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.
Showing posts with label breastfeeding. Show all posts
Showing posts with label breastfeeding. Show all posts
Thursday, July 9, 2009
Saturday, December 27, 2008
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!
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!
Friday, December 19, 2008
Baby talk.
One of the downfalls of night duty is inconsolable babies.
They are inconsolable because their mothers are shattered by hours or days of labour. Their mothers are sucked out husks, facing their second or third night without sleep, with tender inexperienced nipples. They are stroppy babies who haven't read the books on normal physiological lacation processes and therefore are really keen for some stomach filling, like, NOW. They suck and suck, and don't feel right unless they are sucking, but until the milk comes in they are not getting full bellies and therefore are driven to keep sucking. They are dry, pass almost no urine, and run a bit warm as is normal in slight dehydration - all normal for babies of around 48 hours of age. And their mothers are so tired they keep falling asleep and are worried they will drop the baby. And their nipples are tender. And they are often a bit sore, or have mobile phones going at all hours of the day and night!
The woman who has a CS is marooned in bed for those first 12 hours or so, unable to lift the baby in or out by herself, with catheters, drips and epidurals to contend with. The CS may have been planned or an emergency, so the woman is often utterly exhausted after an induction of labour, which has not been successful i.e. the door (cervix) did not open so the baby couldn't be born. It is a lot to take in.
The night midwife is a big part of the adjustment process to new parenting, especially for the woman who has had a caesarean. There is an enormous amount of physical care, including monitoring blood loss and fluid balance, full assistance with breastfeeding, teaching as you go, as well as the emotional care of a woman who is adjusting to the first hours of mothering in a (mostly) unexpected way.
These last 3 shifts I have cared for a number of primips (first timers) some with unexpected CS. One had had many miscarriages and was very unsure of every sound the baby made, every whimper in his sleep, how many sucks it took to constitute a breastfeed - she was a bit incredulous that it needed at least 10-15 mins of a consistent sucking pattern to be called a good feed on day 1 of life. She had read all the books, imagined how her first breastfed would be, and planned every aspect of her skin to skin contact with this baby...following a vaginal birth... but had not made a contingency plan for any other outcome. Luckily her baby seemed to have a pretty good idea that the principles were the same - get a good position, line it up, shape the breast/areola and get a good deep mouthful with the tongue under the breast. And suck away! Bliss! He'd read the books too! Mum had so many questions, needed so much reassurance of normality, and rang the bell every 20 minutes! For her water jug to be filled up (it still had 1/3rd left). Give me strength.
I had had similar nights for the last 2 nights, with the woman in the next room sitting on the bell for every mortal thing. Wrap my baby, burp my baby, pour me a drink. Sure sweetie, I'll be right back. (staggers off, gnashing teeth, wondering how the other 6 women in my care are doing as I wear a path to her door). Some nights are just like that.
Last night I had 6 women and 4 babies, three of whom were inconsolable at regular intervals for long periods. They were all really sucky babes, waiting for their Mums' milk to come in.
The other midwives are as helpful as they can be. Any spare pair of hands is cuddling a fractious baby to give Mum a break for an hour's sleep if we can hold baby off for that long. Last night I had a scrawny little chap who could suck for Australia, miserable without a boobie in his mouth, who nearly sucked the meat off the bones of each of my (clean) little fingers in turn. I only managed to get 70 minutes sleep for his young mum, who was knackered, but her breasts were filling well and I think he'll be very satisfied with the offering today!!!
One baby was really loud. I mean REALLY LOUD. I had seen another midwife with her the previous night, squawking the place down as she was bathed to try and calm her. She wanted a burger, with fries and a milkshake and she wanted it NOW NOW NOW. No chance. I tried to talk soothingly to her, I tried joking with her - she was NOT amused, and I was glad i didn't have her in my tribe that night. Oops - guess who I got last night? Her Mum was really patient with her, and fed her well and readily, but was dropping off the perch with exhaustion. There was a small volume of formula in the room when I started the shift, warming, ready to be finger fed (a method of sucking the formula through a straw like device that feeds in next to the pad of a finger in the baby's mouth). We really try hard not to offer formula, and NEVER mention the possibility of using it to mums. However it seemed mum had asked for a top-up in desperation as nothing would console this child other than a continuous boobie fest. The nipples were a bit tender and grazed despite good attachment. We had the talk about breast comes first, second and third. We agreed to try for another hour or so before offering the formula. In the end we offered it just after midnight. Baby scoffed it down, sucking hard. And finally conked out. I tucked the two of them into their beds and turned out the light. In the morning Mum looked like a new woman after a four hour sleep. Baby was just stirring, still no urine but she had pooped, and pooped again as Mum changed her nappy - she was delighted to see it and laughed and laughed! Nothing like a bit of sleep to restore the sense of humour.
Women need the right information to promote and initiate and sustain breastfeeding. Its a difficult phase, those first few days, waiting for the breasts to kick in. I am a passionate breastfeeder, I know alot about it and I am, I believe, a strong advocate for breastfeeding. But I do also believe there is sometimes a place for the use of something else temporarily, especially in the baby who can suck for the national team. Sometimes you see half-assed, can't be bothered semi breastfeeding, where the breast sort of gets the stimulus it needs to kick into gear, but the baby is not encouraged to stay for long feeds, and growth spurts are not factored in. Building of supply is not factored in and 10 minutes a side each 4 hours just won't cut it after three days or so. Some cultures seem to mix and match, offering bottles freely until the milk comes in, and they then establish a long feeding relationship purely breastfed. Some people genuinely don't care if they feed or not, or have always felt it was not likely to be their thing, and that is honestly fine by me. The sky will not fall in. As long as they are sure. But if they want good information on how to do it, just ask me.
In the meantime, my little fingers will be well used!
PS Our friend A has still not been seen the incident, much instability, occasional phonecalls and cancelled plans. Daughter very anxious and worried, send good vibes.
PPS Sister back - Yay! No job offers for her daughter yet, sadly a No from the locals. (Bloody Sydney Dance Company shuffling staff and catapulting others into job queues ahead of talented newly qualified dancer, grumble, grumble)
They are inconsolable because their mothers are shattered by hours or days of labour. Their mothers are sucked out husks, facing their second or third night without sleep, with tender inexperienced nipples. They are stroppy babies who haven't read the books on normal physiological lacation processes and therefore are really keen for some stomach filling, like, NOW. They suck and suck, and don't feel right unless they are sucking, but until the milk comes in they are not getting full bellies and therefore are driven to keep sucking. They are dry, pass almost no urine, and run a bit warm as is normal in slight dehydration - all normal for babies of around 48 hours of age. And their mothers are so tired they keep falling asleep and are worried they will drop the baby. And their nipples are tender. And they are often a bit sore, or have mobile phones going at all hours of the day and night!
