Saturday, December 27, 2008

Down time

Well, the big day is all over for another year. I enjoyed mine - did you?

I worked until 7.30ish am and then was picked up and taken straight to my sister's place for breakfast. I had got changed at work into a sensational little black dress with pink sequins, nothing gaudy - just a modest sprinkling suitable for breakfast wear (;p) and I found my second wind after a long night shift.

I had had 5 women and 3 babies - all of whom were a bit antsy. Two were scrawny hungry babies (2.1kg, and 2.9kg), one was already on medically indicated formula top-ups, and the other was on pure breastfeeds, so the littlest one slept well in her room with Mum and the middle sized one sucked for hours before coming out for cuddles and a bath to relax her. She was so sweet in the bath, yelling at first and quite cranky, then suddenly after a minute or so in a deep and warm bath she flopped into a sleep, her head resting sideways in my hand, lower ear in the water, her body cradled on my wrist and forearm, legs stretched out. A different baby with no fight in her. I hardly ever get to bath babies alone, but I do like it. I humm and croon to them that they are safe and its ok to relax and sleep, and then I swaddle them up safe and snug in warm clothes and wraps and rock and pat them off to sleep. This little one, Amelia, ended up sleeping for another 2 hours, Handel's Messiah in the background, waking at dawn to greet her Mum with a hungry breakfast call.

Santa came to the ward too! Just after midnight - with pressies for the midwives and a choccy or two. There were Xmas presents for all the mothers too, gift bags from the Body Shop -( I don't know if they were a sponsored thing or if the hospital purchased them) but it was a lovely treat - specially for many of our Mums who would never have the luxury of Body Shop stuff.

For most mothers our attempted gift was a bit of sleep, even an hour or two. My third baby was a big 4kg fella, with a tongue tie - which means he can't attach properly at the breast. He didn't even seem interested. He would just bite, and couldn't get his tongue under the nipple or finger to suck properly. This will spell disaster for the state of Mum's nipples. His Mum had laboured all the previous night (I had been on LBS the night before so remember his birth occurring near dawn) and he hadn't fed well all day. I assisted his Mum to express by hand - not a huge volume but we did it regularly and put it down his neck with a finger feed, so he was fed and Mum could go straight back to sleep. It will be a difficult few days for them, waiting for her supply to kick in. He sounded a bit mucousy too, so probably needed a chuck before he properly will attack a feed. In the meantime we kept the room quiet, and him fed as well as we could for now. I imagine there will be a BF plan for her quick smart, but the priority that night was to sleep.

Breakfast was yummy, unfortunately my camera was at the bottom of my bag and the screen has been damaged (aaargh) which will need to be fixed. I did take a few pics, but will need to be very tricky to get them off the camera, although the card should be OK....hmm. I hit the wall about 9.15am, so we opened some pressies - including some incorrectly labeled ones - oops- and scarpered home.

Back to our place and open presents again with our family - Santa was goooooooood!!! (photos to follow). The kids (nearly 20 and 23) each got a camera (thumbs up for power shopping) plus assorted other welcome delights. I got a beautiful surprise necklace of semi-precious stones and pearls - just gorgeous! And a book, gorgeous craft supplies, Body Shop White Musk yummies, chocolates, a quilt calendar and a Lighthouse diary (Yay, thanks Lesley!!) plus assorted other delights. Very lucky.

Then off to bed for me until 4pm, while hubby and kids joined his side of the family for lunch, then wake up to prepare for my side coming to ours for dinner. We had a BBQ (Reef and Beef) - very easy with desserts prepared by Steff - a divine sticky date pudding with butterscotch sauce, plus a Tiramisu. Charades, lots of merriment and a growing (up) tribe of teenagers running amok and clicking away on their collective cameras as they posed all over the house. They had a ball. Everyone left around 10pm, whereupon we fell into bed.

A quieter day yesterday, just attending a BBQ at a friend's house with many other choristers from our choir days. Singing was enjoyed in the backyard, along with much catching up on news, then home again and watched a movie on telly.

Cricket and a slow start, with jam-making all morning to use our lovely Santa Rosa plums and a few stray cherries. I now have MANY jars of jam. Along with a savoury apricot sauce from the last of the apricot crop.

Its summer....down time.....bring it on!

Friday, December 19, 2008

Baby talk.

