Wednesday, October 29, 2008

Ramblin' on

I have managed to find my way back to the 'New Post' button. Phew!

I have made an actual list of things to excuse my absence, well...more like things that happened when I was away from the keyboard and I feel I might tell you about.

I have been op-shopping (clearly I desperately need more stuff in this house). Buttons galore, some cast glass pieces (imitating cut glass) that I seem to be collecting. Do they have a name as a style? Please let me know.I wonder why I like them? They remind me of my Nanna's sugar bowl which I have and use daily. I'm sure that the sugar bowl is absolutely nothing special in terms of value, probably a fancier looking piece from a department or chain store, but it has always been in use with the Sydney Harbour Bridge spoon from my earliest memories (at least the mid-60s). It has the lovely quality of looking beautiful (esp when freshly washed) but as solid as a rock...let me take a picture (oh bugger, now I'll have to wash it....might as well photograph the rest of the haul....semi-prepared blogging...grumble...grumble). They were all as cheap as chips to buy, but I do like them.Here ya go. I use this one as a pin dish (it may very well be exactly that).

More Wild Women have been crafted, including some brown ones. I am not a brown person. It looks hideous on me. Its not 'my colour'. So I used to naturally shy away from it as a craft choice....but lately I have realised that it was cutting out a whole range of palette for me to play with, and it does combine well as a neutral with all sorts of colours. I don't have to wear it to use it. I'm pleased with these women. I haven't named them yet...But they please me inordinately.

I went to an Enjo party last week (sigh, don't get me started on party plan selling). To be sociable, and because I love the party holder dearly. I knew her late mother, and now the daughter, M and I have ended up doing nursing together (sort of, she was the semester ahead) and midwifery in the same class. When her mum died in 1997 some friends were asked to make quilt squares for a memory quilt for the family. I hadn't started quilting then and I am embarassed to recall my efforts, but I made two blocks for the quilt and sent them off, but never saw the finished quilt. M showed me the quilt at the party. Its huge! And I was relieved that my squares weren't as badly finished off as I recalled.

I was at my daughter's swimming competition last weekend and for some reason (anticipated boredom?) as I ran out of the door I grabbed something to do while sitting for hours. It was knitting. KNITTING!!!! Good Lord! What possessed me? Anyhoo....Using op-shop chunky wool and 9mm needles an elf hat emerged. Quite randomly. For a creamy-beige elf. No pattern, no clue, made it up as I went along. The daughter came third in her race too. I continued the illusion of knitting the next day and attempted to make a headband for the wild-haired son - either his head is gonna have to shrink or a cold, smaller child will find herself with an ear warmer. I suspect the latter. See I can actually knit, just randomly. I even knitted the headband in the round on DPNs!! Double Pointed Needles. Are you impressed? It was a complete pain in the ass, but I'm stubborn. I thought about unpicking it, but instead I got it off the needles ASAP. It's not completely finished, but meh, what's a few buttons. I even crocheted the flower thingy, with the last of the wool. Oy veh. I am NOT dedicated to knitting. Can you tell?

I caught up with a long-lost sister on Sunday (well, not quite lost, but you know...). She is doing well at this end of a very stressful and difficult year, and is enthralled with her new puppy, a pedigree Shi-tszu with a very long name, Poppy for short. Very cute. Sooooooooo cute. Did I mention that she is cute? No photo, sorry, but she is cream, gold and sable saddled with symmetrical markings. She matches the long-haired Burmese cat. And the furnishings. Deliberately. She is just what my sister needed, and I am so pleased to see her looking content.

We saw a movie 'Burn After Reading' on the weekend too. It was really good, hilarious and wicked. Are people really as completely and relentlessly unfaithful to their spouses as depicted in the movies? Or just in Washington? I know, I know, its just a movie, but it did strike me as weird. There was only one sympathetic character in the film. Brad Pitt was so funny as a bonehead gym worker. Frances McDormand was brave and wonderful in her role. George Clooney was as adorable, but despicable as the sex-obsessed public servant. John Malkovich played the uptight, pernickety husband to perfection and Tilda Swinton was revoltingly good and believable as the cold wife of Malkovich's character. Recommended if you like quirky, off the wall plots.

