I am surfacing after a weekend of night shift. Only 3 nights, but what a 3 nights.
I have worked my bum off and been in the deep end, with back-up from colleagues so I wasn't alone, but it has been a very difficult stint.
On the first night I was with a woman who began experiencing a lot of bleeding while in labour with a very prem stillbirth. I really felt for her as her tiny baby was suddenly born in the midst of a roomful of medical and midwifery staff swinging into action to prepare for fluid resuscitation and transfusion. She was fairly calm, but I am so sad that she was unable to have due privacy at that time. She remained brave and dry-eyed, but the drips in inconvenient places meant it was difficult to hold her baby and touch him as he lay on her chest. It was my fiftieth birth, and although I am very fussy about what I call 'mine', and this one was half caught by the doctor during the emergency, I am honoured to claim this little one as a milestone birth, my first time to receive a stillborn. I had cared for his Mum before, during and after the birth and I am touched by our time together. She had left by the time I returned the next night, but for that ten hours I was 'with woman' with her.
The second night I received a woman having her second baby. She had been having a long early labour and was really tired, but it looked like she was kicking into gear and we were ready to catch the little one. Sleep is not really an option when in labour, but she was really keen to do so. She was labouring spontaneously, and coping well. She had had her first child with no pain relief and I was expecting her to do the same. I felt sure there was a baby not far away, and so did a colleague giving a tea relief. She felt the need to urinate frequently so her husband would half-drag her to the bathroom, as she was swaying on her feet. We encourage mobilising in labour so I wasn't concerned. She seemed to 'hit the wall' after a while, and suddenly stopped speaking English, or at least making sense, except for whining and saying 'I can't'. Her blood pressure was creeping up, nothing particularly extreme but she was quite uncooperative, and behaving like a dead duck. She wouldn't even acknowledge questions or make eye contact. I never start an assessment, especially an internal assessment without explicit verbal consent including eye contact permission. I felt myself withdrawing from her emotionally, which rang alarm bells for me, as it is unusual for my patience to be bested. She was going off the boil, but we were all keen for her to have a normal birth with this spontaneous labour, and she wasn't playing the game. She started vomiting, usually a good sign of transition, with a baby not far behind. She was begging for pain relief, as is common, but transient for most women near the end. However she kept vomiting, and I suddenly felt she needed some fluids. But first I checked the BP. It was suddenly high, things were not right, and giving her fluids might not be the right thing. Could she birth quickly and it would be over, or was something going wrong? This was more than me being 'over her'. I felt she'd taken a bad turn, and called for her to be reviewed by the doc.
Within half an hour she was bled, examined, diagnosed with pre-eclampsia, had an epidural underway, monitoring and all the bells and whistles. But it was hard work, as she would/could not engage with staff. Her husband kept trying to speak for her and give consent, but that it not quite good enough. If she is to agree legally to these invasive procedures, such as epidural, and internal assessments, she must give proper consent, or it is assault. And still no baby in sight. I was relieved to get a meal break as it was 8 hours into my shift and I was at the end of my tether, and I really needed sustenance and to regroup. The other staff were all saying what hard work that room was, so I felt a bit better about being so out of sorts with the atmosphere. When I returned, the epidural was in situ but she was still in a bit of pain, but after a top-up we started winning that battle too. The baby was tricky to pick up through her abdomen, and she had a rapid pulse herself that was easy to interpret as the baby's. All in all a very trying night, and I thought I wasn't going to see this baby at all. Just before the end of the shift the doctor came to review her again, and to see whether she had dilated fully or not, and lo and behold she had. She was quite reluctant to push, 'I'm too tired', but this time I did speak quite plainly to her and insist that 'yes you can, then you can rest, so stop making a fuss, lets get this job finished'. We repositioned her for pushing and had her begin the job. We couldn't do it for her! The next shift arrived and a student midwife gloved up and bustled up expectantly. Rarely, I said 'actually, I'm catching this one, I've worked bloody hard all night for this baby. Catch with me, but this one has MY name on it!' The baby was born just before 7.30 am, and although I had vowed to have stern words with her, she was really just too pretty to be cross with her for long. She was quiet and alert, big dark eyes and a head of curls, and her Mum was all of a sudden chatty and interactive and full of thanks, and delighted to have a second girl. I earned my sleep, but didn't sleep well. More's the pity....
The third night was the last straw. We arrived to some devastating news of the death of a young doctor in a car crash. She was a vibrant talented young woman, and we were all reeling in shock. Red-eyed, we made our way into our allocated rooms and tried to quietly compose ourselves. In my room a woman had just started pushing, and her midwife stayed to complete the birth. I was happy to be the background second midwife witnessing. There was some blood on the emerging head, a sign of a vaginal tear somewhere that can't be helped until the baby and placenta is out. The baby was born after a massive effort, a lovely girl welcomed with crows of delight and rejoicing over who had won the bets. Followed by bleeding. A lot of bleeding. Blood started pouring onto the floor. I was reminded of the first time I had seen such a thing, and I had a rough idea that it took about a litre on the bed to do such a thing....Call in the storm troops, get it all happening, the family still on the phone as it unfolds, baby in arms, Mum sweating and feeling the effects. 2.2 litres measured so far. Off to theatre with no time for a breastfeed.
