Last days

Snapshots from my 'place of birth'

A final week of madness on the ward. The hospital is in crisis mode, with a serious bed shortage and a staffing shortage to boot (I have not offered to work an extra shift this weekend).

I was lucky enough to work the same 4 rooms for 4 days, and saw 9 different women through those rooms, and 5 different babies. Some babies were in the nursery, some hadn't come out to play yet. All but one of the babies were great feeders, with sensible practical mums. It really makes a difference.

I can't tell you how many bells I answered, but it was a LOT. I have a sore foot currently and am limping alot of the time, which makes my other hip and my back sore. I was not pleased with frivolous ringing of bells, but I did take a certain pleasure in seeing that I would not be answering bells next week. Just mobile phonecalls.

I had my last late-early split. Bliss. I am well aware that I will be on call and I may long for the life of a rostered day off, but just let me enjoy this tiny fantasy, will you?

I worked a late, early, early, early, and was in a meeting from 9.30-1.40 today. Hubby was away on business and I had to walk/limp to and from work all week as I have no parking permit at work, and I live pretty close anyway so its not worth taking a car for an 8 minute walk. Unless you're limping. This part of the week DID suck.

Word was still spreading about my departure, so I have broken the news and said goodbye to many people all week. I have enjoyed much goodnatured ribbing about people making me hand-embroidered placenta bags if they'd known (my reply? Frankly my dear I'm bloody insulted you hadn't already wrapped it ready for me, what's the holdup? You've had 4 weeks notice!).

I have had 2 avo teas, with cake, wherein I received a lovely gift from my home ward, and many many good wishes, acknowledging my long-held desire to work in this field. Students and former students professed to have enjoyed birthing and working with me, saving lives with me, and laughing with me. I cried. I laughed. We hugged. I assured them I would not be far away, and would not be a stranger to them.

This morning I handed in my uniforms to the cheerful Julia in the hospital laundry/uniform section. She asked where I was heading and was delighted to hear that I was going to be a homebirth midwife. She regaled me with tales of her mother giving birth to 12 babies at home, including one caught by Julia herself when she was 13 years old. Her brother had come really fast and her dad was still away fetching the midwife!

This afternoon I had a final engagement with labour ward. Over two hours staff staggered in and out and asked for information about my next job. Some of them almost seemed to be giving grudging permission for this career move, but were greatly outweighed by those assuring me I would love it, and that it would be a great fit for me. There was much discussion about knowing me, and my capabilities, and knowing that I would understand their expectations if transfer occured. There was more ribbing about me phoning in to transfer primips who had been pushing for 7 hours (c'mon girls, you KNOW my minimum time limit before transferring is 8 hours) and much curiosity about details, which I was largely unable to furnish, as I have yet to be oriented. I caught up on the gossip, who was pregnant (3 of them), who was planning to be and who had got new roles. It was great to touch base with these fantastic bunch of hardworking and talented midwives again. I have missed them over the last 6 weeks and was a little sad not to finish up with them on Labour ward. But I am sure I will see them from time to time, and I know it will be a warm welcome.

Lastly I handed in my security pass. I cried again, suddenly, and couldn't speak as the man took it from my hand, and I left the building with tears rolling down my face for the umpteenth time that day.

The tears are ones of recognition of the importance of that place in my life. Of gratitude to my colleagues who have taught me and shared so much. Of grief to be leaving their daily lives. I have been delighted to work there, to become the midwife that I am. My tears are also of pride in my accomplishments so far. The tears of transition.

Most of all, over the last 4 weeks, I have been humbled by the warm support of mentors. They have been open in their joy for me. I am certainly standing on the shoulders of giants. I mentioned before that I felt like I was at Everest base camp, still with one heck of a climb ahead of me, but Oh! The view!

Who knows what sort of midwife I am yet to become?

Everest Base Camp

I have had one hell of a week. In a good way.

I had a job interview on Monday with a publicly funded homebirth program, one that has led the way for their model of care, one that has been replicated across the country. It has always been my goal to work for them, when I had enough experience. I was encouraged to apply. I applied with my fingers crossed. I thought 'well, if I get an interview I'll be pleased, and I might be a chance, but I will be hysterical if I truly get it'.

I got the job.

Yep. You read it right.

I got the job, my dream job.

And now the climb, the steep learning curve really begins.

I am skipping with happiness.

I wrote my resignation letter, and handed it in person to all my managers. Then I howled on and off about leaving all my lovely workmates that I have shared so much with. Each day since, I have broken the news to a new set of people. Its very exciting.

And then, yesterday to top it off, and just when I was lamenting that I would not catch another baby at my hospital, one of my women on the ward went into precipitate labour while I was at tea. I returned to hear her distressed behind her curtain in the shared 4-bed room. She nearly clawed my arm off and it was clear she was nearly ready to push. Which was a bit of a shame ... because only 2 hours before she had signed for a repeat CS, especially if she laboured. I notified the coordinator that we needed to move, like NOW, and returned to her with a pair of gloves, just in case. She was in the throes of another contraction. She clung to the coordinator, who talked her through it, then she allowed me to examine her - wa-hey! Fully dilated and a breech close to the world. Seemed a shame to waste a perfectly good CS on a baby who had plans for exit via an alternate route.

