General pattern of work

There are 3 ward patterns of work:

• Labour Ward: 8:30am to 8:30pm

• Ward 12: 8:30am to 4:30pm

• Ward 10/11: 8:30am to 4:30pm

If it's a week which is well staffed you may be scheduled to attend clinic or theatre. You may also be scheduled for an admin day at times where you can catch up on dictation of your outpatient letters.

Generally there will be one FY2/ST on each of these wards. At times there may be an extra FY2/ST on labour ward, typically one of the OBGYN ST1s/ST2s, and they tend to assist with the morning c-sections. At other times there may only be one FY2/ST covering wards 10, 11 and 12.

Each weekday morning everyone meets in the Labour Ward doctors’ room. The delivery book (which documents all the deliveries in the department) is reviewed and each delivery during the past 24 hours is discussed. Then all the ante-natal inpatients are discussed (including any elective c-sections planned for this morning), followed by any post-natal inpatients who have issues, followed by the gynaecology patients. After this handover each team does their ward round. A consultant will go round with the labour ward registrar and FY2/ST to see any patient who need reviewed there. If you are on ward 10/11 or 12 you tend to head upstairs to the wards and await the ward round with either the consultant and the registrar or just the registrar.

If you are scheduled to attend clinic you still attend the morning handover but may need to leave just before it finishes at 9am to make sure you are not late for clinic.

Labour ward - Long weekday

As the labour ward FY2/ST you carry bleep 3578. After the morning handover you attend the labour ward round (if there are any patients who have been necessary for review during the handover - there may be none). You then await the elective c-sections which you will assist in. After each section you write the IDL immediately using the appropriate IDL short code (which are detailed below) - always add Paracetamol, Ibuprofen, Dihydrocodeine and Dalteparin to the script (unless there are any contraindications). The amount of Dalteparin is usually 10 days, however there is a protocol sheet dictating this duration and depending on the risk factors it may be a longer course. If unsure, check maternity VTE guidelines on the intranet.

After the elective sections are done you stay in labour ward either assisting in other deliveries (e.g. emergency c-sections, forceps deliveries) or reviewing triage patients. In later pregnancy patients will attend the Labour Ward for assessment for things such as PV bleeding, abdominal pain, spontaneous rupture of membranes. The registrar may tell you about these triage attenders or the midwives will bleep you about them.

It would be wise to note that even for instrumental deliveries you are not involved in it is your responsibility to do the IDL for that patient, including the addition of the medications to the IDL. The short code for each type of delivery is below.

At 4:30pm the FY2/STs from upstairs (Ward 10/11 and Ward 12) come down to Labour Ward to hand over any evening jobs. From this point you drop the Labour Ward bleep and instead only carry bleep 3559. You will then cover Labour Ward, Ward 10/11 and Ward 12. In the evening you may be bleeped up to review patients on ward 11 or 12 who the midwives/gynae nurses are concerned about or to review triage patients on these wards.

At 8:30pm the night team will arrive (one registrar and one FY2/ST). You will meet in the Labour Ward doctors’ room and discuss the patients currently in Labour Ward. You also hand over any jobs/reviews for overnight or any expected triages/triages which you haven’t yet managed to review.

Ward 10/11 - Day Bed Unit/Antenatal and Postnatal Ward

As the Ward 10/11 FY2/ST you carry bleep 3560 which is found in the bleep box in the Labour Ward doctor’s room. After the morning handover you head up to Ward 11 to await the morning ward round - this will either be led by a consultant with a registrar or it may be just you and the registrar. During the ward round you will review all the antenatal inpatients plus any postnatal patients who have issues. There is a computer on wheels you can take around the ward round, however this sometimes does not work so it would be worth taking paper to write down notes for the round which you can type up afterwards.

After the ward round the first thing to get on with is the post c-section reviews. There is a black diary on top of the patient note tray in the Ward 11 doctors’ room which the midwives write any post c-section checks and any other jobs in. It’s important to get the post c-section checks done early as some of these patients will require scripts to go down to pharmacy. Below is a description of what to include in a post c-section review. After each c-section review you update the IDL (which should have been started on Labour Ward immediately after the section) and print it out, placing it in the TTO box or the pharmacy box (if it’s required to go down to pharmacy).

