Saturday, September 27, 2008

One year later.

One year! Thanks for reading my stuff, my reflections, my ups and downs.

Blogging is another tool in the great toolbox of life.

Its a great medium for connecting to people from all over...but you knew that.

Leave a comment by September 30th for a giveaway.

Friday, September 26, 2008

JJ update

I saw them yesterday at the children's hospital.

First of all, JJ is doing well, or not good, depending on who you talk to. I was met with a warm hug from his Mum who is doing pretty well, although not getting enough rest.

The staff, some of whom I know, are quite pessimistic about his prognosis. He has had renal failure and has had some really major brain bleeds. That never bodes well. However when I saw him yesterday his urinary catheter had been removed and they were watching for a natural urine output. He was breathing independently but shuddering and jerking a lot. And his broken legs (both of them) were still splinted and causing him some pain when he moves (he reportedly cries), although he was being carefully monitored for pain on an hourly basis.

His parents declare that he is doing great and they look forward to taking home home in about 3 weeks. His room has been painted and recarpeted and his parents are looking like doting parents totally in love with their son and encouraged by his every breath. He is theirs come what may, and they will face the brain injury/ walking /talking stuff when they have to.

Good for them.

To me, JJ looked heaps better than when I last saw him. The bruising has gone down significantly although there is still a lot of moulding evident, but that could be due to brain swelling. He is much better hydrated and his skin is pink and clear and he no longer looks like a small dessicated lizard with crumbling dried out vernix.

I don't know what to hope for for them all. They are so new to all this, and adjusting so well really. Once again I was quite specific about acknowledging their new role as parents of a really special baby, and how brave they were. They truly do look OK with things. I hope they get to keep him. They are already talking about having a brother or sister for him, after a while when they have a better idea of what he will be like. At least she is sure she will recognise the symptoms of pregnancy for herself this time, and not rely on the GP!!!

I left them with a small gift of a blanket, and a card containing wishes for a peaceful and joyous life together, what ever that journey may entail. It had been a privilege to be their midwife on that eventful night and I will never forget them.

As I was about to leave another woman approached me with recognition. I had been their midwife too, for their birth 3 or 4 weeks ago when I was practically railroaded into a room by their private obstetrician. The woman was labouring fast, prematurely and had been transferred to our hospital from a private hospital due to threatened pre-term labour. She was 'settled down' for a few days while some steroids were got into her, but then labour started again at 33-ish weeks, irrevocably and it was all systems go for an epidural (but she was coping so well!) and then an ugly intrumental birth (!) with an episiotomy which was not pretty. Oh my. So their sweet little girl Sophie was born quite violently and went down to SCN as a premmie. She had been transferred to the children's hospital as a penultimate step before going back to a private hospital to finish cooking. They were pleased to see me, and I them, and as they were in the room next to JJ the 2 sets of parents were quite incredulous that they had each managed to see me again within the one visit! Its a small world!

Being back in the neonatal unit brought back many memories for me as we spent 39 days there, Stephanie and I, in early 1989. I lived in with her, expressing full-time and adjusting to the idea of who this special child would be. Nineteen and a half years later I know, quite clearly, who she is. She is herself. Just, and uniquely, herself. Special indeed. Still challenging, still her Mum and Dad's girl. She has brought me many things that I cherish in this life. Many things.

I know JJ and Sophie will do the same for their parents.

Wednesday, September 24, 2008

The whirlwind returns- now with photos

I'm back!

I feel like that's been the opening line for a number of posts this year. No, I'm not going to check.

