Monday, March 30, 2009

20 years ago

This time twenty years ago I had started contracting after my waters were broken carefully, so no cord slipped through. The doctor was trying to induce me at 41 weeks and 2 days, but the baby was having none of it (below, 38 weeks, with my son, and friends)
I laboured all day, then when assessed at 3 pm-ish was not very dilated, but more effaced. Having had a v-e-r-y long latent phase with my first child I agreed to having some syntocinon put up to get things moving. I had a shower first, put on my favourite pink parrot earrings, then held out my arm for an IV and labour began again. I agreed to intermittent monitoring and refused to get on the bed at all.
Two hours and 16 minutes later...there she was. (above, 8 minutes of age, yes that is a Janet Jackson moment) A daughter, how delightful, a pigeon pair. A bit different (above, aged 6 months) a new experience for us, but our much wanted second child. (below - First day at school aged nearly 7, brother aged 10)
And now she is 20. We are so proud of her (below, taken this morning, aged 20)
Happy birthday darling.

Sunday, March 29, 2009

Granny love

Did I show you the granny square crochet rug I found?
Its a biggish lap size, not quite single bed size. I just love it.

Nearly done

I've been working steadily on Jarryd's quilt this weekend.
It's looking good! It's even got some lighthouses on it!Lesley can have it for quilting soon...(edited - GONE!)

Sunday, March 22, 2009

Asking the question

I've had a very full few days at work. Steadily busy, but not madly so, yet the women I have seen have been so interesting.

I do like meeting women. And men. I s'pose I just like people really.

We've had students through, as is common in any area, but this time I have more actively been seeking them out and keeping them company. I am beginning to feel I could show them stuff, finally, after a few years in the field.

One of my objectives for working in clinics was to gain experience in abdominal palpation. I'm very pleased to feel I have gained confidence in this skill. I have picked up a number of breech lying babes, a few transverse, and become more confident in understanding attitude - i.e. the full position the baby is lying in, including head positions. Phew. Filling in the gaps. It feels good.

I have also wanted to better understand antenatal education given at the visits, and the tests at various stages, and I think I have got that down now. I'm not fast at it, but I understand it much better. I had visits with interpreters, both in person and via the telephone, adolescents, first timers, and grand multips, new migrants from other counties or new settlers from other states in Australia. We track down results from everywhere, even different time zones across the world. It is quite astounding how many phone calls we make and questions we ask over the course of a clinic session.

Some of questions we ask are the hard ones. Domestic violence. Depression screening. Any history of unwelcome sexual contact. This last one is often difficult to broach, and I confess we don't ask it of everyone, although we are alert to the possibility of it in any woman we see.

This week I have referred two women to our psychology services for raised depression screening scores with positive answers to questions of thoughts of self-harm in the last week. I'm so pleased we have these services so readily available. They are vital supports for vulnerable women. One teenager, in a very difficult position, was especially in need and I was hopping from foot to foot as I waited for the clin psych to be free. She was seen within 20 minutes, and will be followed up with a psychiatrist and a visiting midwife for adolescents and social workers and will hopefully be feeling much safer, more stable and supported soon. She was really brave, very private and reserved but clearly in a bad place, and feeling there was 'no happy place'. Poor kid.

Another woman I didn't refer set off all sorts of alarm bells as we had a chat. She was clear that she was going to try breastfeeding again (this was her second child) but that she would not be putting the child to the breast. No thankyou, its not my thing, my body is private and I don't like people touching it. (ding-a-ling-ding), No, I don't want to be referred to a psychologist even though I have a history of postnatal depression and I was medicated but took myself off it because my depression is not related to my baby (ding-a-ling-ding), yes I have a long-standing history of depression, no I don't discuss my depression with my family, they've got enough to be coping with (ding-a-ling-ding), I'm alright. I don't want anyone touching me (she wants a vaginal birth after CS last time) (ding-a-ling-ding). I took a deep breath.

Hmm. Many of the things you're telling me make me wonder... Have you ever experienced unwelcome sexual contact? Perhaps in the past?

She dropped her eyes and with a deep sigh made a decision to break her silence....

She had never told her mother, a former heroin user, because so many people would end up 'down there' she said, indicating a low level with a horizontal wave of her hand. It would tear my family apart. Maybe one day when some people were dead she would tell her family, but for now she chooses to keep it to herself to protect the greater whole. He is still around. She sees him frequently. She never discusses it with him. It stopped, she doesn't know why. She doesn't think it happened to her younger sisters, or is happening to anyone in her circle now. It wasn't her fault. Or his probably. He was not right in the head. But it stopped and she was content to leave it alone. Let sleeping dogs lie. She would only struggle and get all stirred up if she allowed herself to think about it. I've never told anyone else apart from my partner, and two friends, she said, through tight lips and with raised eyebrows as if unable to believe she was telling me now. But she was determined that she did not want any intervention or referral, and to leave it alone.