Word kept coming up and down from theatres. She would be a bit longer, still bleeding, baby was frantic, skin to skin with Dad, the drop of colostrum I had managed to express as we were preparing for theatre not satisfying her at all. Dad asked for a bottle, and we had the discussion about breast first, second and third, but he asked a lot of good questions about breast stimulation that I was happy to answer that skin to skin and breastfeeding could be resumed within minutes of the reunion...whenever that would be. We weighed and measured the baby, she had some more skin to skin time with Dad and he fed her a small amount of formula while she was on his chest, so there was the association with skin. It was definitely a compromise, but a realistic one given the condition of the Mum. I took them to the special care unit to wait for her, then popped into theatre to see how things were going. The bleeding was now controlled with some 'big guns'. I told her about the baby's weight, and praised her bravery, and reassured her that the baby was skin to skin with Dad and waiting for her.
There was a big bag of linen waiting to be weighed for blood loss. The total was large. Ten times the loss we normally expect. A massive PPH. I mean massive. Out of the blue, in a first timer with a spontaneous labour. Once again, we saved a life today.
One of the doctors spent the rest of the shift speculating on what would have happened in the case of such a catastrophic haemorrhage if she had birthed at home, and the answer was clearly not favourable. Does one take the risk of first-time birth at home and take the consequences in these outlying cases? Or does one practice in caution, perhaps risking over caution, with no belief in normal birth and physiology. It is easy to see the slippery slope to constantly defensive practise that has led to the over medicalisation of birth such as we see today.
In three nights I had seen a normal unmedicated birth of a very prem stillborn, with bleeding complications. I had seen a spontaneous labour blow into pre-eclampsia within hours, followed by a normal birth. And another spontaneous labour and normal birth followed by major bleeding. These are among the emergencies midwives prepare for, and when one works in a big hospital one can expect to see a higher rate of complications. But it is sobering nonetheless.
I continue to believe that women should be offered a choice of place of birth, and I hope one day to work in a model of care that allows me to provide the full continuum of care to women including labour and birth wherever they choose, or it is collectively deemed safe. Not 'dominated by fear of the outlying event' safe. That said, I can't imagine how awful it would be to be faced with such a PPH at home with 2 midwives present, without the extensive range of PPH drugs, waiting for an ambulance to transport, without a theatre with the equipment that saved that woman's life. It would certainly shake, if not permanently scar, one's confidence, whatever one's faith in women's physiology and normal birth.
I have seen way too much blood this weekend. But I still...love being a midwife.
Monday, July 27, 2009
Tuesday, July 21, 2009
Wild weather = wild women
Its been a while since I showed you any Wild Women. Wanna see the latest batch?
My previous WW are found here and in mid-April archives. The latest girls have been a while coming as I have been quite stop/start with them.
Here is Nymph.
You've met her before, but she got finished with some extra floral embroidery and is now ready to take off to her new home.
You've met her before, but she got finished with some extra floral embroidery and is now ready to take off to her new home.This is Regina. 
She is a queen of Rio, and dresses in the colours of the carnival.
She is a queen of Rio, and dresses in the colours of the carnival.Below is Minnie. She took her time to reveal herself, and was bald for quite some time. It didn't suit her. But when she claimed some sorbet-coloured locks she came alive.
Her arms and legs are 'milagros' and have a lovely texture
and she has vintage crochet lace as her skirt. I think she is doing the Twist.
Her arms and legs are 'milagros' and have a lovely textureand she has vintage crochet lace as her skirt. I think she is doing the Twist.This is Jaune. Someone I know is having a special birthday soon and guess where Jaune is going to live?
Finally, you have also seen this sweetie before but she was shy and hadn't told me her name yet. She has just whispered it to me...May I introduce Flora. She likes violets.
She was nervous for her close-up, but I think it turned out, don't you?
Monday, July 20, 2009
Cold off the press
WOW!!!!WOW!!!! There has just been the most incredible hailstorm come through here!
The front yard, looking toward the veggie patch
The back yard adrift.
I'm glad I'm not showering outside here today!
This is the back lane , with runoff through the drifts.
This is the neighbour's verge. Ice rinse for the washing, anyone?
The front yard, looking toward the veggie patch
The back yard adrift.
I'm glad I'm not showering outside here today!
This is the back lane , with runoff through the drifts. I can hear the little guy next door whooping in delight as he discovers another pile.
This is the neighbour's verge. Ice rinse for the washing, anyone?Let's see if I can upload the footage I took of it hailing from the back door.
WOW!!!!! It happened nearly an hour ago and its still in drifts.(edited to add it lasted 7 hours, it has only just melted, but Don and Steff both got to see it when they came home)
I have never seen such a heavy hailstorm, I'm grateful there was no damage, as the hailstones themselves were not too big, but I'm glad I took photos.
And there's a bowl of it in the freezer!!!
Friday, July 17, 2009
Because...
To satisfy the curiosity of a certain friend, I gave Harry Potter and the Half Blood Prince 8/10 because...well its difficult to explain. Maybe I'd better just evaluate it as is.
The plot is not strictly according to the book. In the way that film 3 was condensed, with scenes from the book taken slightly out of sequence, or rolled into one for brevity. This film does the same, and it works and removes some of the tedious repetition. There are also completely new scenes and dialogue not from the book. Mostly these work, but one or two give away bits of the plot that one does not come to understand until later. There is a particularly menacing scene set at Xmas. Some characters don't appear at all. Some lose their lines to a different character in one scene then regain them later.
Snape and Draco Malfoy are both played with much more sympathy than previously seen. Some of the Draco stuff is touching. Dumbledore is really good in this, his scenes at the end moving but understated -just the way he would like them, really. Michael Gambon is terrific this time, he approaches Richard Harris for gravitas at last.
The main trio are all really good, and growing up beautifully. They each carry their scenes without too much mawkishness for a change, although Ron Weasley is a bit of a dope. He also has some funny scenes, with Harry, who has a delightful scene alone while under the influence. Teen hormones are raging! And boy, does that Ginny Weasley know what she wants.