We ran with her on the bed to LBS and shanghaied a passing consultant as we skidded around a corner. I found the first empty room and we pushed the bed through the curtain, pulled a warm baby blanket bundle out and threw it on the heater. Then I changed gloves and returned to the woman still on her ward bed and peeked under the sheet - and there was a breech on view. She crawled across onto the birthing bed. I waved my ward coordinator goodbye, and volunteered to stay as the only other midwife around was having her first day at work. The LBS coordinator assembled a team of paediatricians and spare hands, and I urged her to ignore everyone else and focus on me, which she managed really well, and I spoke quietly and encouraged her to go for it, and praised her to the eyeballs. The consultant stood next to me, and talked me through the birth, giving a small hand here and there. And so . . . . I caught my second VBAC breech baby! All pretty textbook. This one was close to term so the maneuvres were harder than last time, but it all went smoothly. I would have preferred a hands off approach, but in that setting it was never gonna happen, and honestly it was an excellent result.

I was utterly thrilled! The woman was shocked but delighted. I handed over to the afternoon staff and tottered back to the ward to pick up the threads of my day, after a very adventurous 90 minutes away! The staff were all agog, it was the talk of the hospital that a midwife had done this birth! The young doctors were high-fiving me, and were delighted to have seen a vaginal breech birth. My manager came back from lunch and told the tale, only to find out it had happened to one of her ward patients with one of her midwives! She then got the full story straight from the horse's mouth.

I saw the woman again today and she is glowing, just radiant that her body worked and that she could give birth vaginally, and that she could be up and about and so well, rather than recovering from surgery. Baby was in nursery for a day or so, but he is nearly ready to come up to the ward! 2.35kg nearly 36 weeker. We congratulated each other on our cleverness, and had a big hug. She is such a darling, and was so brave during her 'amazing experience'. My sixty-ninth baby. Her second. Unforgettable.

I'll miss this place, but I'm looking forward to exploring the big world outside and I know that whatever the setting....I love being a midwife.

Just birth

A candle-lit night of struggle, with nothing but grit and determination and loving support.

Just after dawn, as little ones stirred and sat cuddled on laps, a new family member was born in their own family room.

No bells, no whistles, quite ordinary, yet profound and timeless in its simplicity. A testament to the strength of woman.

Welcome to the world baby boy.

Hearing the call

Did I ever tell you how it was that I became a midwife?

photo from National Geographic August 1999

I had always been interested in birth. I watched my cats give birth to their kittens. I noticed pregnant bellies. I avidly watched nature films with birthing. As a high school student I saw a birth film in year 10 and clearly recall the crowning, and seeing a small tear occur, but knowing that I was seeing something sacred, and mysterious, and rarely seen.



When I had my first child I didn't understand what a midwife was. I have recently reconnected with the midwife who attended that birth, and my son turned 24 last week and we reminisced together. With my second child I had a friend who was a midwife and I read some of her books and came to better understand the role of the midwife.

As you know, that second child led me to a whole new world of discovery. I began to attend women's weekends for mothers of children with disabilities and special needs, where I was introduced to journal processing. This has been a tool to having a life, an inner life, all of my own. It is where I learned to love the questions in my life, rather than feeling I had to have all the answers.


On November 3rd 2001 I did a session where we looked at the personas we held within. The idea was to have a dialogue with one of these inner selves and uncover truths.


Now, a caveat here. Journalling is a very private experience. I have always been taught that it is never to be shared except with ones own voice. It is a private thing that can be shared with others, or done in a group, and the opportunity exists to share through reading. Listening deepens the experience, we often find resonance in other's words. Hearing oneself saying the words that have come out the end of your own pen is confronting, and affirming, and scary sometimes. It deepens the understanding, beyond just having written the words. It is a message from your soul. It is often moving beyond all measure. I have had some of the most profound experiences in my life in a journal room. Journal is secret and respected and a safe place.


So ... This is my blog. This is my erstwhile voice. And I choose to share with you some of this session, and I trust you with this sharing.

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My Secret Selves


My list: the dancer, the midwife, the counsellor, the clear thinker, the love force of the Universe


Come out, come out, whomever you are


Here I am, coming as you have called, inside you, waiting for my time to begin, talk with me, come to know me, name me, put me up as a goal in your life, DO something to reach me.


Who are you? What is your calling? Will I like you? Will the path to reach you be long and hard? Will I have to make the journey alone?


I cannot answer that question. Any path is hard. Nothing will fall in your lap. But if you want to hold the shape of a ripe belly beneath your hands you will have to give up some things. To be a midwife will be 4 years of dedication. Set a date. start towards me, you know you want to. The coursework is not beyond you.


You were born to use your hands in this way. The power of birth, the hovering of life yet unbreathed is calling you. You talk of wanting a job which encompasses all your unique set of skills...this could be the thing. It is the sensuousness of the dance, the skills and knowledge of midwifery, the feminism, the ear and shoulder and warmth of counselling, the celebrator of life and the deliverer of fully formed perfection wrapped in death. The midwife births not only joy, but sometimes sorrow and you are well equipped to accept that challenge with grace and wisdom. Be an empowerer of women, deliver them to joy and peace, treasure their bodies and their new life, nurture the family, comfort and share with them.
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Does that sound like the universe giving a wake-up call? Yeah. I thought so.


