Friday, August 22, 2008

This and that, ici et la.

I am still alive. I am still in slacking mode too (could you tell?).

I've had some nice shifts - very busy, laughably busy, but great for teamwork busy, where we're all so pulled in every direction we just shrug and laugh and pull together. BYO sense of humour, really. Its been good.

At home I've just been running errands, cooking a bit (winter roasts on the menu a lot lately, mmmm). Phone calls to back up our daughter as she starts a new job placement for technical college. Eating delicious bread she bakes at college!

Eating w-a-a-a-a-y too much chocolate. It is a separate food group, right?
And also spreading the joy of Wild Women! I got a package from Artchix this week, similar to Artgirlz with more spare parts for my lovelies. I have been trotting them around to all sorts of places with me, I just love them. Woman and Polly have each been worn for outings and were much admired. Bluebell (previous post) has been sent to her new Mummy, who gasped at her name and told me that bluebells were really significant to her and how did I know? Aaahh, the universe works in mysterious ways! I also gave Bluebell's Mum a kit to make her own WW, which was received with much glee. A future pleasure present indeed.
I caught up with one of my oldest friends who I haven't seen for a good natter (or even a short natter) for ages (she lusts after a WW brooch for her upcoming birthday too). We ate Italian biscuits over coffee by the fire, then I dragged her to her computer and showed her the online world of fabric shops....I hope she forgives me....meanwhile the economy may experience a temporary surge!

And because I have had such a creative week, I also dropped in on my old church craft group the 4Cs - Creating, Care and Compassion through Craft. I just love this bunch of women. I am the youngest by far, they are all old enough to be my mother, but they accepted me with open arms when I was a busy, busy SAHM with wa-a-a-y too many committee duties who needed a creative outlet. It is always so good for the soul to walk through that door and be greeted like a long-lost favourite daughter! Many hugs, lots of chat and laughter, news, gossip, catch-ups, who's got a new grandchild, its great to see them. Sometimes I even get to sit down and do some craft too! We bounce off one another, and seek second opinions from each other, and lead and follow and share so much. I made this WW there this week. Her name is Serenity. She is on the same needle felted merino and cotton muslin base as Bluebell. With some ribbon from a new WW kit that arrived this week. She looks mellow and serene, just drifting and sinking back into a midnight and purple haze and watching the dragonflies meander through the flowers. Her hands are open to the universe. Last night I sat watching So You Think You Can Dance (SYTYCD - I love that show) and I just need a hand stitching project. So I needle felted a new base with silk, merino wool and cotton and fussy cut a new WW, leaving the beautiful new textured base to be seen much more than any other WW I have done. Does she look more wild? She's got presence I think. Her name is Dowager. I just know she's seen a bit of life and sorrow, but has a wisdom from it. She's crowned with it. I'm really taken with her. Her colour haunts me, I dreamed of her last night. Call me strange. Another section of her background has a landscape quality to it, I have trimmed it to a pleasing shape and will explore embellishing the surface. Mmmm, it feels really good to be exploring a new technique.

I am also quite keen to get my Etsy shop up and running. I am creating way too much stuff to be sensible, so might as well bite the bullet and stock it up! Would I get any customers? I don't have that many readers to send there....oh well, I can but try. It feels a bit fraudulent to consider myself as Etsy worthy, but the point of Etsy is to provide an avenue for the small creator. I buy stuff from there and absolutely LOVE that it is a one-off. Let me know what you think.
And in final news, well, old news, this time last year we were in Paris. Yes Paris. Pinch me. God, it was pretty bloody fabulous, even though it poured with rain for the first 3 days, it was Paris people!!!!!! Notre Dame, gargoyles spouting rivulets of water, the Metro, the Louvre (a very cropped picture, removing the CROWDS of people around her)getting ripped off by a gypsy con-artist by the Seine, the Eiffel tower - Oh God it was all stunning. We stayed in a bijou hotel near the Luxembourg gardens, and walked and walked, and trained and bused, and ate and ate, and museum-ed and gallery-ed and took so many photos 'cos they let you! OMG! I would go back in a heartbeat.
I'm a lucky girl.

