Facing the nursing challenge
Today The Royal Gazette launches a weekly series featuring members of the Bermuda Nurses' Association as it celebrates 2020 as the International Year of the Nurse.
April was quieter than normal in King Edward VII Memorial Hospital's maternity ward, but Lisa Blyden expects things will pick up — in roughly nine months.
Like Christmas, Valentine's Day and major hurricanes, the clinical manager of the Maternity and Special Care Baby Unit believes Covid-19 will bring a surge in births.
“April 2020 has been quieter than usual months in numbers in comparison to previous years — especially because it is, after all, nine months after the Cup Match holiday,” she said.
Her comments came as the world observed International Day of the Midwife on Wednesday.
“This year it's really about being bold and brave, speaking up for women's rights when it surrounds their health and childbirth, really trying to educate women about informed choice,” said Ms Blyden, a registered midwife who also aids women with home births.
“The fact that you go to an obstetrician and they don't support you through what your desires are, it's inappropriate. There should be safe options for childbearing women; it's a woman's right.”
The pandemic has limited access to the maternity ward at KEMH.
Only the father of the child is allowed to visit. And, unless there are special circumstances, he is only allowed in the hospital while his partner is in labour and up to two hours after the child is born.
Once they are ready to be discharged, he must wait at the front of the hospital to take them home.
The aim is to protect staff and fellow patients from potentially contracting Covid-19.
“It is really challenging, but people appear to be very understanding of it,” Ms Blyden said.
The youngest of six children, she doesn't remember a time when she wasn't “interested in pregnancy, birth and babies”.
“I chose nursing as a profession because I was fascinated with pregnancy and childbirth and, as the youngest of six children, I was an aunt at the age of 7!”
She earned a bachelor's degree in nursing from Syracuse University in the early 1980s. Back in Bermuda, however, she was very disappointed to find that she had to be a registered midwife to work on the maternity ward or in the newborn nursery.
“That didn't deter me. I thought, ‘What else can I do?'”
She spent four years working in acute psychiatric nursing at St Brendan's Hospital. In 1988, she relocated to Vancouver, British Columbia.
“I was able to get a job really quickly at a tertiary care centre,” she said, explaining that the experience of working with high-risk pregnancies was invaluable.
“I was in awe. I loved going to work every day. I was so busy and I think they were ahead of the US. They were more sort of like what you see now in Bermuda.
“There was a trend to a more natural way of thinking and the health benefits of breastfeeding for both the mother and baby. Learning about the health benefits of breastfeeding influenced my decision to become an international board certified lactation consultant in 1997.”
Ms Blyden joined the Special Baby Care Unit at KEMH in the early 1990s and worked her way up to the management level.
“I really enjoyed that,” she said. “Nowadays we have five or six babies on average in the department, in those days, 20 was the average patient census on maternity, and 20 in the nursery.”
It was under her guidance that dramatic change came about.
Where babies were once kept in the nursery unless being fed, Ms Blyden put them with their mothers to encourage bonding and higher breastfeeding rates.
“New mothers can sleep better with their baby at the bedside rather than being separated. Before that, we were wheeling the babies out to the women, then back again if the baby didn't settle.
“I was interested, because of my experience in Vancouver, to make some changes that appeared to be a more patient-centred approach and different to how things were done in Bermuda and in my student days at Syracuse University where every woman in labour had to have an epidural with a very medicalised approach.
“In Canada it was just a really nice mixture of the two. It was very refreshing. It was more about what women do naturally and babies do naturally; a rhythm between mother and baby that can be developed if they're together.”
In 2009, determined to have “no regrets”, she moved to England with her two daughters and embarked on an 18-month course to become a midwife.
Although typically three years, her programme was shorter because she already had a bachelor's degree.
“The course was very practical and I worked shifts from the beginning, so I finished with a very firm training. It was an excellent experience.”
Twelve-hour shifts were standard and the wages were low. She stayed for a year after she completed the programme and then came home.
“I valued all the experiences I had, but I also knew I couldn't sustain with the wage and the level of intense work. At that point I wasn't a spring chicken, I was in my late forties, early fifties. So I did come back.”
She had risen up the ladder to the role of programme manager of maternal child health at KEMH before she left.
Although it allowed her a bit of influence with regard to change, she wasn't so excited about all the paperwork involved.
“What I wanted to do was the basic hands-on care of midwifery,” Ms Blyden said.
In 2012, she returned to Bermuda where the number of obstetricians had grown to eight, and there were fewer births.
“All of our nursing staff are midwives from their training, mostly Caribbean nurses. They have very practical training.
“A woman comes in labour and we do all the care and call the doctor when it's close to the time for the child to be delivered.”
Like all developed countries, Bermuda has seen a rise in the rate of high-risk pregnancies due to an increase in chronic health diseases such as diabetes, obesity and hypertension.
“We are also seeing older women having their first baby. Because of these factors, childbirth has become more medicalised. Years ago, you would hear the sounds of women howling down the corridors, now it's a very scheduled pregnancy, a scheduled delivery or birth.
“Inductions of labour are more frequent, Caesarean section rates are increasing as well and more women are transferred to tertiary care centres overseas because of complications in pregnancy that increase the potential for premature birth.
“It's almost as if there is no real confidence in the natural progress of labour — we have to speed it up. But on the out of it, we save babies that might not have survived before.”
For the most part, there isn't a great deal of local interest in the field.
And, as many nursing students are more mature with families of their own, they're not interested in leaving the island for the required work experience said Ms Blyden, a part-time clinical instructor who lectures on maternal/child nursing at the Bermuda College one semester per year.
“A more general nursing ward is what they'd be allocated to upon completion.
“Hopefully that will evolve after four years on a medical ward. But the numbers are so low. How much experience can I get on a maternity ward with only three patients?”
• Learn more about the Bermuda Nurses' Association at bna.bm