertake physiological management of the 3rd stage with supervision
6. Undertake prostin insertion and management (if done by midwives in your area)
7. Perform artificial rupture of membranes
8. Apply foetal scalp electrode
9. Provide intensive care for women with PIH
10. Infiltrate the perineum with lignocaine
11. Perform an episiotomy (under supervision of a qualified mentor)
12. Suture perineum (under supervision of a qualified mentor)
13. Assist mother and family to relate to baby
14. Able to identify normal and abnormal respiratory patterns in a neonate
15. Able to accurately assess heart rate of a neonate
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Signature and date Comment
Some of the skills below you may achieve in the neonatal ward
16. Articulates and simulates/demonstrates safe practice in response to a neonate in a collapsed state
17. Articulates and uses knowledge in the identification and prevention of cold stress
18. Discusses and supports parents in temperature maintenance for their baby in hospital and at home
19. Discusses and supports parents in their care of their baby’s skin (umbilical cord care, top and tail, bathing, lotions, massage)
20. Demonstrates knowledge and ability to maintain skin integrity in relation to damage (e.g. rashes)
21. Consistently demonstrates the ability to assess the risk of infection as part of the care for a neonate
22. Articulates and demonstrates the ability to assess a neonate physically and behaviourally in relation to their level of jaundice
23. Identifies normal and abnormal serum bilirubin levels
24. Demonstrates the ability to safely and accurately commence phototherapy
25. Demonstrates the ability to safely care for a neonate receiving phototherapy
26. Identifies normal and abnormal blood glucose levels
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Signature and date Comment
27. Articulates and demonstrates the ability to safely and accurately undertake capillary heel prick sampling
28. Articulates and demonstrates the need for universal precautions
29. Calculate volume of feed required under supervision
30. Articulates and demonstrates the safe passing, fixation and usage of gastric feeding tubes.
31. Articulates and demonstrates sensitive awareness of child protection issues
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European Union Midwifery Directives 2005 Practical and clinical training This training is to be dispensed under appropriate supervision: – Advising of pregnant women, involving at least 100 pre-natal examinations. – Supervision and care of at least 40 pregnant women. – Conduct, by the student, of at least 40 births – Active participation with breech deliveries. Where this is not possible because of lack of breech deliveries, practice may be in a simulated situation. – Performance of episiotomy and initiation into suturing. Initiation shall include theoretical instruction and clinical practice. The practice of suturing includes suturing of the wound following an episiotomy and a simple perineal laceration. This may be in a simulated situation if absolutely necessary. – Supervision and care of 40 women at risk in pregnancy, or labour or post-natal period. – Supervision and care (including examination) of at least 100 post-natal women and healthy new-born infants. – Observation and care of the new-born requiring special care, including those born preterm, post-term, underweight or ill. – Care of women with pathological conditions in the fields of gynaecology and obstetrics.
Keighley T (ed) (2005) European Union Standards Information for Accession Countries (2nd ed) WHO Europe. Available: http://www.euro.who.int/__data/assets/pdf_file/0005/102200/E92852.pdf
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WOMEN CARED FOR DURING THE ANTENATAL PERIOD
Essential Clinical requirement ‘Advising of pregnant women, involving at least 100 pre-natal examinations’ (NMC 2004)
Name
Date seen
Comments e.g. why was she being seen today?, gestation, parity, any problems identified, referrals made.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
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Name Date seen Comments e.g. why was she being seen today?, gestation, parity, any problems identified, referrals made.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
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Name Date seen Comments e.g. why was she being seen today?, gestation, parity, any problems identified, referrals made.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
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Name Date seen Comments e.g. why was she being seen today?, gestation, parity, any problems identified, referrals made.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
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Name Date seen Comments e.g. why was she being seen today?, gestation, parity, any problems identified, referrals made.
48.
49.
50.
51.
52.
53.
54.
55.
56.
57.
58.
59.
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Name Date seen Comments e.g. why was she being seen today?, gestation, parity, any problems identified, referrals made.
60.
61.
62.
63.
64.
65.
66.
67.
68.
69.
70.
71.
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Name Date seen Comments e.g. why was she being seen today?, gestation, parity, any problems identified, referrals made.
72.
73.
74.
75.
76.
77.
78.
79.
80.
81.
82.
83.
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Name Date seen Comments e.g. why was she being seen today?, gestation, parity, any problems identified, referrals made.
84.
85.