A few weeks later I told Don, and his first words were "you'd make a bloody good midwife". And the rest is history.


I love being a midwife.

What do I know?

How many times does a human heart beat in a lifetime?

Today I found myself in the position to count them. Almost literally.

One little sweetheart lived his brief life in my care today.

I know Miracles exist. I thought he had slipped away, after twenty incredible minutes. But his little heart beat on feebly and slowly, for another hour or so of bonus life. Cradled by his brave Mum and Dad, skin to skin with his mother in life, with his father later, in death.

It was one of the most beautiful, incredible days of my life as a midwife. From taking the phonecall, to receiving the couple. From listening in and finding two heartbeats, to seeing one falter. From phonecall to the ward they were in my care, as well as the care of superb specialists . Together, the work we did today was a work of art. An oasis of beauty in a forecast that was never going to be good.

Today, for one day only, I was their midwife.

What a privilege.

Once again, I know, I love being a midwife.

Not drowning, waving (again)

Did I say not drowning? Well.... its probably accurate.

I have been watching too much TV, playing way too much Bejewelled on FB, attending work back on the postnatal/antenatal ward and had a random night shift thrown in to the middle of a dayshift fortnight (I know) which has completely thrown my body clock for a loop and I lost close to 2 days in sleep disturbance. Sigh. I'm back on days this weekend for 4 days but then I have a week of rostered days off, before working for 4 days then having 15 days on hols before Xmas. Woot! I love to be back on the ward with all the darling staff members I was mentored by when I was a student. I am also working with my own mentee, which is a lovely change as our rotations have not coincided frequently at all and it is good to see her functioning clinically, even though our relationship flourishes mostly outside the workplace. She is so bright and buzzy, a real individual.

The workload is as full-on as usual, challenging physically and emotionally as well as an organisational challenge. To top it off the ward has been renovated since I was last there, so nothing is where I expect it to be. I am being a big girl and sucking it up. I'm just very lucky, I repeat to myself. But it does make me think of how different things might be in a year's time, in a different style of care. I am scared. But I am determined. Why does it matter to me what people think? I have good reasons for taking the path less travelled, and everyone I have mentioned it to seems to think it is an excellent move, but I suppose I must suck it and see. It may not be for me. I will be quite happy being a plain midwife out there, but how big will my envelope be? How far will I push it? There will be stuff I can only learn out there. I am not fearless, but nor am I fearful. I have a very healthy respect for the process, and the risks. I must keep my clinical judgement about me and distinguish between space for evolution and recklessness. There's a lot going on in my brain. But in the end - Megan says it well here.

I also saw New Moon on Thursday morning bright and early - its not bad, I found it very absorbing and the performances were much better this time, with less of the trembly, changing half-formed mouth movements from Kirsten Stewart that gave me the pip the first time around. She really is much better this time around, more natural. Its certainly one for the fans, but it ends a bit suddenly! There is almost the case for editing books two and three together to shift the action along, but it was still satisfying and beautifully done. The three leads were less wooden +/- overacting. The Jacob character was good and well performed. There were funny bits. The Edward character was much better made up although for a perpetual 17 y.o. someone carved from marble-like perfection he somehow looks haggard and older and a lot more manly, which was very appealing. Am I an Edward or a Jacob girl? Hmm, I think I prefer manly, but a bit of exuberant animal buff is good. The rest of the Cullen clan could have done their shots in less than a week, apart from Alice. Thinking back, they are mostly only shown in asembled set shots, with little dialogue. All in all 8/10.

Today I have a lunch with fellow midwives before the long awaited head MRI to see if there is any sinister reason for the dizzies - we suspect not, but lets rule it out. The medication is really helping and they are 90-95% gone. Edited to add - I'd forgotten how LOUD those MRIs are! Even with earphones it was like having my head trapped inside the DJ desk at a really bad alien robot techno rave, with error messages going off. Geez! 20 minutes of it!

The Big Picture tour by a Canberra ACM staff member, Abby, is going really well. She is such a dynamic presenter, and has been really flexible and super-organised and great fun as well. It is half over now, and this time next week will be all over, but it was well worth the effort. We had lunch yesterday, and she is tired but happy so far, and on days off now down south with her family. I look forward to next week.

So, I wish I had some new craft to show you, but I don't. I c.b.a. (can't be arsed) getting the camera from the other room to even show you a pic of the gorgeous Abby from Canberra. I have no excuses, I just know that if I left the computer now something bright and shiny and completely unecessarily random would catch my eye and it would be 3 o'clock before I remembered the unpublished post on the computer....so, really, we'd better play it safe and hit publish now. Yes, really.

Night shift news

Hello world. Phew. Night shift and labrynthitis are a bad combination.

It was getting better until sleep disturbance and nausea kicked in, or they kicked each other in....or, oh heck who knows? Anyway I'm on the second of 3 days off, before I lose 5 days of my life with 4 nightshifts over the weekend. Sigh.

