Layla

Brief Outline: Layla has been a research midwife for about a year and a half. She has worked on a number of studies around different aspects of pregnancy, including blood pressure monitoring and prenatal testing for chromosomal abnormalities.

Background: Layla is a research midwife. She is divorced and has children aged 12 and 8. Her ethnic background is mixed.

More about me...

Layla has been a research midwife for about a year and a half. She completed her nursing training in Canada before moving to the UK 18 years ago, where she became a midwife. Layla’s interest in research was sparked when she wrote a Continued Professional Development article for a nursing journal and it got her “thinking about things from a different perspective”. Layla was looking for a change in her work life and she came across an advertisement for a research midwife post. She is currently employed full-time on a study about self-monitoring blood pressure in pregnancy and had previously worked on a couple of studies, including one about prenatal testing for chromosomal abnormalities.

Layla first started working as a research midwife part-time alongside working as a clinical midwife. However, regulations at the hospital meant that she was required to work at least 24 hours of shifts per week and this, coupled with her research role, pushed her total employment hours well beyond the maximum allowed. This resulted in her choosing to be a research midwife full-time. There is now an arrangement in place whereby she is employed on a midwives bank so that she can do occasional clinical shifts, which gives her more working options and is a way to keep up clinical skills.

The research activities that Layla has undertaken have varied across the studies she has worked on. Her current study involves recruitment (including identifying eligible participants and making arrangements to discuss the study with them) and ensuring participants complete questionnaires at the appropriate times. She is based in a hospital department and finds recruiting participants often involves “working around” their clinical appointments (e.g. ultrasound scans). In a previous study, Layla’s role was to review medical notes and she found this desk-based work less rewarding than seeing people face-to-face.

In Layla’s experience, there are some important differences between working clinically as a midwife and research midwifery. For example, there is a lot of responsibility placed on clinical midwives because “when things go wrong in childbirth, they tend to go wrong very quickly”. In contrast, her role on the current study is largely removed from such “life and death” situations. It took a while for Layla to get used to the new arrangements in her research role. Initially, she felt she had to inform her line-manager about “every little thing I was doing” to account for all of her time. She is now more comfortable with the independence she has in organising her workload and finds it “refreshing” to be in an environment where there are plenty of opportunities for training. Layla is glad she no longer has to work weekend clinical shifts. She sometimes works in the evenings but finds this suits her well, as the flexibility allows her to fit some study tasks around looking after her children.

Layla says that good working relationships with clinical staff are important, and she sometimes helps out with particular clinical tasks, such as setting up pregnant patients on the CTG machine. In doing this, she thinks staff are more likely to welcome and help her as a research midwife. However, Layla also emphasises that the responsibility for the patient rests with the clinical staff, not the research midwife, and that there are other tasks that she will not do. She is also cautious that pregnant women should understand her role, and she introduces herself as a research midwife to emphasise the difference.

Layla isn’t sure what her next steps will be career-wise but feels that becoming a research midwife has “opened up quite a lot of possibilities”, and that she is still learning about “all the different routes that you can go” with it. She plans to continue working as a research midwife alongside the work she does for a nursing journal, and see what opportunities develop in the future.

When Layla felt “ready for a change”, her decision to become a research midwife was a gradual one.

And never thought I would do-, move into research at all. It didn't occur to me for a long time. But then gradually I was ready for a change, I'd done the clinical side for a long time, was looking for something new. And then by accident had kind of fallen into doing a bit of work for a nursing journal, which-. So I wrote a CPD article on pre-eclampsia. And as a result of that, that sort of got me a bit more interested in it. Because I was looking at a lot of research and that. And just thinking about things from a different perspective. And I think around the same time I was wanting to make a change career-wise, but wasn't quite sure what. And then - but had been talking to some of the research midwives at work and it all just kind of- it's a bit incremental. It's one of those things, one thing leads to another. And then saw the advertisement for this job on blood pressure self-monitoring and it just seemed sort of the perfect fit with my experience and interests and background. So, that's how I made the move.