86.
87.
88.
89.
90.
91.
92.
93.
94.
95.
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Name Date seen Comments e.g. why was she being seen today?, gestation, parity, any problems identified, referrals made.
96.
97.
98.
99.
100.
101.
102.
103.
104.
105.
106.
107.
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WOMEN CARED FOR DURING THE ANTENATAL PERIOD
Name Date seen Comments e.g. why was she being seen today?, gestation, parity, any problems identified, referrals made.
Please photocopy this page to continue to add women to your records.
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SPONTANEOUS VAGINAL BIRTHS WITNESSED You should witness at least 5 spontaneous normal vaginal births before you begin to deliver.
Date Parity Type of birth Comments e.g. gestation of the baby, analgesia
used, management of 3rd stage, Apgar score.
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Date Parity Type of birth Comments e.g. gestation of the baby, analgesia used, management of 3rd stage, Apgar score.
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INSTRUMENTAL OR OPERATIVE BIRTHS WITNESSED Please document ventouse, forcep and Caesarean section births here.
Date Parity Type of birth Comments e.g. parity, gestation of the baby,
analgesia used, management of 3rd stage, Apgar score.
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INSTRUMENTAL OR OPERATIVE BIRTHS WITNESSED Please document ventouse, forcep and Caesarean section births here.
Date Parity Type of delivery Comments e.g. gestation of the baby, analgesia
used, management of 3rd stage, Apgar score.
Please photocopy this page to continue to add women to your records.
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WOMEN CARED FOR IN LABOUR BUT NOT BIRTHED BY YOU This is to acknowledge the care you give to women who may not birth while you are on duty.
Date & woman’s first name
Comments e.g. Parity, care given by you, management of labour (augmented), analgesia used, type of birth (if known and when this occurred, after you went home or while you were there), Apgar score etc.
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WOMEN CARED FOR IN LABOUR BUT NOT BIRTHED BY YOU This is to acknowledge the care you give to women who may not birth while you are on duty.
Date & woman’s first name
Comments e.g. Parity, care given by you, management of labour (augmented), analgesia used, type of birth (if known and when this occurred, after you went home or while you were there), Apgar score etc.
Please photocopy this page to continue to add women to your records.
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Women birthed by you, but have a retained placenta or are too pre-term (under 36 weeks) to be included in numbers
Date & woman’s first name
Comments e.g. Parity, care given by you, management of labour (augmented), analgesia used, type of birth (if known and when this occurred, after you went home or while you were there), Apgar score etc.
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Women birthed by you, but have a retained placenta or are too pre-term (under 36 weeks) to be included in numbers
Date & woman’s first name
Comments e.g. Parity, care given by you, management of labour (augmented), analgesia used, type of delivery (if known and when this occurred, after you went home or while you were there), Apgar score etc.
Please photocopy this page to continue to add women to your records.
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PERSONAL BIRTHS
Essential Clinical requirement ‘At least 40 deliveries personally carried out by the student’ (WHO Europe 2005 and NMC 2009)
(Preterm babies < 36 weeks are not to be counted, twins = one birth) No. 1
Mother’s first name
Date and time of birth
Parity Onset of labour i.e. spontaneous, IOL
Length of 1st stage
Length of 2nd stage
Length of 3rd stage and management
Blood loss Perineal trauma
Baby, sex and weight Apgar score
Midwife’s signature Print name Date
Comments e.g. analgesia used, people supporting, any aspects of the care plan, comments on the CTG if one was used
2 Mother’s first name
Date and time of birth
Parity Onset of labour i.e. spontaneous, IOL
Length of 1st stage
Length of 2nd stage
Length of 3rd stage and management
Blood loss Perineal trauma
Baby, sex and weight Apgar score
Midwife’s signature Print name Date
Comments e.g. analgesia used, people supporting, any aspects of the care plan, comments on the CTG if one was used
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No. 3
Mother’s first name
Date and time of birth