The woman who has a CS is marooned in bed for those first 12 hours or so, unable to lift the baby in or out by herself, with catheters, drips and epidurals to contend with. The CS may have been planned or an emergency, so the woman is often utterly exhausted after an induction of labour, which has not been successful i.e. the door (cervix) did not open so the baby couldn't be born. It is a lot to take in.
The night midwife is a big part of the adjustment process to new parenting, especially for the woman who has had a caesarean. There is an enormous amount of physical care, including monitoring blood loss and fluid balance, full assistance with breastfeeding, teaching as you go, as well as the emotional care of a woman who is adjusting to the first hours of mothering in a (mostly) unexpected way.
These last 3 shifts I have cared for a number of primips (first timers) some with unexpected CS. One had had many miscarriages and was very unsure of every sound the baby made, every whimper in his sleep, how many sucks it took to constitute a breastfeed - she was a bit incredulous that it needed at least 10-15 mins of a consistent sucking pattern to be called a good feed on day 1 of life. She had read all the books, imagined how her first breastfed would be, and planned every aspect of her skin to skin contact with this baby...following a vaginal birth... but had not made a contingency plan for any other outcome. Luckily her baby seemed to have a pretty good idea that the principles were the same - get a good position, line it up, shape the breast/areola and get a good deep mouthful with the tongue under the breast. And suck away! Bliss! He'd read the books too! Mum had so many questions, needed so much reassurance of normality, and rang the bell every 20 minutes! For her water jug to be filled up (it still had 1/3rd left). Give me strength.
I had had similar nights for the last 2 nights, with the woman in the next room sitting on the bell for every mortal thing. Wrap my baby, burp my baby, pour me a drink. Sure sweetie, I'll be right back. (staggers off, gnashing teeth, wondering how the other 6 women in my care are doing as I wear a path to her door). Some nights are just like that.
Last night I had 6 women and 4 babies, three of whom were inconsolable at regular intervals for long periods. They were all really sucky babes, waiting for their Mums' milk to come in.
The other midwives are as helpful as they can be. Any spare pair of hands is cuddling a fractious baby to give Mum a break for an hour's sleep if we can hold baby off for that long. Last night I had a scrawny little chap who could suck for Australia, miserable without a boobie in his mouth, who nearly sucked the meat off the bones of each of my (clean) little fingers in turn. I only managed to get 70 minutes sleep for his young mum, who was knackered, but her breasts were filling well and I think he'll be very satisfied with the offering today!!!
One baby was really loud. I mean REALLY LOUD. I had seen another midwife with her the previous night, squawking the place down as she was bathed to try and calm her. She wanted a burger, with fries and a milkshake and she wanted it NOW NOW NOW. No chance. I tried to talk soothingly to her, I tried joking with her - she was NOT amused, and I was glad i didn't have her in my tribe that night. Oops - guess who I got last night? Her Mum was really patient with her, and fed her well and readily, but was dropping off the perch with exhaustion. There was a small volume of formula in the room when I started the shift, warming, ready to be finger fed (a method of sucking the formula through a straw like device that feeds in next to the pad of a finger in the baby's mouth). We really try hard not to offer formula, and NEVER mention the possibility of using it to mums. However it seemed mum had asked for a top-up in desperation as nothing would console this child other than a continuous boobie fest. The nipples were a bit tender and grazed despite good attachment. We had the talk about breast comes first, second and third. We agreed to try for another hour or so before offering the formula. In the end we offered it just after midnight. Baby scoffed it down, sucking hard. And finally conked out. I tucked the two of them into their beds and turned out the light. In the morning Mum looked like a new woman after a four hour sleep. Baby was just stirring, still no urine but she had pooped, and pooped again as Mum changed her nappy - she was delighted to see it and laughed and laughed! Nothing like a bit of sleep to restore the sense of humour.
Women need the right information to promote and initiate and sustain breastfeeding. Its a difficult phase, those first few days, waiting for the breasts to kick in. I am a passionate breastfeeder, I know alot about it and I am, I believe, a strong advocate for breastfeeding. But I do also believe there is sometimes a place for the use of something else temporarily, especially in the baby who can suck for the national team. Sometimes you see half-assed, can't be bothered semi breastfeeding, where the breast sort of gets the stimulus it needs to kick into gear, but the baby is not encouraged to stay for long feeds, and growth spurts are not factored in. Building of supply is not factored in and 10 minutes a side each 4 hours just won't cut it after three days or so. Some cultures seem to mix and match, offering bottles freely until the milk comes in, and they then establish a long feeding relationship purely breastfed. Some people genuinely don't care if they feed or not, or have always felt it was not likely to be their thing, and that is honestly fine by me. The sky will not fall in. As long as they are sure. But if they want good information on how to do it, just ask me.
In the meantime, my little fingers will be well used!
PS Our friend A has still not been seen the incident, much instability, occasional phonecalls and cancelled plans. Daughter very anxious and worried, send good vibes.
PPS Sister back - Yay! No job offers for her daughter yet, sadly a No from the locals. (Bloody Sydney Dance Company shuffling staff and catapulting others into job queues ahead of talented newly qualified dancer, grumble, grumble)
Thursday, October 9, 2008
Second stage
Hello again world.
I had 2 lovely shifts with a student midwife earlier this week. Yes, really, and no drama was attracted! It was such a wonderful change (for us both). We were both just delighted with our birth together on Monday.
We entered for an afternoon shift to an 18 year old primip who had just achieved full dilation about 30-ish minutes ago. Her morning midwife was gentle and very low-key and non-interventionist, and has recently returned to the hospital after a long stint working with homebirths, so I knew she had really good assessment skills and faith in the natural process. It was a spontaneous labour and the room was calm, and the only attachments were the CTG because the woman had opted for an epidural. She was standing at the foot of the bed as we entered and the bed was arranged as a big low armchair for her to sit upright in if she wanted to. It was good to see it like that, I had forgotten that it could be put in that arrangement.
We were waiting for the contractions to do the work of inching the baby closer to the exit for the next hour before starting any active pushing. So we just encouraged her to stay upright and rest as she was comfortable with her epidural and quite mobile as well. Its a good combination when you can get it. She had her Mum and a sister-in-law with her, her partner was quite squeamish and was waiting outside by mutual consent. This was women's work.
After a while it was time to start having a push. It often takes a long time to get the hang of pushing a baby out, especially in a woman with an epidural. They don't get the same sensations of the baby within that an undrugged woman does, nor do they get the expulsive reflex that is just irresistible and almost pleasurable. The midwife uses words to guide her pushing efforts, or gives feedback as she can see the progress (or lack of it) of the push. It is a tricky process. I usually start by describing what I'm looking for - a flowering open of all the bits that are usually tucked up, as they expand in the way Nature designed. I will see an expansion of the perineal area, a parting of the labia, a pouting of the bottom, a tiny bit of stool pushed out in advance of a descending head - these are the signs we look for that tell us descent is happening. Most women are (understandably) reluctant to think of the appearance of poop as a 'good thing' but we midwives are very encouraged by it.