Work has been good too, absorbing and challenging. My baby drought has continued, I haven't caught a baby myself for about 5-6 weeks. I cared for 2 families with stillborns last weekend, they were so sweet and tiny, their parents were devastated to see the end of their hopes for those children. The memories we make for them to keep are so important, and I'm always delighted to work with midwives with great photography skills, or presentation skills who will help create worthy records and mementos of that short precious time with the baby. Parents are always so touched to receive the gifts of quilts, clothes, teddies etc that are provided for their little ones, often by families who experienced such a loss themselves and in memory of their own baby. Grandparents who provided teeny little teddy bears 4" high can keep a photo of their grandchild's perfect little hand on teddy's tummy, just the right size for a tiny 23 weeker. Its a privilege to care for them.

I'm starting to make plans for next year at work. I'm talking to my manager about rotations to a birth centre on-site, that provides care across the continuum for low-risk women in a team or group practice model. They work shifts and regular on-call, do their own education sessions, and provide short-term postnatal care on-site (<24hrs) and do their own visiting home postnatal care. I am looking forward to seeing more spontaneously labouring women. Fingers crossed for my rotations!

Last thing! I went to craft today with all my old friends. They are all besotted with my Wild Women (what's not to like?) and want me to lead a class in making them, so I will find a date in early December for that. We made some silk 'paper' with silk 'topping' and added threads. I'm quite pleased with it. It should be a cover for a new small journal, or maybe something else. As I said at craft this morning - I may use it straight away, or I may find it again when I am 72 and I hope I remember the day when I made it and the company of such dear friends. And the friends I shared it with online.

Right! Consider yourselves caught up!

Thursday, October 23, 2008

Temporary absence

Can't blog.

Am still reading blogs x 103. (updated 105, hello William Horner)

Lots of work.

Child 'round neck constantly.

Re-reading Harry Potter 7 (still sooking about it 4 reads later). Updated -Finished AGAIN

House is a (garbage) tip. (updated - get real, still a tip)

Must. Do. Tax. (updated - Done! for two!)


Thursday, October 16, 2008

What do I know?

What do I know now that I didn't know this time last week? (Will I love this question?)

Well, I know that keeping labour normal is not always a job for which one will receive thanks. Not that I expect any in particular. But in the case I'm thinking of, should I have done so?

The unit was crazy, like....Crazy! There had been 10 inductions started the night before and they were all coming home to roost, so to speak.

I had already seen the couple I had been caring for the previous evening (one of the inductions), who had just had their baby at lunchtime, an hour or so before I started. He was a whopper! 9lbs 14oz (4.485kg - the same as my son!) it was a pretty yukky birth in the end (he had a REALLY big head!) and she was being stitched up pretty extensively. I spent an hour or so in their room, cleaning up the chaos post-birth, and organising some solid pain relief for her immediately and planning the next few days worth of it too! There was pressure to get her up to the ward quickly as labouring women were piling up in the corridors and there was a room crisis.

So I was removed from the first couple (their morning midwife took them up to the ward) while I was allocated to another room - their third midwife of the day in all the shuffling around. There was a young woman of 25, labouring spontaneously, hot and heavy. Just holding it together with the use of gas. Oh, and she'd had a shot of morphine too. The husband was in and out of the room, and was clearly quite anxious and unsure of his role. She was attended by her Mum and sister, who were in a great rythm with her, and she sought them as each wave came. She was really focused, eyes open and intense with each contraction, membranes intact. Just how we midwives would expect it to be. Woo-hoo I thought, another spontaneously labouring primip! I know normal birth! I can keep birth normal! I can do this!

I introduced myself softly between contractions, watching quietly as the labour continued thick and fast. Checked the room quietly, gathered a few things ready to meet a baby in the next hour or so. She was so in the zone, sitting cross-legged on the bed. I was just in awe, in fact at one point I was moved to tears by her beauty and strength, she was that amazing. I almost never cry at births, and this is certainly the first time I had cried watching someone labour! Her mother and sister were a little surprised, but I decided to be unashamed about my damp face and silently pointed to her and gave a pat of my heart, acknowledging her effect upon me. They whispered to me "are you always like this?" to which I shook my head- but she is that good.