Parity Onset of labour i.e. spontaneous, IOL
Length of 1st stage
Length of 2nd stage
Length of 3rd stage and management
Blood loss Perineal trauma
Baby, sex and weight Apgar score
Midwife’s signature Print name Date
Comments e.g. analgesia used, people supporting, any aspects of the care plan, comments on the CTG if one was used
4 Mother’s first name
Date and time of birth
Parity Onset of labour i.e. spontaneous, IOL
Length of 1st stage
Length of 2nd stage
Length of 3rd stage and management
Blood loss Perineal trauma
Baby, sex and weight Apgar score
Midwife’s signature Print name Date
Comments e.g. analgesia used, people supporting, any aspects of the care plan, comments on the CTG if one was used
5 Mother’s first name
Date and time of birth
Parity Onset of labour i.e. spontaneous, IOL
Length of 1st stage
Length of 2nd stage
Length of 3rd stage and management
Blood loss Perineal trauma
Baby, sex and weight Apgar score
Midwife’s signature Print name Date
Comments e.g. analgesia used, people supporting, any aspects of the care plan, comments on the CTG if one was used
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No. 6
Mother’s first name
Date and time of birth
Parity Onset of labour i.e. spontaneous, IOL
Length of 1st stage
Length of 2nd stage
Length of 3rd stage and management
Blood loss Perineal trauma
Baby, sex and weight Apgar score
Midwife’s signature Print name Date
Comments e.g. analgesia used, people supporting, any aspects of the care plan, comments on the CTG if one was used
7 Mother’s first name
Date and time of birth
Parity Onset of labour i.e. spontaneous, IOL
Length of 1st stage
Length of 2nd stage
Length of 3rd stage and management
Blood loss Perineal trauma
Baby, sex and weight Apgar score
Midwife’s signature Print name Date
Comments e.g. analgesia used, people supporting, any aspects of the care plan, comments on the CTG if one was used
8 Mother’s first name
Date and time of birth
Parity Onset of labour i.e. spontaneous, IOL
Length of 1st stage
Length of 2nd stage
Length of 3rd stage and management
Blood loss Perineal trauma
Baby, sex and weight Apgar score
Midwife’s signature Print name Date
Comments e.g. analgesia used, people supporting, any aspects of the care plan, comments on the CTG if one was used
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No. 9
Mother’s first name
Date and time of birth
Parity Onset of labour i.e. spontaneous, IOL
Length of 1st stage
Length of 2nd stage
Length of 3rd stage and management
Blood loss Perineal trauma
Baby, sex and weight Apgar score
Midwife’s signature Print name Date
Comments e.g. analgesia used, people supporting, any aspects of the care plan, comments on the CTG if one was used
10 Mother’s first name
Date and time of birth
Parity Onset of labour i.e. spontaneous, IOL
Length of 1st stage
Length of 2nd stage
Length of 3rd stage and management
Blood loss Perineal trauma
Baby, sex and weight Apgar score
Midwife’s signature Print name Date
Comments e.g. analgesia used, people supporting, any aspects of the care plan, comments on the CTG if one was used
11 Mother’s first name
Date and time of birth
Parity Onset of labour i.e. spontaneous, IOL
Length of 1st stage
Length of 2nd stage
Length of 3rd stage and management
Blood loss Perineal trauma
Baby, sex and weight Apgar score
Midwife’s signature Print name Date
Comments e.g. analgesia used, people supporting, any aspects of the care plan, comments on the CTG if one was used
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No. 12
Mother’s first name
Date and time of birth
Parity Onset of labour i.e. spontaneous, IOL
Length of 1st stage
Length of 2nd stage
Length of 3rd stage and management
Blood loss Perineal trauma
Baby, sex and weight Apgar score
Midwife’s signature Print name Date
Comments e.g. analgesia used, people supporting, any aspects of the care plan, comments on the CTG if one was used
13 Mother’s first name
Date and time of birth
Parity Onset of labour i.e. spontaneous, IOL
Length of 1st stage
Length of 2nd stage
Length of 3rd stage and management
Blood loss Perineal trauma
Baby, sex and weight Apgar score
Midwife’s signature Print name Date
Comments e.g. analgesia used, people supporting, any aspects of the care plan, comments on the CTG if one was used
14 Mother’s first name
Date and time of birth
Parity Onset of labour i.e. spontaneous, IOL
Length of 1st stage
Length of 2nd stage
Length of 3rd stage and management
Blood loss Perineal trauma
Baby, sex and weight Apgar score
Midwife’s signature Print name Date