At 1.45 she started pushing. Her contractions were quite short, and it was difficult to get much momentum going with the pushes as they would die away just as she got to full push power. There was nothing visible after half an hour of pushing. One of the docs came in and suggested a bit of synto to help strengthen and lengthen the contractions, as she was well covered by the epidural and it shouldn't distress her. So we all agreed on that, and stopped pushing for 45 minutes to let them build up and for more descent. She walked to the toilet, remained upright, and saved her energy while we went to tea.
At 3pm we started again. The woman was really mobile and I was confident that she could position quite freely to assist descent. The baby wasn't huge, but the other midwife felt the head was sitting a little tilted off to one side instead of presenting the central back of her head to the exit. I hadn't examined her at all, but trusted the assessment, and the slow progress with pushing backed it up. The answer in this situation is positioning. Keep moving. Have three contractions in that position - if no progress - CHANGE something. Free mobility is really so useful in second stage - e.g. walking up stairs, crawling up or down stairs, lunging or clambering like a bear up on the bed or over a chair can shift the angles of the head in relation to the pelvis and provide that 'give' that gets things moving. So in this case, with a young fit, mobile young woman I was determined to give it a go, and keep birth normal!
I can't do it, its not working she cried. Nonsense - it just hasn't worked yet sweetie. You're doing so well, you're really actively giving birth here, not having it taken from you. Pull it out, suck it out! she moaned. No, we may need to ask for a hand in a while, but first we need to know you have tried everything! Leave no stone unturned for you to give birth unassisted and push this baby out on your own. She agreed that was worth doing.
By this time I had her standing on one leg with her other leg kneeling up on the bed at near right angles. I was kneeling behind her, gently stroking the base of her spine and hips, encouraging her to rock in wide circles while I spoke soothingly to her, encouraging her to sway her pelvis to shake that baby loose. She was in a bit of a trance. With each push she would strain, and then hold back as she sensed something shift. She didn't want to poop or fart. I told her quite plainly that I would cheer if she farted in my face! It would mean something was moving. We all had a laugh and with the next contraction a teeny bit of poop came out - hooray we were on the move!
The morning midwife was due off shift, but was keen to see a bit of this baby's head. Alas that bit of poop was all we could manage for the next 15 minutes. She went off after giving a top-up of the epidural as the woman was feeling the contractions again and we felt the relaxation of less pain for her would help us all out if it was going to be a long process, and frankly, with such slow progress it was likely she would end up with an assisted birth. She left at 3.35pm.
A bit more poop. Change position. Back onto the bed to push sitting back a bit, on the side now. More poop. Finally we had some labial parting, but then she would hold back when it moved forward - it does feel a bit freaky, but I remind women that if it feels scary you're doing it right! I encouraged her to feel inside and tell me what she could feel. She was reluctant, but I could do it if I wanted to. There was a little head about an inch inside. Swollen on top but finally close to the world. With the next contraction she had a go and felt it too. Eee-ew! she said and wiped her finger- but her eyes lit up a bit - it was real. There really was a baby coming! It was 3.45pm.
The contractions were still quite short, but I would get her to do 'one more push for luck' as it was easing off, which unless I asked for it she would try and get away without doing it. 18 year-olds are so cheeky! It became a running joke. At 3.47 there was enough labial parting to get a peek of the head with pushes. Head on view. At last. The trace never looks good with pushing especially at this late stage. It is physiologically normal for the heartrate to reduce with the contraction and expulsive effort, and to recover between contractions as the squeeze is off, but it is watched nervously nonetheless and with central monitoring there are often many people watching. This means that there will frequently be someone at the door asking if things are alright, or actually entering the room and tempted to intervene if they don't quite trust that things are well or moving fast enough.
That little head stayed elusively away from the exit. She just wouldn't crown. I started to mentally prepare for a shoulder dystocia (as is often preceded by slow descent) and quietly communicated this to the student, planning which side we would apply suprapubic pressure from and getting the bed controller at the ready for fast maneuvring in case of emergency.
I heard the door open as she was pushing again. I spoke more loudly than I usually do and said "good girl, yes, thats much more head than we've seen so far, ooh look at that hair! Good pushing, nearly there" as the feet at the curtain identified themselves as the consultant. A quick peep around the curtain to glimpse the vertex for himself and he melted away again with encouraging noises. It was 4pm.
With the next contraction there was a little more head to see, but still not too much. I examined her to see if there was a band of tight tissue, considering an episiotomy, and feeling only a smallish band of the hymenal ring, but a lot of moulding of the head and it was still a bit tilted. It was a tightish fit (what you would expect really) but I could slide my finger all around the head and couldn't feel a hand as well or anything, so we would just wait. Maybe consider legs pulled right back, and recline back a bit more. Ah there we go, thats the best we've seen, we are nearly crowning now. The shortish contractions inched along but came frequently enough. The woman was getting desperate despite our encouragement - can't you suck it out? No honey - its honestly not worth opening the sterile packs - baby is right there. Don't give up, she'll be here any minute. She could shoot out like a pea with the next contraction. It was 4.15.
I heard the sound of the vacuum trolley being wheeled outside the door. At 4.17 the door opened again. It was the young female doctor who started the synto. Ah very clever, she cried as she could see the almost crowning head. Our eyes met and we were thinking the same thing. She came in for backup- we both prepared for a shoulder dystocia by dropping the head of the bed, with legs pulled back. Finally the head crowned, followed slowly by the face and then the chin. We waited for a turtle sign, where the chin pulls back into the vagina as the shoulders hook up on the pelvis. No turtle sign, feel around for a cord at the neck, no, no cord, ready student? Its all yours, OK hon one last push now - here she comes! It was 4.20pm and cheers erupted in the room, the young Mum was sobbing with relief and joy, her Mum was misting up and SIL too, and she came forward to cut the cord. Little Aliyah was a bit stunned but soon had a brief yell and then lay frowning and blinking on her mother's chest in the afternoon light as she was cuddled and wiped.
What an effort! A three hour fifty minute second stage. Admittedly with an hour and a bit for descent initially, followed by another 45 minute rest, but it was still pretty prolonged for a hospital birth and she still managed to push her baby out. We were all absolutely rapt. I felt like a Midwife! It was rare to get the space to conduct such an active second stage, with minimal intervention from docs or others, and the woman herself was just terrific. She tried so hard, and pushed so hard, and cooperated, and hung in there despite collywobbles at times. It was such a group effort. We were all just thrilled to bits. And an intact perineum with minimal blood loss. Baby number ten for the student midwife, who was just tickled pink. She too felt we had dodged a bullet, no assisted delivery, a truly active second stage even with the epidural. She said she learned so much about positioning, and moulding and understanding the principles of descent and pushing with an asynclitic presentation (the tilted head). It was just great.
Dad came in within minutes and was suitably delighted and misty to meet his daughter. Baby Aliyah saddled up for a feed promptly, and boy could she suck! What a talent. Her mother had great nipple shape too so it was easy to put it all together with minimal assistance from us. We couldn't praise them enough.