The conference was great! It was a co-badged event with the Australian College of Midwives, The Royal Australian College of Obstetricians and Gynaecologists and the Australian College of Rural and Remote Medicine. There were guest speakers from Canada and the USA, and all over Australia. There were some ugly, shameful statistics and some stories of hope and inspiration. Most of all there were stories that traced the pattern of the erosion of normal birth, and these are steps that can be reversed to a large extent to reduce the interventions in normal birth, reclaim the skills that have been lost (i.e. vaginal breech birth) as a result of overestimation of risk and to increase 'parturient autonomy'. This will also free up midwives to practise more fully with women within the full scope of their skills that they already have. We heard the terms VBAC (vaginal birth after caesarean), NBAC (next birth after caesarean) and GBAC (Give Birth A Chance!!), industrialised birth, and in an hilarious debate heard an obstetrician challenge anyone to approach a woman labouring on all fours (as her pelvis would dictate) and to perform a CS 'doggie style'. Ah, it was an earthy crowd! (BTW, I have no idea who that fat chick is on the right wearing my clothes).

The Gold Coast of Queensland is an area I have never been to before, but it has a lot to offer. I was picked up by my dear friend Kate (who was married on the beach in March) and we drove back into northern NSW to see her little town where she started work this week. What a lovely spot. She and her husband have just bought a beautiful property backing onto two national forests and plan to birth their first child at home on the property in March next year. Kate has just started to 'pop' - so exciting- can you see the bump? After a bit of lunch we headed back over the border and checked into the hotel and had a nanna nap. Then off to the reception and opening speeches which really set the scene well for the next few days.
We ate well, especially the conference dinner on Friday night sponsored by the Northern Territory crowd which featured Darwin market food - such delicious variety! Asian influenced, bush tucker, kangaroo and emu, oysters, limes, fish, absolutely fanastic food. The hotel was good, and catered well for milling crowds of midwives and others without long queues. It was really great to get a chance to meet others from my state and elsewhere, and share info from the concurrent sessions that we had attended. The program was really well organised, not a dud among them. A great success. I even put my plump toes into the Pacific Ocean at dusk on the last night, and collected some tiny rocks and shells for my collection. So Natalie, if you go and have a toe-dip in a few weeks time - we'll be sharing wading water!

On Sunday I headed to the airport for the trip to Melbourne to see my niece perform for her graduation concert. She was really lovely, and in good company. There were 14 dancers graduating and each was featured in various ways and within larger ensembles. Without bias I can say she was in the top group of performers that night. She certainly deserves good things to come her way. I hung out with my sister, niece and Mum and because accomodation was a bit squashy I lobbed in with another niece for the night, so got to see her, her partner, and her sister and husband (the Melbourne wedding of March this year) for brekky the next morning. What a gorgeous group of young people they are! SO interesting. They all went off to work and I returned to my sister's place for the day.

We went to see Wall-E which I had been looking forward to for ages. I confess I was slightly disappointed. I got the concept from the start, but found the rest of it predictable. I laughed out loud at some bits. I was touched, but not deeply moved as I had expected to be from the hype. There was nothing terrible about it, it just didn't rock my world as I had expected. Palpable waves of boredom from the seats alongside probably didn't enhance my aesthetic experience. I think the rest of the party were annoyed for having been persuaded by me to go! Sigh. Choosing a film is such a responsibility!

The last leg of my jaunt was to get to the airport early - never usually a priority for me. Why? WHY? To have my first blogmeet! It was so exciting! How would I recognise them? I had seen a few photos of Frogdancer, but never one of Widget (deliberately). But having spoken on the phone to Froggie a few times I was quite sure I would know that voice anywhere! And I knew she would be carrying a bag containing a QIP (a Quilt in Progress). So I was looking for a shortish woman, carrying a bag, talking a blue-streak with a woman who looked like a 'thirty-something' blogger who could be a music teacher. I look pretty much the same as my photo up in the corner. And I had texted them to tell them where I was sitting. But I spotted them first! (I think).

It was like meeting old friends, in many respects, except I had 'forgotten' what their faces looked like. I won't again. We had a really easy time together, within the culinary confines of the airport, although we didn't have to resort to Hungry Jacks (phew). We discussed the pros and cons of Pierce Brosnan vs Daniel Craig as 007 (verdict: neither would be turfed out of boudoirs), mutually confessed our mucousy reactions to the deaths in the last 2 Harry Potter books (it was all too close to the surface for, ahem, some of us) and talked employment history and how nannying really is a rehearsal for teaching.