Comments e.g. analgesia used, people supporting, any aspects of the care plan, comments on the CTG if one was used
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No. 15
Mother’s first name
Date and time of birth
Parity Onset of labour i.e. spontaneous, IOL
Length of 1st stage
Length of 2nd stage
Length of 3rd stage and management
Blood loss Perineal trauma
Baby, sex and weight Apgar score
Midwife’s signature Print name Date
Comments e.g. analgesia used, people supporting, any aspects of the care plan, comments on the CTG if one was used
16 Mother’s first name
Date and time of birth
Parity Onset of labour i.e. spontaneous, IOL
Length of 1st stage
Length of 2nd stage
Length of 3rd stage and management
Blood loss Perineal trauma
Baby, sex and weight Apgar score
Midwife’s signature Print name Date
Comments e.g. analgesia used, people supporting, any aspects of the care plan, comments on the CTG if one was used
17 Mother’s first name
Date and time of birth
Parity Onset of labour i.e. spontaneous, IOL
Length of 1st stage
Length of 2nd stage
Length of 3rd stage and management
Blood loss Perineal trauma
Baby, sex and weight Apgar score
Midwife’s signature Print name Date
Comments e.g. analgesia used, people supporting, any aspects of the care plan, comments on the CTG if one was used
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No. 18
Mother’s first name
Date and time of birth
Parity Onset of labour i.e. spontaneous, IOL
Length of 1st stage
Length of 2nd stage
Length of 3rd stage and management
Blood loss Perineal trauma
Baby, sex and weight Apgar score
Midwife’s signature Print name Date
Comments e.g. analgesia used, people supporting, any aspects of the care plan, comments on the CTG if one was used
19 Mother’s first name
Date and time of birth
Parity Onset of labour i.e. spontaneous, IOL
Length of 1st stage
Length of 2nd stage
Length of 3rd stage and management
Blood loss Perineal trauma
Baby, sex and weight Apgar score
Midwife’s signature Print name Date
Comments e.g. analgesia used, people supporting, any aspects of the care plan, comments on the CTG if one was used
20 Mother’s first name
Date and time of birth
Parity Onset of labour i.e. spontaneous, IOL
Length of 1st stage
Length of 2nd stage
Length of 3rd stage and management
Blood loss Perineal trauma
Baby, sex and weight Apgar score
Midwife’s signature Print name Date
Comments e.g. analgesia used, people supporting, any aspects of the care plan, comments on the CTG if one was used
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No. 21
Mother’s first name
Date and time of birth
Parity Onset of labour i.e. spontaneous, IOL
Length of 1st stage
Length of 2nd stage
Length of 3rd stage and management
Blood loss Perineal trauma
Baby, sex and weight Apgar score
Midwife’s signature Print name Date
Comments e.g. analgesia used, people supporting, any aspects of the care plan, comments on the CTG if one was used
22 Mother’s first name
Date and time of birth
Parity Onset of labour i.e. spontaneous, IOL
Length of 1st stage
Length of 2nd stage
Length of 3rd stage and management
Blood loss Perineal trauma
Baby, sex and weight Apgar score
Midwife’s signature Print name Date
Comments e.g. analgesia used, people supporting, any aspects of the care plan, comments on the CTG if one was used
23 Mother’s first name
Date and time of birth
Parity Onset of labour i.e. spontaneous, IOL
Length of 1st stage
Length of 2nd stage
Length of 3rd stage and management
Blood loss Perineal trauma
Baby, sex and weight Apgar score
Midwife’s signature Print name Date
Comments e.g. analgesia used, people supporting, any aspects of the care plan, comments on the CTG if one was used
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No. 24
Mother’s first name
Date and time of birth
Parity Onset of labour i.e. spontaneous, IOL
Length of 1st stage
Length of 2nd stage
Length of 3rd stage and management
Blood loss Perineal trauma
Baby, sex and weight Apgar score
Midwife’s signature Print name Date
Comments e.g. analgesia used, people supporting, any aspects of the care plan, comments on the CTG if one was used
25 Mother’s first name
Date and time of birth
Parity Onset of labour i.e. spontaneous, IOL
Length of 1st stage
Length of 2nd stage
Length of 3rd stage and management
Blood loss Perineal trauma
Baby, sex and weight Apgar score
Midwife’s signature Print name Date
Comments e.g. analgesia used, people supporting, any aspects of the care plan, comments on the CTG if one was used
26 Mother’s first name
Date and time of birth
Parity Onset of labour i.e. spontaneous, IOL
Length of 1st stage
