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)


NessH said...

Hi Laura Jane..thank you for the most amusing stories..I love reading your blog with your very amusing, honest truthful stories about birthing, feeding etc..nothing against the midwives I had for both my births but I would have loved to have had u there..keep up the stories..u take me back to 2 very different but amazing experiences in my life..I loved being pregnant and I loved the birthing process even more.
thank you

Natalie said...

Hip-hip hooray for breasts and hungry babies... a winning combination! I wish more people understood and valued the effort and the results... it would change the world!

Lisa L said... so took me back to those days when I worked postpartum and newborn nursery! The baby's mouths like little bird beaks, all hollering for food :) And tired mommies who were so desperate for sleep. And mommies who didn't mind if you supplemented the baby, and mommies who would threaten you with a law suit if you did :) (Aside - we never gave a supplement without permission) I would get off night shift absolutely exhausted. Day shifts were a little easier as there was usually (not always) a relative or friend in the room to help mom out. Esp the c-sections.

infomidwife said...

oh this is all so true, I have watched my daughter and daughters in law over the last four years, and with 3 grandchildren this year this rings all too true!
Happy Festive Season and all the best for 2009.

fiveandtwo said...

I love your midwifery stories, wish you'd been mine when I had my babies, especially the little fellow I lost.
As for A; recovery is a very long term process, and depends a lot on the skill of her psych. professionals (assuming she is receiving this). In her favour though is the love her family and friends have for her.
Christmas cheer to you and your family!