But the piece-de-resistance was seeing the progress on the quilt. A while back Frogdancer was having a pretty crappy time, so I decided that she needed a quilt and should raid my (considerable) stash and derive some comfort from it. It was such fun putting together the package for her in pinks, greens and neutralsand sadly didn't even make a dent in the stash, but I can now reveal the result! Its just lovely. So beautiful. From 66 different fabrics for scrappy quilt, Froggie has produced this. Tah-dah! Take a bow Froggie! She's done a wonderful job with it all, and there was enough fabric leftover to make a potholder for Widget and me as little side presents. I'll treasure it - and its not going NEAR a pot I can tell you! These are Widget's hands displaying pressies, with her rings removed for de-identifying purposes. I gave them each a tiny bracelet with red and green beads with butterflies, and I have one too. We're a team!Widget takes her anonymity seriously! But will see me in Perth again in December when she is in WA for a holiday. Woo-hoo! Next blogmeet my place! I was a bit self-conscious at first, but my plane was delayed and it was just as well - we got on so well we could have talked for ages! It was really nice to meet them both - I wish Froggie had been able to bring her boys too! Isn't the internet an amazing medium?
So here I am, back at home and loving it as I have a week off work now. And a daughter home to keep me company (I didn't plan for that). I did have plans for creating and crafting in my jammies all day, but its Wednesday already and we have appointments together and .... rats. I'm still catching up on all the bloglines to read (208 on return - yikes!) Still I will definitely be making more Wild Women brooches for upcoming birthdays and the like, and if I could just get Blogger to cooperate with uploading photos (3 tries with no luck) I would be well happy. We did a bit of craft together yesterday, and I plan more today. Its good for both of us.

The news on baby JJ is that he has been moved to the children's hospital and is not fabulous. I will probably see them this week too. I am their midwife, and want to see this through.

Must dash! Please de-lurk and leave a comment and say hi, and maybe where you are from! Its the nearest I can come to putting the kettle on!

Have a good week!

Wednesday, September 17, 2008

Learning the hard way

A brief hello before I dash to the airport in an hour's time.

I have been on night shift and busy between since I last blogged. There has been another night away with my dear one (sigh, happy sigh) and some very challenging shifts, Monday night in particular.

Its a very long and traumatic story, and some of it would leave you incredulous. It did all of us staff and the couple themselves, along with their extended family. Suffice to say it was a very late discovered first pregnancy(near term), a very thick GP, some unfavourable maternal factors for an unknown little passenger, a pretty unwell baby, no amniotic fluid, an eventful attempt at labour, a long and interesting discussion with the top doctor about the language of CS and 'failure to progress', followed by a trip to theatre and the most traumatic CS I have ever taken part in. The little fellow was in a pretty bad way after an enormous and heroic struggle to birth him, and after a full resus his battered little self was transferred to the nursery where he struggles on, but he doesn't look fabulous.

I found his Dad wandering the corridor dazed so I arranged for some phone calls to put through for him while I dashed back upstairs to do the minimal I could to get out of there. We sat outside in the dawn light after my shift finished, as he waited for his Mum to return. The doctors were quite hopeful of his outlook at that stage, only just over an hour since birth..... Dear little JJ. I have my fingers crossed and am sending prayers for a gentle life for you and your sweet parents.

I'm tottering since that night, reeling from the events, and still reflecting on it and will for some time. What his poor parents must be feeling is beyond my comprehension, but I worked really hard during the labour to prepare them for anything, and any outcome. I addressed it quite specifically, trying not to scare them any more than they already were, but not painting sunshine and roses either. Sunshine and roses will be a great bonus for this couple, but they've had one hell of a 4 days. This time a week ago they didn't even know they were going to be parents, and now they have an express ticket for the rollercoaster of special needs parenting.

I'm heartbroken for them. I wish it could be different for them. What a shitty deal.