Length of 2nd stage
Length of 3rd stage and management
Blood loss Perineal trauma
Baby, sex and weight Apgar score
Midwife’s signature Print name Date
Comments e.g. analgesia used, people supporting, any aspects of the care plan, comments on the CTG if one was used
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No. 27
Mother’s first name
Date and time of birth
Parity Onset of labour i.e. spontaneous, IOL
Length of 1st stage
Length of 2nd stage
Length of 3rd stage and management
Blood loss Perineal trauma
Baby, sex and weight Apgar score
Midwife’s signature Print name Date
Comments e.g. analgesia used, people supporting, any aspects of the care plan, comments on the CTG if one was used
28 Mother’s first name
Date and time of birth
Parity Onset of labour i.e. spontaneous, IOL
Length of 1st stage
Length of 2nd stage
Length of 3rd stage and management
Blood loss Perineal trauma
Baby, sex and weight Apgar score
Midwife’s signature Print name Date
Comments e.g. analgesia used, people supporting, any aspects of the care plan, comments on the CTG if one was used
29 Mother’s first name
Date and time of birth
Parity Onset of labour i.e. spontaneous, IOL
Length of 1st stage
Length of 2nd stage
Length of 3rd stage and management
Blood loss Perineal trauma
Baby, sex and weight Apgar score
Midwife’s signature Print name Date
Comments e.g. analgesia used, people supporting, any aspects of the care plan, comments on the CTG if one was used
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No. 30
Mother’s first name
Date and time of birth
Parity Onset of labour i.e. spontaneous, IOL
Length of 1st stage
Length of 2nd stage
Length of 3rd stage and management
Blood loss Perineal trauma
Baby, sex and weight Apgar score
Midwife’s signature Print name Date
Comments e.g. analgesia used, people supporting, any aspects of the care plan, comments on the CTG if one was used
31 Mother’s first name
Date and time of birth
Parity Onset of labour i.e. spontaneous, IOL
Length of 1st stage
Length of 2nd stage
Length of 3rd stage and management
Blood loss Perineal trauma
Baby, sex and weight Apgar score
Midwife’s signature Print name Date
Comments e.g. analgesia used, people supporting, any aspects of the care plan, comments on the CTG if one was used
32 Mother’s first name
Date and time of birth
Parity Onset of labour i.e. spontaneous, IOL
Length of 1st stage
Length of 2nd stage
Length of 3rd stage and management
Blood loss Perineal trauma
Baby, sex and weight Apgar score
Midwife’s signature Print name Date
Comments e.g. analgesia used, people supporting, any aspects of the care plan, comments on the CTG if one was used
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No. 33
Mother’s first name
Date and time of birth
Parity Onset of labour i.e. spontaneous, IOL
Length of 1st stage
Length of 2nd stage
Length of 3rd stage and management
Blood loss Perineal trauma
Baby, sex and weight Apgar score
Midwife’s signature Print name Date
Comments e.g. analgesia used, people supporting, any aspects of the care plan, comments on the CTG if one was used
34 Mother’s first name
Date and time of birth
Parity Onset of labour i.e. spontaneous, IOL
Length of 1st stage
Length of 2nd stage
Length of 3rd stage and management
Blood loss Perineal trauma
Baby, sex and weight Apgar score
Midwife’s signature Print name Date
Comments e.g. analgesia used, people supporting, any aspects of the care plan, comments on the CTG if one was used
35 Mother’s first name
Date and time of birth
Parity Onset of labour i.e. spontaneous, IOL
Length of 1st stage
Length of 2nd stage
Length of 3rd stage and management
Blood loss Perineal trauma
Baby, sex and weight Apgar score
Midwife’s signature Print name Date
Comments e.g. analgesia used, people supporting, any aspects of the care plan, comments on the CTG if one was used
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No. 36
Mother’s first name
Date and time of birth
Parity Onset of labour i.e. spontaneous, IOL
Length of 1st stage
Length of 2nd stage
Length of 3rd stage and management
Blood loss Perineal trauma
Baby, sex and weight Apgar score
Midwife’s signature Print name Date
Comments e.g. analgesia used, people supporting, any aspects of the care plan, comments on the CTG if one was used
37 Mother’s first name
Date and time of birth
Parity Onset of labour i.e. spontaneous, IOL
Length of 1st stage
Length of 2nd stage
Length of 3rd stage and management
Blood loss Perineal trauma
Baby, sex and weight Apgar score
Midwife’s signature Print name Date
