#
Mathematical

Salad

## Intersections: maths and the midwife

06 May 2018

**Heather Drozd is a midwife working in Essex, with two young children of her own.
**

*How would you characterise your current work?*

I have been working as a midwife for six years. I only work on the labour ward, so I provide antenatal and labour care, assist with deliveries of babies, and also do a small amount of postnatal care.

*How do you feel about maths?*

I don’t feel I have a very good relationship with maths; I wouldn’t go as far as to say I hate it, but I’ve always been pretty bad at it – or maybe just had a ‘bad attitude’ towards learning it. If I’m confronted with anything mathematical, I tend to stop in my tracks. I was always in the lower groups for maths, and my maths teachers would always tell me how I needed to work harder to remember facts to help me move on with harder topics. I ended up retaking my GCSE five times because I got Ds every single time. I really wanted to go to university so I persevered, and I actually didn’t end up getting my C until I left school. I had to reapply for university and do an access course to help get me to the point where I could get in – it was around this time that I met my husband, who was really good at maths and supported me in helping me pass the course. I felt like not getting that magic grade held me back so much and stopped me pursuing my career for a long time.

*What is it about your work that is mathematical?*

I would say drug calculations, mostly. Most of it is done for us – it’s written up in very specific guidelines – and we tend to use the same drugs every time, so we don’t have to redo the equation every time we need to prescribe. We generally have to input the drug dose or the rate, and we get the other value back. Sometimes drugs get given in a different amount than we’re used to and we have to convert into different units. (We measure drugs in ml, units, grams, or suspensions – g per ml). Sometimes four or five of us will sit there checking each other’s’ calculations for fear of getting it wrong; surprisingly, we find the doctors sometimes lack in confidence too, but the pharmacists are almost always excellent at these sorts of calculations, so we ask them if we can. People might be surprised by that!

We also often use calculators or IV drug machines to work out the drip rates, for example, so we input values into the machines and it calculates the rates for us. Feed requirements for babies are also mathematical because we have to work out how much volume the baby should take each feed based on ml per kilo of weight, and how many times a day you feed (e.g. three or four hourly).

We have to pass a drugs calculation course to qualify as a midwife, and you have to get 100% to pass. I also had to do another one for the Trust hospital when I moved jobs. They’re not too difficult – there’s no formulae to learn as they give them to you in the test, and you just have to fill in the relevant values. There’s a certain amount of questions you can use a calculator for, but some are non-calculator at the moment.

We have something called a partogram which is a type of graph or chart used for every patient during labour (see an example of one, left). It is used to capture information like cm dilation, blood pressure, baby’s heart rate, contractions – to manage labour, and show deviation from ‘normal’ progression so we can see if something might be wrong. This happens on a piece of paper on the patient’s notes – like a ‘picture’ of their labour. We used to have an action line (starting at 4cm which is beginning of labour) where we would plot the time and the dilation, and if they progress much slower than the ‘normal’ line into the ‘action’ line, we would need to do something about it. But they are getting rid of this now – we’re not sure why, but maybe because people aren’t using it correctly.

*How do you use maths, calculation or numeracy in your work? What tools do you use to help you?*

As I mentioned, calculators or IV drugs machines, and we also use infusion pumps (pictured below), which also do a lot of calculations if we want them to – e.g. how much or at what rate. The machines are calibrated and tested yearly and obviously we have to place a lot of trust in them. I have noticed that people coming through the training now seem to have better mathematical or numerical skills overall – they changed the interview process a few years ago and we are seeing that coming through. We used to have lots of ‘people’ people, who had a good bedside manner and were good at the ‘caring’ side of the job – but now they seem to be more ‘academic’, better at clinical procedures, but what’s lacking now seems to be those social skills. I wonder if it’s always a choice between one or the other.

*Do you think maths is creative? If so, how*?

I guess it can be…I probably do some of it myself and don’t really realise it. Origami, for example… but I honestly don’t think I ever experienced creative maths teaching as a pupil. The most creative I can remember is my teacher ripping up a ten pound note in a lesson – the memory stuck, but I can’t even remember the point of it!

*Do you use or rely on any maths that you learnt in school?*

Not that I can think of…

*How would you change the school curriculum, if you had the chance? Why?*

Try and make it more fun. I guess you can’t change attitudes towards maths that easily, but I wish you could. For me it was so clearly drilled in that you have to be good at the Big Three (English, Maths and Science) – like have to, have to, have to - and it makes them the three subjects you don’t want to do, because all you do is get drilled over and over. I do remember a little bit of maths being applied to everyday stuff, but it just wasn’t that realistic or obvious – I would have liked more application to day-to day stuff like the things I use now in my job.