The team at work have been really supportive of me, wussing my way around on the next shift (and even now), but the whole hospital is aghast at the events and I was the only midwife present. It was so hard to fill out the paperwork documenting his injuries.... I had also had a medical student with me for that shift (geeze, you think they would avoid placing them with me by now - I seem to be a bit of a shit magnet when paired with a med student!). She was taking photos in theatre initially, but as it went down she got selective about what the parents may have wanted recorded. No-one needs photos of 2 doctors and a midwife doing CPR on their newborn.

I had a good shift last night, with a lovely calm gentle and normal spontaneous birth with a student midwife who was a delight to supervise. The woman birthed just before midnight, and stayed with us for a few hours, then there was paperwork to complete from the previous night on JJ's birth.

Just before knockoff we received a woman labouring thick and fast with twins. There is a lot to be done for a twin birth (are you surprised?) and it was nice to have a student to show the ropes to for her first exposure to a twin birth. We didn't get to see them born, but wouldn't have missed them by much!

I'm off for 5 days to Queensland for a conference, and Melbourne briefly to see my niece graduate from the Australian Ballet School. My Mum will be in Melbourne for the event too, and I get to see my dear sister who misses us all so much (and we miss her too). I will stay with another niece, meet her sister for breakfast, and squeeze in a blogmeet at the airport on the way home with Frogdancer and Widget! Then I will have the rest of the week off. Phew! Its all go!

See you when I get back.

Sunday, September 7, 2008

Conferencing with the in-crowd

Yesterday was the conference for National Caesarean Awareness Day (NCAD).

It was organised locally by a fantastic group called Birthrites (link now repaired) who support woman after caesarean birth, and supported by a number of other sponsors including the Australian College of Midwives WA branch. It was attended by 77 registrants and held in the UWA Club in Crawley.

The theme of the day was "Getting clear about fear" and the speakers all discussed aspects of fear: women's fear of birth, professional fear, the illusion of control, the illusion of choice, experiencing a caesarean, planning the next birth after caesarean, psychophysical manifestations of fear, mythbusting the statistics used to deny women VBAC and so on. It was a marvellous day, very thought provoking, clarifying and inspiring. We all got to hang out together and have great discussions, great food and boost each other's energy.

NCAD Prizes were awarded to a midwife of the year, Sally Westbury, an independent midwife for her support of a woman wanting a VBA2C (a vaginal birth after 2 CS) which was achieved at home in a very culturally specific environment. The citation was superb. I was lucky enough to work for a few days with Sally in 2004 and greatly admired her down to earth style, I learned a lot from her. A second award was made to an obstetrician of the year for sensitive handling of a woman pursuing a VBAC in a hospital environment who, even though she ended up birthing by a repeat CS, felt Dr Sara Gibberd had been very kind, thoughtful and respectful of the woman at all stages of the labour and birth. The awards were well deserved by both.

Later this month I will be attending the national conference of the Australian College of Midwives in Queensland on the theme of Keeping Birth Normal. I'm sure it too will be invigorating and stimulating to take part in.

Work has been very busy this week. I only worked two shifts late in the week and will be on night shift from this Monday night. I worked with some really interesting couples, both overdue, one going for VBAC who ended up with a repeat CS after the cervix hadn't dilated after 9 hours of contractions. They were fairly OK about it, and were delighted that at least this time the husband would be present and the woman awake! Last time, in Korea, it was a general anaesthetic and she didn't see the baby for 2 days! The other couple were having their first baby and she was labouring spontaneously really well then got a bit stuck at 6 cm for 8 hours. I stayed as they were short staffed until after midnight, at which time they were going to put up some synto, but was pleased to see when I came the next morning that she pushed her baby out with no help just before 3am. Thank goodness it did the trick! I'm so pleased for them. They were such a nice couple.

Speaking of GA CS... young Zachary and his parents are doing well. I saw them all on Friday afternoon and he was being offered the breast! Both his chest tubes were out and he was nuzzling up and having a bit of a go. The SCN are taking such good care of them, I have seen the same nurses with them every time, they really could not be in better hands.