I was not surprised. She asked what had made me ask the question. I explained the signs I had seen in her tough, fiercely independent and private defence system. Most brick walls are not so high, or so tough. These kind of walls are built extra strong for a reason. A good reason.

We tossed around some of the connections and ramifications of her experiences. I joined a few dots, she joined a few, and we acknowledged her survival. Her choices. But it was important that she knew that she was not alone in her walled community. I reminded her that we had people who were able to support her if she wanted to knock out a few bricks in the wall.

One wonders about the ability of young women living these tightly wound and edgy lives to grow a well nourished baby to term. Last time her baby was small and growth restricted and she ended up with a CS due to concerns about the prem baby's ability to cope with labour. I'm not sure what her chances are like to achieve a VBAC this time around. Labour will not be pleasant, and she will be quite challenging to care for, as women pursuing VBAC are closely monitored, and vaginal examination will be extremely threatening for her. I hope she is able to labour well at home and stay away from the hospital for a good while, and arrives almost ready to push. And that the midwives pick up the subtext of her behaviour and are able to leave her alone as much as possible. And that her baby is better grown than the last one and able to cope well with labour. That's a lot to hope for.

Thursday, March 19, 2009

Lesley says hi

Just a quick post to pass on a message from Lesley of Chapter III .

She says to say a big hello to all, and to say that she has moved into a FABULOUS rental house this week, and the internet will be connected on April 3rd. She is well, and has had a trying week or so and can't wait to get back to her computer and bloglife.

I spent the day with her today and she is enjoying settling in and unpacking (a bit) in the house - it really is a great house. The main stuff will hopefully arrive by mid-April. She has lots to tell you all, but I'll let her do that.

I'm as busy as a bee, but was thrilled to have demolished heaps of my to-do list by 8.45am!!!

I was gobsmacked. It helps when you are phoning (twice) the east coast which is 2 hours ahead. But it left me free to get to Les earlier than I'd hoped.

She is living behind where my paternal grandmother used to live. Grandma died when I was 15. Yet today I was near her house, and when Les and I were out driving I saw a very early model Ford Escort, same colour, similar rego to the one she drove at the end of her life. I think she was with me today...somehow.

Off to a meeting now...more minutes.... :(

See ya

Sunday, March 15, 2009

Lighthouse love

Look what I found in a market today!
A set of cups and saucers with lighthouses on them! Just lighthouses! No extra nautical nonsense, just pure lighthouses and a bit of sunshineyness.I'm delighted with them. Don is shaking his head "where are we going to put those? We don't need any more cups and saucers, we don't use the ones we have now.....moan, whinge, rue"
Honey...its not about the drinking implements.
Look, there're four different ones- red, green, blue and PURPLE! LustAnyway, I just remembered I owe you a post about the Cape Naturaliste lighthouse. This lighthouse was completed in 1905, and manned until (um I've forgotten, but I think it was 1980 or so).
There were 3 lighthouse keepers and their families here, with a house each (one of them pictured above). They worked in shifts around the clock with jobs at the top and the bottom to be completed each 20 minutes. Pumping fuel up to the light, and rewinding the clockwork mechanism to keep it rotating, that was limited by the height of the tower. Sheesh!
This very accessible lighthouse is not too tall, which means we can all climb to the top without too much effort It was very windy. The flag was straining at the leash. There is a remote weather station inside which records wind gusts experienced at the lighthouse. It peaked at 33 knots while we were there. The interior is a round room with a spiral staircase leading to only two upper levels. The views and angles were pretty enticing to photograph. The walls were REALLY thick, and the windows offered interesting glimpses of the surroundings. On the first floor, we saw the turning mechanism for the lens, with a heavy mercury base for stability and glide. There were glimpses of the lens as it rotated above our heads. We saw it every 10 secs and it was really hard to get a shot of it.... Nope... Nope, missed it again...see what I mean? Ah, at least that one was a little more in focus. Then we went up to the next level. Here we had a chance to go out onto the exterior platform. It was REALLY windy. Steff was worried she'd blow away so she stayed inside when it was time to go outside on the upper railing.
I didn't have that concern...
South Africa is thataway.
Once again the shots of the rotating lens were hard to resist taking, even if they don't mean much. (Am I boring you? You had to be there I suppose). They keep the lens rotating 24/7 so the powerful lens doesn't focus the suns rays and set fire to the lighthouse.
When I came back inside I realized that every 10 secs there was the most amazing sequence of rainbows being flashed intermittently on the wall from the prisms above. Could I capture the best of them?
Nope.... 27 shots later I gave up. Honest...there was a really broad one that was dazzling. We headed downstairs. They shine the brass railing every day...I was impressed...I was reluctant to leave. It was so compelling. I'm so glad I went.
I'm off to have a cup of tea now....I think I'll use the purple one.