Cinematography was good. The mood was amazing, no sweetness and light here. And the scenes in the cave were well realised. Great tension towards the end of the film. Slightly disappointed to have no funeral to sob over further, with a strangely awkward bit of editing that shifts the mood a bit prematurely for me, ending with a very obvious ribbon tying class for loose ends and demonstrating the way forward. If it had gone a bit harder with the grief work I may have been more satisfied, but the romance and comedy was great. Luna Lovegood was delightful.
It didn't drag in the slightest, in fact I would have been happy to sit for another 10-15 minutes to include a scene or two more. I especially missed one of the opening scenes from the book involving Fudge and the muggle Prime Minister, although the atmosphere was well and truly established by brief scenes of London under attack.
Once again I was frustrated by how much Dumbledore knew and didn't teach Harry. What a waste!
Maybe eight is a bit mean. Its possibly a nine. I can't wait to see it again!
The plot is not strictly according to the book. In the way that film 3 was condensed, with scenes from the book taken slightly out of sequence, or rolled into one for brevity. This film does the same, and it works and removes some of the tedious repetition. There are also completely new scenes and dialogue not from the book. Mostly these work, but one or two give away bits of the plot that one does not come to understand until later. There is a particularly menacing scene set at Xmas. Some characters don't appear at all. Some lose their lines to a different character in one scene then regain them later.
Snape and Draco Malfoy are both played with much more sympathy than previously seen. Some of the Draco stuff is touching. Dumbledore is really good in this, his scenes at the end moving but understated -just the way he would like them, really. Michael Gambon is terrific this time, he approaches Richard Harris for gravitas at last.
The main trio are all really good, and growing up beautifully. They each carry their scenes without too much mawkishness for a change, although Ron Weasley is a bit of a dope. He also has some funny scenes, with Harry, who has a delightful scene alone while under the influence. Teen hormones are raging! And boy, does that Ginny Weasley know what she wants.
Cinematography was good. The mood was amazing, no sweetness and light here. And the scenes in the cave were well realised. Great tension towards the end of the film. Slightly disappointed to have no funeral to sob over further, with a strangely awkward bit of editing that shifts the mood a bit prematurely for me, ending with a very obvious ribbon tying class for loose ends and demonstrating the way forward. If it had gone a bit harder with the grief work I may have been more satisfied, but the romance and comedy was great. Luna Lovegood was delightful.
It didn't drag in the slightest, in fact I would have been happy to sit for another 10-15 minutes to include a scene or two more. I especially missed one of the opening scenes from the book involving Fudge and the muggle Prime Minister, although the atmosphere was well and truly established by brief scenes of London under attack.
Once again I was frustrated by how much Dumbledore knew and didn't teach Harry. What a waste!
Maybe eight is a bit mean. Its possibly a nine. I can't wait to see it again!
Wednesday, July 15, 2009
Multitasking
Happy Harry Day!
We are going to see the latest HP flick tonight and we are sooooo excited! There is jumping up and down! And that's just with ME!
Also on my to-do list for today:
Colour my hair (in progress, be grateful I don't have live webcam)
Hang out washing (done) before men come to pull down the back fence adjacent to washing line (only found out about this one 30 minutes ago)
Hopefully have hair and shower achieved by the time men come to do said fence.
Fold a very large amount of washing.
Vacuum through.
Make fried rice and pumpkin scones for a pre-Harry large avo-tea, as the session goes over dinner time and I know I'm not gonna last.
Cut and colour my sister's hair.
Fuss over my Mum who is quite sick with a shocking chest, but insists on coming to Harry tonight. She can gawk at photos while I do hair.
Receive, feed and keep the hysteria down on 2, no, 3, no ....well, on all of our pre-Harry excitement. Oh who am I kidding? I can't wait!!!!!
Better get onto it!
We are going to see the latest HP flick tonight and we are sooooo excited! There is jumping up and down! And that's just with ME!
Also on my to-do list for today:
Colour my hair (in progress, be grateful I don't have live webcam)
Hang out washing (done) before men come to pull down the back fence adjacent to washing line (only found out about this one 30 minutes ago)
Hopefully have hair and shower achieved by the time men come to do said fence.
Fold a very large amount of washing.
Vacuum through.
Make fried rice and pumpkin scones for a pre-Harry large avo-tea, as the session goes over dinner time and I know I'm not gonna last.
Cut and colour my sister's hair.
Fuss over my Mum who is quite sick with a shocking chest, but insists on coming to Harry tonight. She can gawk at photos while I do hair.
Receive, feed and keep the hysteria down on 2, no, 3, no ....well, on all of our pre-Harry excitement. Oh who am I kidding? I can't wait!!!!!
Better get onto it!
Thursday, July 9, 2009
Slotting back into it
Ahh, its nice to be back at work.
I was hanging around home for the last few days, after a stressful and emotional week at home post-holiday, wondering if I was bored and ready to go back to work. The answer appears to be YES!
Its lovely to be back! Back with women and babies, and boobs, and most of all my fellow midwives.
I have been pleasantly busy, certainly fully absorbed, for two shifts now, with a great variety of women, from all walks of life. Women with prem babies, who are doing really well and come up to the ward (less than 35 weeks!!!), women with babies with unexpected birth defects, taking it all in their stride. Women having their second baby but breastfeeding for the first time, or giving it another go with the second after a less than stellar first time around the block. Brave women, loving their babes, or terrified of their baby, or hoping the baby stays in and gets cooked a bit more if they can stop bleeding.