Comments e.g. analgesia used, people supporting, any aspects of the care plan, comments on the CTG if one was used
38 Mother’s first name
Date and time of birth
Parity Onset of labour i.e. spontaneous, IOL
Length of 1st stage
Length of 2nd stage
Length of 3rd stage and management
Blood loss Perineal trauma
Baby, sex and weight Apgar score
Midwife’s signature Print name Date
Comments e.g. analgesia used, people supporting, any aspects of the care plan, comments on the CTG if one was used
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No. 39
Mother’s first name
Date and time of birth
Parity Onset of labour i.e. spontaneous, IOL
Length of 1st stage
Length of 2nd stage
Length of 3rd stage and management
Blood loss Perineal trauma
Baby, sex and weight Apgar score
Midwife’s signature Print name Date
Comments e.g. analgesia used, people supporting, any aspects of the care plan, comments on the CTG if one was used
40 Mother’s first name
Date and time of birth
Parity Onset of labour i.e. spontaneous, IOL
Length of 1st stage
Length of 2nd stage
Length of 3rd stage and management
Blood loss Perineal trauma
Baby, sex and weight Apgar score
Midwife’s signature Print name Date
Comments e.g. analgesia used, people supporting, any aspects of the care plan, comments on the CTG if one was used
41 Mother’s first name
Date and time of birth
Parity Onset of labour i.e. spontaneous, IOL
Length of 1st stage
Length of 2nd stage
Length of 3rd stage and management
Blood loss Perineal trauma
Baby, sex and weight Apgar score
Midwife’s signature Print name Date
Comments e.g. analgesia used, people supporting, any aspects of the care plan, comments on the CTG if one was used
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No. 42
Mother’s first name
Date and time of birth
Parity Onset of labour i.e. spontaneous, IOL
Length of 1st stage
Length of 2nd stage
Length of 3rd stage and management
Blood loss Perineal trauma
Baby, sex and weight Apgar score
Midwife’s signature Print name Date
Comments e.g. analgesia used, people supporting, any aspects of the care plan, comments on the CTG if one was used
43 Mother’s first name
Date and time of birth
Parity Onset of labour i.e. spontaneous, IOL
Length of 1st stage
Length of 2nd stage
Length of 3rd stage and management
Blood loss Perineal trauma
Baby, sex and weight Apgar score
Midwife’s signature Print name Date
Comments e.g. analgesia used, people supporting, any aspects of the care plan, comments on the CTG if one was used
44 Mother’s first name
Date and time of birth
Parity Onset of labour i.e. spontaneous, IOL
Length of 1st stage
Length of 2nd stage
Length of 3rd stage and management
Blood loss Perineal trauma
Baby, sex and weight Apgar score
Midwife’s signature Print name Date
Comments e.g. analgesia used, people supporting, any aspects of the care plan, comments on the CTG if one was used
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No. 45
Mother’s first name
Date and time of birth
Parity Onset of labour i.e. spontaneous, IOL
Length of 1st stage
Length of 2nd stage
Length of 3rd stage and management
Blood loss Perineal trauma
Baby, sex and weight Apgar score
Midwife’s signature Print name Date
Comments e.g. analgesia used, people supporting, any aspects of the care plan, comments on the CTG if one was used
46 Mother’s first name
Date and time of birth
Parity Onset of labour i.e. spontaneous, IOL
Length of 1st stage
Length of 2nd stage
Length of 3rd stage and management
Blood loss Perineal trauma
Baby, sex and weight Apgar score
Midwife’s signature Print name Date
Comments e.g. analgesia used, people supporting, any aspects of the care plan, comments on the CTG if one was used
47 Mother’s first name
Date and time of birth
Parity Onset of labour i.e. spontaneous, IOL
Length of 1st stage
Length of 2nd stage
Length of 3rd stage and management
Blood loss Perineal trauma
Baby, sex and weight Apgar score
Midwife’s signature Print name Date
Comments e.g. analgesia used, people supporting, any aspects of the care plan, comments on the CTG if one was used
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PERINEAL SUTURING – WITNESSED AND PERFORMED Essential Clinical requirement
‘Performance of episiotomy and initiation into suturing, including theoretical instruction and clinical practice. The practice of suturing has included suturing of the wound following an episiotomy and a
simple perineal laceration (or a simulated situation where absolutely necessary)’ (NMC 2009).
Date Name Type of wound sutured
Witness (W) Simulated (S) Performed (P)
Comments e.g. episiotomy or tear, technique used.