I saw them again the next day and they were doing just great, all smiles, very comfortable and pleased with themselves. What a lovely start for this little family. I'm so pleased for them.
The morning midwife saw me the next day and was skipping that we had achieved a spontaneous birth. I was still grinning too! I swear I must have had the Jedi mind control that day - to talk soothingly to all the docs and others, reassuring them and having them melt away while we had that head on view for so long. It was fascinating, and I suppose that they must have had confidence in me to call them if we needed help. I was completely fine with the backup of the doc at the last minute, in cases of shoulder dystocia you don't want to muck around, but the student midwife got the catch after all her hard work that afternoon. It was win-win.
Our next shift together was also terrific, a lovely woman and her husband and Mum, where she had had a shoulder dystocia with her previous birth, so it was certainly the flavour of the week! She laboured really intensely with us all shift, and we were sure we would get to see her little one, but she went on to birth an hour or so after the end of our shift. The birth was straightforward with no emergency, so we were pleased to hear that even though we didn't get to see her baby.
Achieving that birth on Monday has boosted my confidence in my 'normal birthing' skills, that are easy to lose in a tertiary hospital environment. I do recognise normal. I can model the normal to my student midwife. I can keep birth normal. I can recognise if things deviate from normal and am trained to respond appropriately, but all the time I am shaping my care and responding to the needs of the woman at the centre. It is good to have this experience after a few weeks of turmoil and drama (which is still playing out).
I love being a midwife.
I had 2 lovely shifts with a student midwife earlier this week. Yes, really, and no drama was attracted! It was such a wonderful change (for us both). We were both just delighted with our birth together on Monday.
We entered for an afternoon shift to an 18 year old primip who had just achieved full dilation about 30-ish minutes ago. Her morning midwife was gentle and very low-key and non-interventionist, and has recently returned to the hospital after a long stint working with homebirths, so I knew she had really good assessment skills and faith in the natural process. It was a spontaneous labour and the room was calm, and the only attachments were the CTG because the woman had opted for an epidural. She was standing at the foot of the bed as we entered and the bed was arranged as a big low armchair for her to sit upright in if she wanted to. It was good to see it like that, I had forgotten that it could be put in that arrangement.
We were waiting for the contractions to do the work of inching the baby closer to the exit for the next hour before starting any active pushing. So we just encouraged her to stay upright and rest as she was comfortable with her epidural and quite mobile as well. Its a good combination when you can get it. She had her Mum and a sister-in-law with her, her partner was quite squeamish and was waiting outside by mutual consent. This was women's work.
After a while it was time to start having a push. It often takes a long time to get the hang of pushing a baby out, especially in a woman with an epidural. They don't get the same sensations of the baby within that an undrugged woman does, nor do they get the expulsive reflex that is just irresistible and almost pleasurable. The midwife uses words to guide her pushing efforts, or gives feedback as she can see the progress (or lack of it) of the push. It is a tricky process. I usually start by describing what I'm looking for - a flowering open of all the bits that are usually tucked up, as they expand in the way Nature designed. I will see an expansion of the perineal area, a parting of the labia, a pouting of the bottom, a tiny bit of stool pushed out in advance of a descending head - these are the signs we look for that tell us descent is happening. Most women are (understandably) reluctant to think of the appearance of poop as a 'good thing' but we midwives are very encouraged by it.
At 1.45 she started pushing. Her contractions were quite short, and it was difficult to get much momentum going with the pushes as they would die away just as she got to full push power. There was nothing visible after half an hour of pushing. One of the docs came in and suggested a bit of synto to help strengthen and lengthen the contractions, as she was well covered by the epidural and it shouldn't distress her. So we all agreed on that, and stopped pushing for 45 minutes to let them build up and for more descent. She walked to the toilet, remained upright, and saved her energy while we went to tea.
At 3pm we started again. The woman was really mobile and I was confident that she could position quite freely to assist descent. The baby wasn't huge, but the other midwife felt the head was sitting a little tilted off to one side instead of presenting the central back of her head to the exit. I hadn't examined her at all, but trusted the assessment, and the slow progress with pushing backed it up. The answer in this situation is positioning. Keep moving. Have three contractions in that position - if no progress - CHANGE something. Free mobility is really so useful in second stage - e.g. walking up stairs, crawling up or down stairs, lunging or clambering like a bear up on the bed or over a chair can shift the angles of the head in relation to the pelvis and provide that 'give' that gets things moving. So in this case, with a young fit, mobile young woman I was determined to give it a go, and keep birth normal!
I can't do it, its not working she cried. Nonsense - it just hasn't worked yet sweetie. You're doing so well, you're really actively giving birth here, not having it taken from you. Pull it out, suck it out! she moaned. No, we may need to ask for a hand in a while, but first we need to know you have tried everything! Leave no stone unturned for you to give birth unassisted and push this baby out on your own. She agreed that was worth doing.
By this time I had her standing on one leg with her other leg kneeling up on the bed at near right angles. I was kneeling behind her, gently stroking the base of her spine and hips, encouraging her to rock in wide circles while I spoke soothingly to her, encouraging her to sway her pelvis to shake that baby loose. She was in a bit of a trance. With each push she would strain, and then hold back as she sensed something shift. She didn't want to poop or fart. I told her quite plainly that I would cheer if she farted in my face! It would mean something was moving. We all had a laugh and with the next contraction a teeny bit of poop came out - hooray we were on the move!
The morning midwife was due off shift, but was keen to see a bit of this baby's head. Alas that bit of poop was all we could manage for the next 15 minutes. She went off after giving a top-up of the epidural as the woman was feeling the contractions again and we felt the relaxation of less pain for her would help us all out if it was going to be a long process, and frankly, with such slow progress it was likely she would end up with an assisted birth. She left at 3.35pm.
A bit more poop. Change position. Back onto the bed to push sitting back a bit, on the side now. More poop. Finally we had some labial parting, but then she would hold back when it moved forward - it does feel a bit freaky, but I remind women that if it feels scary you're doing it right! I encouraged her to feel inside and tell me what she could feel. She was reluctant, but I could do it if I wanted to. There was a little head about an inch inside. Swollen on top but finally close to the world. With the next contraction she had a go and felt it too. Eee-ew! she said and wiped her finger- but her eyes lit up a bit - it was real. There really was a baby coming! It was 3.45pm.
The contractions were still quite short, but I would get her to do 'one more push for luck' as it was easing off, which unless I asked for it she would try and get away without doing it. 18 year-olds are so cheeky! It became a running joke. At 3.47 there was enough labial parting to get a peek of the head with pushes. Head on view. At last. The trace never looks good with pushing especially at this late stage. It is physiologically normal for the heartrate to reduce with the contraction and expulsive effort, and to recover between contractions as the squeeze is off, but it is watched nervously nonetheless and with central monitoring there are often many people watching. This means that there will frequently be someone at the door asking if things are alright, or actually entering the room and tempted to intervene if they don't quite trust that things are well or moving fast enough.