Thursday, August 14, 2008


Introducing Bluebell.
She is the latest in the stable of Wild Women (WW). She is destined to be a birthday gift for a friend.
I have used different sizes and shapes of beads for her to create texture and to hint at hidden depths. There are many layers and facets to Bluebell that are not immediately obvious. She is going to a rather special friend. With hidden depths. And layers.
Here she is with her sisters Polly and Woman. They need more sisters. I know someone red, and someone green are just lurking somewhere. Maybe someone bluesy. Someone even more wild (did you see the comment that their original designer/creator left on the first post I did about them?). I spent a bit of time online choosing accessories for more WW -I'm trying to challenge myself to make someone genuinely wild, instead of pretty or elegant (I never thought my work being described as elegant would make me feel I'd been safe).
Anyway, when I'm not creating elegant Wild(ish) Women I have been to work, where I had a day as section queen, and then a lovely shift with a primip who seemed to warm to me instantly and declared herself very keen to push her baby out into my hands.
Her story had me feeling slightly reserved about the possibility of this happening, as she had had an epidural at 1cm dilation (!), was a fairly large lady and had collapsed and spent a while on the floor until she got feeling back in her legs. The trace looked pretty dodgy as soon as I saw it, and I was quite sure that the docs would be hovering and keen to use any excuse to chop her.
However we bonded nicely, and she was quite unaware of the concerns we were feeling in the background. The synto was on at a reasonable level, and the baby was moving heaps - always a good sign. The docs were busy with a string of other emergencies, so they had enough to keep them busy while I just kept her calm and distracted, and we chatted and laughed, and talked and I answered her questions and it was all sweet. When it was time to examine her I felt she was very well dilated. almost fully, but the head kept moving and swinging from side to side as if baby was jockeying for position for descent. Its a strange feeling, but you know baby has a bit of room and energy to move well, so its usually good.
We positioned her on the side to await the last little bit of dilation and to allow the baby to descend as completely as possible before she started pushing. The woman had a medical condition where it was preferable to avoid prolonged pushing effort. There was a lot of rectal pressure pain, but a bit of epidural tweaking helped with that. In the end, she only pushed about 4-5 contractions worth and pushed out a very sweet little girl, creamy and pink with fair hair. The medical student (the one who had got such an eyeful on her first birth [forceps, very ugly] with me in early July) got a lovely catch and we couldn't praise little Aimee's Mum enough. So clever. What a complete genius she was to labour so beautifully, and push out such a splendid baby with so little fuss. Her mother and husband were thrilled to bits, as was she herself. It was such a love-in. Baby Aimee went skin to skin with Mum while she had a few stitches put in and was calm and alert and cooing and communicative. It was gorgeous.
So I skipped home, glowing with delight at having helped to create such a positive birth experience for this young woman. Those kinds of births really help sustain one's energy. Even though there was an epidural, and augmentation of labour, and a continuous trace, and fluids and catheters and blood in the urine, there was a pretty normal birth behind it all. In the end her cervix dilated really smoothly and she birthed beautifully. I just know her next birth will be even better, with the confidence that she now has in her body and her abilities.
I love being a midwife.

Monday, August 11, 2008

Caesar Queen

I'm home after a knackering day at work.

I was the midwife attending the elective CS today (a.k.a. the section queen). You carry a pager and run up and down to the wards and get to meet the women beforehand.

I was as busy as a bee, even though there were only 3 CS booked. I picked up an undergraduate nursing student too, who was meant to be in the day surgery unit, but it was quiet so she hung out with me instead. She wants to be a midwife, so she had a good time (I think).

The first baby was really big. Over 4kg, and it was a bit of a struggle to persuade him to come out! What a whopper, a welcome second son named Angelo. His Mum was unattended in theatre as her husband was minding the 3 y.o. outside. That was a bit sad, but we helped her to have a long cuddle with him before taking him to the ward. He was plump and gorgeous.

The second birth was from pregnancy number 11 for the next woman. She had a long and tragic obstetric history with two miscarriages, two ectopics, a neonatal death at 8 days and two stillbirths plus 3 livebirths, two of these by CS (including one classical section at 26 weeks). All babies but one of the stillbirths had been girls. In this pregnancy her cervix had been supported by a special stitch to help keep the internal door (the os) closed. She and her husband did not know the sex of this last baby, saying "It is up to God, this is our last child even if it is another girl". We were all most delighted to welcome a little boy mid-morning, who seemed vigorous at first, but started to struggle a bit with breathing after 8-10 minutes. Luckily I had hung on to the paediatrician for a bit longer, and she called her registrar to review him. His oxygen levels were only at 80% and he was pushing in his abdominal muscles to exhale and grunting and 'singing'. We took him down to the nursery where he was given CPAP to help keep his lungs from collapsing. Mum and Dad were pretty brave about sending him off so soon, Dad came too, and we were all agreed that God was actually pretty good to give them a son, and for there to be facilities to help him when needed. He was just a bit undercooked at 37 weeks and a few days, and I'm sure he'll be fine in a few days or so.