I did three shifts with two nights early this week. Good shifts, if slightly mad. Really busy on Monday night. Dementedly so, poor coordinator was tearing her hair out. I happened to be in the rooms in her eyeline so every time I walked past I would get another little job to do. "quick - 29 weeker coming in, wants to push, you're it!" The woman arrives, screeches to a halt in a room with a big resus unit hastily assembled in a just cleaned room, not very distressed or labouring particularly, a little pain arrives, doesn't palp too strongly, yes waters have broken...or have they? The story is convincing with a witness. Ooh, baby's coming! she wails. Can I check? May I begin? Cervix long and closed and tucked away behind baby's head, just where it belongs. Excellent. Good news! You're not going to have your baby in the next hour. Lets take you back around to the assessment unit, where you can get sorted and admitted. Its too late for a fetal fibronectin test (which will indicate if she's likely to labour in the next week) as I have examined her, but it turns out she is known to staff as a 'frequent flyer' with every little thing and vague twinge. Ambulance guys have to take things on face value and bring em in, and if things were as presented we were ready to deal with it. As it was the floor of that room could now continue to dry undisturbed.

I had been sent to theatre on arrival for a breech CS. Lovely couple, sweet baby, wet and steaming to her chest, alert and responsive. Great photos, happy relatives. I was happily present when the grandparents learned the sex of their newborn first grandchild and saw him, travelling with us to the ward. Joy all around. Told her about a clinic at our hospital for women experiencing second birth after CS, so she could start planning her next birth. Back to LBS and had a cuppa.

Technically had 2 women at this point, being induced. Gave antibiotics to one of them. The other one was snoring. Got given another woman, a multip in early labour at 4cm, contracting irregularly...but who knows, sometimes multiparous women only need half an hour of good contractions before they produce the goods. Settled her into a room on my corridor (yeah, I had a whole one to myself by this time) and went in search of a listening lead for my CTG. Bloody hell, none to be found. Grabbed a handheld Doptone and made use of that instead. Major language barrier, my Mandarin is not that hot, but we established a pleasant simple rapport as I listened in and then made tea for her and her mother. I left her to it and popped in each half hour. She went off the boil, well....was never really simmering in my time with her anyway. She went on to birth at 11-ish in the morning.

In the meantime I was still dogsbodying my way through the night, attending an imminent birth of a 7th child, there was thick meconium so I called a paed for the birth and prepared the cot in case he didn't make it in time. The fetal heartrate dropped dramatically, and the baby was not coming despite vigorous pushing from the experienced mum. Sunny-side up, we all said, but the heartrate was getting really low. We'd called a few docs when the FH dropped and they quickly attached a simple suction device and helped baby out, covered in mec. He was floppy and flat as a tack, but we didn't stimulate him immediately, as the paed needed to suck out his airway so he didn't breathe mec into his lungs. HR was 40 while we poised ourselves ready to commence chest compressions, right, GO! A minute of compressions and oxygen saw his heartrate improve but he was still completely non-responsive and floppy, I ducked out to grab an oximeter from the room next door (where the 29 weeker didn't deliver) and when I came back baby was squawking and starfishing and protesting at his awakening. Poor little mite, it was all a bit sudden, but he was down and on the way out, and as much as I promote gentle birth, I was quite glad to see him yelling. I stayed there for another half hour, to get him settled and cuddled up and fed, and documenting the resus, then returned to my odd jobs. I was most grateful to get a dinner break, then I received another semi-labouring second-timer who had a quick birth last time. She too was not quite ready to labour, but I made her comfortable, hubby re-parked the car (during which time she didn't have a single contraction) and she went on to birth at 5.30 later that day. I handed over 3 women to 3 different midwives and staggered home, literally walking home half asleep.

The next night I was allocated to first-timer who had been stuck at 2 cm, on stacks of synto. Everyone assumed she was for the chop, but my student and I breezed in with positive attitudes and explained about cervical effacement and assured her that the cervix was ready to get on with it now and start dilating. And it came true! Her epidural had been working really well, and continued to do so. The trace had been really good, and was mostly good still, it just had a pattern of decelerations one sees with head compression, followed by a period of sleep where the trace looks quiet. We worked our butts off in that room, keeping the trace well monitored, adjusting the receivers, keeping the epidural well topped up, fending off doctors who kept showing up and scaring the woman, talking about 'heart rate dips, can only do it for so long, then they get tired' wanting to do fetal scalp samples, but every time that dear little baby showed a fabulous acceleration when it was needed and warded off intervention. In the end she was born easily and quite beautifully, despite the doctors inviting themselves into the room and standing at the end of the bed and itching to get their hands in there, and asking if we had episiotomy scissors. We held them off, almost literally, and the little one emerged via the student and I to her stunned and thrilled Mum and grandma, after a mammoth effort. The doctors disappeared like magic, and the student and I dealt with a snapped cord and got the placenta out without them, whole and intact, although we did invite the doctors back to do some straightforward suturing and assist with management of a slow PPH, which had been anticipated after that much synto. There was no CS. There was no transfer to theatre for placenta removal, there was a beautiful healthy 3.7kg baby and her Mum staying in the same room, where they had stoically borne their labour together. It was a great result really.