That little head stayed elusively away from the exit. She just wouldn't crown. I started to mentally prepare for a shoulder dystocia (as is often preceded by slow descent) and quietly communicated this to the student, planning which side we would apply suprapubic pressure from and getting the bed controller at the ready for fast maneuvring in case of emergency.
I heard the door open as she was pushing again. I spoke more loudly than I usually do and said "good girl, yes, thats much more head than we've seen so far, ooh look at that hair! Good pushing, nearly there" as the feet at the curtain identified themselves as the consultant. A quick peep around the curtain to glimpse the vertex for himself and he melted away again with encouraging noises. It was 4pm.
With the next contraction there was a little more head to see, but still not too much. I examined her to see if there was a band of tight tissue, considering an episiotomy, and feeling only a smallish band of the hymenal ring, but a lot of moulding of the head and it was still a bit tilted. It was a tightish fit (what you would expect really) but I could slide my finger all around the head and couldn't feel a hand as well or anything, so we would just wait. Maybe consider legs pulled right back, and recline back a bit more. Ah there we go, thats the best we've seen, we are nearly crowning now. The shortish contractions inched along but came frequently enough. The woman was getting desperate despite our encouragement - can't you suck it out? No honey - its honestly not worth opening the sterile packs - baby is right there. Don't give up, she'll be here any minute. She could shoot out like a pea with the next contraction. It was 4.15.
I heard the sound of the vacuum trolley being wheeled outside the door. At 4.17 the door opened again. It was the young female doctor who started the synto. Ah very clever, she cried as she could see the almost crowning head. Our eyes met and we were thinking the same thing. She came in for backup- we both prepared for a shoulder dystocia by dropping the head of the bed, with legs pulled back. Finally the head crowned, followed slowly by the face and then the chin. We waited for a turtle sign, where the chin pulls back into the vagina as the shoulders hook up on the pelvis. No turtle sign, feel around for a cord at the neck, no, no cord, ready student? Its all yours, OK hon one last push now - here she comes! It was 4.20pm and cheers erupted in the room, the young Mum was sobbing with relief and joy, her Mum was misting up and SIL too, and she came forward to cut the cord. Little Aliyah was a bit stunned but soon had a brief yell and then lay frowning and blinking on her mother's chest in the afternoon light as she was cuddled and wiped.
What an effort! A three hour fifty minute second stage. Admittedly with an hour and a bit for descent initially, followed by another 45 minute rest, but it was still pretty prolonged for a hospital birth and she still managed to push her baby out. We were all absolutely rapt. I felt like a Midwife! It was rare to get the space to conduct such an active second stage, with minimal intervention from docs or others, and the woman herself was just terrific. She tried so hard, and pushed so hard, and cooperated, and hung in there despite collywobbles at times. It was such a group effort. We were all just thrilled to bits. And an intact perineum with minimal blood loss. Baby number ten for the student midwife, who was just tickled pink. She too felt we had dodged a bullet, no assisted delivery, a truly active second stage even with the epidural. She said she learned so much about positioning, and moulding and understanding the principles of descent and pushing with an asynclitic presentation (the tilted head). It was just great.
Dad came in within minutes and was suitably delighted and misty to meet his daughter. Baby Aliyah saddled up for a feed promptly, and boy could she suck! What a talent. Her mother had great nipple shape too so it was easy to put it all together with minimal assistance from us. We couldn't praise them enough.
I saw them again the next day and they were doing just great, all smiles, very comfortable and pleased with themselves. What a lovely start for this little family. I'm so pleased for them.
The morning midwife saw me the next day and was skipping that we had achieved a spontaneous birth. I was still grinning too! I swear I must have had the Jedi mind control that day - to talk soothingly to all the docs and others, reassuring them and having them melt away while we had that head on view for so long. It was fascinating, and I suppose that they must have had confidence in me to call them if we needed help. I was completely fine with the backup of the doc at the last minute, in cases of shoulder dystocia you don't want to muck around, but the student midwife got the catch after all her hard work that afternoon. It was win-win.
Our next shift together was also terrific, a lovely woman and her husband and Mum, where she had had a shoulder dystocia with her previous birth, so it was certainly the flavour of the week! She laboured really intensely with us all shift, and we were sure we would get to see her little one, but she went on to birth an hour or so after the end of our shift. The birth was straightforward with no emergency, so we were pleased to hear that even though we didn't get to see her baby.
Achieving that birth on Monday has boosted my confidence in my 'normal birthing' skills, that are easy to lose in a tertiary hospital environment. I do recognise normal. I can model the normal to my student midwife. I can keep birth normal. I can recognise if things deviate from normal and am trained to respond appropriately, but all the time I am shaping my care and responding to the needs of the woman at the centre. It is good to have this experience after a few weeks of turmoil and drama (which is still playing out).
I love being a midwife.
Sunday, September 7, 2008
Conferencing with the in-crowd
Yesterday was the conference for National Caesarean Awareness Day (NCAD).
It was organised locally by a fantastic group called Birthrites (link now repaired) who support woman after caesarean birth, and supported by a number of other sponsors including the Australian College of Midwives WA branch. It was attended by 77 registrants and held in the UWA Club in Crawley.
The theme of the day was "Getting clear about fear" and the speakers all discussed aspects of fear: women's fear of birth, professional fear, the illusion of control, the illusion of choice, experiencing a caesarean, planning the next birth after caesarean, psychophysical manifestations of fear, mythbusting the statistics used to deny women VBAC and so on. It was a marvellous day, very thought provoking, clarifying and inspiring. We all got to hang out together and have great discussions, great food and boost each other's energy.
NCAD Prizes were awarded to a midwife of the year, Sally Westbury, an independent midwife for her support of a woman wanting a VBA2C (a vaginal birth after 2 CS) which was achieved at home in a very culturally specific environment. The citation was superb. I was lucky enough to work for a few days with Sally in 2004 and greatly admired her down to earth style, I learned a lot from her. A second award was made to an obstetrician of the year for sensitive handling of a woman pursuing a VBAC in a hospital environment who, even though she ended up birthing by a repeat CS, felt Dr Sara Gibberd had been very kind, thoughtful and respectful of the woman at all stages of the labour and birth. The awards were well deserved by both.
Later this month I will be attending the national conference of the Australian College of Midwives in Queensland on the theme of Keeping Birth Normal. I'm sure it too will be invigorating and stimulating to take part in.
