The Value of a Good Midwifery Supervisor

Originally published in Midwifery Matters, the magazine of the Association of Radical Midwives.

September 2022.

During my time at university, the new NMC education standards were published. So I had one year of the Mentorship system and two years of the Supervision and Assessment system. Over the three years I had more placements than I can now remember, each with their own mentor/supervisor. It was really hard, as it is for so many students, to turn up at a new workplace every few months and be greeted by someone who seems to hold all the keys to your future – and you’ve no idea how you’ll get on. Some mentors/supervisors were anxious, some were cautious, some were confident, some loved students and some were downright bullies. It was a rare day when you turned up to be greeted by smiles and warm welcomes; so many NHS staff seem so completely overwhelmed by the appalling staffing numbers and increasing workloads, that engaging in pleasant socialising is just too much. However, it is equally hard to turn up to a new workplace, without a say in your shift pattern, surrounded by strangers who could very easily put the brakes on your career. I say this, not to complain about being a student – we all had it hard – and not to criticise midwives who I’ve worked with in the past (that would be a whole new article!) but to emphasise how significant a good mentor/supervisor really is. Educationally, they can push you to new heights and drive you forward to learn skills you never thought you’d master. Psychologically, they can support you through a draining and often unrewarding placement/term/year. Physically, they can take care of you in ways they themselves don’t have access to – making sure you use the toilet, get your full break and have time after difficult events to compose and reflect. I have seen mentors/supervisors be completely dejected by the treatment they face on shift every day, and yet still put their student first. I have seen mentors/supervisors really work to get their student to access the support/experiences they need to complete the placement. I have seen mentors/supervisors put in place valuable and supportive action plans, and liaise appropriately with the University. This article is a personal celebration of three mentors/supervisors who made a difference in my midwifery education.

First Year – Delivery Suite

I was so excited to work on Delivery Suite, the concern that I might be too squeamish to be a midwife had gone completely out of the window and I loved interacting with women and their families, as well as being witness to the bringing of new souls earthside. My mentor told me she loved working with students, loved learning herself and loved teaching. She was extremely enthusiastic and very on the ball with paperwork. It was a high risk, highly medicalised and very busy unit. That whole six week placement, I didn’t see a single ‘normal’ birth. I did manage to get three “deliveries”, as my mentor networked frantically around the Unit to get me into the right rooms at the right times. The complete absence of normality on this ward was shocking, and very jarring against the holistic aims we were supposed to be achieving for our university paperwork.

I remember one shift my mentor and I went in to a room for handover just prior to birth, my mentor instructed me to scribe and observe. A week or so later she took me aside to a private space and said the notes had been audited and there was a discrepancy with the signatures. We had a very calm conversation about the importance of documentation, and although I can’t remember the details, there had been a misunderstanding over my signatures. I walked away feeling like we had clarified whatever the problem had been, and I suddenly realised I’d been “told off”! It takes an exceptional mentor to bring up a concern with a student and for it to be resolved, without the student even realising a ‘telling off’ was happening! This mentor used to encourage me to participate in handovers, ward rounds and documentation from day one. She would get me to write out the full history in SBAR format every time I made an entry, to ensure I grasped the importance of reading back through women’s notes, keeping accurate accounts and making sure I could have the answer on the tip of my tongue when the doctor asked! Her enthusiasm will stay with me for a long time, as well as her ability to overcome ward politics to put women and her students first.

Year Two – Birth Centre

This was a fantastic but such a hard placement! My supervisor was a young midwife who qualified several years before me. She clearly adored her job; the midwifery work and the social aspect (with both colleagues and birthing women). It is so lovely to see someone at work, who gets on so well with her colleagues in a completely non-toxic way. This supervisor really kept me on my toes, she also seemed to thoroughly enjoy teaching and would set up resuscitation or ARM practice during quieter periods. She was competent at both ‘low risk’ and ‘high risk’ care, able to rotate round to Delivery Suite without feeling out of her depth or put-out that she wasn’t working in her usual area.

