Wednesday, April 23, 2008

Living the dream

Hi again, sorry I've been preoccupied with this, that and the other.

This being dealing with bureaucracy for daughter. Sigh. It never gets any easier.

That being constantly tempted away by textile fetishes of one type or another. Its a constant struggle. Bright and shiny, or tactile and colourful, all just begging to come home with me. They don't have to cost (much) money, I can give them a home. The pouches are on their way to completion, and looking quite good, although I've only done the brown ones so far (brown thread on machine).

No news on the sock front - I hurt my thumb and my adjacent forefinger got strained on the weekend, so zero socks were cast on (i can tell you're all dying to know about it ;P). Sigh. Its a surprise - he'll never know anyway.

The other is starting work in the community as a home visiting midwife. If you had asked me 5 years ago what I would kill to be doing - it would be working in the community as a midwife. Don't look now Laura - your dream has come true!

Its kinda lump-in-the-throat making to see that in print, and realise that I have spent my last 2 working days doing it. All by myself. Gulp. Just me and a car, and a mobile phone. And my common sense. And my experience. And my knowledge base. And my enthusiasm. Sigh. No wonder I'm running late.

But its both nice and (only slightly) exasperating to see new families settle into the reality of life at home with their newborn. Nice in a heartwarming way to see them discover the wonder of watching their baby sleep, and marvelling at the little dreamy REM-sleep faces and panting that babies do. The miracle of life. How did that baby fit in there? And get out of there?

And exasperating to see other families place such pressure on themselves to be perfect and have all the answers, and the perfect house, the perfect toys, the latest equipment etc.

Today I went to 5 houses. One was in a less well-off suburb on the outskirts of the metro area. The house looked OK from the street, but behind the rollerdoor...past the barking large dog being restrained... The squalor was quite confronting, tiny cockroaches crawling across the unswept concrete floors, cats burrowing into all the clutter that looked like every object that couple had ever owned or received in their own lives, stacked up on every surface. Their third child looking content enough in a washing basket with a pillow in it as a makeshift crib (I always tell parents it doesn't matter if your baby sleeps in a fruit box!). And a slightly grumpy but talkative young woman apologizing for not having cleaned up as she had been in hospital for 4 days. There were handprints all over the walls, and years worth of clutter, but I assured her I spoke fluent Mess, and was happy to come and take her stitches out and do a postnatal check and weigh the baby. I also made phone calls to the local baby nurse to make sure followups got done, and although she was a big girl her wound looked the best healed CS wound I have seen in weeks. I was delighted! You never can tell where you are going to have a good result. That child will be well enough parented, for all the gunna-do-one-day home decor aspirations of his parents, and I finally got out of there with very dirty knees after an hour and a half! I stopped at a Golden Arches for a wee and a handwash - I didn't fancy trying my luck asking for a bathroom! Thank God for Aqium gel (an alcohol gel - for my hands, people!).

The next place (running late) called the office as I was 5 minutes from them - a 25 minute drive from the first house. I was too late - they had to meet folks at the airport and couldn't wait any more for me. Sigh. I get to meet them tomorrow.

Another 25 minute drive to stop 3. An overseas family living expat in Asia, stopped into Australia to have baby 4 in conditions with reasonable medical back-up after a difficult pregnancy. Nice family, confident friendly older children, baby barely 2 days old, but they were all doing OK. Her breast were very hard and lumpy - which was unusual in a woman so close to delivery, but we did all the things we are meant to do, and tried to express them to softness, with minimal result. I left her with a breast pump and a plan, and will review her tomorrow hopefully her milk will be properly 'in' by then and the baby (or the pump) can shift the rocks - or its the hospital for her.

Stop number 4 - a new family with a first baby. A sweet little girl, lots of questions, lots of reassurance, lots of show and tell, lots of 'education', giving them the confidence to follow some instincts of their own and helping them to understand the baby's reflexes and instinctive responses. Can we spoil her? What about a dummy? Oooh I haven't touched my breasts much, I don't know if they have lumps! Encouraging her to get in touch (literally) with her feminine side! And mine! I helped her to feel all around her breast (no lumps) but filling with milk, then allowed her to compare to my breasts - lighter and softer although they look larger than hers -can she feel the difference? The sense of fluid within? Oh yes her nipples look in great shape, well done, I saw good attachment earlier and she should should have no problems, her baby shows good instincts and shows clear signs when she wants a feed - see - you two already understand her signals, great work! Lots of encouragement. How about skin-to-skin contact? its a great idea for when she is fed thoroughly but still seems a bit fussy, Mum or Dad can do it, babies just love to be up close and personal with their favourite grown-ups. Very soothing for both of you, lovely opportunity for bonding, especially for Dad. Yes, actual skin to actual skin, heart to heart. Aren't you doing well? 90 mins later ... I''ll leave you to it and see you tomorrow!