Work has been very busy this week. I only worked two shifts late in the week and will be on night shift from this Monday night. I worked with some really interesting couples, both overdue, one going for VBAC who ended up with a repeat CS after the cervix hadn't dilated after 9 hours of contractions. They were fairly OK about it, and were delighted that at least this time the husband would be present and the woman awake! Last time, in Korea, it was a general anaesthetic and she didn't see the baby for 2 days! The other couple were having their first baby and she was labouring spontaneously really well then got a bit stuck at 6 cm for 8 hours. I stayed as they were short staffed until after midnight, at which time they were going to put up some synto, but was pleased to see when I came the next morning that she pushed her baby out with no help just before 3am. Thank goodness it did the trick! I'm so pleased for them. They were such a nice couple.
Speaking of GA CS... young Zachary and his parents are doing well. I saw them all on Friday afternoon and he was being offered the breast! Both his chest tubes were out and he was nuzzling up and having a bit of a go. The SCN are taking such good care of them, I have seen the same nurses with them every time, they really could not be in better hands.
I also got to see an external cephalic version performed on Friday - where the doctor gently strokes and flips the baby from a breech position to a head-down position. I have always been elsewhere when one is happening, or the baby has been found to have already turned! It was really interesting to see performed, and it was good to palpate a breech so clearly. I wish there was more opportunity to get some breech experience in birthing, I've never attended (myself as primary accoucheur) a woman birthing a breech, although I have seen them done by others. I may have to wait a while :)
This time around I have been less distressed by working on LBS than I was when I first rotated there. I am certainly finding my feet. I am really enjoying being part of a team environment. Not team-style midwifery (although that would be great too), but feeling like a functioning member of staff. I'm really pleased to be getting to know my colleagues, and seeing how we all fit together and pull together in any crisis, or quiet time. I have taken pleasure lately in letting them know that I respect their skills and enjoy working with them. Some are surprised, but all are touched to be acknowledged. Not in a flashy way, just an aside to a patient (when seconding) about being in good hands, or 'I can't think of anyone I would rather have in a room in a tight spot'. I hope they don't think I'm weird that I give them this feedback. Maybe I come across as an over-thinking-brain (sigh, story of my life), but I do actively reflect on my practice and how I feel about each shift. Its important to give credit where it is due, and in a work environment where we are often under enormous pressure it is a small but vital courtesy to support one another.
Anyway.....I've been asked if I will consider doing some shifts in the Next Birth After Caesarean clinic at our hospital and I am very tempted. It is an area I am interested in, involves some antenatal work, and could lead to some caseload work, where I would be the primary midwife for a (bunch of) woma(e)n and follow her wherever she was in the hospital. It would mean less time to make Wild Women, and I have been commissioned to make 3 of them...I'll be having further talks I think. I could ease my way in.
In other news, we have a new side wall. Next-door is renovating and part of it involved the removal of a falling down asbestos fence and the building of a new you-beaut limestone wall for most of the length of the block. With the building demolition we have had no fence on that side for more than two months now, and in the last week it has been all go with the wall-building effort. There is now 300 tons of limestone between us and the neighbours, and a 150 ton hole in the bank balance, but it does look lovely. Next-door wanted their side to be flush faced and Perfect, especially at the part where they will have an outdoor room and eating area - close to our back door. We wanted our side to look more rustic and traditional. We both got what we wanted.
Hubby is beside himself with Spring delight planning the garden and patio renovations. Even I have had a look-in (and I don't do gardens or get my hands dirty) because it involves Entertaining and Roses - both of which I am entitled to an opinion on. The upshot is that the back patio - which looks HUGE - is to be gussied up with a pizza oven (long-term) and a new spot for the BBQ, with lighting etc, and the close patio will be reclaimed as a summer eating area, with a rejuvenated rose garden in between along with new ground covers and a wall-feature in the eating area. It is so nice to have our backyard privacy again. And I did get my hands slightly dirty today as I went to the nursery (gasp) and chose a new rose, and then helped to plant it!!!! I even chose some fun sunflowers to put along the western fence and planted those seeds too. You have now heard the sum-total of my gardening effort for the next 5 years. Seriously. I get to choose the wall-feature - I am thinking an old garden gate or an old wrought-iron shape/screen/something against the wall - I'll have fun visiting some scrap yards this week.
Have a good week!
It was organised locally by a fantastic group called Birthrites (link now repaired) who support woman after caesarean birth, and supported by a number of other sponsors including the Australian College of Midwives WA branch. It was attended by 77 registrants and held in the UWA Club in Crawley.
The theme of the day was "Getting clear about fear" and the speakers all discussed aspects of fear: women's fear of birth, professional fear, the illusion of control, the illusion of choice, experiencing a caesarean, planning the next birth after caesarean, psychophysical manifestations of fear, mythbusting the statistics used to deny women VBAC and so on. It was a marvellous day, very thought provoking, clarifying and inspiring. We all got to hang out together and have great discussions, great food and boost each other's energy.
NCAD Prizes were awarded to a midwife of the year, Sally Westbury, an independent midwife for her support of a woman wanting a VBA2C (a vaginal birth after 2 CS) which was achieved at home in a very culturally specific environment. The citation was superb. I was lucky enough to work for a few days with Sally in 2004 and greatly admired her down to earth style, I learned a lot from her. A second award was made to an obstetrician of the year for sensitive handling of a woman pursuing a VBAC in a hospital environment who, even though she ended up birthing by a repeat CS, felt Dr Sara Gibberd had been very kind, thoughtful and respectful of the woman at all stages of the labour and birth. The awards were well deserved by both.
Later this month I will be attending the national conference of the Australian College of Midwives in Queensland on the theme of Keeping Birth Normal. I'm sure it too will be invigorating and stimulating to take part in.
Work has been very busy this week. I only worked two shifts late in the week and will be on night shift from this Monday night. I worked with some really interesting couples, both overdue, one going for VBAC who ended up with a repeat CS after the cervix hadn't dilated after 9 hours of contractions. They were fairly OK about it, and were delighted that at least this time the husband would be present and the woman awake! Last time, in Korea, it was a general anaesthetic and she didn't see the baby for 2 days! The other couple were having their first baby and she was labouring spontaneously really well then got a bit stuck at 6 cm for 8 hours. I stayed as they were short staffed until after midnight, at which time they were going to put up some synto, but was pleased to see when I came the next morning that she pushed her baby out with no help just before 3am. Thank goodness it did the trick! I'm so pleased for them. They were such a nice couple.
Speaking of GA CS... young Zachary and his parents are doing well. I saw them all on Friday afternoon and he was being offered the breast! Both his chest tubes were out and he was nuzzling up and having a bit of a go. The SCN are taking such good care of them, I have seen the same nurses with them every time, they really could not be in better hands.