Every now and then she would rouse and speak, I took her BP every 2 hours, someone came and took the CTG machine (we weren't using it, I could use the Doppler). At one point she asked for an epidural, and her Mum asked her to wait another half-hour, which she agreed to. She sailed through that and on and didn't ask too hard again. Her husband was worried, will she be strong enough to push the baby out after all this pain now? I can't stand seeing her in pain like this. I told him that women were so much tougher than they looked, that's the way God made 'em and that his wife was an absolute Goddess and doing it all superbly.

The madness outside was not getting much better. I was asked to 'prang her' (i.e. rupture the membranes) and get her going and out of there! Well, no! I decided. She was in spontaneous labour, the cervix was dilating steadily (I was watching the line), the waters were intact and she was only just coping with the pattern of contractions now, without bringing them harder and faster, not to mention the effects on the baby - who may need those waters to help him turn to a good position for birth. There was no indication that an ARM was necessary. I regretted performing a belated ARM on staff request on a 34 weeker a few weeks ago who shot into a less than favourable position and ended up being born abdominally via CS. I was not keen to go back there again. I felt I would make the decision for the preservation of normal. So I ignored the request.

The woman refused to reposition, or get up for a wee. When she asked again for an epidural I offered to examine her and see if she was near the finishing line and that may help her decide if she wanted one or not, if the birth was going to be soon. After a wait of a few really intense contractions, she was 7cm dilated. There was a brief discussion of pros and cons of epidural, and I stated that of course she could have one if she wanted one, but that it would be a shame to turn a normal labour into an abnormal one - with a monitor and bells and whistles etc. She was doing so well. The contractions were so powerful, she was so focused .... she lost herself in the next one and kinda never brought the subject up again for a while.

I went for a meal break, ex-HB midwife relieved me and persuaded her up for a wee. Hooray! I was expecting her to report feeling pushy any time. She did report rectal pressure with the peak, but not overwhelming. There was a bunch of mucous - a good sign. It was all really intense, but 7pm came and no baby.

Back to sitting on the loo, listening in to the fetal heart regularly, noticing that the rate is always in a similar range - definitely fetal, but not widely varying, during or after a contraction. I encouraged her to drink fluids, which she did. She was getting really exhausted and desperate and whiny (its typical transitional behaviour) and I was pretty sure she was fully or close to. She agreed to be examined - I thought it was 8-9cm dilated, but there was a pulsating bit off to one side that i was sure was a front fontanelle, and a gap at the left back - bugger! She nearly hit the roof during the exam, which I apologised for, but it was important that I rule out the pulsation as NOT being due to a cord presentation. She stayed on her back, gasping as the next contraction hit, and just lay there. It was horrible to watch. I did that to her. She was coping before and now, for this one, she wasn't. When it passed I helped her immediately to a sitting position and reminded her that she was comfortable in this spot and she would be again, lets regain that working formula.

At this point I had some decisions to make. I felt that with a deflexed or neutral positioned head, even with membranes still intact, it may be a bit longer yet until she was ready to push this baby out. As I had tried to tuck the baby's head down to chin on chest, it had almost risen away from me - yet on abdo palp it felt well down, although in the pelvis it was barely at spines. Her blood pressure had also crept up, not startling, but a sign of prolonged pain/stress. The fetal heart rate variability told me that the baby was either asleep or starting to get stressed. I was getting concerned about her and felt that with all these factors I should have her reviewed. I had kept her normal, but I also recognised that this was deviating from the norm and starting to add up to needing a second opinion. The first step before any further assessment would be possible was to get her out of pain, so as not to cause her trauma.

I apologised again for the stressful VE. Then I suggested she have an epidural, as although she was progressing well, I felt it may be a while yet due to the baby's position and she may need break from pain before the effort of pushing (funny how we can couch the same words as the husband in our favour when we have to, eh?). She readily agreed. Gratefully agreed. Almost kissed my feet agreed!