One of the downfalls of night duty is inconsolable babies.

They are inconsolable because their mothers are shattered by hours or days of labour. Their mothers are sucked out husks, facing their second or third night without sleep, with tender inexperienced nipples. They are stroppy babies who haven't read the books on normal physiological lacation processes and therefore are really keen for some stomach filling, like, NOW. They suck and suck, and don't feel right unless they are sucking, but until the milk comes in they are not getting full bellies and therefore are driven to keep sucking. They are dry, pass almost no urine, and run a bit warm as is normal in slight dehydration - all normal for babies of around 48 hours of age. And their mothers are so tired they keep falling asleep and are worried they will drop the baby. And their nipples are tender. And they are often a bit sore, or have mobile phones going at all hours of the day and night!

The woman who has a CS is marooned in bed for those first 12 hours or so, unable to lift the baby in or out by herself, with catheters, drips and epidurals to contend with. The CS may have been planned or an emergency, so the woman is often utterly exhausted after an induction of labour, which has not been successful i.e. the door (cervix) did not open so the baby couldn't be born. It is a lot to take in.

The night midwife is a big part of the adjustment process to new parenting, especially for the woman who has had a caesarean. There is an enormous amount of physical care, including monitoring blood loss and fluid balance, full assistance with breastfeeding, teaching as you go, as well as the emotional care of a woman who is adjusting to the first hours of mothering in a (mostly) unexpected way.

These last 3 shifts I have cared for a number of primips (first timers) some with unexpected CS. One had had many miscarriages and was very unsure of every sound the baby made, every whimper in his sleep, how many sucks it took to constitute a breastfeed - she was a bit incredulous that it needed at least 10-15 mins of a consistent sucking pattern to be called a good feed on day 1 of life. She had read all the books, imagined how her first breastfed would be, and planned every aspect of her skin to skin contact with this baby...following a vaginal birth... but had not made a contingency plan for any other outcome. Luckily her baby seemed to have a pretty good idea that the principles were the same - get a good position, line it up, shape the breast/areola and get a good deep mouthful with the tongue under the breast. And suck away! Bliss! He'd read the books too! Mum had so many questions, needed so much reassurance of normality, and rang the bell every 20 minutes! For her water jug to be filled up (it still had 1/3rd left). Give me strength.

I had had similar nights for the last 2 nights, with the woman in the next room sitting on the bell for every mortal thing. Wrap my baby, burp my baby, pour me a drink. Sure sweetie, I'll be right back. (staggers off, gnashing teeth, wondering how the other 6 women in my care are doing as I wear a path to her door). Some nights are just like that.

Last night I had 6 women and 4 babies, three of whom were inconsolable at regular intervals for long periods. They were all really sucky babes, waiting for their Mums' milk to come in.

The other midwives are as helpful as they can be. Any spare pair of hands is cuddling a fractious baby to give Mum a break for an hour's sleep if we can hold baby off for that long. Last night I had a scrawny little chap who could suck for Australia, miserable without a boobie in his mouth, who nearly sucked the meat off the bones of each of my (clean) little fingers in turn. I only managed to get 70 minutes sleep for his young mum, who was knackered, but her breasts were filling well and I think he'll be very satisfied with the offering today!!!

One baby was really loud. I mean REALLY LOUD. I had seen another midwife with her the previous night, squawking the place down as she was bathed to try and calm her. She wanted a burger, with fries and a milkshake and she wanted it NOW NOW NOW. No chance. I tried to talk soothingly to her, I tried joking with her - she was NOT amused, and I was glad i didn't have her in my tribe that night. Oops - guess who I got last night? Her Mum was really patient with her, and fed her well and readily, but was dropping off the perch with exhaustion. There was a small volume of formula in the room when I started the shift, warming, ready to be finger fed (a method of sucking the formula through a straw like device that feeds in next to the pad of a finger in the baby's mouth). We really try hard not to offer formula, and NEVER mention the possibility of using it to mums. However it seemed mum had asked for a top-up in desperation as nothing would console this child other than a continuous boobie fest. The nipples were a bit tender and grazed despite good attachment. We had the talk about breast comes first, second and third. We agreed to try for another hour or so before offering the formula. In the end we offered it just after midnight. Baby scoffed it down, sucking hard. And finally conked out. I tucked the two of them into their beds and turned out the light. In the morning Mum looked like a new woman after a four hour sleep. Baby was just stirring, still no urine but she had pooped, and pooped again as Mum changed her nappy - she was delighted to see it and laughed and laughed! Nothing like a bit of sleep to restore the sense of humour.