I also got to see an external cephalic version performed on Friday - where the doctor gently strokes and flips the baby from a breech position to a head-down position. I have always been elsewhere when one is happening, or the baby has been found to have already turned! It was really interesting to see performed, and it was good to palpate a breech so clearly. I wish there was more opportunity to get some breech experience in birthing, I've never attended (myself as primary accoucheur) a woman birthing a breech, although I have seen them done by others. I may have to wait a while :)

This time around I have been less distressed by working on LBS than I was when I first rotated there. I am certainly finding my feet. I am really enjoying being part of a team environment. Not team-style midwifery (although that would be great too), but feeling like a functioning member of staff. I'm really pleased to be getting to know my colleagues, and seeing how we all fit together and pull together in any crisis, or quiet time. I have taken pleasure lately in letting them know that I respect their skills and enjoy working with them. Some are surprised, but all are touched to be acknowledged. Not in a flashy way, just an aside to a patient (when seconding) about being in good hands, or 'I can't think of anyone I would rather have in a room in a tight spot'. I hope they don't think I'm weird that I give them this feedback. Maybe I come across as an over-thinking-brain (sigh, story of my life), but I do actively reflect on my practice and how I feel about each shift. Its important to give credit where it is due, and in a work environment where we are often under enormous pressure it is a small but vital courtesy to support one another.

Anyway.....I've been asked if I will consider doing some shifts in the Next Birth After Caesarean clinic at our hospital and I am very tempted. It is an area I am interested in, involves some antenatal work, and could lead to some caseload work, where I would be the primary midwife for a (bunch of) woma(e)n and follow her wherever she was in the hospital. It would mean less time to make Wild Women, and I have been commissioned to make 3 of them...I'll be having further talks I think. I could ease my way in.

In other news, we have a new side wall. Next-door is renovating and part of it involved the removal of a falling down asbestos fence and the building of a new you-beaut limestone wall for most of the length of the block. With the building demolition we have had no fence on that side for more than two months now, and in the last week it has been all go with the wall-building effort. There is now 300 tons of limestone between us and the neighbours, and a 150 ton hole in the bank balance, but it does look lovely. Next-door wanted their side to be flush faced and Perfect, especially at the part where they will have an outdoor room and eating area - close to our back door. We wanted our side to look more rustic and traditional. We both got what we wanted.

Hubby is beside himself with Spring delight planning the garden and patio renovations. Even I have had a look-in (and I don't do gardens or get my hands dirty) because it involves Entertaining and Roses - both of which I am entitled to an opinion on. The upshot is that the back patio - which looks HUGE - is to be gussied up with a pizza oven (long-term) and a new spot for the BBQ, with lighting etc, and the close patio will be reclaimed as a summer eating area, with a rejuvenated rose garden in between along with new ground covers and a wall-feature in the eating area. It is so nice to have our backyard privacy again. And I did get my hands slightly dirty today as I went to the nursery (gasp) and chose a new rose, and then helped to plant it!!!! I even chose some fun sunflowers to put along the western fence and planted those seeds too. You have now heard the sum-total of my gardening effort for the next 5 years. Seriously. I get to choose the wall-feature - I am thinking an old garden gate or an old wrought-iron shape/screen/something against the wall - I'll have fun visiting some scrap yards this week.

Have a good week!

Monday, September 1, 2008

Many birthdays later...

Hello world.

It has been 10 days my last confession and I have not been idle.

I have just completed a five day stint where we have alternated between being quiet, and crazy busy, or at least my allocations have been. Some of those shifts I have been scuttling as fast as my feet will carry me, and I pass the various desks where staff gather and I will see a full house of midwives all chatting, unallocated, rooms all checked and ready and cleaning done, waiting for the next woman to come through the door. For an hour or so, some days, that has been me too. Then I will be sent off somewhere, or given a job to do which leads to something else.