I was sad that the docs felt they had a right to come in uninvited and stand at the end of the bed, scolding her at her to 'push into your bottom' (as if any of them had ever done it themselves). If we hadn't been there they would have held her vagina open so they could see the descent and crowning better! I feel sad that they so rarely see the way a midwife conducts a birth, with gentle encouragement and positive language. We see their way of work frequently, and frankly it can be pretty brutal sometimes. It is noteworthy when its not. Sometimes it seems that they know no other way but fear and mistrust of birth, and litigation, and invading the privacy of the moment in their relentless quest for accountability. We will call them in if we need them. We do, honestly. Just like we did for the little one with thick mec and the really declining heart rate. I like having docs there to expand the skill level if need be. They are our back-up. We work together. I don't mean to doctor-bash. This is more a doctor-whinge maybe. But when they come in uninvited I can sometimes hear myself sounding a bit terse as I respond to their appearance, at which time I politely and pointedly introduce them to the woman and her family as if they had entered the woman's home, which in effect, the birthing space is, or should be. I try to believe that they KNOW this is the case, but somehow they don't behave that way. I'm sure they think I'm a grumpy cow towards them some days. Thats to the ones that aren't arrogant. When they are being mentored by the insufferably arrogant, they are just asking for terseness.

But I can guarantee them this. If, and when, any of them are in my care when they are labouring and birthing I will protect their rights to privacy and advocate just as strongly on their behalf as I do for any woman I care for. And I will use my clinical judgement to call for back-up when the situation warrants it.

Because I love being a midwife.

Whattup?

Hello? Anyone still there? (sounds of crickets chirping)

I have had some more plane related mishaps and hiccups. As a consequence I have had only one day at home in the last 9 days...yeah, yeah, excuses excuses, and a to-do list a mile long. .. in the next 2 days before I work for 5 further days. I really do have a lot to tell you. But typing time. . .. . is short. I met Kelly and her family and had a delicious dinner (see her account of it here). I attended 4 full days of information about national registration, MidPLUS, Midwifery Practice Review, MBS and PBS, and other practical midwifery stuff. I talked, I schmoozed, I ATE, I shopped, I danced, I laughed and cried. It was really super. Photos WILL follow, I promise.

Check out this you-tube clip for an upcoming video....it looks really interesting. I saw it on Public Health Doula, a little blog I have just started subscribing to. Its about how the media shapes one's view of birth, but this film shows the real deal. The real site it's from is here. It seems you can order a DVD.

http://www.youtube.com/watch?v=V9Gd7pqeESE&feature=player_embedded

See if you can guess my favourite birth moment in the clip. I'd love to hear which snippet strikes you. (ooh, you commenters are good! You have picked two of my three faves, go for gold now and complete the trifecta)

And....Tomorrow is a special day. That's all I'm saying.

Laying low

I am here, alive, just on night shift, and quite absorbed in the other doings of life.

Thankyou all so much for your kind words about my memories of my Dad. He was quite a man. I have enjoyed seeing that photo on my blog.

I am reading everyone else's blogs, dropping comments here and there, I just haven't had much chance to post as I am sharing the computer with the boy wonder currently as well. There's fierce competition.

What else have I been up to?

I have had a sister turn 40.

We have lost a dear cousin to lung cancer after a brief illness. As this branch of the family are Tassie there have been many phonecalls, and flowers sent, and notices lodged. It is not fair to lose such a lively witty man, who had such depths that he hid so readily. He follows his late son, his only child who died in a car crash about 15 years ago. He was loved by many.

Stephanie has finished work for now, as her site closed unexpectedly with short notice. She is now going to pursue open employment (gulp) as the alternative supported placements are probably not for her, sadly. We're all putting a brave face on it but it is disappointing after she was settling in so well and experiencing some success. The new phase involves MANY appointments, not always easy to fit in with shift work, or her Dad's work commitments.

I have worked 20 hours, and been flat tack with some very messy and tricky cases. Had a birth just in the nick of time 7 minutes before knock off yesterday morning, that kept me busy for a further hour or more. This was after a pretty torrid night, but we were grateful to see this baby and end his Mum's suffering ... she really suffered, quite unusually given the numbers of measures in place for her comfort, but it happens sometimes. Her little one really needed to be out for complicated reasons and finally he emerged in a fragile state, into the arms of paeds who resuscitated him very well and he is doing OK in the nursery where he can finish growing without relying on an abrupting placenta!

And today a new baby was born into the Tassie family, another grandchild to dear cousin Susan and her husband Richard, after the loss of her elder brother last week. They will welcome two more grandchildren by Xmas, one from each of their surviving 3 children. They too lost an adult daughter in a separate motorbike accident over a decade ago. They are stoic and brave, but I know they all miss seeing her become a parent along with her siblings.

Welcome to the world Abel Craig, named after your Mum's cousin. Babies are such a treasure.

And finally in the midst of it all I have been quite obsessed with playing Bejewelled Blitz on Facebook. It is VERY BAD. And VERY ADDICTIVE. The chink-chinking sound of the jewels clicking into place sends me into a trance and I spend waaaaay too much time developing RSI in my tapping-the-mousepad finger..... I am fairly disciplined with it, and set myself a time limit but I have been known to exceed it. I'm doing fairly well though....

Today I have been a housefrau staying in to see the refrigerator repair man...who informs me that I need a new fridge. When I think about it the old one is 21 years old! Its done very well, but I'm sure there are much more energy efficient ones available. We kind of chose one this evening, with a 5.5 star rating, but then came home to rearrange the kitchen a bit to accommodate it, so I'll go back and buy it for real tomorrow. Isn't my life scintillating?