Over time, Layla adjusted to working with more autonomy than she had been used to as a clinical midwife.

I'm so used to being-, having to account for every single thing that I do, and- whereas I have much more freedom to sort of plan my time and the workload and that. Which when you work clinically as nurse and midwife, you don't. I mean, it's very- it's very rigid, you've got to do this, this, this and this, in this order, and hand over to this person. And, yeah, I think I was sort of telling my manager every little thing I was doing and it was like-. And I realised I didn't have to. They're just, you know. You have, you have more freedom to kind of work independently, I think, and-. Which is nice. But, yeah. It took a little bit of getting used to.

A study Layla worked on was about prenatal testing technology. The potential impacts for participants were complicated and sensitive.

Certainly when I was working on the [study name] study, which was non-invasive prenatal testing, that was different because we were looking at screening for chromosomal abnormalities. And then there's the whole can of worms of what do you do if you get a high risk result? And it's trying to explain the difference between the current programme of screening and the benefit of the screening that's coming in, and. So for the women- it was singleton pregnancies in that study, they wouldn't get a result. So essentially they're taking part in this research for the benefit of women in the future, there was no direct benefit to them or their baby by taking part in that study. But they were really doing it for, you know, just people in the future. Whereas the women in the [study name] twin study did get a result. And so they then would be faced with the possibility of having a high risk result from the study test and a low risk result from the current screening, and then what do you do? And then do you have an invasive test on top of that? And so there are a lot of issues that you had to think about and try to convey to the women that they needed to think about before they agreed to take part as well.

Layla found that helping clinical staff sometimes facilitated research. However, it was important to be clear about responsibilities – including to avoid patients feeling obliged to participate in research.

So I think it's just if I can help other staff clinically, then that's good for them because it means I'm not adding to their workload. And it's good for me because they're more likely to be receptive to me being there. But it's also- you have to make that distinction-, you have to be quite careful with the women, in terms of making that distinction of although I'm helping out the midwife clinically, I might put the CTG [Cardiotocography machine] on or take bloods, it's- I work there. But at the same time, be really careful to, that, for- I'm not responsible and the clinical midwives know that I'm not responsible for interpreting that CTG or documenting in the notes about what position-. But they, that's still their responsibility and they have to do that. But also for the women, I think it's reassuring to them to know that I'm a midwife but at the same time know that I'm there in the research capacity. And even though I might put that monitor on or, you know, just start them off on that process, they're- you don't want them to feel coerced in any way into then taking part in the research because of it. You don't want them to feel pressured. So they have to know that they- you have to make it very clear to them that, “I'll start this off because-”. And generally, I think they appreciate that by my doing this, it means they're not waiting quite as long either, as if they had to wait for the clinical midwife. But you just- you have to be really careful that you're not making them feel then that they're under an obligation to take part in the study, because you've got those two hats. So, it's- it's just something you have to be very careful of and mindful of.

Layla had wanted to work clinical part-time alongside her research job, but there were restrictions imposed by the hospital which prevented it.

The only barrier I had initially was- because I took the job, I took the job- it was a part-time position. So what I wanted to do was carry on working part-time as well for the hospital. But it was the hospital that has this barrier, that they have a minimum requirement of- what was it? I had to work two shifts a week. Whereas-, 24 hours a week, minimum requirement. Which, with the research, would have taken me to over full-time. So I had to quit that. Like so I had to quit that job and then go on the bank, and just work-. Which, so that was a barrier. Which seemed crazy because they're desperate for midwives. And yet they make- they had an experienced midwife who could have worked one day a week. You know, 12 hour day. And now, yeah, but now it's actually resulted in me just going to research full-time, and just doing the odd bank shift here or there, so. It wasn't a barrier from the research side, it was a barrier from the clinical side.