The ward is being renovated currently which makes for a slightly smaller number of women to care for, but a bit more chaos and rearranging of Stuff We Need. Instead of the neonatal assessment area being in a central location it has moved to one end of a long ward, and today when workmen set off the alarm for the nursery we all rushed to the new location....but luckily it was an accident and the sheepish workmen were unaware that they had even had midwives running. As if we needed the exercise!
The breadth of issues being faced and dealt with by women and their midwives on a daily basis continues to impress me. Today I had a work experience student with me, a mature age one, so my every move was shadowed by someone. Sometimes she was able to join in and have a little bit of hands on - listening to a baby's heartbeat with the stethescope, gently feeling a postpartum abdomen to feel the contracting uterus as it shrank back into the pelvis, but mostly she watched quietly and asked questions in the corridor as we whizzed off to the next room. She asked good questions, and I hope she was able to get a feel for the range of a midwife's work. I had a gynaecology patient as well so she got a bit extra thrown in! As she'd had 7 children of her own I felt there wasn't much could shock her (not that I tried at all) and at the end of the day she expressed her appreciation of the new perspective. For all that she'd had 7 babies she had never experienced an epidural, or a caesarean, or a premmie, or a sick or disabled baby so there is always something to learn from every situation and she showed alot of empathy.
She asked briefly about drug addicted babies, and stillbirths and 'what happens' and I answered her questions as honestly as I could without going into too much detail. Our hospital truly does offer a wide range of experiences, and I'm very grateful to be seeing so much, as well as being able to teach students coming through.
I got a lovely surprise on my return to work. There was envelope for me with an excellence notation for my portfolio, and a beautiful email from a great couple I had been with for their birth in late March. I've just gone back and checked and I didn't tell you about this birth, but the commendation and photo they sent have reminded me what a fantastic day it was.
I remember they were a couple in their late 30s, their first baby, who had been together for 20+ years. It was a spontaneous labour, term or thereabouts, and they were so intune with each other. Just leaning and swaying together. She would look for him with each contraction, an obvious touchstone for her tranquility and there was no fighting or reluctance with the strength of each wave. It just came, was accepted and went away. She was a slightly built woman with long light brown hair and a lively face, and just so calm, it was a pleasure to be with her. I had a student with me that day too, and was really pleased to see such a spontaneous unmedicated woman - it was her first out of 5 hospital labours she had seen.
The room was dark, the monitor was off, I just listened in every now and then, baby was steady and gorgeous. At transition she got a bit shaky, and didn't quite know what to do with herself, but I suggested she go into the loo to be by herself, or with her hubby and regroup, and to come out when she was ready or wanted to push. So she did. Often women don't know what sensations to respond to - the pressure in their bottom caused by the descending head, the nausea and shakes of transition - for some it is the welcomed last time they throw up in the pregnancy! SO a change of scene will often do the trick. Additionally, the walking and sitting/squatting helps melt the last bit of the cervix away....
And so it was. She asked to be examined and she was fully dilated with a bulging bag of waters which actually popped shortly afterwards. The pushing began, she felt more secure on the bed so we positioned and positioned to help the descent of the head, which was slow but steady. The end of the shift was nigh, but the afternoon midwife was working with us, and after 30 minutes we spied a little head in the dark depths. Yay! And there it stayed for a tantalising 10 minutes, and then took another 10 minutes to crown properly. I was getting a bit antsy, and considering a rare episiotomy to release the head as I couldn't hear the fetal heart very well with the baby so deep within the canal. At last the head fully emerged followed quickly by the rest of the babe who lay there like a stunned mullet. I scooped her up and popped her onto her Mum, who announced the sex as I gritted my teeth waiting for the first breath...and waited...rub, rub....waiting...rub, rub...cut the cord... over to the resus warmer.... bag and mask, rub, rub c'mon sweetheart come and take part....heart rate good.....nil respiratory effort.....puff, puff.....getting pinker.....heart rate still good.......eyes still wide open and staring......come on little one, rub rub, still floppy....come and play. The afternoon midwife and I were both working on her as she was pretty stunned after that prolonged crowning. After two and a half minutes she gave a splutter, then blinked and sort of screwed up her face and let out a weak yell of protest, then started waving her arms and pedalling while taking deep breaths. Within 30 secs she was with her Mum and Dad, where she stayed skin to skin, pink and pretty (for ages I'm told), so calm and alert after a slow start.
Just one of those days....It was the second resus I'd done in as many days, after a few months without any. I recall being grateful again for my skills, our constant training and updates that allow us to just act without hesitation, and her pink perfection was a wonderful reward. I recall feeling sad for them that they were to be separated, by her staying in overnight in hospital. They hadn't been apart for a night in 23 years. How's that for a strong team? She was so amazing in her labour, so little fuss, so stoic and accepting of the process and I couldn't praise her enough, and made sure the student knew what a lovely birth she had seen - although she had seen 7 homebirths (more than I have) and was happy to finally have seen a gentle spontaneous hospital birth! This woman really was very beautiful and very clever and an absolute natural. So clever. So good at birthing. She should definitely do this again!
I don't recall the resus being a big deal or drama in the room, or any particular anxiety from the parents, they just happily accepted her back into their arms...but they may have reflected on those first few minutes later and wrote to the hospital expressing their appreciation to the three of us for our labour and birth care. It was a most welcome reminder of a great day.
I love being a midwife.
I was hanging around home for the last few days, after a stressful and emotional week at home post-holiday, wondering if I was bored and ready to go back to work. The answer appears to be YES!
Its lovely to be back! Back with women and babies, and boobs, and most of all my fellow midwives.