Well, I'm off to bed, very late but I'm between night shifts and its barely worth retraining my body clock after 2 shifts on with 3 off before 4 more nights, so I've been staying up late. Sigh.

Thanks for feeding the fishies!

Learning curves

Just when you think you've got a handle on things...some toughies come your way.

Its been a rough week.

Can't really talk about it.

Some of it is up to God. It was another one that would NOT have been good at home.

But it was topped off by a little boy born 'sunny side up' this morning. Yep, I guess that really was an anterior fontanelle at 2 o'clock on VE. Little devil.

Reflective practice

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.

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.

Yay!

Thought you may be interested to hear about this budget news as it affects the great majority of midwives in Australia in some form or another.

Australian College of Midwives MEDIA RELEASE
“Mothers and Midwives Budget winners”



“Today is an historic day for childbearing women and their families in Australia,” said Associate Professor Hannah Dahlen, National Media Spokespersons for the Australian College of Midwives.
“Not only has the Rudd Government made the welcome commitment to parental leave to better support families with newborn babies, but they have also provided for:
mothers to receive Medicare rebates for midwifery care,
access to PBS for midwives,
national collaborative maternity care guidelines,
increased access at state level to birth centres,
indemnity for midwives
measures to enhance the access of rural and remote women to maternity care as close as possible to their home community.

A national telephone support service for pregnant women and mothers of newborns
“These reforms will together make it much easier for women living anywhere in Australia – from the middle of our largest cities to remote communities - to access continuity of care by a known midwife” Assoc Prof Dahlen said. “They will also be vital in helping to close the gap on disadvantage for Aboriginal and Torres Strait Islander mothers and babies in partnership with Indigenous people themselves.”

Continuity of midwifery care involves a pregnant woman being cared for by a known midwife throughout her pregnancy, labour and birth. It also involves follow up care in the home for up to 6 weeks after the birth of the baby to provide professional support with the all important transition to parenting.

“This is not about substituting doctors with midwives” Assoc. Prof Dahlen said. “Obstetricians will, of course, continue to have a vital role in maternity care. Midwives providing continuity of care collaborate with obstetricians and allied health professionals throughout the episode of care, in response to the individual needs of each woman and her baby.”

Research evidence shows a range of benefits when women are cared for by known midwives from early in pregnancy till well after the birth. These include fewer admissions to hospital antenatally, less need for epidurals or for any pain relief, fewer episiotomies, more normal births, reduced need for their baby to be admitted to a special care nursery, more success with breastfeeding, and less vulnerability to postnatal depression or anxiety.
“Health Minister Nicola Roxon is to be commended for listening to Australian women during the recent national review of maternity services and for acting on the evidence that their needs could be better met with greater access to continuity of care by midwives, said Assoc Prof Dahlen

“These reforms pave the way for tens of thousands of women and their families to benefit from continuity of midwifery care while maintaining Australia’s solid record of safety for mothers and babies,” said Assoc. Professor Dahlen. “The confidence the government has expressed in midwives through these major reforms will be embraced by the profession around Australia.”

“Today the government has honoured women and motherhood in this country and recognised that ‘the hand that rocks the cradle’ does indeed ‘rule the world,’ and that we as a society need to support women and invest in the future– our children,” said Associate Professor Dahlen.

For further information contact the Australian College of Midwives www.midwives.org.au

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.

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.

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 Mum....am 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.

Number forty six

All good things come to those who wait. (Yes bold Em, I'm talking to you).

Today I was unexpectedly sent to LBS.

I arrived 4 minutes after the birth of a little one, to a primip who had laboured beautifully and quickly, a few stitches (not by me), done and dusted. I had a student midwife with me who was just terrific, really efficient with obs etc. The couple were pretty pleased with themselves, baby fed promptly, gave him his top to toe check on Mum's tummy, he was really relaxed. All was good.

Mum was in the shower and almost ready to go to the ward when I was called to another room.

It was another labouring primip, already 7cm dilated. I took handover and she stayed standing up at the windowsill. She was attended by husband and mother who were doing really well with massage, and she was rocking, not making much sound.

After a while she informed me there was 'something there'. I peeped and there was a pouting bottom, that went away with the contraction's end. But I knew there was a baby not far behind!

I kept peeking up her dress with contractions, seeing a bit of poop here, a bulge there. She was trying not to push, just let the contractions do the work.

It worked. What a genius, what a natural she was.

On the fifth look, there was definite perineal bulging and .....a head on view! I got the hubby to push the bell to call another midwife for the imminent birth, and asked her if she wanted to stay standing up for the birth. No, I want to get on the bed. Then you'd better be quick! I replied.

The second midwife turned up, I got my gloves on and the head was there, then slipped back after the contraction. Just enough time for the student midwife to come skidding in the door and scramble into a pair of gloves. We caught the baby together after a slow and gentle crowning, then a quick restitution and baby slithered out in a hurry, with a hand under the chin.

What is it? Mum asked - I don't know - you tell me! Its a girl! she cried Yes! I prayed for this!

There were sobs of delight, repeated thankyous and much joy in the room. Baby A blinked and looked around at all the grinning adults, pink and perfect and alert. She was calm and observant and very pretty. Her parents were just delighted, and so they should be. We midwives were most fulsome in our praise for them too. Such a clever woman, such a fantastic labourer, she made it look easy. We were stoked.