The student was getting quite an education about the role of the midwife! Today when little Mohammed went off, I had just finished talking with her about how the midwife is essentially in theatre for the emotional support of the mother, and the physical support of the baby, as the theatre staff are there for the clinical support of the Mum. I would in no way consider myself as flash in the neonatal support area, but today I knew a baby with respiratory distress when I saw one. Phew. I was glad I had the paed with me as we put the monitors on him and gave him oxygen, then the registrar took over the oxygen CPAP from me as he arrived.

One of the medical students I had last week mentioned how she saw me keeping tabs on so many things at once- blood loss, neonatal adaptation and respiratory sounds, guiding her hands, noting times and obs mentally while doing other things. I was grateful and slightly surprised to hear her observation, because I realized that she was right. All of a sudden I am doing all those things at once. Multi-tasking - Woo-hoo!

So, back to the day. I ran up and down stairs between theatre and LBS all day, retrieving paperwork, getting ice for blood gases, taking placentas to the fridge, getting changed, seeing women, taking babies to wards, all interspersed with standing for long periods waiting for surgeons to enter and go through adhesions etc, while teaching their own more junior staff the finer points of CS techniques. It makes my back ache to stand in theatre!

Our third baby of the day was another big baby, a near to term girl, who also needed to be squeezed out of the incision! In the end they used forceps. She was snuggled on to her mother's chest for a while before we headed up to the ward. Baby Sairharni weighed just over 4kg too, and joins her big brother in the family. She has the longest eyelashes I have seen for some time.

Back to LBS, paperwork, weighing placentas, showing the student the finer points of placenta examination, entering all the many details in the birth register, sending paperwork all over the hospital and then it was time for home.

It was a lovely day, but I am a bit achey. I've had some panadol, now its time for a cuppa, and a good sit down.

I feel another brooch coming on.....

Sunday, August 10, 2008

Wild Woman - correction Women

Hot off the needle. I can see a few of these being made while watching Olympics coverage! And now I have made the second one too!

This is Polly. She has a brooch back and is about 4 and a half inches high.
I needle felted the base from hand-dyed merino wool and pink chiffon. The hair/ruff/mane is from a trim I'm fond of and it made a great textured base for the embellishments.
The skirt is individual lace motifs stitched together, coloured and embellished. She took about 4 hours to make.
Ah, I do like a hand stitching project. Even if it does involve a few seed beads being spilled. (At this point I shall apologise for Blogger being most uncivilized about formatting and ignoring my paragraph marks. Just pretend I have been educated and formatted this correctly. OK?)

She was most satisfying to make. And I just know she'll need some sisters. I can barely sleep for all the images of them in my head. Shame I ever have to go to work really. I kinda miss being a full time crafter, but just as well that I LOVE being a midwife too eh?
Well, who have we here? A sister already? Why yes, her name is simply Woman. She was my first one nearly finished, then Polly butted in. Woman is patient. She didn't mind that her woolly minded sister jumped the queue.
Isn't her face beautiful? These faces (along with the arms & legs) are bought pieces, from Artgirlz. I coloured them with some groovy special marker pens. Variegated threads work wonders with these kinds of stitcheries. As you can see, they sometimes make just the hair you need. Just what I needed. Woman is about 4 inches tall, including dangles.
In other news ... Steph has got a laptop computer, wirelessly connected, so by default - I have this computer all to myself, and coincidentally that also means that no-one else need come in this room for computing (or any other purposes really) but me. Yes- just me. So I rule this room! My cunning plan to clutter it up so badly that no-one else could find a thing has worked! Total world domination is only a heartbeat away!!!!!!! I may get delusions of grandeur and start calling it a studio soon. I have plans y'know :)
This time a year ago we were coming to the end of our week in London. The weather was divine, the art was superb, the city was like a childhood story and a Monopoly board come to life. We went to the Proms (terrible program), we ate like royalty at my aunts' house, we tubed and walked, and M&S'd and Westminster Abbeyed in pure delight. I'm so pleased I've been there and can't wait to go again. I can scarcely believe I have been to (and enjoyed) so many of the world's greatest cities. I am a very lucky girl.

Our next stop (Aug 12) was Edinburgh and a few days in Scotland which was also absolutely wonderful (even if drizzly in an entirely appropriate Scottish way). I'll catch you up on those when next I post.