So then we waited for an anaesthetist. And waited. Finally after 45 minutes (the longest 45 mins in her life I bet) a consultant comes in from home. He is fast and good, considering we don't even have IV access yet. I had everything assembled, the machine, the epidural stuff, the IV stuff. It is in quite quickly, just in time for the night shift staff member to come on. I was attaching the trace as she entered, doing BPs, the woman was smiling, hubby smiling, the intensity was all altered. We were saying that we had waited for a while to meet this baby and the night midwife was going to catch him instead of me - yet I would have bet good money that I would see this baby before the end of my shift! Oh well.

And then we saw the trace. Gulp. It was pretty awful. Late dips all over, pretty crappy variability. Still contracting frequently but oh my, that baby was not coping well. It was the first time we had put a trace on him - there was no reason to - this woman was normal, low risk, and now look at it! The night shift midwife scooted me out the door as I had a morning shift the next day. She is a very capable new midwife with ICU experience, and loves a challenge. So I went home.

I slept really badly. I woke up at midnight and couldn't get back to sleep until 2-ish, and then only fitfully. My alarm was going off at 6, and so when I woke up and started tossing again at 5.30 I gave up and got up.

I dragged my yawning butt into work, where I found out that the baby was born by vacuum extraction at 1.26am, and needed a bit of resus with Apgars of 4 and 9. They had ruptured membranes not long after I left (when she was comfy and in no pain) and there was thickish meconium. Followed by fetal blood samples every hour or so, which weren't too dire, so she was allowed to push for a while before they dragged that 4kg baby out of her when the trace got too terrible to watch any more. Baby was sent to nursery for a while due to respiratory distress. I saw them briefly the next day, still with the whole entourage in tow, and trying to breast feed the baby with 6 people in the room. Sigh - what are their chances of establishing that?

So, in terms of normal childbirth, what did I preserve? Was I all misty eyed about my ideals for her birth? Everything I did was on her birth plan. Should I have said YES, Certainly! when she first asked for an epidural? Which wasn't on her birth plan, and of course she can change her mind, although could she have known that she would cope so beautifully that her midwife would see such beauty and cry, for fuck's sake? Was I so busy singing Kumbayah and reassuring the husband that 'this is all normal' that I ignored danger signs? Was it that dangerous? If I had blindly followed orders and 'pranged her' at 3.45pm and given her an epidural at that time would the mec have been picked up earlier? Was it there then? Did she actually care about having a normal birth? Or does her idea of a normal birth include an epidural? Cos it technically isn't...and introduces all sorts of interventions that can start the cascade of interventions that lead to CS ...oh for God KNOW all this!

I'm a bit frustrated and bewildered. Is this a win some/lose some situation? Cos if it is, I could have just saved her all the trouble and pain and got her an epidural 5 hours earlier - even though it would have meant finding a spare CTG machine in a full LBS with all the women on all the monitors already...sigh. Has anyone been done a favour here? Answers on a postcard please.

In other news - something else I know now, that I didn't know last week, is how to suture perineums. I did a workshop yesterday. It was fun! Yes, really. I can now be Really Useful. I took to those knots like a duck to water. It was fun having a trial run on a piece of mutton. It took a while, but I think I am willing to do it under supervision this weekend when I am working 5 shifts in a stretch. (We then had to undo all the stitches so the demonstrator could take it home for her dog! )

Be good.

Thursday, October 9, 2008

Second stage

Hello again world.

I had 2 lovely shifts with a student midwife earlier this week. Yes, really, and no drama was attracted! It was such a wonderful change (for us both). We were both just delighted with our birth together on Monday.

We entered for an afternoon shift to an 18 year old primip who had just achieved full dilation about 30-ish minutes ago. Her morning midwife was gentle and very low-key and non-interventionist, and has recently returned to the hospital after a long stint working with homebirths, so I knew she had really good assessment skills and faith in the natural process. It was a spontaneous labour and the room was calm, and the only attachments were the CTG because the woman had opted for an epidural. She was standing at the foot of the bed as we entered and the bed was arranged as a big low armchair for her to sit upright in if she wanted to. It was good to see it like that, I had forgotten that it could be put in that arrangement.

We were waiting for the contractions to do the work of inching the baby closer to the exit for the next hour before starting any active pushing. So we just encouraged her to stay upright and rest as she was comfortable with her epidural and quite mobile as well. Its a good combination when you can get it. She had her Mum and a sister-in-law with her, her partner was quite squeamish and was waiting outside by mutual consent. This was women's work.