Unfortunately there were quite a few stitches needed here and there, nothing catastrophic but a bit ouchy initially. She was really great again, and turned to me for support during the stitching, which doesn't often happen, but I was really pleased to be 'with woman' in this way. She slipped her hand in mine, our heads were close and she asked softly that I tell her a story...so I began.

Once upon a time...there was a lovely young woman who was having her first baby, and when it was time to labour she was really brave and strong and beautiful and stayed home for a long time while her contractions came thick and fast. And when she got to hospital she was already near the end. And so she kept labouring beautifully, talking to her midwife when she needed to and telling her when the baby's head was there. And then she pushed out her baby easily and calmly, and everyone was very proud of her, and she was proud of herself, because she had done an amazing job bringing her baby to the world. What a miraculous thing is the female body, and the process of birth. God is very good.

It was such a special thing. I have never had a woman ask me for that before, and I was surprised that I slipped so automatically into storytelling mode, as if she was a child. She wasn't of course, but it seemed right. And she responded shyly but with delight to hear her tale already the stuff of legend. I told her that she should think about having her next baby at home, or in a birth centre as she had done so well she was an ideal candidate.

The baby remained calm and alert, and fed well and easily. It was really special. Her prayers were answered...and so were mine.

How delightful to spend the day with two new mothers who birthed with such power and ease. With two sweet, calm babies who didn't fuss but just responded well to their natural instincts. And to work with a student midwife who was so competent and thoughtful. We had a chat at tea, about how moved we frequently are at seeing women birthing so strongly, trusting their bodies to follow the physiological process, and how it all can go so smoothly. It is a privilege like no other, to be a witness to these births.

To top off our lovely day, on the board where the women's names are logged room by room, and they are noted as 6cm, delivered, or whatever, next to our room the coordinator had written:

"Delivered, beautifully"

I love being a midwife

Down time

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

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


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

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

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

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

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

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

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

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

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

December begins.

(images from Google, - thanks Google,- except for the last one)

If you're reading this you are alive. Yes indeed. More fortunate than nearly 200 people in Mumbai. What a waste of life. A shocking, shocking waste. For no purpose, by brainwashed people who think it is a perfectly valid thing to do to fellow human beings. I hope I never understand that mentality. Clearly their parents, or other influential adults in their lives have severely failed them. I have been to Mumbai, seen and been inside some of the buildings involved, breathed the same air as those mowed down. Senseless, inexpicable stuff. I hope India recovers its spark, its such an incredible place.

It IS December, and its very strange to be home alone. Steff has gone to Melbourne to spend time with my sister and her cousins. Much planning involved. It is our chance for a rest from the High School Musical soundtrack, Hannah Montana, Pokemon and Saturday Disney, cat-obsession and narrow food-choices - and her chance to have a break from us too. She's had a tough year, its been a struggle. Its a good break for all of us. I hear she's having a great time, and has many plans for the week ahead.

My plans for the week involve a list of errands of boring stuff, which I am alternating with creative interesting things that I can do while free to gallivant. You all know what boring stuff looks like so I'll spare you that list...but the gallivanting! Oh the gallivanting!

I have started the painting. What painting? THE painting. We have been looking for a piece of art in a horizontal format to go between the sofa back and the overhead mounted bookshelves. A tricky space dimensionally. Pretty dumb planning on our part I suppose, but it was filled with framed kids art for years and has only recently been calling for an alternative. We have looked for over a year. It is very unusual to enter a gallery and head straight for a particular size, rather than a colour or subject. We then look at everything in that size. We looked. And looked. Without finding anything that we loved, or even liked enough to date (one of the galleries allows home visits, for getting to know you purposes). Exhibition after exhibition, empty-handed, stony-hearted, except with the sneaking suspicion that I/we could have a go at doing something ourselves.

Ages ago we bought a canvas, plus two smaller side canvases to completely fill the space, (to complete the artistic series, doncha know). Finally this weekend I tackled it. On Saturday evening as I was about to dish up dinner (literally) I was seized with the urge to prepare the canvas. While the chips were in the oven I set up at one end of the long outdoor table and primed it in a soft clay/camel brown. I then set up the other end with the tablecloth, cutlery and glassware. We ate outside, trying to ignore the large brown thing at the other end of the table.

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

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

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

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

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

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

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

Progress report (now with random photos)

Well, my to-do list still looks a bit sick. (I've taken a leaf out of Frogdancer's book and illustrated with holiday snaps- the photos are from the Italian leg of our trip last year, on the theme 'Rome wasn't built in a day') Catch more babies - Nope - not a one. Despite the best efforts of my colleagues to fling all multiparous and other quickies in my direction.