I have been pleasantly busy, certainly fully absorbed, for two shifts now, with a great variety of women, from all walks of life. Women with prem babies, who are doing really well and come up to the ward (less than 35 weeks!!!), women with babies with unexpected birth defects, taking it all in their stride. Women having their second baby but breastfeeding for the first time, or giving it another go with the second after a less than stellar first time around the block. Brave women, loving their babes, or terrified of their baby, or hoping the baby stays in and gets cooked a bit more if they can stop bleeding.
The ward is being renovated currently which makes for a slightly smaller number of women to care for, but a bit more chaos and rearranging of Stuff We Need. Instead of the neonatal assessment area being in a central location it has moved to one end of a long ward, and today when workmen set off the alarm for the nursery we all rushed to the new location....but luckily it was an accident and the sheepish workmen were unaware that they had even had midwives running. As if we needed the exercise!
The breadth of issues being faced and dealt with by women and their midwives on a daily basis continues to impress me. Today I had a work experience student with me, a mature age one, so my every move was shadowed by someone. Sometimes she was able to join in and have a little bit of hands on - listening to a baby's heartbeat with the stethescope, gently feeling a postpartum abdomen to feel the contracting uterus as it shrank back into the pelvis, but mostly she watched quietly and asked questions in the corridor as we whizzed off to the next room. She asked good questions, and I hope she was able to get a feel for the range of a midwife's work. I had a gynaecology patient as well so she got a bit extra thrown in! As she'd had 7 children of her own I felt there wasn't much could shock her (not that I tried at all) and at the end of the day she expressed her appreciation of the new perspective. For all that she'd had 7 babies she had never experienced an epidural, or a caesarean, or a premmie, or a sick or disabled baby so there is always something to learn from every situation and she showed alot of empathy.
She asked briefly about drug addicted babies, and stillbirths and 'what happens' and I answered her questions as honestly as I could without going into too much detail. Our hospital truly does offer a wide range of experiences, and I'm very grateful to be seeing so much, as well as being able to teach students coming through.
I got a lovely surprise on my return to work. There was envelope for me with an excellence notation for my portfolio, and a beautiful email from a great couple I had been with for their birth in late March. I've just gone back and checked and I didn't tell you about this birth, but the commendation and photo they sent have reminded me what a fantastic day it was.
I remember they were a couple in their late 30s, their first baby, who had been together for 20+ years. It was a spontaneous labour, term or thereabouts, and they were so intune with each other. Just leaning and swaying together. She would look for him with each contraction, an obvious touchstone for her tranquility and there was no fighting or reluctance with the strength of each wave. It just came, was accepted and went away. She was a slightly built woman with long light brown hair and a lively face, and just so calm, it was a pleasure to be with her. I had a student with me that day too, and was really pleased to see such a spontaneous unmedicated woman - it was her first out of 5 hospital labours she had seen.
The room was dark, the monitor was off, I just listened in every now and then, baby was steady and gorgeous. At transition she got a bit shaky, and didn't quite know what to do with herself, but I suggested she go into the loo to be by herself, or with her hubby and regroup, and to come out when she was ready or wanted to push. So she did. Often women don't know what sensations to respond to - the pressure in their bottom caused by the descending head, the nausea and shakes of transition - for some it is the welcomed last time they throw up in the pregnancy! SO a change of scene will often do the trick. Additionally, the walking and sitting/squatting helps melt the last bit of the cervix away....
And so it was. She asked to be examined and she was fully dilated with a bulging bag of waters which actually popped shortly afterwards. The pushing began, she felt more secure on the bed so we positioned and positioned to help the descent of the head, which was slow but steady. The end of the shift was nigh, but the afternoon midwife was working with us, and after 30 minutes we spied a little head in the dark depths. Yay! And there it stayed for a tantalising 10 minutes, and then took another 10 minutes to crown properly. I was getting a bit antsy, and considering a rare episiotomy to release the head as I couldn't hear the fetal heart very well with the baby so deep within the canal. At last the head fully emerged followed quickly by the rest of the babe who lay there like a stunned mullet. I scooped her up and popped her onto her Mum, who announced the sex as I gritted my teeth waiting for the first breath...and waited...rub, rub....waiting...rub, rub...cut the cord... over to the resus warmer.... bag and mask, rub, rub c'mon sweetheart come and take part....heart rate good.....nil respiratory effort.....puff, puff.....getting pinker.....heart rate still good.......eyes still wide open and staring......come on little one, rub rub, still floppy....come and play. The afternoon midwife and I were both working on her as she was pretty stunned after that prolonged crowning. After two and a half minutes she gave a splutter, then blinked and sort of screwed up her face and let out a weak yell of protest, then started waving her arms and pedalling while taking deep breaths. Within 30 secs she was with her Mum and Dad, where she stayed skin to skin, pink and pretty (for ages I'm told), so calm and alert after a slow start.
Just one of those days....It was the second resus I'd done in as many days, after a few months without any. I recall being grateful again for my skills, our constant training and updates that allow us to just act without hesitation, and her pink perfection was a wonderful reward. I recall feeling sad for them that they were to be separated, by her staying in overnight in hospital. They hadn't been apart for a night in 23 years. How's that for a strong team? She was so amazing in her labour, so little fuss, so stoic and accepting of the process and I couldn't praise her enough, and made sure the student knew what a lovely birth she had seen - although she had seen 7 homebirths (more than I have) and was happy to finally have seen a gentle spontaneous hospital birth! This woman really was very beautiful and very clever and an absolute natural. So clever. So good at birthing. She should definitely do this again!
I don't recall the resus being a big deal or drama in the room, or any particular anxiety from the parents, they just happily accepted her back into their arms...but they may have reflected on those first few minutes later and wrote to the hospital expressing their appreciation to the three of us for our labour and birth care. It was a most welcome reminder of a great day.