Women need the right information to promote and initiate and sustain breastfeeding. Its a difficult phase, those first few days, waiting for the breasts to kick in. I am a passionate breastfeeder, I know alot about it and I am, I believe, a strong advocate for breastfeeding. But I do also believe there is sometimes a place for the use of something else temporarily, especially in the baby who can suck for the national team. Sometimes you see half-assed, can't be bothered semi breastfeeding, where the breast sort of gets the stimulus it needs to kick into gear, but the baby is not encouraged to stay for long feeds, and growth spurts are not factored in. Building of supply is not factored in and 10 minutes a side each 4 hours just won't cut it after three days or so. Some cultures seem to mix and match, offering bottles freely until the milk comes in, and they then establish a long feeding relationship purely breastfed. Some people genuinely don't care if they feed or not, or have always felt it was not likely to be their thing, and that is honestly fine by me. The sky will not fall in. As long as they are sure. But if they want good information on how to do it, just ask me.

In the meantime, my little fingers will be well used!

PS Our friend A has still not been seen the incident, much instability, occasional phonecalls and cancelled plans. Daughter very anxious and worried, send good vibes.

PPS Sister back - Yay! No job offers for her daughter yet, sadly a No from the locals. (Bloody Sydney Dance Company shuffling staff and catapulting others into job queues ahead of talented newly qualified dancer, grumble, grumble)

Tuesday, December 16, 2008

Days whizzing by

Its that time of year where the days DO whizz by.

Last weekend (two weekends ago now) I repaired and enlarged a large shadecloth that we attach to the side of the house - This bit belowIts now 7 m long and 3.6m wide, and attaches to various treees and parts of the fascia boards. I got quotes for some fancy schmancy company to make us one, but it was going to be $4000 and ugly as sin, plus we would have had to take it down in a wind or with rain. No thanks. $60 worth of shadecloth, and two hours later- its great!!! Its less droopy now that it has been tightened up.

The plants love it.
Xmas shopping - at least half done, with ideas for the rest. I did some of last weekend with WIDGET!!!! She is in WA for a holiday visit and we caught up on Saturday. She likes our weather (it has been warm and gorgeous all weekend) and approves of my Power Shopping methods. Step 1- Get idea. Step 2 -Buy it, quickly, while praising the customer service skills of young people who appreciate a decisive customer. Step 3 -Walk out, job done. Works for me!(who is very lucky to now have sufficient income to achieve this method)

Plans for Xmas day - now complete.

Work - I commence nightshift again tonight for three nights, with a further two shifts next week on the 23rd and 24th - which means I finish work Xmas morning at 7.30am. Guess what I will be doing for most of Xmas day? Before we host my family for dinner. Go on, guess.

My sister is back from Melbourne! With her lovely daughter, and we hope they will be staying in Perth! yay, bouncing joy on this one! We hope our niece will get snapped up in an audition soon and get a job (hopefully in Perth) but my sis is likely to stay even if her daughter moves elsewhere for work.

Anyway, must dash - the shower is calling and I clock on in 52 minutes time!

Wednesday, December 10, 2008

A day in the life

So, our girl is back from Melbourne and BUSTING to see HSM3 with her bestie, they've been planning it for months, only there is no reply to the phone messages left on Monday.

As I leave for work on Tuesday I call again, and her Mum answers the phone, sounding shattered. Downplaying any problems. Sorry, A is in the shower, we're only just back from the hospital. WTF?

Turns out she has been cutting herself for the last 6 months. Long back-story, not mine to tell. But we see her regularly and care deeply for her. She went further this time and got a vein. No surgery, but sedation and patching up. She will be OK, but the battle for her tranquility goes on.

We are all absolutely gutted. Our daughter is devastated and very fearful. I call work, and hubby (who knew about the cutting but hadn't told me) and he comes home. We send flowers with a big message of "WE LOVE YOU".