I had a day in the assessment unit - where it is frowned upon to catch babies unless you genuinely have ZERO time to whizz them around the corner.
I spent a shift with a delightful young primip who spoke minimal English (my French was fairly rusty, oui, c'est vrai). Her trace looked like crap (she was on the trace due to augmentation of labour) and the baby heartrate kept bottoming out, so needed to go for CS. Bummer. Near perfect gases. Cord only around the kid once, but had been in a spot that got squashed a lot and made the trace look crappy. The heartrate did take time to recover, more each time, and can only do that for so long, but it was disappointing for everyone. Baby came out squawking. Happy Maman and Papa. (Hopefully happier than this Maman below, Michaelangelo's finest work, the Pieta. Forget the Sistine chapel. This is it. Oh, and his David - who is also utterly magnificent.)
Today I came on to two delivered women. One was asking about circumcision for her new son - she wasn't too fussed whether it happened or not, just thought it was what you did. "In the olden days: we know better now, why cut something off when you can just wash it?" I told her. Thats the way God makes 'em, might as well leave them alone! Besids - he'll be the odd one out, it is so rare to find a circumcised boy under the age of 20 in Australia. (and thats a good thing) She was most relieved, it was one less thing to accomplish, and once I gave her the script to brush off enquiries from old-style pressure groups she was very happy to leave him as nature intended. We had a brief discussion about how to care for it (self-cleaning mostly, or just a swish until it pulls back fully and needs to be gently attended to by the fella himself) and then talked about Sci-fi fantasy books! (these look a bit like bookends to me)I was then sent to collect a multip who was a sure thing for a catch. A nice couple with a good history of spontaneous easy birth, including a multiple birth. Nix. Nada. Bupkiss. I even stayed behind nearly two hours after everyone else from my shift,but she went off the boil, even after rupture of membranes. I have just phoned - she had her son two hours after I left. I'm pleased for her, but sheesh. What does a midwife have to do? No-one else was scoring any babies either today, it was uncharacteristically slow, and two rooms were closed for water leaks! But I will be heading to the ward this week, and not be rostered back on LBS for a long few months. My catches remain at 45!
My perineal repairs remain at zero. No catches, no repairs. Easy equation. Not much call for it on the ward either (one hopes). Even less in clinics or VMS!

K2 CTG training remains unfinished - I have had no time to complete it at work this week, but can access it from home and will apparently be paid for the time I take from home. It is very interesting to do, I am refreshing and building on my knowledge. Its great.

The mentoring is all sytems go. We will meet soon, but had a brief catch-up at work, during which she beamed when I said Yes. A good sign. I have a few things planned to start with already. She is an interesting woman and its a good challenge for me professionally.
I have had a pretty definitive NO about getting some temporary work in the birth centre, more's the pity. Ah well, when one door opens another may open. I'll keep my ear to the ground for suitable continuum opportunities.
At home - I have been struggling a bit with a sore throat this week, along with an unwell hubby with a viral illness. Its not like him to take time off work, let alone go to the doctor and he has done both this week. He's not sleeping well, but I think it is starting to lift, and he is finally accepting that pain relief IS a necessary part of coping with sinus pain. He does allow a bit of cossetting every now and then.
I saw my Mum - who was not terribly cheerful or positive following her trip. We went out to a rose nursery near her place to get some rose bushes struck from a cutting I had taken of a stunning climbing rose 'Chrysler Imperial' with a heady fragrance. It was a favourite of my Dad's - I'm sure I've posted about it before. However the nurserywoman was most blunt - nuh, wrong time of year. Nuh, got no root stock to graft it onto. We finally dragged the month of January out of her as a good time to try again. Customer service training surely can't cost too much can it? Heavens above, at least be forthcoming with information - we were the only customers in the whole enormous place - it can't be too hard. To top off our frustration the nursery cafe where we had planned to have lunch was also not open on the day of our visit. I could feel a Mum-shaped meltdown coming on, so we wandered out to distract her and bought some new roses instead. Sigh. They also had some very pretty decorator pots which made a lovely advance birthday gift for Mum. Another gift off the pressie list.

Oh yeah, make a list, check it twice....that was on my to-do list. DONE!!!! Yay! Now to get to the shops and achieve the purchasing, or do the making......
Minimal crafting achieved this week, apart from... oooh I lie! I made two little button bracelets on Wed night at swimming. And I altered a polo shirt for work by appliqueing some pretty bright rose print cutouts over a very unattractive logo on the breast of a new white polo shirt, and adding a matching trim around the collar to cover up an orange stripe. I don't do orange. It doesn't suit me. But the alteration worked out well, and I wore it to work successfully (successful in the fashion stakes, not the baby-catching stakes, sigh). I even sold a bag this week! Which inspired me to stitch a few more. I may join Calamity Kim and make a craft pledge to make 3 small items a week in 2009. Just competing with myself, but also for etsy stock. (shop still empty, I'll blow the horn when its open). Its not like I don't have the stash!

Speaking of which...House still a tip? Check!

Purchased Xmas tree? Nope. The hunt continues, I seek them everywhere I go.
(BTW - we have absolutely NO idea what this item above is. They were fixed to the walls at regular intervals in many places in Rome, Siena and Florence and are at about head height to me. But we took a photo, and I love it 'cos it shows Don's hand. I love his hands)

More op-shopping. I found a blue cowgirl + tiara hat! I need it. Truly. The theme for our staff Xmas party is Country and Western! See - I DO need it. And the matching shirt, which hubby will claim when I'm finished with it. We also found some gorgeous Bally shoes for Steff. $10. Worn once. Very stylish black and cream loafers with sedate tassles. Di-vine. Italian leather designer shoes. We were suitably stoked (I bet Kelley is very jealous - do you have teeny-tiny micro feet? Cos Steff does!) And a sassy tote bag for fun. It is a rare day when our local Vinnies doesn't give some sugar!

Enough rambling on .... Be good.