After a while it was time to start having a push. It often takes a long time to get the hang of pushing a baby out, especially in a woman with an epidural. They don't get the same sensations of the baby within that an undrugged woman does, nor do they get the expulsive reflex that is just irresistible and almost pleasurable. The midwife uses words to guide her pushing efforts, or gives feedback as she can see the progress (or lack of it) of the push. It is a tricky process. I usually start by describing what I'm looking for - a flowering open of all the bits that are usually tucked up, as they expand in the way Nature designed. I will see an expansion of the perineal area, a parting of the labia, a pouting of the bottom, a tiny bit of stool pushed out in advance of a descending head - these are the signs we look for that tell us descent is happening. Most women are (understandably) reluctant to think of the appearance of poop as a 'good thing' but we midwives are very encouraged by it.

At 1.45 she started pushing. Her contractions were quite short, and it was difficult to get much momentum going with the pushes as they would die away just as she got to full push power. There was nothing visible after half an hour of pushing. One of the docs came in and suggested a bit of synto to help strengthen and lengthen the contractions, as she was well covered by the epidural and it shouldn't distress her. So we all agreed on that, and stopped pushing for 45 minutes to let them build up and for more descent. She walked to the toilet, remained upright, and saved her energy while we went to tea.

At 3pm we started again. The woman was really mobile and I was confident that she could position quite freely to assist descent. The baby wasn't huge, but the other midwife felt the head was sitting a little tilted off to one side instead of presenting the central back of her head to the exit. I hadn't examined her at all, but trusted the assessment, and the slow progress with pushing backed it up. The answer in this situation is positioning. Keep moving. Have three contractions in that position - if no progress - CHANGE something. Free mobility is really so useful in second stage - e.g. walking up stairs, crawling up or down stairs, lunging or clambering like a bear up on the bed or over a chair can shift the angles of the head in relation to the pelvis and provide that 'give' that gets things moving. So in this case, with a young fit, mobile young woman I was determined to give it a go, and keep birth normal!

I can't do it, its not working she cried. Nonsense - it just hasn't worked yet sweetie. You're doing so well, you're really actively giving birth here, not having it taken from you. Pull it out, suck it out! she moaned. No, we may need to ask for a hand in a while, but first we need to know you have tried everything! Leave no stone unturned for you to give birth unassisted and push this baby out on your own. She agreed that was worth doing.

By this time I had her standing on one leg with her other leg kneeling up on the bed at near right angles. I was kneeling behind her, gently stroking the base of her spine and hips, encouraging her to rock in wide circles while I spoke soothingly to her, encouraging her to sway her pelvis to shake that baby loose. She was in a bit of a trance. With each push she would strain, and then hold back as she sensed something shift. She didn't want to poop or fart. I told her quite plainly that I would cheer if she farted in my face! It would mean something was moving. We all had a laugh and with the next contraction a teeny bit of poop came out - hooray we were on the move!

The morning midwife was due off shift, but was keen to see a bit of this baby's head. Alas that bit of poop was all we could manage for the next 15 minutes. She went off after giving a top-up of the epidural as the woman was feeling the contractions again and we felt the relaxation of less pain for her would help us all out if it was going to be a long process, and frankly, with such slow progress it was likely she would end up with an assisted birth. She left at 3.35pm.

A bit more poop. Change position. Back onto the bed to push sitting back a bit, on the side now. More poop. Finally we had some labial parting, but then she would hold back when it moved forward - it does feel a bit freaky, but I remind women that if it feels scary you're doing it right! I encouraged her to feel inside and tell me what she could feel. She was reluctant, but I could do it if I wanted to. There was a little head about an inch inside. Swollen on top but finally close to the world. With the next contraction she had a go and felt it too. Eee-ew! she said and wiped her finger- but her eyes lit up a bit - it was real. There really was a baby coming! It was 3.45pm.