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PERINEAL SUTURING – WITNESSED AND PERFORMED Essential Clinical requirement
‘Performance of episiotomy and initiation into suturing, including theoretical instruction and clinical practice. The practice of suturing has included suturing of the wound following an episiotomy and a
simple perineal laceration (or a simulated situation where absolutely necessary)’ (NMC 2009).
Date Name Type of wound sutured
Witness (W) Simulated (S) Performed (P)
Comments e.g. episiotomy or tear, technique used.
Please photocopy this page to continue to add women to your records.
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BREECH BIRTHS
Essential Clinical Requirement ‘Active participation with breech deliveries or where this is not possible because of lack of breech
deliveries in a simulated situation’ (NMC 2009). Please ensure you write in all the simulated breech sessions you do as part of your midwifery training. Date Name Witnessed (W)
Simulated (S) Comments
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WOMEN CARED FOR DURING THE POSTNATAL PERIOD
Essential Clinical Requirement
‘Supervision and care (including examination) of at least 100 postnatal women and healthy infants examinations’ (NMC 2004)
Name Date seen Comments e.g. type of birth, how many days P/N, how she is feeding her baby, general wellbeing, assessments undertaken, actions based on those.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
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Name Date seen Comments e.g. type of birth, how many days P/N, how she is feeding her baby, general wellbeing, assessments undertaken, actions based on those.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
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Name Date seen Comments e.g. type of birth, how many days P/N, how she is feeding her baby, general wellbeing, assessments undertaken, actions based on those.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
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Name Date seen Comments e.g. type of birth, how many days P/N, how she is feeding her baby, general wellbeing, assessments undertaken, actions based on those.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
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Name Date seen Comments e.g. type of birth, how many days P/N, how she is feeding her baby, general wellbeing, assessments undertaken, actions based on those.
47.
48.
49.
50.
51.
52.
53.
54.
55.
56.
57.
58.
Name Date seen Comments e.g. type of birth, how many days P/N, how she is feeding her baby, general wellbeing,
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assessments undertaken, actions based on those.
59.
60.
61.
62.
63.
64.
65.
66.
67.
68.
69.
70.
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Name Date seen Comments e.g. type of birth, how many days P/N, how she is feeding her baby, general wellbeing, assessments undertaken, actions based on those.
71.
72.
73.
74.
75.
76.
77.
78.
79.
80.
81.
82.
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Name Date seen Comments e.g. type of birth, how many days P/N, how she is feeding her baby, general wellbeing, assessments undertaken, actions based on those.
83.
84.
85.
86.
87.
88.
89.
90.
91.
92.
93.
94.
WOMEN CARED FOR DURING THE POSTNATAL PERIOD
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Name Date seen Comments e.g. type of birth, how many days P/N, how she is feeding her baby, general wellbeing, assessments undertaken, actions based on those.
Please photocopy this page to continue to add women to your records.
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INFANTS CARED FOR DURING THE POSTNATAL PERIOD
Essential Clinical Requirement
‘Supervision and care (including examination) of at least 100 postnatal women and healthy infants examinations’ (NMC 2009)
Name Date seen Comments e.g. born at what gestation, how many days old now, how is mother feeding baby? How is baby generally, assessments made and actions taken based on these.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
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Name Date seen Comments e.g. born at what gestation, how many days old now, how is mother feeding baby? How is baby generally, assessments made and actions taken based on these.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
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Name Date seen Comments e.g. born at what gestation, how many days old now, how is mother feeding baby? How is baby generally, assessments made and actions taken based on these.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
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Name Date seen Comments e.g. born at what gestation, how many days old now, how is mother feeding baby? How is baby generally, assessments made and actions taken based on these.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
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Name Date seen Comments e.g. born at what gestation, how many days old now, how is mother feeding baby? How is baby generally, assessments made and actions taken based on these.
46.
47.
48.
49.
50.
51.
52.
53.
54.
55.
56.
57.
Name Date seen Comments e.g. born at what gestation, how many
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days old now, how is mother feeding baby? How is baby generally, assessments made and actions taken based on these.
58.
59.
60.
61.
62.
63.
64.
65.
66.
67.
68.
69.
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Name Date seen Comments e.g. born at what gestation, how many days old now, how is mother feeding baby? How is baby generally, assessments made and actions taken based on these.
70.
71.
72.
73.
74.
75.
76.
77.
78.
79.
80.
81.
