Wednesday, January 16, 2008

As safe as life gets.

I've had an interesting week. Only 3 shifts really, 24 hours in my life, but full of those twists and turns of fate I mentioned before.

One of the reasons I entered midwifery was to be 'with woman' through it all. This week I have.

In my portfolio I stated that I looked forward to celebrating the everyday but unique miracle of birth with the women and families in my care. But I know I can really make a difference to families experiencing a different outcome through disability or bereavement.

This is the lemonade I can make. And this week, for the first time, I was handed the lemons in my professional capacity. And I am quietly very proud of the care I gave. I work in a great place too, that has built up superb practices for families experiencing loss.

Day 1. A couple from a rural town, baby a bit small at anatomy scan, should be repeated in a few weeks. They have 4 kids and not a lot of money. And the car broke down, and it was Xmas, and it was hot, and school holidays. Its 4 weeks until they can get to the nearest scanner 100kms away to have a scan that shows the baby has died. They drive to our city, leave the kids with her sister (single mum of 4 - looking after 8 kids under 12 for however long it takes to birth this babe). They're pretty stressed and sad, but brave. They cry a bit when I talk with them about the siblings, and give them a small handmade bear for each sibling in memory of this little one. To the Mum I give a handknitted and embroidered heart, something beautiful I felt she would need / cherish to remember this baby. And to the Dad I gave a velvet heart that he could keep in his pocket as a touchstone. We talked about the painted memory boxes we give to families and how they may wish to keep all the things in it after a while, along with the quilts we give families for their little ones. I started her labour off, and went off shift. By the time I returned the next day they had had their tiny daughter and returned home. The little one will be remembered by name at a monthly service at our hospital, but they will have her ashes in a tiny little butterfly box to be kept closer to them. I was distressed to hear from the midwife who took over their care that she felt they had delayed reporting lack of fetal movements in order to get the Federal money for a birth over 20 weeks, and that they seemed more interested in going outside for a smoke immediately after the birth than in their baby. I completely disagreed with her opinion, and gently told her so. 4 days after the scan concerned they qualified for the money, and were well within the recommended repeat period. Besides they were genuinely shocked to hear they would receive the money for a stillbirth. In addition, nicotine is a fierce addiction, especially when stressed - perhaps by a cynical midwife.

Day 2. Entered to find a 14 minute old boy about to be taken to the nursery for some breathing support and investigation of known renal and cardiac anomalies. Dad and the morning midwife headed off with him, leaving me and another midwife who had lent a hand with Mum and an overjoyed grandmother. Yes, overjoyed. They were a migrant family who had spent years in a refugee camp in Africa and for them to have a new child and grandchild born in a peaceful country with ready access to a neonatal nursery, a clean bed to birth in and food arriving on a tray within 30 mins was a complete blessing to them and they broke out in song and a shuffling dance, praising God because He was so good. It was a joy to behold, and very moving because these people get it. Praise God indeed. They would have the best care for their son and he would probably be with them by the evening, and she was unlikely to bleed to death or lose him to infection or hunger. It was uplifting, and we were all delighted to be a small part of it, and even today talking about it again and reporting it to the other midwives we were a bit misty. And they were all a bit jealous (even the cynical ones).

Later in the day I got to care for a couple having their first child, whom I had met twice before. She was fed-up and had high blood pressure and the time had come to just get it over with! I was disappointed to not be able to care for them overnight and when I started work this morning they had just gone up to theatre for a trial of forceps - which worked - it was a tight squeeze. At last he was born. They resisted the urge to call him Mud for all the trouble he had given her in pregnancy, and I was happy to visit them later in the day and at last give him a cuddle. She was most relieved it was all over and vowed he would be an only child!

