Friday, June 27, 2008

Great beginnings

I had a beautiful night shift this week.

I was assigned to a couple having their first baby, 10 days overdue, and being induced. I took handover from a lovely midwife who assured me the cervix was really soft and favourable, the head was low and now the waters were broken. They were really excited and smiley and chatty.

"So, this is the kick-off, eh?" the husband asked. I assured him they would not be getting out of this labour suite without a baby, and I planned to catch it before morning. She was having a few niggly contractions before I started the drip, but as I turned it up gradually over the next 2 hours the contractions started to get her attention and she became restless. She moved really instinctively, circling and rocking her hips, remaining upright, alternating standing with sitting and moving on the birth ball. He was a bit unsure of himself at first, and she kept assuring him she was fine, and there's nothing I need you to do yet, thanks hon. He settled into a chair and dozed briefly, but kept getting up and walking over to her. I encouraged him to stand behind her at the back of the ball in case it scooted out from under her, and to touch her between contractions.

We had discussed their birth plan, and they were really not keen for any analgesia other than a shot of opiate perhaps, and really didn't want an epidural at all. I asked her how many times she was allowed to beg me for one before I gave in. "Five" she stated very firmly. OK its a deal. We talked about how things were going to get hot, heavy and pretty intense at various points with smiles wiped off faces. Thats fine, they said. I told them I would do my level best to encourage her through the tough bits, and would let them know about the next bits as they approached. There would be a phase where she was gonna lose the plot for a bit, and swear and beg, feel shaky and sick and want to go home, but that it was normal and that I would be glad to see it, because it would mean she was progressing well. OK? Yep, that's OK, we agreed.

It was beautiful to behold. The only downer was that she had to be monitored due to the induction and drip and post-dates, but she was just marvellous, and didn't complain once about the monitoring. It was my problem, and my shoulder was pretty sore from reaching out to keep contact but it was worth it.

About 2.30am she started drawing within. By 3.30am she started saying that it really hurt and that she may need some analgesia. At 3.45 she asked for an epidural. "That's once" I said. She was starting to really dread the next contraction. We went into drawing her out mode, lots of praise and encouragement as she was starting to lose the plot. To hold her off I got all the equipment out for an epidural insertion. She had asked 3 times by now. It was becoming more difficult to monitor the baby with her movement and agitation, and the coordinator was hovering wanting to know why there were big areas of poor trace. As soon as she entered she could see why.

"I don't know yet if I can offer you an opiate shot or epidural - how about we examine you and see where we're at?" She readily agreed. Onto the bed for the first time. A quick examination and I attached a scalp clip to reduce the number of belts she needed - 5cm dilated - slightly less then I had expected behaviourally, but I really felt she was cracking on. Get up and go to the loo, keep that bladder empty, yes do a poo if you need to, make room for the baby. Hmm electrode not reading too well, and there's a lot of fetal heart changes with contractions. A passing middle rank doctor was called to review the trace and the electrode positioning on baby's head.

"Ahh, you're almost there" he smiled. 9cm now, 30 mins after the previous examination! Sorry hon, I grinned, no epidural - you'd be sitting on the baby's head before we could get it in! She was not quite amused, and was quite frowny for the next 10 minutes.

Then she started holding her breath and involuntarily pushing with contractions. It is quite something to witness, and to experience. You know how when you need to throw up and you have a few dry retches first? It is just like that. Irresistible. We had talked about this sensation, and I assured her she would know when it was time to push. Go ahead hon.

It didn't take long before there was bulging and twitching and unfolding occurring. It's wonderful to see. She was less impressed. Its often quite hard to push effectively at first, and to get into the pattern of understanding the downward/forward progress of the head within you. And she was still feeling pretty ripped off about having asked for analgesia and not getting any. So as the unfolding occurred she was not sure she liked it at all! We changed position regularly, encouraging her by reminding her that it was all in their birth plan to push in these positions! She found it hard to coordinate her breathing with pushing, and would let her energy go between pushes, which meant the head would slip back and she covered the same ground 3 times each contraction! Finally she got the hang of it, and asked how it could be speeded up. "By doing the scariest-feeling thing, and then going further!" I replied. "I'll tell you each step of the way what to expect next." Within the next two contractions we had head staying on view between bouts of pushing.

"OK," I said "this next bit is going to sting and burn. It will feel pretty crappy, but I'll talk you through it, so try to work with me and stick it out. It won't last long. And then there'll be this really great bit where the head is out and the relief is sensational. And then there's this fantastic bit where the rest slips out and it is the best feeling in the world. Ready?"

And it was just like that. God- she was wonderful. What a champ. At 5.29am her baby surfed out on a wave of amniotic fluid, to her gasp of triumph. I helped her lift him to her chest where she welcomed him with an introduction of "Hello my darling baby, I am your Mummy". After a minute or so she and her husband thought to ask, "Oh - is it a boy or a girl?" I helped her to reposition the babe so she could see his beautiful rosy scrotum. "Its a boy!" they cried to each other.

She needed a few stitches, which another midwife performed, and after an hour or so we weighed him - 3.670kg - 8lbs 1oz. She was as high as a kite, the baby was alert and calm, and they were all so proud of each other for making and birthing such a beautiful baby. A triumph all round.

"So ... you never did get to asking me five times" I said to her with a hug. "You are very good at this birthing business, you should do it again!" She laughed and said that the head just out, and the slipping out bits were just as I had described them! Fantastic!

It was such a delight to look after them, and I saw them again on the postnatal ward the next night. Baby was starting to feed quite well, and she was really calm and confident, and still on a high after the birth.

And so was I. I am starting to feel like I can function as a midwife now. I've seen 7 births since my return to LBS, 5 x CS (! - although 4 of those were when I was working on the section list) and 2 normal vaginal births with no analgesia. Plus my friend's homebirth. I know which births I prefer.

I really am keen to work in the community, or at least in a model of care that offers continuity of carer/midwife. I was chuffed that morning to have the coordinator ask me if I could see myself working as a community midwife. When I readily answered yes, she said I would be good at it, and that it had been a lovely birth. I couldn't help but feel all warm inside. A beautiful labour and birth, and a compliment. I have been qualified a year, and working for 9 months now, and I really feel like I am finding my feet as a midwife. There are now 2 groups of midwives who are less experienced than me. I am sucking it up and getting on with it more, but still very ready to ask for guidance.

Of course as a rotational midwife I don't stay in one area for too long, but move around every 2 months or so. The next shift I was sent unexpectedly to the postnatal ward, where I had the care of 6 women including 3 women less than 24hrs postpartum, 5 babies including a 36 weeker twin, a withdrawing 37 weeker under phototherapy and a 3 week old baby whose Mum was very ill and was unable to care for it safely. The other staff were very kind and helpful, and cuddled and fed and answered my bells when I had my hands full, but it was a bit of a rude shock after the idyllic previous shift!!

They were both good shifts (in the end) and made me realise how much I have learned as a midwife in a short space of time. Two more night shifts to go in this stretch.

I still love it.


Natalie said...

This was wonderful... every bit. I feel so happy for you. I appreciate your pride and I congratulate you for what you've learned and for what you obviously possess intuitively.
This is good stuff!

CNH said...

Your blog is brilliant! Thanks for stopping by and checking on my twins occasionally. :)

Frogdancer said...

Lovely post. (Still glad I had all mine by caesarian, though!)

Alby Mangroves said...

Wow.. what a great writing style you have to illustrate this - it brings it to life for me, and makes me very nostalgic for when I was in hospital with my babies :)

Gill - That British Woman said...

what a lovely story, I was with you right through the story and I think I felt her pain at times....LOL

Great blog,