Wednesday, August 6, 2008

Telling tales

So, I have finished this stint of nights and it was pretty good really.

On Saturday night I had the care of a woman having her second child. She didn't speak a lot of English and seemed to be coping fairly well with labour but it was getting tough. For a change, it was a spontaneous labour with no risk factors that would necessitate continuous monitoring so I just listened in each 15 minutes for the length of a contraction or so to check the baby out. When she entered the transition phase she became very vocal and thrashy and grabby. I hadn't examined her for a few hours and when she started involuntarily pushing and started asking for an injection for pain relief, I offered to examine her to see if it was safe for the baby to receive a drug so close to birth. I was fairly sure the cervix was fully dilated and it was, and the head was quite close to the world, so the answer would be no (to drugs). She was disappointed about the drugs, and I'm sure swore a bit in frustration in her own language. I just smiled encouragingly. Within 5 pushes the baby was out and the medical student with me had half-caught another one for her book. It was a girl, there was much delight in the room, and they couldn't dress her in pink from head to toe quickly enough! Dad hadn't seen the birth of number one, so was pretty impressed with his wife. And the baby was such a cutey, little Ishmeet.

Across the hall an hour later, around 3am, a shocked, and shivering woman was wheeled in by ambulance (shaking is fairly normal after birth). The ambo walking after her had a silver wrapped bundle in her was a baby! I briefly congratulated her on the little one and went back to my room, but soon I was called in to be another pair of hands in what turned out to be quite a drama. It was a cold night, expected to be 3 degrees C, and the woman had been asleep alone in the house with her 2 year old when she was woken by sudden strong labour pains. The contractions were coming so thick and fast she couldn't get to the phone to call for help. The baby was born 30 minutes later in the bathroom as Mum sat on the loo, splash, clunk! Poor woman. She pulled baby out and wrapped him in a towel and struggled to the phone where she called an ambulance and her Mum. She then had a big bleed, and ..and..oh dear, it would not have been pretty. The woman herself was still sobbing in hysterical shock and really seriously cold. We kept taking her temperature and not quite believing it was so low, but I called for a special warmer from theatre, and warm IV fluids to raise her temperature as soon as we could. The baby was also seriously cold. We are taught that babies must be warm, pink, sweet and clean. Meaning they must be ideally between 36.5-37.1C, have good circulation and heart rate, adequate blood glucose levels and be kept free from infection. Between being so cold, and banging his head at birth he was not in fantastic shape. He was taken to the nursery pretty quickly where he was in a pretty bad way for a few days. I haven't heard how he is today. Mum continued to bleed, and with a poor circulation due to low body temperature it was hard to get it all under control. We kept having to remove the blankets from her to assess her loss, put in catheters, new drips, massage the fundus. Her mother arrived after finding someone to look after the 2 year old, and was still beside herself with shock. She said the house looked like a murder scene, and was clearly very traumatised even by the aftermath. She shuttled up and down to the nursery seeing the baby, and then the woman, who was moved to special care once she had been slightly stabilised after 3 hours of constant attention. It took 12 hours or so to get her temperature back up. It was quite a night.

I was pleased to work with a homebirth family requiring a CS last week. The baby was in a persistent and damnably unfavourable position for a homebirth and there was a very clear plan to transfer for CS after a bit of labour, which is what happened. Baby was born just after midnight and went skin to skin after the resps were established at 30-40 seconds. She was pretty squished from the labour and the unusual position in the uterus. They had half an hour together on the table, then she went to Dad and returned to Mum in recovery 10 minutes later, where she had the first of many feeds as she remained skin to skin for essentially the next 6 hours. There were no beds for postnatal care so she came back to LBS with me and I looked after them for the rest of the night. Baby Ryder didn't even get weighed until 6 hours of age because she just fed from side to side for all that time. It was really nice, a lovely family, so gentle and calm with their baby (who could suck for Australia if a place came up on the national team!)

What else? Hmm, lots of things. A young woman with a stillbirth, a 2.2L PPH and really high blood pressure - she really hit the bad luck jackpot, poor girl. Another couple of PPHs, 1.8L, and 800mls, that is always a fun way to start the shift! A really intrusive friend at a birth who just wouldn't shut up while she was pushing, and later while the mother and baby were bonding and trying to feed. I felt like saying - if I rip the baby from his mothers arms and weigh him (to give you the information you're clearly dying to be the one to spread) will you PLEASE shut up and f*** off? But of course I didn't. I just kept addressing the new mother directly in a quiet voice and ignoring her friend, or gently but firmly correcting all the negativity the friend was spouting that was all about her, not the precious moments she was intruding upon in the room she was a guest within. We did all sigh with happiness and the mother actually stated "oh its so quiet" as soon as the friend left. The Mum and Dad were so enraptured with their little fella, Jacob, who was extremely edible, all 8lbs 5oz of him. Quite, quite yummy he was.