During the day you may be bleeped by Day Bed Unit (ward 10) for prescriptions or reviews. Low risk ante-natal patients are reviewed here as triages. Patients with chronic conditions of pregnancy, such as pregnancy induced hypertension, may come for regular reviews throughout their pregnancy and you may be bleeped by the Ward 10 midwives if there is an issue with their review.

At 4:30pm you head down to Labour Ward to hand over to the evening FY2/ST (who has been on Labour Ward that day). You hand over any remaining jobs or expected triage patients. Drop your bleep back into the bleep box.

Ward 12 - gynae ward

As the ward 12 FY2/ST you carry bleep 3559 which is found in the bleep box in the Labour Ward doctors’ room. After the morning handover you head up to ward 12 and await the ward round. This ward round takes place after the ward 11 ward round. Ward 12 use paper notes so prior to the ward round it may be useful to find the notes and get organised.

After the ward round you may have a few jobs to do from this. There is also a gynae doctors’ diary which will have some jobs in it - typically these will be follow up jobs from triage patients, such as chasing blood or scan results. There also may be some patients who are coming in for review after scans written in this book.

During the day there will be triage patients who attend the ward from GP or A&E. They will be Gynae triage patients (for example, LIF pain/cyst) or early pregnancy patients (up to 12 weeks, attending with pain/bleeding/ectopic/miscarriage). You will review them, organise any necessary investigations (for example, ultrasound scans, serum HCGs) and then discuss with the registrar if necessary. Depending on the time of day they may not be able to get their investigations the same day - if this is the case and they are well enough to go home you put a patient sticker plus contact details for the patient with a small description of what needs ordered/chased the in the Gynae doctors’ diary for the next day.

At 4:30pm you head down to Labour Ward to handover to the evening FY2/ST (who has been on Labour Ward that day). You hand over any remaining jobs or expected triage patients. Drop your bleep back into the bleep box.

Night shift

Night shift begins at 8:30pm. You and the night registrar meet the evening registrar and FY2/ST in the Labour Ward doctors’ room. You take a handover from the day team, talking through all the patients on labour ward and through any patients upstairs who may need reviewed/intervention over night. You may also get handed over some triage patients who are waiting to be reviewed that the day team did not manage to see.

Overnight you carry beep 3559 and the H@N arrest bleep. Overnight you may have gynae and ante-natal triage patients to review, along with ward reviews. You may also have to go to theatre for emergency c-sections or other instrumental deliveries.

Nights can be a bit of a feast or famine. At times it may be very quiet and H@N may ask you to help in MAU or on the other wards. This is fine to do if you have time and wish to do so but do keep in mind that MAU is quite far from the obstetric department and things can change very quickly and it’s not always ideal if you are far away.

Handover to the day team is at 8:30am in the Labour Ward doctors’ room.

Weekend shift

The weekend shift begins on the Friday long day on labour ward as described above. You carry bleep 3559. On Saturday and Sunday you start at 8:30am, meeting the night team in the Labour Ward doctors’ room. The weekend consultant often comes in in the morning for handover and the ward round, although it depends - some consultants come in later to see how things are going.

After handover you head upstairs with the senior doctors to start a ward round on Ward 11, then subsequently doing a round on Ward 12.

After the ward round the best thing to do is to head back to Ward 11 to start working on the diary jobs such as the post c-section reviews, working through the Ward 12 jobs after this. You may be bleeped with either ante-natal or gynae triages during the day, along with possible theatre for emergency c-sections. Depending on how busy the ward is with reviews and how many triages there are things can build up easily - the registrar is usually happy to help with triage reviews should you feel snowed under.

Handover to the night shift is in the evening at 8:30pm in the Labour Ward doctors’ room.

Ward round times

As described above.

Clinical meetings

Usually O&G meetings every week or every other week are held in the Education Centre and are on varied topics such as CTGs, audit presentations or teaching from registrars. There is also a biannual neonatal and maternal morbidity and mortality meeting. There is a programme of this available to view in Labour Ward.

Teaching

Weekly FY2/ST teaching is in the Labour Ward meeting room. This takes the form of an FY2/ST signing up to present on given topic to deliver to other FY2/STs and is supervised by a consultant. Generally this either takes place on a Tuesday or Wednesday lunchtime. There are opportunities to go on a day long PROMPT course (Practical Obstetric Multi Professional Training) during your placement which teaches you through simulation to manage common obstetric emergencies alongside senior doctors and midwives. These generally run 4 times throughout the year and, if interested, get in touch with Dr Court or Senior Midwife Fiona Coyne.