Day 3. In some ways the most challenging day. Today I cared for another woman experiencing a perinatal loss. Her baby had also died suddenly in utero at around 5-ish months, and had been born the previous day. In our unit these families often spend the whole postnatal admission with us, rather than transfer to a ward with lots of crying babies. They can spend as much time with their babies as they want, family can visit and we take photos and prepare memory boxes as I described before. Today was the day she was going home. It was a hard day for her, and my job for the day was to bring her baby in and out to her and her family, take photos and to complete the (extra) mountain of paperwork associated with a bereavement. It was quite confronting. It required great linguistic sensitivity. But I felt OK. His Mum was quite practical about the realities of a very small and soft body. Distressed and concerned for him and his comfort as a mother always is, but practical. She took part fully in the memory and grief process. His sisters had written letters for him, she told him stories about the family he would meet in the next place. He had teddies and hearts and his quilt, and his name card with a long and thoughtful name that connected him with his family, who loved him and would miss his presence in their lives. His sisters and grandmother saw him briefly, we took some photos of the family group, and him with his quilt which his mother would keep with his smell on it. It was very sad, but an honour to work with them. They left soon after, carrying their painted box with butterflies, expressing gratitude for the fact that a midwife would come to see her at home for the next few days to continue her postnatal care.

These are memories that link our lives. Mine, and theirs. I was one of the few people who got to see, hold and dress that child in this world. My finger pressed the shutter on the camera, creating the precious memories that help that family KNOW that child existed in this world. For a few short days. The quilters who make the Blankets of Love, the folk-art painters who donate the painted boxes, the craft groups who donate the handmade and knitted garments that the babies are dressed and wrapped in, the teddies and hearts. The families who donate more little teddies in memory of their little ones who were with them only briefly. Its all a work of heart.

Too many people forget that having a baby is as safe as life gets. Not everyone gets to keep and hold their children every day.

Our lives are made in these small hours. Cherish them. And each other.


Natalie said...

Thank you. I love these stories.

Lesley said...

Laura, you write this as beautifully as I know you do your work. It's an honour to read and feel part of these wonderful stories. Very misty-eyed and grateful for my three hearty offspring.

Lisa W. said...

thank you for sharing some of the harder aspects of our work. here in alaska we also make a memory box, with the babe's hand and footprint in a soft clay that hardens, and a professional photog comes in (who has lots of experience with this type of work) and she makes beautiful and peaceful black and white photos for the memory box.
i am also amazed at how frequently forceps are used there! I've only seen them out twice and used once in over 700 babies...and the one they were used on, mom was a quadraplegic.....we do vacuum though...and the midwives are trained for vacuum (ventouse) too. We must get together for a cup of tea sometime!

Laura Jane said...

We also do inked foot and handprints but the midwives do all of the social photos, some more willingly and artistically than others.

These were the first perinatal loss families I had actually worked with, although I have been attending workshops in it for years. The practical tasks were the most difficult with such tiny fragile babies. I have helped behind the scenes with term still births where the babies were easier to handle physically, but where their stillness was even more of a wrench. Only a heart beat from perfection. Very sad.

Tea sounds great Lisa. White with none. Anytime.

Jennifer said...

The love and tenderness we can offer, most especially to the people we don't really know but whose lives intersect somehow with ours, is the real underlying hope for humanity. Not becoming cynical in the face of what becomes the "everyday" in a medical profession, understanding that grief has many forms and faces, sympathy for what a woman, a family goes through -- such gifts you are giving to us all.

Laura Jane said...

Thank you all for your kind and warm comments.

When I made the decision to become a midwife it was as if a cosmic conspiracy came true. This is a position of enormous privilege, and I have a real sense of bringing everything I am to this arena. It feels so right. Women in my care respond to me, and I feel my light shining and spilling again. Phew.

Thanks readers/friends


Sarah Stewart said...

Thank you very much for dropping by my blog the other day. Great to hook up with a midwife in Australia and know there are other midwives in blogger land. Best wishes, and please keep in touch, Sarah

Frogdancer said...

Beautiful post.

I know that without modern medicine Jack and I would've died. (He was an averaged sized baby that couldn't emerge from my delicate, ladylike pelvis.) When I read accounts from history about the hideous deaths of women in childbith, I'm always so thankful that Jack and I live nowadays. (4 caesarians. A most civilised way to give birth!)