Friday, March 13, 2009

There but for the grace of God...

Busy week.

An unexpected shift on LBS on Wednesday instead of clinics. I had a very busy shift, a challenging shift. I am looking forward to returning there at the end of the month.

One of the challenges was working with a woman with significant drug issues. She was stable, and had birthed already when I met her, but it really gave me an insight into the chaos and consequences of her lifestyle.

Her teenaged children were present following the birth, and were quite loud, and demanding but were obviously keen to be there and to see their new sister. Dad was there too, and her Mum, and then her brother-in-law, his wife, her kids, another friend all turned up and could barely be persuaded to leave while she was being sutured up. They hung around outside her room (not ideal) and were just...really LOUD. The 14 year old daughter was all whiny and demanding "Mum said i could bath her first, when can we bath her, i want to pick out her clothes, how much does she weigh? Blah blah, blah" Her 13 year old brother was all "she's prettier than you Sis" then Sis would whine and protest to I painting a picture?

The woman was trying to referee from the bed, Nanna was all "I'm gonna take this baby back to Melbourne with me, she's so cute" It was pretty full on. I was completely over them all within half an hour. The woman was paranoid about her teenagers not walking with the baby so would yell at them if they twitched on the lounge with her. In the end I suggested we weigh the baby and do her top-to-toe check. Everyone agreed that would be a lovely thing to see.

I brought the warmer over to near the woman - she declined to hold the baby for the check - and lowered the side so she could see more clearly. I usually talk through the check, doing an inventory of eyes, ears, etc, turning the baby gently from side to side and telling her how pretty she is and pointing out the features to all present. We examine the reflexes, the spine, and demonstrate the stepping reflex of the newborn, which is always entertaining. The last thing we do is a genital inspection and check for an anal wink - where we lightly touch the sphincter and expect to see a 'wink' reflex tightening, if the spinal reflexes are intact. Hers was a little buried in a crevice and I gently separated the cheeks to better see it. I also checked a dimple in her butt crack to check it had a bottom to it, not a hole through to the spinal space. It didn't, all was well. But while I was carefully doing this I forgot to talk and explain my actions.

The woman spoke really aggressively to me - hey, what are ya doing? That must hurt her! I stopped immediately and considered what I was doing, then realized it must look strange. I explained my actions very simply, and gave her the commentary I had omitted. Oh, thats alright then, she said. I see now. But I felt bad, and completely understood how it must have looked to her in those brief moments. Sometimes we don't know fully the background of a woman in our care, and I wondered if I had accidentally hit a sore spot, that made her especially protective.

I weighed the baby and, with her permission, dressed the baby in our clothes for now (to save family fights) and sent everyone out for some peace and quiet. I gave her the baby to cuddle for a while. She was really worried about some blood on the baby's head, and I imagine it was about blood-borne contaminants, although she never said this out loud. She was in pain, and fed-up, and exhausted and aggressive, but was so sweet with her new baby. She freaked out about every drop of blood, although I was completely unphased by it. I recognized the risks of exposure. We wear gloves for those aspects of care for every woman, this one was no different, but she and her family were really grossed out by every smudge. It was quite trying. I gave her as much pain medication as I could, and resolved not to be offended by her manner towards me.

I wouldn't want her life.

Not the stressful, demanding, anxious, whiny teenagers; not the addiction; not the prospect of bringing up another baby in those circumstances. I could see she was trying hard with behaviour management of the kids. She was trying to control so much it was bound to do anyone's head in. She snapped and bit readily, the next 3 hours with her d.r.a.g.g.e.d to be honest. She was proud, and had limited mobility, and hated being dependent. I offered small amounts of practical assistance in the tight spaces of the bathroom. It was a huge effort to get her showered, redressed, epidural out and transferred up to the ward. I was sweating bullets by the end. She had mountains of luggage, and was snapping at her partner to NOT carry it, No, the kids aren't carrying it either, she'll get a trolley (meaning me). I got the trolley from the other end of the ward, sagging in the sluice doorway as I asked the support staff to please, pretty please, locate a large trolley for All. The. Stuff. Soon.

After corralling the energetic entourage at the far end of the postnatal ward, I settled her in to her fresh new room, which she complained about (its too small, smaller than my other one - Actually they're all the same. I said evenly, Oh well, we'll just have to make do). She had found fault with so many trivial things that day. I wished her a speedy recovery, and I walked away from her, exhausted. The receiving midwife's brows were furrowing at the prospect of the remainder of the shift.

I returned to LBS, answered an assist bell and scribed for a brief emergency. I did a tea relief for another very challenging patient with specialised complex needs. Then after my dinner I received another woman who was to be induced. She was delightful and the rest of the evening was spent sorting out her very complex medical needs and 'doing the shopping' i.e. restocking the room so it was ready for anything.

