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.


Alby Mangroves said...

Seriously, after I started reading your blog a few months ago, I looked into the study required to do what you do. You are an inspiration. I hope you realise how important women like you are. Oh, and thanks again for continuing to read my rambling.

Frogdancer said...

You're a saint.

I'm sure i would have slapped her. Or the kids.

ZenCrafter said...

I was delighted in your delight of predicting that the last woman was ready to give birth. You are an amazing woman, as every midwife I've been lucky to encounter has been. Thanks for chronicling the ups and downs of your work.

Madre Adoptiva said...

You are obviously exactly where you're meant to be. I sense that you truly love doing what you do... even for the worst of them. The US needs people like you!

Blossom said...

What a lovely person you are......I don't know I would have been a patient with her or the family.....

Lovely another mum asked for wonderful!

River said...

Years ago I used to wonder if I could be a midwife but I've come to realise the only part I like is newborn babies. So, no, that's not for me.

Laura Jane said...

Slapping is NOT an option (too much paperwork).

I do whinge about the challenges and frustrations of shifts like this. Here on the blog, or with much rolling of eyes and sighing in the tearoom. And we ALL deal with clients like this daily. She was NOT the worst.

But she DID need care, and patience, and being snippy with her would absolutely NOT have helped and would NOT have made my shift any better, in fact it would be grossly counter-productive. I just had to be thorough, and professional and not buy into all the bickering.

And I give her credit where it is due, because she did ask some insightful questions, and was clearly trying with her family to the best of her current ability.

So...I am NOT a saint. By any means.

Tillybud said...

Credit to you for trying to understand why she might behave in certain ways. I'm sure your kindness and patience made things easier for her whether she showed it or not.

Anonymous said...

You really need a medal. Keeping it together with people like that is damned hard work.

Cosy said...

I love your birthing stories. I love that you're a midwife. I wish you could be MY widwife!!


potty mouth mama said...

Sounds like an incredible challenge - patience, understanding, tolerance, my goodness, I know how I would have felt under those circumstances!

I love reading about your experiences. Truly inspiring.

And how tuned are you to know about that other woman's impending birth - wowsers!