If there has been a theme to my 5 days it is meconium stained liquor. I haven't seen a nice birth (myself) for days. They have happened though. To others. Sigh. I've seen some pretty yukky births actually. (Reading back - I just remembered that I supervised a nice normal birth with a resident doctor that was pretty nice on Thursday, that seems so long ago. Oh hang on, that was a fast birth where the baby's face was really bruised, and then she had a PPH.....oh bugger, welcome to my world this week) .

Last Friday (my sister's birthday - hope you're feeling better hon) I was allocated to two rooms with a newish student midwife, almost half way through her course. We had the care of two nulliparous women, one aged 16, and one aged 24. The younger one was quite complex, with many issues that were going to need some tactful handling including a very intrusive mum who had, umm, 'boundary deficits'. The background was quite tricky, but I was a bit relieved when Mum announced she was going home to get some sleep and she was going to leave her daughter to feed herself if she was interested (as opposed to mummy holding the spoon for her). Phew. I left the young couple to go for a walk and do their own thing as she was not in established labour and knew to return if anything interesting happened.

We scooted into the next room to meet an emo-looking couple and their friend. The woman was contracting frequently and quite vocal, growly and frowny with the pain. She was quite funny really, and would say things like 'rrrrr, I hate your dick! Its NEVER going near me again!' Her husband was really shy and quiet, I never heard a voluntary peep out of him, literally not a peep. He just blushed and cringed and slunk away, poor guy, but she would demand his hand with each contraction so he had a role! Their friend was a cheerful and practical young woman, expecting her second child in 2 months time so had some experience and was very encouraging. We introduced ourselves and got the story on the pregnancy and the labour so far. She was 10 days overdue and had presented with reduced fetal movements and a greenish discharge. ? Waters had broken? There was not much fluid around baby so she was offered a gel induction straight away to get things going. The trace was good, baby was apparently in healthy shape, but there was nothing draining in the way of fluid... I left the student midwife with her, to settle in and help her cope with contractions for a while, before she was due for assessment.

I shuttled between rooms for a while, sorting paperwork into piles in case of rapid need, getting more background on each woman. We went to tea, said goodbye to the morning staff and settled in for an evening shift. Would either of them birth before the end of the shift? Would the student midwife get a catch? I was just in seeing Miss 16 when the student midwife came for me at a run, 'come now'.

I sprinted after her, the trace showed a serious dip in heart rate. Over we go sweetheart, onto your side, no? Not improving? Other side then. Ah there we go, its coming back up now. The woman's eyes were bulging in panic, she was praying and urging her son to be all right. She was a big girl and couldn't move fast, and was quite feisty and highly strung. I didn't want to scare her, but we discussed what had just happened, possibly due to there being less fluid around the baby and his cord may/likely have been compressed and caused the drop. The trace had been fantastic, the consultant had just been in to see them and commented how good it all was, and now it was time to reassess her cervix. She asked me to do it rather than the doctor, yep, no problem. There was very little change from 6 hours previously. This was disappointing, but the decision was that the hormone drip should go up for a while, and that we hoped it would help the cervix open. Yes there were plenty of pain relief options, we would discuss those when the time came. She'd coped really beautifully up to now, lets see how she got on. In the meantime I reminded the student to press the assist bell if the heartrate dropped like that again and I wasn't with her. We had a brief but honest discussion about what may happen if the heartrate dropped again, and the possibility of CS was raised if there looked like a serious compromise of the baby. Mostly it doesn't happen too frequently, and hopefully you will tick along nicely and push this baby out in this room, into our hands. That's our plan!

It took a while to get the hormone drip organised. The doctors were having their round, communications were slightly delayed. The hormone drip was eventually started really slow. In the meantime the other young couple were waiting for an assessment, and maybe some pain relief as she was contracting more frequently, and she was due for some antibiotics. Every time I picked up my gloves the phone would ring, or she was in the toilet, or something would crop up. I had the antibiotics made up ready to give Miss 16 and was just inviting her to come over to the chair when the assist bell went for the other room.