I love being a midwife.
Monday, July 6, 2009
Photos, photos
I am having some trouble showing you photos from our trip without uploading them all.
The markt sold all many of things, from peonies (tulips were now out of season) 
to seeds for plants that it is, um, not legal to grow in most countries. I wasn't tempted.
The Amsterdam/Delft photos are on Flickr (I can't get a link to work, dammit, but they are on my FB photos if you can be bothered). However these are a few of my favourites. There is a story to each one of course....they reflect my interests which transcend international boundaries and may bore you all to tears e.g. this one was taken because I found a lighthouse picture in a shop display. (sigh)
This is the quilting fabric shop I found in the Albert Cuypermarkt, so I had to bring 2 pieces home. I was restrained.
to seeds for plants that it is, um, not legal to grow in most countries. I wasn't tempted.
There were beautiful canal walks, with luscious trees and stately and really old canal houses to admire, including the old warehouses with big shutters. I was fascinated to learn that many houses have block and tackles attached to the front top of the house for ease of furniture removal. Sometimes the house even leaned a little to facilitate this.
On the last day we went by train to Delft, home of the famous painted Delftware. They even made a chair!
There were more pretty canals and houses. It was hard to take a terrible photo, everywhere was so picturesque.
I'm especially pleased to have caught this windmill from the train as we zoomed past.
There were some impressive churches in Delft, a 'new church' and an 'old church'. This is a Green Man piece of plaster work from the old church that I like because it is so weathered - I believe it is from 1400-ish. Australians really do scratch our heads in wonder at the concept of such old buildings. Unfortunately both the churches were closed for the day and we couldn't go inside...pity, they each looked amazing from the outside.
One of the places that was open was the Johannes Vermeer Museum. It was really lovely, with lifesize reproductions of each of his 36 known works. It was sad to think he had so few works. Many of the works were painted in a setting in his studio with the light coming from teh upper left as seen below in this pic. There was a little setup with a camera holder to recreate the conditions. 
This is a random woman I asked to pose for me. She did take one of me but it turned out very blurry. Don was museumed out that day and he sat in the town square with a beer while I took in the JV museum. I'm glad I did. We both cried when we saw the original of the Milkmaid in the Rijksmuseum. It was extraordinarily beautiful. The Girl with a Pearl Earring was in The Hague, which we thought of going to see, but it seemed too hard to reach there from the station, so she 'got away'.
I'll post pics from Italy next time.
Wednesday, July 1, 2009
About that piece of patisserie...
Never boast on your blog that getting to an airport is going to be a piece of patisserie.
I am now at home in my own cluttered study. We walked through our door just before 5am, drooping with weariness after a very long journey home.
We boarded the RER train in plenty of time to hit the airport well ahead of our flight. Then the train stopped before emerging onto the second station. I immediately felt Don's panic rising as we sat in a tunnel, with PA announcements not to open the doors. Eventually we crawled into the station where people were exchanged, then after a short delay we set off again. Approaching the next station this was repeated with additional announcements about a known delay at a stop 2 further along. We sat and waited. And waited. There was another announcement confirming significant delays of unknown duration due to there being a person on the track at Stade de France. Don went from jittery to practically whistling like a newly boiled kettle! I had already offered to get off and get a taxi, which he had declined. Now I just stood up and grabbed the cases. It was no longer an offer but a certainty. The track was blocked. There was no way around the obstacle because there would be no further trains beyond the blockage to pick up.
We emerged onto the street to an empty taxi rank. Don was swearing and hypercrabby about every jolt of the cases over every bump. I ground my teeth and picked up my guide book (that I had nearly packed in the suitcase) and my mobile phone (with the battery failing fast) and called a taxi company. Just as she was promising me a cab in 7 minutes one pulled up (in front of a bus)in response to Don's frantic hailing. We piled in gratefully as the phone battery died. Eighteen minutes later we arrived where I was left as hostage to the taxi driver while Don entered the airport to find an ATM. He emerged after 10 minutes with 60 euros which he thrust at the driver for a 48 euro fare. When you tot up how much our initial tickets had cost as well, it was a very expensive airport ride!
We checked in easily, in plenty of time and headed to the gate where our seats would be allocated. The girl at the counter assured me we would have good seats but the flight was full. We queued dutifully and passed through all the security checks and got on to our bulkhead seats the centre two of four, with no-one on our outsides. Until ... 5 minutes prior to closing the doors a man with a cute baby appeared on one side, with many bags and trying to hold the kid while he stuffed things into overhead lockers. I beckoned for the baby who flirted very appealingly with me. As I was mid-flirt, a young woman appeared from the other side, looking curiously at me and frowning at the man across us. I then noticed that she had put down a baby carrier at the exit row. As she dumped more bags in the seat next to me it was quite clear that the baby had a Mama. And a sister. And that Don and I were somehow seated between parents of 8-month old twins. Two babies! Yes, I'm so lucky to be on a long flight with two babies, Mama moaned. We offered to move so they could sit together. Our offer was rejected irritably. It seemed she was just quite irritated. Full stop.
Papa had retrieved his little guy from me and was struggling to get him double seat-belted in place for take-off. Mama had settled the sleeping little girl to her chest under many floaty drapes without noticing the need for a double seat-belt. She turned her head and tried to feign sleep, while sniffing away tears. Okay.....