Around half way through the placement I started to feel that I was gaining in skills, knowledge and confidence, so my supervisor asked me to take ‘responsibility’ for a birth with arms-length supervision. A woman arrived at the Unit to birth her first baby, appearing incredibly calm but saying she was struggling to cope. After observing her for a while, she appeared to be in active labour and internalising her experiences. I set things up; getting the pool ready, with notes as well as a stack of towels to hand. After a few hours of labouring quite peacefully in the pool, she pushed out a beautiful baby girl. With a slow and agonising crowing phase which she just breathed through like she’d done it all before. I was so pleased,  I felt like I was doing a good job, and that I’d managed to support a first time mother to birth her baby in peace, all with appropriate documentation afterwards! When we got our break (at 17:00) I asked my supervisor what feedback she could give me for this birth, I was completely shocked when she pulled out a list of improvements for me. Initially I felt quite hurt that she hadn’t focused on the positives I felt I’d experienced, and a bit hard done by with what seemed to be some very picky criticism. It didn’t take me very long to swallow my pride though, and see the feedback for what it was – a real and genuine attempt to get me to absolutely hone my skills. To level up, to not be just “good”. Following this birth, my supervisor was on Annual Leave for a week and I was supervised by other midwives on the Unit. I remember really clearly this one birth, in the early hours of the morning, where  I felt completely overwhelmed. ‘Have I done this, have I done that, is this ready, is that out of the way, when did I last auscultate, do I have access to emergency drugs if needed,’ etc. The feedback that my supervisor had given me was very much along the lines of being aware of the wider picture, and I felt so overwhelmed by holding everything in my mind at once. This time the labouring woman came in quite distressed, her blood pressure was slightly raised so we monitored her for a while until she stabilised. The baby was still very high in her pelvis so we left her to have some peace and quiet. After not too long I went in to see if she needed any support and her waters suddenly went quite explosively, she became very shaky and started to push. I called my supervisor in and the baby was born with the mother kneeling; a third boy in the family, weighing nearly 4.5kg. She immediately swept him up in her arms and nestled him close. About 30 minutes later we got our break (this time at 0500!), and another midwife came in to relieve us. Apart from a snarky comment from the relieving midwife about the baby not yet having had vitamin K, it was very successful from a student point of view. I felt I had done everything my supervisor had told me to do: have synthetic oxytocin drawn up in case of a sudden haemorrhage, make sure the path is clear to the door in case medical staff need to run in during an emergency, make sure the ‘bed’ is far enough away from the wall so a second midwife can get alongside to assist with shoulder dystocia manoeuvres if needed…. However, I went home and that weekend broke down in front of my husband and said “it’s so hard, I don’t know if I am just not cut out for this or if I am reaching the top of a hill and once the skills are learned, they’ll become second nature.” I wondered if this was me becoming better than “good” or failing completely!

Of course, my supervisor knew what I didn’t; how far I could be pushed in order to achieve what she believed I was capable of. Although in many ways I would describe her as a ‘harsh’ teacher, she was always incredibly warm and encouraging. She had a clear and individualised expectation of what you could achieve and was going to get you there no matter what! If I was going to work in the medical system, I could see myself striving to emulate much about her practice both as a supervisor and midwife.  

Third Year – Caseholding

In my third year we did a ‘low risk’ Caseholding module, and it really was exactly how I wanted to practice. It was smack bang in the first wave of Covid policies and so presented many challenges to students and registered midwives alike, both on personal and professional levels. A few months later I remember coming across a midwife who looked so much like my Mum, who I hadn’t seen in months, that I almost burst into tears. However, I was incredibly lucky to be placed in a really supportive team and so for this third account I’ll focus on the whole team rather than an individual.

They were situated almost on the borders of the Trust and so relied on each other much more than I’ve seen other teams do, and really had each other’s backs. Everyone of course had their own clinics and because the team was small most women saw the same midwife for most visits. Everyone knew each other’s schedules so if someone finished their visits early, they would go and take the caseload of another who was busier. I hadn’t seen midwives work like this until this point, it felt like a little family. And I was immediately included in that family and given a huge amount of autonomy and responsibility. It enabled me to achieve everything I wanted to from Caseholding and gave me a taste of what being an RM could be like. I feel it also enabled me to offer the women under my care, proper dedicated attention; something that is often so lacking in many women’s feedback about their experiences.

I felt secure to discuss professional issues within the team, to speak my mind; questioning practice as well as seeking advice. There was one postnatal visit where as I walked through the door I felt something was off. There were a lot of people in the house - the woman was well supported - but she was tearful and her husband was struggling. There was an atmosphere of a big event having happened, and everyone was quite sombre and trying to do their best. The woman had moved downstairs and was living on the sofa, as she was unable to walk up the stairs or really to mobilise much at all. I stated the importance of her mobilising, but as I read through her notes, I realised the woman had suffered what I felt to be iatrogenic and unnecessary physical trauma from her baby’s birth. It horrified me that something like this had happened and I was unsure how to proceed. The way the doctor had reportedly spoken to the woman had been dehumanising, and they had blamed her body for the injury rather than their own intervention. (The doctor’s words as repeated to me were so offensive that I couldn’t put them into writing here.) However, I could now understand why the woman was struggling to keep active. Before being part of this team I wouldn’t have known how to raise a concern like this or what to do in the first place, but I was able to discuss it both with my supervisor and assessor and we formed a plan together. This was a really important lesson in teamwork for me, because my initial thoughts would have been to make a report of some kind. Being part of a team however, meant other people were involved - I was not this woman’s named midwife - and I realised that even (and maybe especially) significant concerns can be shared and raised together.

This team gave me the confidence to be a ‘midwife’ alongside them; after years of feeling like I was struggling to fit in, straining against the Trust and University culture and sweating over every grading. I had finally been welcomed with open arms.