I also got to see an external cephalic version performed on Friday - where the doctor gently strokes and flips the baby from a breech position to a head-down position. I have always been elsewhere when one is happening, or the baby has been found to have already turned! It was really interesting to see performed, and it was good to palpate a breech so clearly. I wish there was more opportunity to get some breech experience in birthing, I've never attended (myself as primary accoucheur) a woman birthing a breech, although I have seen them done by others. I may have to wait a while :)
This time around I have been less distressed by working on LBS than I was when I first rotated there. I am certainly finding my feet. I am really enjoying being part of a team environment. Not team-style midwifery (although that would be great too), but feeling like a functioning member of staff. I'm really pleased to be getting to know my colleagues, and seeing how we all fit together and pull together in any crisis, or quiet time. I have taken pleasure lately in letting them know that I respect their skills and enjoy working with them. Some are surprised, but all are touched to be acknowledged. Not in a flashy way, just an aside to a patient (when seconding) about being in good hands, or 'I can't think of anyone I would rather have in a room in a tight spot'. I hope they don't think I'm weird that I give them this feedback. Maybe I come across as an over-thinking-brain (sigh, story of my life), but I do actively reflect on my practice and how I feel about each shift. Its important to give credit where it is due, and in a work environment where we are often under enormous pressure it is a small but vital courtesy to support one another.
Anyway.....I've been asked if I will consider doing some shifts in the Next Birth After Caesarean clinic at our hospital and I am very tempted. It is an area I am interested in, involves some antenatal work, and could lead to some caseload work, where I would be the primary midwife for a (bunch of) woma(e)n and follow her wherever she was in the hospital. It would mean less time to make Wild Women, and I have been commissioned to make 3 of them...I'll be having further talks I think. I could ease my way in.
In other news, we have a new side wall. Next-door is renovating and part of it involved the removal of a falling down asbestos fence and the building of a new you-beaut limestone wall for most of the length of the block. With the building demolition we have had no fence on that side for more than two months now, and in the last week it has been all go with the wall-building effort. There is now 300 tons of limestone between us and the neighbours, and a 150 ton hole in the bank balance, but it does look lovely. Next-door wanted their side to be flush faced and Perfect, especially at the part where they will have an outdoor room and eating area - close to our back door. We wanted our side to look more rustic and traditional. We both got what we wanted.
Hubby is beside himself with Spring delight planning the garden and patio renovations. Even I have had a look-in (and I don't do gardens or get my hands dirty) because it involves Entertaining and Roses - both of which I am entitled to an opinion on. The upshot is that the back patio - which looks HUGE - is to be gussied up with a pizza oven (long-term) and a new spot for the BBQ, with lighting etc, and the close patio will be reclaimed as a summer eating area, with a rejuvenated rose garden in between along with new ground covers and a wall-feature in the eating area. It is so nice to have our backyard privacy again. And I did get my hands slightly dirty today as I went to the nursery (gasp) and chose a new rose, and then helped to plant it!!!! I even chose some fun sunflowers to put along the western fence and planted those seeds too. You have now heard the sum-total of my gardening effort for the next 5 years. Seriously. I get to choose the wall-feature - I am thinking an old garden gate or an old wrought-iron shape/screen/something against the wall - I'll have fun visiting some scrap yards this week.
Have a good week!
Wednesday, May 14, 2008
Boobs are my bag
Ooh I have just read this post from Lisa. I am so envious. How inspiring.
Somehow I have forgotten to attend any conferences or workshops this last year. I am aghast, as I love going to those things. I wonder if its because of the rostering hassles of being a rotational midwife. I move around a lot, each 8 weeks or so, and am constantly unsure of whether I will be on nights, or whatever. I am also a bit vague and unorganised about making roster requests in advance, especially when I don't know the area I will be working in, or its a new area for me.
Its a big hospital, I am often a long way from where I must go to make the request (if I remember to do it). I am often tired. I don't have access to the computerised in-house rostering program either - what a nuisance. Some areas make rosters 6-8 weeks in advance, some only 2 weeks in advance. Its one of those health system workforce things that I haven't quite adjusted to yet. I am such a slow learner about some things. Sigh.
Anyway I have resolved that i will make roster requests to give myself ONE day at home per week with no 'kids', which means Thursday currently. Unfortunately, given that visiting midwives tend to need continuity of clients, that means that out of the last 8-9 weekends I have worked 6 of them - both days! Groan. I start again on Friday and work 6 days straight, then get a week off, including my first weekend in a month! There has got to be a better way! I have made requests for my first few weeks in LBS for mid-June. Lets see what I get!
Its fairly self-inflicted, and think of all the money I get working on weekends. Anyhoo.... I think I have finished whining about that. You're probably very relieved. (This is my daughter in 1993).
I have had an interesting couple of weeks on the road, and met some interesting families. I have seen some incredibly large and engorged breasts!!! They could easily be feeding twins, but they each had only one small baby to deal with all that milk! Then later in the day I would see other scrawny babies whose mothers were a bit half-hearted about feeding them diligently, who were not gaining weight. I could have put them in my pocket and taken them to the next house and put baby to the breast of that over-supplied woman! If only I could do that! Or feed them myself!
I have noticed that I am experiencing let-down again while on VMS. I used to get it on the postnatal ward, especially when I first started in midwifery. Its never really left me, even after more than 18 years since I last breastfed a baby. (ooh there it is again, just thinking about it). I don't mind. I don't leak or anything, but I still experience it. I feel it means that I am just very connected to this field, and that it means that my body is passionate about breastfeeding too! See what I mean - body and soul!! I am coming to realise that I know a lot about this area.
The photos throughout this post are mostly of a much younger me, from 1989, when I was breastfeeding my daughter. Above is our first mother-daughter photo - she is about 8 minutes old and I am having a quick cuddle before she went to intensive care. (Yes, I am on the floor. Yes I am naked. Be grateful I cropped out the cord hanging out! TMI?) She was born with a cleft palate as part of a syndrome, so was unable to feed directly. In fact she never went directly to the breast. Below is the breast pump I used in hospital - this photo was taken when Steff was a few weeks old, and we were still living in hospital together.
I am moved to see this photo of Patty, age 3, with his sister aged 3 weeks. Still being nursed on her stomach as all babies with her syndrom are (Pierre-Robin Syndrome). It was pretty hard for him to lose his Mum to this strange little sister. Maybe not much has changed in 19 years.
This one, with me being sooky, is of my last express, when she was 29 weeks of age. I always cry at big occasions. I was sad but triumphant, and baked a boob cake to celebrate my achievements. (My hair is pretty bad here, I had just got up, and it was shorter as it had all fallen out postpartum. Did that happen to you too? I always lost my hair after giving birth.)
I did try to express directly into her mouth one time, but as she had a gag reflex from hell and thought every attempt to put anything into her mouth was a threat/an attempt to kill her, she retched and vomited straight away after the first few drops, losing far more nutrition than those drops had given her. Sigh. It was too confronting and directly wasteful/punishing to see this milk wasted in this fashion, and she threw up so much on a daily basis that her growth was severely compromised anyway, so I didn't try it again.
This photo is from one of those rare times when Stephanie actually fed orally in a coordinated fashion, where she cried with hunger and accepted her mouth being filled (delivered from from a soft-sided squeezy bottle because she couldn't generate the suction to get it from a bottle like regular babies), then swallowed - without gagging. It was a miracle to us to see her do it, hence the photo.