As we taxiied she leaned forward and saw the extra seat-belt stuffed into the seat pocket. She clucked her tongue and curled her lip as I offered to help. It would have been nice to know of this earlier she snarled. I applied my soothing never mind, it won't take a minute voice as she lifted the draped sleeping baby from her chest and I groped for her seatbelt, unfastened it, added the baby bit and reclipped it onto her, then clicked it around the baby. There, there. We took off to the loud wailing of baby boy, dummyless (it was in one of the many bags). Sigh.
It didn't get much better from there, in fact it descended into some level of hell for the first 8 hours of the 12 hour flight which left at midnight. As soon as the seatbelt sign was switched off the flight staff assembled the bulkhead bassinets for the babies, but only after they put up our screens on stalks from the armrests of our seats, effectively trapping us in our extremely hard seats for the duration of the flight.
(edited to add:If it sounds like I am hard and unsympathetic to families flying with two babies across the world...um....I don't mean to be. My heart did sink for them, a bit, as soon as I saw them. But it sank for us a trifle more, especially when I realised that the bassinets meant we would be trapped in our seats. They themselves had asked to be seated in that configuration. They did refuse to be sat together, and frankly it would not have made much difference. Someone had to sit next to them. Besides, my ass wouldn't fit into one of the aisle seats anyway. And I do like babies, so ... I suspect I was somewhat reluctant partly because I had a cold-sore healing on my face, and I couldn't snuggle and drool on them as I would ordinarily like. I looked like a leper. It was a drawback.)
Am I painting an effective picture? A bulkhead seat never gives quite enough legroom anyway with the seatpockets blocking full knee extension. The seats were rock-hard from the moment we sat down. They didn't tilt back much, and we couldn't extend our legs anyway. The aircon was set to inferno. The seats were so narrow my hips were cemented in the forward facing position. The couple tutted at each other across us, each dealing with their own baby. And Don and I tried to get some sleep (who am I kidding) It. was. not. good. Because of the bassinet barriers we had to climb up onto the seats and walk over the armrests to get out to go to the toilet. I managed it twice on my side and had to wake Mama up from her deep sleep (in those 5 mins) to get back in.
After 8 hours we possibly lost all sensation to our backs and lower limbs, because it seemed we were marginally less uncomfortable, but it could have been that our spines were now permanently remoulded. I'll let you know about that.
Breakfast was served about 1.5 hours prior to landing and both parents had their hands full. After we finished Papa was struggling to get a mouthful with a wriggling little guy who was yelling his head off so he came to sit on my lap again for a while and I fed him a breadroll which kept him very amused for 20 minutes as he gummed and sucked it to death and rained crumbs down the two of us. Mama had disappeared for a while but when she came back her little girl decided that she wanted some of the roll too so we passed it around and all got crumby together. It was a fun way to end the flight.
They live in Singapore so were not coming on to Perth (shame) but we landed to the news that the homeward flight was delayed by 2.5 hours, so we had 4 hours in Singapore. That left us with time to scour the terminals looking for a replacement hat for a fantastic little number that Steff had lost in Melbourne after only 2 weeks last year. It was such a good hat that it needed to be replaced. We found it in the last terminal we searched. It was so worth it.
Finally our flight boarded and we had a row of four to ourselves. There is a God. A bit of sleep then an hour of immigration, baggage waiting, customs and taxi queues.
We crept into the house and put the kettle on (its been 2 weeks since we've seen a kettle) while I jumped into the shower. Then I got out hurriedly to let Don in to cool off a burn to his groin from a hot cuppa he had slopped straight from the kettle. Bugger. It was not too bad but it stopped him from sleeping in bed as he needed a cold compress to stop it blistering. Luckily it missed all the interesting bits of anatomy, but it made him think twice about sleepily getting naked in anticipation of a shower while manoevering boiling water! Its OK today, although for a minute there I could see myself heading straight to the hospital at 5.30am before we'd even slept.
The house was in good shape. Presents have been given and well received. I'm heading out to the shops to get a roast for dinner. I've seen both of the kids only now- Steff went to work while I was crashed this morning and Don only saw her briefly before he fell back asleep on the couch, and she has just arrived home. Mum is blogging...what else is new - in my defense I had hoped to be finished with it but got interrupted with a phonecall I couldn't get out of. Our reunion was very happy nonetheless.
I haven't downloaded any photos yet. You'll see them when I do.
I am now at home in my own cluttered study. We walked through our door just before 5am, drooping with weariness after a very long journey home.
We boarded the RER train in plenty of time to hit the airport well ahead of our flight. Then the train stopped before emerging onto the second station. I immediately felt Don's panic rising as we sat in a tunnel, with PA announcements not to open the doors. Eventually we crawled into the station where people were exchanged, then after a short delay we set off again. Approaching the next station this was repeated with additional announcements about a known delay at a stop 2 further along. We sat and waited. And waited. There was another announcement confirming significant delays of unknown duration due to there being a person on the track at Stade de France. Don went from jittery to practically whistling like a newly boiled kettle! I had already offered to get off and get a taxi, which he had declined. Now I just stood up and grabbed the cases. It was no longer an offer but a certainty. The track was blocked. There was no way around the obstacle because there would be no further trains beyond the blockage to pick up.
We emerged onto the street to an empty taxi rank. Don was swearing and hypercrabby about every jolt of the cases over every bump. I ground my teeth and picked up my guide book (that I had nearly packed in the suitcase) and my mobile phone (with the battery failing fast) and called a taxi company. Just as she was promising me a cab in 7 minutes one pulled up (in front of a bus)in response to Don's frantic hailing. We piled in gratefully as the phone battery died. Eighteen minutes later we arrived where I was left as hostage to the taxi driver while Don entered the airport to find an ATM. He emerged after 10 minutes with 60 euros which he thrust at the driver for a 48 euro fare. When you tot up how much our initial tickets had cost as well, it was a very expensive airport ride!