I go to work an hour late. To be sent to an area I have never worked in. With a very sick young woman who has just had a stillbirth, and who doesn't speak much English, and whose family oppose many of the practices we commonly do around stillbirth and creating memories. She is very sick, but after a big sleep wakes up feeling a bit better. Her hubby has spent time with the baby while she was sleeping, and has been supported by us to take photos and have them, even if keeping them private from the family.

She is very emotional to hear that her hubby has seen their baby, but is encouraged to think she could see her baby, even in the middle of the night, and the extended family doesn't have to know. Its important that her needs are met. She asks for her immediately. And wants photos, and holds her, and loves her. The couple drink their sweet little one in, and begin to talk about themselves as mother and father to this baby.

Unleashed from restriction the parents want to see her in their favourite outfits, and photographed with things they will keep as mementoes, an urgency to it all. Shuttling back and forth (to the usual area with all the camera, supplies and equipment) and it takes time to dress her and undress her and make her look peaceful, tidy and beautiful, although she is a very pretty baby. All this in a ward area where deceased babies are rarely seen, passing through public areas with a veiled cot. Its a tricky day.

I end my shift handing over the parents and the baby to a night staff member who is quite unused to providing bereavement work, and a bit daunted about the requirements of it all. But I need to get home to see how my own family is.

They are doing OK. They have spoken to A on the phone, the girls had a good long talk, and our daughter is reassured that her friend will recover and they made plans to see the movie when she is feeling up to it.

When I explained what I had been doing at work all day my husband was a bit freaked out. What - a dead baby? You've been dressing up a dead baby? And they've been holding it? And you've been taking photos? He was a bit on edge after dealing with confronting issues all day, and then told me about having the conversation with A, describing it as a conversation with a living person. And how diagnoses of mental illness are all just labels, and this poor kid didn't need more labels, she needed someone to just love and support her.

I slipped quietly into the house, hugged our girl and was grateful to see her reassured and not teary-eyed as she had been when I left. I was in a bit of a daze after a fairly intense day, but realizing that although work was challenging it had kept my mind off the horror and grief of the news of A's hospitalisation. I went to bed early, choosing not to watch the ridiculousness of Brad Pitt and Angelina Jolie trying to kill each other in the "Smith" movie - it just didn't appeal somehow.

And now I should get off the computer and get myself ready for another day at work.

What will it bring?

Thursday, December 4, 2008

No waaaaay - yes way!

Saw a Dad stretched out snoozing in the ward nursery today - what a sweet sight with his new baby on his chest. I offered to take their picture.

We got you do, and he mentioned his son's full name. With a familiar and pretty unusual surname. I punched lightly him on the arm, and laughed. He looked a bit intimidated, but not for long....

Turns out, the Dad was my first boyfriend at high school. No waay! Yes way! 1974 flashback!

Now featuring baby number seven from wife number three.

Its a small world.

Monday, December 1, 2008

December begins.

(images from Google, - thanks Google,- except for the last one)
If you're reading this you are alive. Yes indeed. More fortunate than nearly 200 people in Mumbai. What a waste of life. A shocking, shocking waste. For no purpose, by brainwashed people who think it is a perfectly valid thing to do to fellow human beings. I hope I never understand that mentality. Clearly their parents, or other influential adults in their lives have severely failed them. I have been to Mumbai, seen and been inside some of the buildings involved, breathed the same air as those mowed down. Senseless, inexpicable stuff. I hope India recovers its spark, its such an incredible place.
It IS December, and its very strange to be home alone. Steff has gone to Melbourne to spend time with my sister and her cousins. Much planning involved. It is our chance for a rest from the High School Musical soundtrack, Hannah Montana, Pokemon and Saturday Disney, cat-obsession and narrow food-choices - and her chance to have a break from us too. She's had a tough year, its been a struggle. Its a good break for all of us. I hear she's having a great time, and has many plans for the week ahead.
My plans for the week involve a list of errands of boring stuff, which I am alternating with creative interesting things that I can do while free to gallivant. You all know what boring stuff looks like so I'll spare you that list...but the gallivanting! Oh the gallivanting!
I have started the painting. What painting? THE painting. We have been looking for a piece of art in a horizontal format to go between the sofa back and the overhead mounted bookshelves. A tricky space dimensionally. Pretty dumb planning on our part I suppose, but it was filled with framed kids art for years and has only recently been calling for an alternative. We have looked for over a year. It is very unusual to enter a gallery and head straight for a particular size, rather than a colour or subject. We then look at everything in that size. We looked. And looked. Without finding anything that we loved, or even liked enough to date (one of the galleries allows home visits, for getting to know you purposes). Exhibition after exhibition, empty-handed, stony-hearted, except with the sneaking suspicion that I/we could have a go at doing something ourselves.
Ages ago we bought a canvas, plus two smaller side canvases to completely fill the space, (to complete the artistic series, doncha know). Finally this weekend I tackled it. On Saturday evening as I was about to dish up dinner (literally) I was seized with the urge to prepare the canvas. While the chips were in the oven I set up at one end of the long outdoor table and primed it in a soft clay/camel brown. I then set up the other end with the tablecloth, cutlery and glassware. We ate outside, trying to ignore the large brown thing at the other end of the table.