I was pretty knackered but satisfied with a full day's work. I slept well that night.

I have learned alot in clinics and now have a much better idea of education and resources, tests, abdominal palpation at all gestations, depression screening, how the clinics run and results and charts get to people (doctors and women). I have had busy shifts and very quiet shifts. I have met many new midwife colleagues, and enjoyed meeting students and showing them around a bit. It has been a break from the madness and overwork of the ward. And I have had a chance to really become comfortable providing antenatal care, especially to women pursuing VBAC.

I was delighted last week to see a woman I met in January, who asked for me again on Friday. We had a great visit together. She was near term and I offered her a stretch and sweep to help things along. We took our time and her cervix felt very favourable and I was confident her pregnancy was nearing the last days. I was feeling really bubbly and excited for her, and showed it readily, which she thought was hilarious. She had a vaginal birth 24 hours later. It was really special to hear - I had a feeling she was in labour and called LBS - she was. I was as high as kite.

I look forward to sharing this with many other women. Of all walks of life. Even if they are challenging.

I love being a midwife.

Monday, March 9, 2009


Do you want to hear about dentists?

I'm a bit over them myself currently, however nice they are. I'm having a lot of work done at the moment and Monday mornings are becoming a bit of a haze as I regain feeling in my face and jaw. My eyelid sensation was knocked off this morning for about an hour (that was interesting) but at least I didn't cry today. Don't ask. Just don't.

Lesley is back. It is indescribably good to know she is HERE. Within cooee. I have missed her so much, even with Skype and regular blog exchanges. She and Dave came for dinner on Saturday night and we talked and talked. It was a late night, a good night.

My sister is back from living in Melbourne too. We have seen each other on the last two weekends and done each other's hair (cut and colour each). Yesterday we went to the gluten-free foods and allergy expo. It was really worthwhile - except our two GF people didn't attend themselves - but we tried everything and had a good time. Her daughter and her have just returned after a 5 week RTW trip for auditions in USA, Europe and NZ - she was well received but unfortunately too short to join the Joffrey or the Canadian Ballet. What a life. One's career predicated not on prodigious talent but the gene pool that made her 5ft 3in. Anyway, it was a confidence boost to have some positive comments, after 4 years of the approval drought that is rampant in her national training establishment. She has returned to commence a teaching position in her old alma mater, and from all accounts has made a very promising start. Good for her.

I have recently read all four Twilight books. They were really great reads, and I'm delighted to have seen the film too, with a great cast. My daughter has also cottoned on to them and there has been a maturation of alliance from Harry Potter and Zac Effron to Robert Pattinson as Edward, whose large sultry photo has now joined the wall art above our girl's new double bed. We're thrilled to see her reading so much, apparently taking it in and finishing books much more easily than ever before, taking her work train journey as a starting point. Change is everywhere!

We have accepted a quote for the bathroom renovation. Gulp. Can't wait to see it finished. Hope I don't have night shift while it is in progress - could get ugly....although the builder is going to plumb an outdoor hot & cold shower for us to use, down the side of the house. Could be fun, and an unexpected bonus. We've decided to get a new bath too, rather than re-using the old one, and the new one is bigger and wider than the current one. Its gonna be soooo good.

If I can find a tame person to build the base for us, the pizza oven will be going ahead too. We've got some big limestone blocks from the new wall that can be used for the base, but they are too big and heavy for us to manage....I'm sure there's a capable young man out there who will be up for this small but heavy job.

The conference was really good, very interesting. Somehow there were only two midwives from our hospital present. Shrug. We heard some inspiring presentations and innovative solutions to long-standing problems, and I left with a bit of hope that things could change and that I could be part of the change. I am forming a clearer understanding of how to position myself to be part of these approaching changes. This of course ties in with my work with the College of Midwives. It was good to be part of a multi-strata, multi-disciplinary audience exchanging information about health systems, and although I wouldn't say it is my central raison d'etre in this field, it is very helpful to understand the bigger picture nationally and internationally. I was reminded that I used to work in this arena in the 1990s and I suddenly felt a return of confidence that came with my memory of 8 years work in this area. How could I have forgotten this grounding? It just shows how thoroughly my focus has changed since I entered as health professional. Wow. SO I have signed up to be part of a network looking at women's and newborns health policy and issues. In my spare time.

Jarryd's quilt is half pieced. Its coming along nicely, Lesley likes it. I aim to have it finished by late April.

I have hardly had time to read any bloglines daily lately, so there are 120+ when I get to it. Gulp! Maybe I should prune my subscriptions...

Planning our trip to Amsterdam, northern Italy and Paris in late June. Sigh :]. Lucky, lucky girl.

A pile of things to get done by then, starting....NOW.

See ya x