One more added to the list, 9 days postpartum with bleeding nipples. OOOOwww. Only one solution - REST!!! Copious supply, and she already has a breast pump - Thank the Lord! Now has that baby got a tongue tie? Yep, looks like it! Call the breastfeeding centre, make an appointment with the GP, them (the lactation consultants), and a surgeon to get the tiny snip done to free the tongue to stop the damage. Phew! And the baby health nurse for a followup. Write a plan and a list of further phonecalls for the Mum to make, hand over a bit more equipment and move on again!

Across town, near to home, to pick up a breast pump that had been outstanding for 2 months! At least the woman and baby were still happily breastfeeding at 4 months of age. Yay!

By this stage it was after 5pm. I had arrived at the office to get the car and the referrals at 8am. Go, go, go all day. Talk, talk, talk all day. Smile, encourage, reassure all day. A few crackers and nuts in the car, and a coffee from Maccas. I was starving! And a bit stiff from essentially being on my knees or on the floor all day talking to Mums on couches, and looking at boobs and babies!

Tomorrow should be a bit easier as they were all new clients today, and all only came home yesterday, with new babies, settling in, etc. Tomorrow the groundwork should be done, but there is always the potential for engorgement, weight loss, constipation, tears, jaundice and more.

Last week I had similar clients, with domestic violence, contraceptive failure and a fifth baby, social isolation, perinatal loss, massive engorgement, an uncertain and plucky young woman with 3 dogs and a huge house out in the sticks alone with a baby after managing a team of adults in the workplace! No experience of babies at all! Migrant families doing it tough, and migrant families revelling in their peaceful and socially supportive new country where women with mean, violent husbands have somewhere to turn for financial support. And a visiting midwife to praise them for their efforts and hug them goodbye as they bravely embark on their lonely journey. I was moved when the mother cried as I hugged her - I had cared for her on the ward, and again for 3 days at home, and she was really brave. I kissed her baby and told her(the baby) to be good to her parents, but only just good and respectful enough to her dad! I wish I could go and hug and encourage that woman every day.

I'm still feeling my way...but its stuff I know. Parenting, breastfeeding, driving! But its all part of the scope of practice of being a midwife, and it's all expanding my confidence in my own practice. I have a lot of students with me from next week onwards - so I'd better iron my bugs out before I start with them! Its a big responsibility!

I look old and sensible but I still feel like a complete beginner, 'faking it til I make it'!!! Putting it all together gradually, and working as a community based midwife would give me the chance to work in all areas - I can't imagine not working in the labour and birth area (I still dream about catching babies) but all this antenatal and postnatal part is equally important. And I do feel very committed to midwifing women in all areas, not just low-risk women qualifying for 'midwifery' care, and the rest making do with less touchy-feely stuff. Its important. There's got to be a way.

But for now this, that and the other are the best I can do! Gradually, the dream is coming true.

How lucky am I?


Frogdancer said...

How fantastic! Congratulations. There's no better feeling than doing what you love for a living.

thenerms said...

Finally Laura it is all about you...

Well done hugs and hearts and lots of kisses to you.. I am proud of you very much......... Love Helen..

Lisa W. said...

sounds like you are doing a WONDERFUL job and obviously loving every minute of it. it's your calling and your passion and your gift. enjoy!

Natalie said...

I am sympathetically exhausted and exhilarated. Can we toast you, or salute you? Something to acknowledge how awesome and inspiring you are. I am in awe and feel better about the world for your presence in it, for the good you do. Thank you.

Lesley said...

Big hugs and kisses. Tears in my eyes for how far you've come and how wonderful it is now you've got there.
Those lucky women!
PS: I reckon there's a book in here, Laura. Let's revisit that idea after a year and see what's cooking!

M said...

I'm happy for anyone who is happy with their work. And your work sounds exhausting, and rewarding. Fabulous.