There's been quite a bit of time on night shift to get to know some other midwives better, which has been nice. Some new staff, some staff returning from maternity leave. Some politics, some passion, some laughs and frustrations. Helping each other with the formal wording required in our competency documents for professional development. Sorting out the state of midwifery in Australia vs England. All sorts of things. Challenging and exploring each other's views on a range of topics. Burnout, job satisfaction, intervention rates, is normal birth possible in a high risk setting?

I was pleased to be able to see that doctor who had given me such grief over the woman wanting a VBAC. She assessed another woman whose cervix had not dilated over an 11 hour period and there was a fully agreed and harmonious collective decision to go for CS. When I asked her off to one side to give me some technical details related to reason for section, i.e urgency of need, and reason for CS she said 'failure to progress'. I took a deep breath and said 'actually - how about we put the reason as delay in first stage progress, so the woman doesn't start her mothering journey being labelled 'a failure' ". She looked taken aback a little, but said "well, its probably the same thing, but I can see how that would make a difference to the woman, so yes, fine". I was quietly pleased, and hope I have sown the seed for a change in her thinking. This step had been suggested to me by professor of midwifery who I had contacted after the first incident had distressed me. It was a really good idea from her.

I'm coming to the realisation that I have become comfortable as a midwife now. Maybe it is just feeling more consolidated in my skills. I feel this second stint on LBS, following from the stint in the community on the visiting midwifery service has seen me become so, and I can feel that I might be ready to start making some decisions in my future directions. Some of the clinical midwives I work with have been asking my intentions, and have all said they could see me working in the community, but I don't think I'm ready for that. However if the chance came up at a more caseload model of care - where a small practise of midwives are assigned the care of women and back each other up to provide antenatal, intrapartum and postnatal care that would be a good way for me to go, I feel. Maybe in a birth centre setting.The drawback of that model apparently is the on-call work, but there is one very near where I live, which could make the on-call work more manageable. I feel the time is right to start making plans to actively seek those opportunities, and to gain the skills I will need to be competitive when I apply.

I am still looking and reflecting within as I practise, but I am now more able to raise my eyes from the road, and look to the journey ahead. Its a big wide world out there.

Monday, August 4, 2008

Nightshift Haze

Hey all

I am alive, and on night shift, 2 down and 2 to go. I am not actually up right now, I'm just on the 'need a pee-go for a walk past the computer-if I don't talk to anyone I'll go back to sleep ASAP' break that night shifters do. Kinda the equivalent of sleep walking. Ooh, my son just arrived home and is in danger of talking to me too much....hug me and nick off boy!

I've been cruisin a bit, and still in lazy days mode (see last post).

I've been making bags. Yummy.

I've been to a craft and quilting show. Double yummy! Check out the Wild Woman brooches at this place. Uh-oh, a new obsession may lurk to go with healing dolls. I'm part way through a set of three already. I felted the base of part-felted merino wool and thread embellishment. Its very satisfying to do. And I love the name Wild Woman - so tempting.

Work has been really good. Caught a few, seen a few, interesting tales to tell for another day. Thinking a lot about hypothermia and circulating volumes etc - its been a physiology lesson for the last few days, plus the effects of hypothermia on the newborn - I've been hitting the books to revise my stuff.

In the meantime this time a year ago we were in New York. Sigh. It was a great few days in a fabulous city. I have not given you specific links for our time in the Grand Canyon, New Orleans, Little Rock Arkansas to see the presidential library of Bill Clinton, and unexpected night in Dallas Forth Worth and a compressed trip to Madison Wisconsion. But if you take the link (and look in archives under July and August 2007) you can see the little amount we wrote from these places, or the photo albums from there. It was really hard to find public internet in the USA. We won't make that mistake again.

Dear Lesley is back in WA for a few days following the death of a dear friend. So tragic. I will see her later in the week. I look forward to her moving home so I can see her without the thought that someone is seriously ill or worse when I see her.
Yawn, I will be back I promise......Oh bugger, there is cool reggae playing (softly) and I'm hungry. And I've got a friend coming for dinner for her birthday - it will have to be an IOU present - a future pleasure present. I just hope I can grab a banana and get back to sleep.

See ya