On Sunday morning I wandered out and felt daunted by the size and pristine nature of it. Would I divide it up into segments - would I use wavy lines? I didn't want symmetry...what did I want? I grabbed three colours and a rag and literally dabbed and dragged new colour over it to break it up. I stood outside and pottered on it all morning (getting sunburnt I now discover), dragging out assemblage pieces, papers, pens, fabric, texture paste, magazines for collage, scrapbooking supplies. I have cut up pieces of Indian sari I bought in India, , I've penned on quotes I find inspiring and I'm not done yet!

I stopped for a while to go see a movie (In Bruges, a black comedy, with a large amount of foul language in it, but delivered with the most charming Irish accents, and really quite touching and sad. Great performances). When I came home I didn't go back to it. It sat there, I felt a bit self-concious about it to be honest. I still do. Who am I to try and 'do art'? You know, that kind of internal dialogue....but this morning I looked at it again and thought well, I may as well keep going, and if it turns out to be complete shite I have a big enough bin to dispose of it. I have embellished and attached door handles, and I am having fun with it. It needs more texture now, more detail, some framing of elements, more collaged onto it. I'm digging into the stash and tossing round ideas. Maybe a Wild Woman needs to enter a frame? Its been so long since I painted that I have lost confidence in my brush skills (she says, as if she ever had any, but I did do some folk art in the late 90's). But it is building up and coming together.

No pics yet, I hope I feel able to show you when I finish it. But with Steff away and only 3 more days not working til she comes back I feel I should push on. I did discover the value of painting over a crappy bit! Nothing is permanent, it can always be embellished over!

I have started back on the ward now. I had 3 shifts scheduled but went home sick after the second and called off the third due to still being crook. A bit of a dampener to start our weekend alone with me feeling like death...but I improved.

Ward work has been OK so far, but I have been lucky to have 4 antenatal women plus only one postnatal woman and her baby. I seem to remember what to do, and when to do it, and when they are mostly women who have had babies before there is not much to educate them on, except for the circumstances that led them to be admitted. Its a tough deal, to be admitted with very prematurely ruptured membranes for your fifth baby, with kids at home etc. Especially if you're from a rural area and used to being the boss of the show for a large brood. Control = zero. Its very hard for them to adjust, and not fret, while becoming a long-term patient. To be patient when waiting for factors out of their control to kick in, or to be put off as long as possible. Others come and go fairly quickly, 17 years old, 34 weeks pregnant, contracting a bit and having a small post-coital bleed - disappeared after breakfast never to be seen again! Taking control her own way! Or the older mother with a poor history coming in to make sure her diabetes is in control so she doesn't lose another baby at term. A woman having her fifth CS who still receives mountains of flowers! What's her secret? She is clearly valued as a mother, with new nighties and PJs, and visitors bearing freshly cooked food and hand feeding her.

Contrasted with a shy young woman, unattended, with barely a change of clothes, snuggling her baby in with her in bed, whispering responses to my (too many but necessary) questions as she takes in the miracle that she has produced. Trying hard to assimilate this busy big-city place where you have to come, because there are no VBAC births 'allowed' in your area because there are no doctors able to provide care in case you needed another CS. So you arrive with a plastic bag, knowing no-one and wait it out, postponing the shared family joy you crave.

Many stories. Sorry it takes so long to bash them out, but I have limited time with hubby and yesterday was the first day in AGES when I didn't even turn the computer on. It was a temptingly creative day! I should do more of it!