She only did it 7 times in her first year of life. It still brings tears to my eyes to think of those sessions.
So to see half a dozen little babies daily, attach at the breast and suck for all their lives are worth, and do it every two hours! Wow, what a miracle. What a privilege to feed your baby that way. I know ... I did it for nearly 18 months with Patty. He fed heartily, lustily, frequently until that time, and was still feeding to sleep most times, and waking to feed in the night when I decided I'd wean so I wouldn't be getting up in the night to him just to feed. It seemed like a good idea at the time. If I'd known that it would be the last time I would have a babe at my breast I would have gone on.....
I have breastfed two children. In very differing fashions. My only reason to have another child would have been to have another beautiful period of feeding. I did love it so. I think I did it well. This photo is from 1996, Patty 10, Steff, 7.
So this is another aspect of my life that I can bring to my practise.Its not about me, and I rarely mention it to any mothers I care for, but when they are pumping to establish or boost supply I can genuinely identify with their task.
I remind them that growth spurts happen, and to let them happen, and to surrender to it. These are the periods where the baby wants to feed constantly, a mother will say 'I have no milk' or 'my milk dried up'. We hear it a lot. But with the right information and support from her family, and only if she wants to (because some women don't really mind whether they feed or not, and I'm not gonna force them) our imparted knowledge will mean that she knows how to maintain and boost her supply, and the lactation bond will continue.
I like boobs. And babies. And bumps. Lucky I'm a midwife, hey?
Somehow I have forgotten to attend any conferences or workshops this last year. I am aghast, as I love going to those things. I wonder if its because of the rostering hassles of being a rotational midwife. I move around a lot, each 8 weeks or so, and am constantly unsure of whether I will be on nights, or whatever. I am also a bit vague and unorganised about making roster requests in advance, especially when I don't know the area I will be working in, or its a new area for me.
Its a big hospital, I am often a long way from where I must go to make the request (if I remember to do it). I am often tired. I don't have access to the computerised in-house rostering program either - what a nuisance. Some areas make rosters 6-8 weeks in advance, some only 2 weeks in advance. Its one of those health system workforce things that I haven't quite adjusted to yet. I am such a slow learner about some things. Sigh.
Anyway I have resolved that i will make roster requests to give myself ONE day at home per week with no 'kids', which means Thursday currently. Unfortunately, given that visiting midwives tend to need continuity of clients, that means that out of the last 8-9 weekends I have worked 6 of them - both days! Groan. I start again on Friday and work 6 days straight, then get a week off, including my first weekend in a month! There has got to be a better way! I have made requests for my first few weeks in LBS for mid-June. Lets see what I get!
Its fairly self-inflicted, and think of all the money I get working on weekends. Anyhoo.... I think I have finished whining about that. You're probably very relieved. (This is my daughter in 1993).
I have had an interesting couple of weeks on the road, and met some interesting families. I have seen some incredibly large and engorged breasts!!! They could easily be feeding twins, but they each had only one small baby to deal with all that milk! Then later in the day I would see other scrawny babies whose mothers were a bit half-hearted about feeding them diligently, who were not gaining weight. I could have put them in my pocket and taken them to the next house and put baby to the breast of that over-supplied woman! If only I could do that! Or feed them myself!I have noticed that I am experiencing let-down again while on VMS. I used to get it on the postnatal ward, especially when I first started in midwifery. Its never really left me, even after more than 18 years since I last breastfed a baby. (ooh there it is again, just thinking about it). I don't mind. I don't leak or anything, but I still experience it. I feel it means that I am just very connected to this field, and that it means that my body is passionate about breastfeeding too! See what I mean - body and soul!! I am coming to realise that I know a lot about this area.
The photos throughout this post are mostly of a much younger me, from 1989, when I was breastfeeding my daughter. Above is our first mother-daughter photo - she is about 8 minutes old and I am having a quick cuddle before she went to intensive care. (Yes, I am on the floor. Yes I am naked. Be grateful I cropped out the cord hanging out! TMI?) She was born with a cleft palate as part of a syndrome, so was unable to feed directly. In fact she never went directly to the breast. Below is the breast pump I used in hospital - this photo was taken when Steff was a few weeks old, and we were still living in hospital together. I am moved to see this photo of Patty, age 3, with his sister aged 3 weeks. Still being nursed on her stomach as all babies with her syndrom are (Pierre-Robin Syndrome). It was pretty hard for him to lose his Mum to this strange little sister. Maybe not much has changed in 19 years.This one, with me being sooky, is of my last express, when she was 29 weeks of age. I always cry at big occasions. I was sad but triumphant, and baked a boob cake to celebrate my achievements. (My hair is pretty bad here, I had just got up, and it was shorter as it had all fallen out postpartum. Did that happen to you too? I always lost my hair after giving birth.)I did try to express directly into her mouth one time, but as she had a gag reflex from hell and thought every attempt to put anything into her mouth was a threat/an attempt to kill her, she retched and vomited straight away after the first few drops, losing far more nutrition than those drops had given her. Sigh. It was too confronting and directly wasteful/punishing to see this milk wasted in this fashion, and she threw up so much on a daily basis that her growth was severely compromised anyway, so I didn't try it again.
This photo is from one of those rare times when Stephanie actually fed orally in a coordinated fashion, where she cried with hunger and accepted her mouth being filled (delivered from from a soft-sided squeezy bottle because she couldn't generate the suction to get it from a bottle like regular babies), then swallowed - without gagging. It was a miracle to us to see her do it, hence the photo.
She only did it 7 times in her first year of life. It still brings tears to my eyes to think of those sessions.
So to see half a dozen little babies daily, attach at the breast and suck for all their lives are worth, and do it every two hours! Wow, what a miracle. What a privilege to feed your baby that way. I know ... I did it for nearly 18 months with Patty. He fed heartily, lustily, frequently until that time, and was still feeding to sleep most times, and waking to feed in the night when I decided I'd wean so I wouldn't be getting up in the night to him just to feed. It seemed like a good idea at the time. If I'd known that it would be the last time I would have a babe at my breast I would have gone on.....
I have breastfed two children. In very differing fashions. My only reason to have another child would have been to have another beautiful period of feeding. I did love it so. I think I did it well. This photo is from 1996, Patty 10, Steff, 7.So this is another aspect of my life that I can bring to my practise.Its not about me, and I rarely mention it to any mothers I care for, but when they are pumping to establish or boost supply I can genuinely identify with their task.
I remind them that growth spurts happen, and to let them happen, and to surrender to it. These are the periods where the baby wants to feed constantly, a mother will say 'I have no milk' or 'my milk dried up'. We hear it a lot. But with the right information and support from her family, and only if she wants to (because some women don't really mind whether they feed or not, and I'm not gonna force them) our imparted knowledge will mean that she knows how to maintain and boost her supply, and the lactation bond will continue.
I like boobs. And babies. And bumps. Lucky I'm a midwife, hey?
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