The contractions were still quite short, but I would get her to do 'one more push for luck' as it was easing off, which unless I asked for it she would try and get away without doing it. 18 year-olds are so cheeky! It became a running joke. At 3.47 there was enough labial parting to get a peek of the head with pushes. Head on view. At last. The trace never looks good with pushing especially at this late stage. It is physiologically normal for the heartrate to reduce with the contraction and expulsive effort, and to recover between contractions as the squeeze is off, but it is watched nervously nonetheless and with central monitoring there are often many people watching. This means that there will frequently be someone at the door asking if things are alright, or actually entering the room and tempted to intervene if they don't quite trust that things are well or moving fast enough.

That little head stayed elusively away from the exit. She just wouldn't crown. I started to mentally prepare for a shoulder dystocia (as is often preceded by slow descent) and quietly communicated this to the student, planning which side we would apply suprapubic pressure from and getting the bed controller at the ready for fast maneuvring in case of emergency.

I heard the door open as she was pushing again. I spoke more loudly than I usually do and said "good girl, yes, thats much more head than we've seen so far, ooh look at that hair! Good pushing, nearly there" as the feet at the curtain identified themselves as the consultant. A quick peep around the curtain to glimpse the vertex for himself and he melted away again with encouraging noises. It was 4pm.

With the next contraction there was a little more head to see, but still not too much. I examined her to see if there was a band of tight tissue, considering an episiotomy, and feeling only a smallish band of the hymenal ring, but a lot of moulding of the head and it was still a bit tilted. It was a tightish fit (what you would expect really) but I could slide my finger all around the head and couldn't feel a hand as well or anything, so we would just wait. Maybe consider legs pulled right back, and recline back a bit more. Ah there we go, thats the best we've seen, we are nearly crowning now. The shortish contractions inched along but came frequently enough. The woman was getting desperate despite our encouragement - can't you suck it out? No honey - its honestly not worth opening the sterile packs - baby is right there. Don't give up, she'll be here any minute. She could shoot out like a pea with the next contraction. It was 4.15.

I heard the sound of the vacuum trolley being wheeled outside the door. At 4.17 the door opened again. It was the young female doctor who started the synto. Ah very clever, she cried as she could see the almost crowning head. Our eyes met and we were thinking the same thing. She came in for backup- we both prepared for a shoulder dystocia by dropping the head of the bed, with legs pulled back. Finally the head crowned, followed slowly by the face and then the chin. We waited for a turtle sign, where the chin pulls back into the vagina as the shoulders hook up on the pelvis. No turtle sign, feel around for a cord at the neck, no, no cord, ready student? Its all yours, OK hon one last push now - here she comes! It was 4.20pm and cheers erupted in the room, the young Mum was sobbing with relief and joy, her Mum was misting up and SIL too, and she came forward to cut the cord. Little Aliyah was a bit stunned but soon had a brief yell and then lay frowning and blinking on her mother's chest in the afternoon light as she was cuddled and wiped.

What an effort! A three hour fifty minute second stage. Admittedly with an hour and a bit for descent initially, followed by another 45 minute rest, but it was still pretty prolonged for a hospital birth and she still managed to push her baby out. We were all absolutely rapt. I felt like a Midwife! It was rare to get the space to conduct such an active second stage, with minimal intervention from docs or others, and the woman herself was just terrific. She tried so hard, and pushed so hard, and cooperated, and hung in there despite collywobbles at times. It was such a group effort. We were all just thrilled to bits. And an intact perineum with minimal blood loss. Baby number ten for the student midwife, who was just tickled pink. She too felt we had dodged a bullet, no assisted delivery, a truly active second stage even with the epidural. She said she learned so much about positioning, and moulding and understanding the principles of descent and pushing with an asynclitic presentation (the tilted head). It was just great.

Dad came in within minutes and was suitably delighted and misty to meet his daughter. Baby Aliyah saddled up for a feed promptly, and boy could she suck! What a talent. Her mother had great nipple shape too so it was easy to put it all together with minimal assistance from us. We couldn't praise them enough.

I saw them again the next day and they were doing just great, all smiles, very comfortable and pleased with themselves. What a lovely start for this little family. I'm so pleased for them.