Name Date seen Comments e.g. born at what gestation, how many
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days old now, how is mother feeding baby? How is baby generally, assessments made and actions taken based on these.
82.
83.
84.
85.
86.
87.
88.
89.
90.
91.
92.
93.
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Name Date seen Comments e.g. born at what gestation, how many days old now, how is mother feeding baby? How is baby generally, assessments made and actions taken based on these.
94.
95.
96.
97.
98.
99.
100.
101.
102.
103.
104.
105.
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INFANTS CARED FOR DURING THE POSTNATAL PERIOD
Name Date seen Comments e.g. born at what gestation, how many days old now, how is mother feeding baby? How is baby generally, assessments made and actions taken based on these.
Please photocopy this page to continue to add infants to your records. Please photocopy this page to continue to add women to your records.
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NEWBORN AT RISK
Essential Clinical Requirement ‘Observation and care of the newborn requiring special care, including those born pre-term, post-
term, underweight or ill’ (NMC 2004)
Name of infant Date seen Comments e.g. born at what gestation, how many days old now, how is mother feeding baby? How is baby generally, assessments made and actions taken based on these. Why is this baby deemed at risk. Reasons such as jaundice, small for gestational age, mother has a medical condition
1.
2.
3.
4.
5.
6.
7.
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Name of infant Date seen Comments e.g. born at what gestation, how many days old now, how is mother feeding baby? How is baby generally, assessments made and actions taken based on these. Why is this baby deemed at risk. Reasons such as jaundice, small for gestational age, mother has a medical condition
8.
9.
10.
11.
12.
13.
14.
15.
16.
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WOMEN AT RISK
Essential Clinical Requirement ‘Supervision of care of 40 women at risk in pregnancy, labour or postnatal period’ (NMC 2009)
Name Date seen Comments e.g. is she A/N, I/P or P/N? What gestation, days P/N, what is the nature of her being deemed at risk?
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
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Name Date seen Comments e.g. is she A/N, I/P or P/N? What gestation, days P/N, what is the nature of her being deemed at risk?
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
Name Date seen Comments e.g. is she A/N, I/P or P/N? What
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
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gestation, days P/N, what is the nature of her being deemed at risk?
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
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Name Date seen Comments e.g. is she A/N, I/P or P/N? What gestation, days P/N, what is the nature of her being deemed at risk?
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
WOMEN WITH PATHOLOGICAL CONDITIONS
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Essential Clinical Requirement Care of women with pathological condition in the fields of gynaecology and obstetrics (NMC 2009)
Name of infant Date seen Comments e.g. is she A/N, I/P or P/N? What gestation, days P/N, what is the nature of her being deemed at risk?
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
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ADDITIONAL PERSONAL CLINICAL EXPERIENCE
Examples: During your training you should attend clinics such as family planning, sexual health clinics, well women and child health clinics. You should also spend time with a health visitor and visit the ultra sound department, attend breastfeeding workshops. This list is not exhaustive. Write what you had hoped to achieve with the visit and if your aims were met. Please explain how you may use this additional experience to enhance your midwifery care.
Date Where attended Aims of this experience
What I gained from this experience.
Date Where attended Aims of this experience
What I gained from this experience.
Date Where attended Aims of this experience
What I gained from this experience.
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Date Where attended Aims of this experience
What I gained from this experience.
Date Where attended Aims of this experience
What I gained from this experience.
Date Where attended Aims of this experience
What I gained from this experience.
Please photocopy this page to continue to add women to your records.
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Notes page
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Verification of mentor signatures Clinical area Print name Signature of
mentor Sign off Mentor Yes/No
Confirmed by link lecture/CPF
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Verification of mentor signatures Clinical area Print name Signature of
mentor Sign off Mentor Yes/No
Confirmed by link lecture/CPF
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
155
Verification of mentor signatures Clinical area Print name Signature of
mentor Sign off Mentor Yes/No
Confirmed by link lecture/CPF
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
156
Personal Tutor Review Year 1
Date Summary of discussion Days to make up
Signature of personal
Lecturer/CPF or Sign off Mentor
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
157
Personal Tutor Review Year 2
Date Summary of discussion Days to make up
Signature of personal
lecturer /CPF or Sign off Mentor
King’s College London, BSc Midwifery Studies with Registration as a Midwife (3 year course)
158
Personal Tutor Review Year 3
Date Summary of discussion Days to make up
Signature of personal
lecturer/CPF or Sign off Mentor