We checked in easily, in plenty of time and headed to the gate where our seats would be allocated. The girl at the counter assured me we would have good seats but the flight was full. We queued dutifully and passed through all the security checks and got on to our bulkhead seats the centre two of four, with no-one on our outsides. Until ... 5 minutes prior to closing the doors a man with a cute baby appeared on one side, with many bags and trying to hold the kid while he stuffed things into overhead lockers. I beckoned for the baby who flirted very appealingly with me. As I was mid-flirt, a young woman appeared from the other side, looking curiously at me and frowning at the man across us. I then noticed that she had put down a baby carrier at the exit row. As she dumped more bags in the seat next to me it was quite clear that the baby had a Mama. And a sister. And that Don and I were somehow seated between parents of 8-month old twins. Two babies! Yes, I'm so lucky to be on a long flight with two babies, Mama moaned. We offered to move so they could sit together. Our offer was rejected irritably. It seemed she was just quite irritated. Full stop.
Papa had retrieved his little guy from me and was struggling to get him double seat-belted in place for take-off. Mama had settled the sleeping little girl to her chest under many floaty drapes without noticing the need for a double seat-belt. She turned her head and tried to feign sleep, while sniffing away tears. Okay.....
As we taxiied she leaned forward and saw the extra seat-belt stuffed into the seat pocket. She clucked her tongue and curled her lip as I offered to help. It would have been nice to know of this earlier she snarled. I applied my soothing never mind, it won't take a minute voice as she lifted the draped sleeping baby from her chest and I groped for her seatbelt, unfastened it, added the baby bit and reclipped it onto her, then clicked it around the baby. There, there. We took off to the loud wailing of baby boy, dummyless (it was in one of the many bags). Sigh.
It didn't get much better from there, in fact it descended into some level of hell for the first 8 hours of the 12 hour flight which left at midnight. As soon as the seatbelt sign was switched off the flight staff assembled the bulkhead bassinets for the babies, but only after they put up our screens on stalks from the armrests of our seats, effectively trapping us in our extremely hard seats for the duration of the flight.
(edited to add:If it sounds like I am hard and unsympathetic to families flying with two babies across the world...um....I don't mean to be. My heart did sink for them, a bit, as soon as I saw them. But it sank for us a trifle more, especially when I realised that the bassinets meant we would be trapped in our seats. They themselves had asked to be seated in that configuration. They did refuse to be sat together, and frankly it would not have made much difference. Someone had to sit next to them. Besides, my ass wouldn't fit into one of the aisle seats anyway. And I do like babies, so ... I suspect I was somewhat reluctant partly because I had a cold-sore healing on my face, and I couldn't snuggle and drool on them as I would ordinarily like. I looked like a leper. It was a drawback.)
Am I painting an effective picture? A bulkhead seat never gives quite enough legroom anyway with the seatpockets blocking full knee extension. The seats were rock-hard from the moment we sat down. They didn't tilt back much, and we couldn't extend our legs anyway. The aircon was set to inferno. The seats were so narrow my hips were cemented in the forward facing position. The couple tutted at each other across us, each dealing with their own baby. And Don and I tried to get some sleep (who am I kidding) It. was. not. good. Because of the bassinet barriers we had to climb up onto the seats and walk over the armrests to get out to go to the toilet. I managed it twice on my side and had to wake Mama up from her deep sleep (in those 5 mins) to get back in.
After 8 hours we possibly lost all sensation to our backs and lower limbs, because it seemed we were marginally less uncomfortable, but it could have been that our spines were now permanently remoulded. I'll let you know about that.
Breakfast was served about 1.5 hours prior to landing and both parents had their hands full. After we finished Papa was struggling to get a mouthful with a wriggling little guy who was yelling his head off so he came to sit on my lap again for a while and I fed him a breadroll which kept him very amused for 20 minutes as he gummed and sucked it to death and rained crumbs down the two of us. Mama had disappeared for a while but when she came back her little girl decided that she wanted some of the roll too so we passed it around and all got crumby together. It was a fun way to end the flight.
They live in Singapore so were not coming on to Perth (shame) but we landed to the news that the homeward flight was delayed by 2.5 hours, so we had 4 hours in Singapore. That left us with time to scour the terminals looking for a replacement hat for a fantastic little number that Steff had lost in Melbourne after only 2 weeks last year. It was such a good hat that it needed to be replaced. We found it in the last terminal we searched. It was so worth it.
Finally our flight boarded and we had a row of four to ourselves. There is a God. A bit of sleep then an hour of immigration, baggage waiting, customs and taxi queues.
We crept into the house and put the kettle on (its been 2 weeks since we've seen a kettle) while I jumped into the shower. Then I got out hurriedly to let Don in to cool off a burn to his groin from a hot cuppa he had slopped straight from the kettle. Bugger. It was not too bad but it stopped him from sleeping in bed as he needed a cold compress to stop it blistering. Luckily it missed all the interesting bits of anatomy, but it made him think twice about sleepily getting naked in anticipation of a shower while manoevering boiling water! Its OK today, although for a minute there I could see myself heading straight to the hospital at 5.30am before we'd even slept.
The house was in good shape. Presents have been given and well received. I'm heading out to the shops to get a roast for dinner. I've seen both of the kids only now- Steff went to work while I was crashed this morning and Don only saw her briefly before he fell back asleep on the couch, and she has just arrived home. Mum is blogging...what else is new - in my defense I had hoped to be finished with it but got interrupted with a phonecall I couldn't get out of. Our reunion was very happy nonetheless.
I haven't downloaded any photos yet. You'll see them when I do.
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