The morning midwife saw me the next day and was skipping that we had achieved a spontaneous birth. I was still grinning too! I swear I must have had the Jedi mind control that day - to talk soothingly to all the docs and others, reassuring them and having them melt away while we had that head on view for so long. It was fascinating, and I suppose that they must have had confidence in me to call them if we needed help. I was completely fine with the backup of the doc at the last minute, in cases of shoulder dystocia you don't want to muck around, but the student midwife got the catch after all her hard work that afternoon. It was win-win.

Our next shift together was also terrific, a lovely woman and her husband and Mum, where she had had a shoulder dystocia with her previous birth, so it was certainly the flavour of the week! She laboured really intensely with us all shift, and we were sure we would get to see her little one, but she went on to birth an hour or so after the end of our shift. The birth was straightforward with no emergency, so we were pleased to hear that even though we didn't get to see her baby.

Achieving that birth on Monday has boosted my confidence in my 'normal birthing' skills, that are easy to lose in a tertiary hospital environment. I do recognise normal. I can model the normal to my student midwife. I can keep birth normal. I can recognise if things deviate from normal and am trained to respond appropriately, but all the time I am shaping my care and responding to the needs of the woman at the centre. It is good to have this experience after a few weeks of turmoil and drama (which is still playing out).

I love being a midwife.

Thursday, October 2, 2008

And the winner is...

Wow- 14 comments!

I don't think I've ever cracked 10 comments before so I'm delighted to hear from you all and accept your good wishes as I enter my second year as a blogger. Technically there are 14 people subscribed to my feed through bloglines, but one of those is me, so I suppose a giveaway enticed a few people to de-lurk from random blog-visit world too. Welcome!

The winner is Suzy of the blog Identity Crisis, which I find very moving. She is one brave woman. I'm so pleased she has a gift coming her way. Suzy - Please reply to the email when you're up to it.

So, what have I been up to? Not much washing I can assure you as our only 7 year old washing machine has spat the dummy and stopped spinning. Its little electrics had it convinced it had an open lid, and nothing on God's earth would persuade it otherwise. I'm a busy woman with limited time in which to wash clothes, and I need the machine to be reliable and do its job. Not wuss around saying, wait, I'll finish it soon, really, even though it isn't rinsed, or spun, or even washed thoroughly. I've got teenagers for that.

So it was off to the big electrical retailer to buy an energy efficient, watersmart, rebate attracting new washer. Which of course they didn't have in stock. And wouldn't be getting until November (my clothes are dirty, like, NOW). No, sorry, the next model up isn't in stock either, same delivery date, and besides it may not fit through the space we need it to. Yes, maybe you can buy the one from the showroom floor for immediate delivery. Lets do that. All signed up, we'll follow you home - oh wait! The warehouse man has said he can give you one set aside for someone else who doesn't expect delivery until November, so we can allocate/substitute theirs in November and you can have that one NOW.

So here I am awaiting the delivery and installation of my new washing machine. Ooh! There's the doorbell, BRB.

Woo-hoo! Its here, all installed and they took the old one away too. Phew. I have read the instruction manual and crossed out all the pages that don't refer to OUR model to save swearing and frustration (See Widget, I'm systematic about some things). Said intruction manual will be displayed in a waterproof sleeve near the enw machine while all and sundry try it out. Then I will secretly set it to the usual settings I like and simplify it. It is a very clever machine, if such things can be asigned an IQ. But I can't use it until I go buy some special detergent for high-efficiency Nobel Prize candidate machines. Sigh. I'll let you know how it goes.

SO much to tell you. New wall photos? Here ya go. Nice huh? Long view. Here's the metally-y thingy I had to have on the end wall. As you can see its a 'room divider'. This is the view from the back door.It should look OK soon - where's the home improvement makeover teams who achieve wonders in 48 hours? Not in my back yard, sad to say.