I shot across, it was another serious dip, the room was filling up and the woman's eyes were wide with panic again. Hormone drip off. I fought my way to her side and talked /coerced her into cooperating with the docs for a quick internal assessment as we struggled to find the heartbeat again, even with a scalp-clip. Crap! Right- said the doctors - we're going upstairs - call a code! I called the code through, hung up and grabbed Dad by the shoulder and said 'get your shoes hon, we're off to theatre, stick with me'. Within one minute we had left the room, the prepared notes bundled up en masse and we headed for the next floor.

My goodness there were a lot of people in the theatre! It was an unfamiliar theatre to me, and I had trouble finding the fetal heart monitor, but eventually we found it and the FH was still pretty low. The surgeon made a decision for a general anaesthetic (GA). It was an agonising wait, with the student midwife and I focusing on the woman as she went under, promising her that we would look forward to meeting her son soon. When it is a GA dads are not allowed in theatre. The student went out to tell him of the progress, and we would be out again when his son was born.

It was not pretty. The surgery was fairly straightforward, and our hospital has a method for holding up a big girl's gorgeousness to help them get to the CS site without another person being scrubbed to hold it up. The surgeon needed me to apply upward pressure on the head to release it from the pelvis, which is tricky to do while crawling under the sterile drapes. I was apologising to the woman as I did it, but it only helped a little. After a struggle the surgeon finally released the baby from the thick meconium filled uterus. She was white with the effort, and told me later it was the most difficult release she had ever done. Baby was limp and green.

The baby went straight to the crash team, who finally got him breathing after 5 minutes, but his lungs and stomach were pretty full of mec and he was stained with green from head to toe. He headed down to the SCN on a ventilator, but fighting it already. His young Dad went with him, crying quietly, but relieved to see him alive. We went back in to see his Mum again and tell her (even though she was still asleep) that her boy was doing pretty well so far, and then returned to LBS.

The surgeons emerged shortly afterwards, all a bit subdued, and knees knocking from the aftereffects of adrenaline. We all felt it. I hope I don't experience it again for a long time.

I have seen the parents once and baby twice since. Young Zachary had a good evening and even came off the respirator that evening and was in the bath getting the mec scrubbed off him when he slid back into respiratory distress. Both lungs collapsed within a couple of hours and he has been a pretty sick young man, but has improved significantly today, although he will be in the nursery for a few weeks at least. Mum was chirpier than I expected and was recovering quite well in herself, and proud of her son's fighting spirit, and was reassured by each tiny step off the machines again. We had a long debrief chat and rehashed the events, and I filled in some bits of the picture for the two of them. I hadn't slept well since that night, and was so grateful for the chance to see her and give her a hug, and tell the two of them how brave they had been in the emergency. She said she had initially been angry, but as soon as she saw him about 10 hours afterwards she felt it melt away when she saw how sick he was. I think they will be OK, after a very close call.

The student midwife played a really important part in that birth. She hit the assist bell at the right time, and kept her head and stayed focussed on the woman, and has visited them as well. I couldn't have asked for more of her, and made sure she knew she had acted very well in the emergency. She got a lengthy comment in her book detailing her actions.

So, that was a long story about part of Friday's shift. (Sheesh what is it with me and students? They sometimes get more than they bargain for!) We had dinner and then focussed on Miss 16, giving her antibiotics, running her a nice bath for pain relief, eventually assessing her and finding she had cracked on with a bath and hotpacks for comfort, plus two panadol! It was the end of our shift.

The night shift midwife reports it was a beautiful birth on all fours, her Mum arriving loudly just as the head was crowning and being firmly shushed, and not spoiling it too much. Everyone was most pleased with events, and very proud of her. The midwife got a second quick birth that same night, where a woman walked awkwardly in to the LBS and said "I don't think I can get on the bed" and when encouraged to push where she was standing, proceeded to deliver her baby into the midwife's waiting hands 3 minutes later. Aaaahh, how yummy. The midwife was all glowing and teary describing it to me in the morning. Half her luck.

I'll tell you the stories of some other birthdays another time.