Work? Very interesting too. Had a vague day on return to work on Monday, went for a booked CS with a woman, helped out a bit on return to LBS, flitted about, completely forgot what I was meant to be doing for an hour or so and kept myself busy doing something entirely different. Then remembered with a gasp (new woman in Room 3!) and reappeared in the room to the bemusement of the woman (how embarassing). Was thrown a bit by being invited in for a chat with a clinical midwife consultant about JJ, for a debrief and to clarify why JJ's Mum was so upset after my visit when she read the card with my honest words about having a different journey ahead of them. What do you mean I have a special needs child? was her question. Hmm, I thought I had been really clear with them, we had discussed it specifically in relation to his walking and talking and how it may be different for him and they would deal with it when they got to it. They have apparently not liked being at the new hospital, and don't like to see social workers or a particular senior doctor because he 'tells them bad news'. So I guess my card falls into that category too. I just feel sad for them. I can see where they are at. Its not a good place. Maybe in time to come they will look back and realise that I was the first to address the truth with them. Even before he was born I was talking about the reality of 'what if he's not healthy?'. Then again in time I, too, may be blanked out or shot as the messenger of a truth they didn't want to hear. It doesn't change the truth. I'm still really sad for them, but I won't approach them again. Poor family.

The next two shifts were better, with labouring women. Baby Rhys was born at 2043 on Tuesday night after a fraught last hour or so (looking at the trace, which was crappy because he had had morphine, but flap was raised nonetheless) where mum pushed him out in 8 pushes with the threat of fetal scalp sampling hanging over her head! Luckily she had achieved full dilation at shortly before, after some slow-ish progress and the docs backed off and let the resident doctor and I get the birth. Which turned out to be quite nice really if a bit beetle-y (lying on her back and pushing like mad, sigh). She was delighted not to need stitches after her first birth, and he was a quite, quite yummy baby.

Little baby Teresa entered the world early(34+ weeks) yesterday at 1406 to her young Mum, 16, after a steady labour that would not be denied. After opting for an epidural it didn't work very well so the woman was really struggling with no sleep and continuing pain with each contraction. Finally the anaesthetist adjusted it and gave some super-duper extra drugs that were really effective so she was really comfy but limited with mobility. I kept the lights down low, the mood light and the membranes intact despite pressure from outside. We all thought she would push this pipsqueak baby out easily, membranes were intact and everything, but the trace looked dodgy (gee do you think the machines could be fallible, or maybe we don't know everything about the normal range!) so the waters were broken an hour after full dilation to aid descent of the head into the pelvis. The head was still at spines, facing upwards with head tilted back, I could feel the anterior fontanelle. Deflexed OP. No pushing or anything, just awaiting rotataion and descent with contractions. Except it didn't. I positioned her to maximise descent, as she couldn't move well for herself. She wanted to sleep now that she was free from pain. So I left her to have a nap. After 2 hours we started her pushing and then the trace looked really crap and I called in the docs. Bugger.

Suddenly we were upstairs with a trial of intrumental birth. Which didn't work after a heroic effort and three pulls where she didn't budge, even with episiotomy. So they converted to CS. DAMN! We were all really disappointed, including the doctors. They were really upset. If there was anyone who needed a cut fanny AND a CS wound like a hole in the head it was a 16 year old girl!

I staggered back downstairs after taking Teresa to the SCN (she was fine, quite serene really and very pretty, but had a sore head, was breathing up a bit and needed some time to finish cooking) and wandered off home, after having a bitter laugh with the coordinator about my 'ability' to keep a birth normal and get a 34 weeker out without a drama. You win some, you lose some. The young woman herself was pretty unfazed by it all really, just delighted to see her little girl who she kissed and nuzzled on the table with joy. Her Mum was with her (she had had 3xCS) and she too was unfazed, and glad to have made the birth after flying down from 1200km away and arriving as we started pushing!

Its makes me wonder about the expectations of child-bearing women, that she could accept all that intervention and still be smiling and just be keen to have a sleep! Maybe if you don't overthink it you can just take it in your stride. It's when one agonises over the meaning in all such things that the potential for disappointment and bad experiences peak. I wonder how she'll feel when approaching her next birth.

And finally, because I do so love making them, another two Wild Women . These are for my best friend and one of my sisters who requested a blue one for her birthday (woo-hoo - pressies ready in advance!). This is Nancy. Fancy Nancy. With cute shoes and a handbag. And a heart on wings. Seems like a good concept to uphold.
And this is Sister. I adore her face. She catches fish. And leaves. And houses. And has wild hair.
So, enough of me, tell me about you...