Deja-vu

In a re-run of the incredible hailstorm of July last year, today Perth experienced a phenomenal hailstorm with really large hailstones.

I heard solid plinking and plunking and thought someone was tampering with the roof. I went outside to find huge hailstones in the front yard, so I grabbed a camera and took some snaps.

Then it began to rain, and hail some more.....and then came the wind.

Good heavens. I've never seen anything like it!

The upshot of it is that our skylight was smashed and the ceiling panel took direct hits that punched through the plexiglass. There is power in the shaft for the light. Yikes. There were hailstones bouncing all over the kitchen floor and benchtops. When the second front passed the holey plexiglass fell out from the weight of rain falling directly into the kitchen. The rain is still falling. There are more storms predicted for tonight until tomorrow morning.

The shadecloth tore free from the mounting pole where it was triple stitched and has remained unmoved for 15 years, weighted down with at least 20kg of ice and tree debris. I couldn't lift it. I was worried the gutters and fascia boards would fall off under the weight. When Don got home, he lifted the bulky, sagging ice mass and we released one corner. It still hasn't fully melted.

Our car looks a little like a golf ball, with fine dents all over it, but luckily no windows smashed. Many people are a lot worse off, with serious flooding, and landslides, and no power to 150, 000 households. Poor devils. All the same I hope our house will be weatherproof again soon.

The temporary flooding in our yard has settled mostly. What with all the foliage stripped from the trees, it was like wading in very wide shallow heavily minted glass of icy punch. This is where we're having Steff's 21st party on the back patio on Saturday. We're renting a woodfired pizza oven and have 40+ people coming. The garden will be stripped and ice damaged, but . . . oh well. The forecast is fine and 27 degrees. We won't need a shadecloth at night, and I won't have time to repair it before then anyway.

Life's never dull!

Holiday activities

Spend four nights with favourite husband in a cosy and private beach-side getaway. Tick.

Spend a day of getaway baking beloved Christmas cakes. Best. Batch. Ever. Tick.

Play Bingo with hubby. Tick. I still don't win.

Tackle Xmas pressie shopping with a relaxed hubby by my side. Tick.

Get bathroom door and dining room wall painted 6 months after bathroom renovation. Tick.

Attend Xmas parties in blistering heat. Tick.

Host Xmas party in blistering heat, wondering why people say they are coming but don't. Tick.

Eat leftovers. Tick.

Read on FB that a young depressed work colleague has died tragically. At work, with colleagues finding her. Reel in shock. Make many phonecalls to distraught colleagues. Grieve the loss of a lovely young midwife. Sadly, tick.

Value life even more preciously and vows to love and support even more. You betcha.

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.

Waving

HI!! Can you see me waving? I am.

Hello November! Where did you come from? I blinked and you arrived, while I was working and organising and conferencing and feeling crappy and stressed and finishing night shift. And getting bad feelings about anonymous comments. Sigh.

Sometimes a blog just feels like another thing to feel guilty about. So I put the blog in the too hard basket. Just for a couple of weeks.

To make myself feel better I am crafting (or half-assed-crafting). I am cutting out. I have sewn some stuff. Half-finished things. Frogdancer and Victoria your pressies are nearly ready to go. I have a pretty fab red giant tote half assembled.

Blogs are being read. Otherwise they would Pile Up and add to my load of Stuff Un-done.

I have folded an enormous pile of clean washing. Six baskets full.

I have cleaned off my desk. Gasp. Its true, Lesley has seen it!

I have Made Plans. Midwifery plans. Hah! I am both inspired and a bit terrified by this. Therefore it must be good.

I am working (what seems like) a lot. Probably seems like it because I have so much to do on the days 'off'. Like conferences. Like organising a two week statewide tour for a lovely and important guest, although I am getting lots more help with that now, phew.

I have favourite people coming to WA (ooh, they've just landed), and a favourite niece having a party tonight for her birthday and I am working :( but I will have the next two weekends off and see them all then.

On the upside- a friend has started an unexpected new romance that is thrilling and wonderful and that she thoroughly deserves. And my daughter has found a JOB! It is 95% fabulous, with small forecasts of glass-half-empty, depending on your point of view. We're pretty delighted, but it also involves the doing of Stuff. Which I add to my Do In My Spare Time list. You know the one.

I am feeling about 50% better in the swoon department, although I have to go back on a medication I hoped to not take. It seems this is a new manifestation of migraine. Cos two sorts are barely enough. Bummer. On the upside it means I am sleeping better / heavily. Take THAT night shift diurnal rythm messer uperer.

I'll stop whining now. I'm sick of myself.

Back with REAL blogging soon, I promise. But that was a small catchup of why I've been offline.

You'll never get those minutes of your life back, so no asking for a refund, alright?

A week in dot points

• If you're looking for something midwife-y and moving today...sorry...I don't have much However.....I've seen some yummy babies born.
• Father's day was really lovely at both ends, with young Dads greeting their first-borns, along with both Grandads in the labour room until it got intense i.e. time for pushing...then I cheerfully turfed them out to the waiting room with a hearty "Its time to go guys, next time I see you it will be with congratulations!" They were quite happy to go, while the young Dad jigged with excitement by the woman's side. He was soooooo happy to be meeting his son, and his 19y.o. partner did a lovely job of pushing the baby out. Both so accepting of the role ahead, breastfeeding promptly, then taking the baby out to meet his two grandfathers on Father's Day. Really sweet.
• Night shift. The work is good, the staff are great, the workload ridiculous at times, with barely a lull in proceedings, (trying not to) rush from room to room, turning on the charm again and again to butter up a new room of folk, just waiting, waiting, trying not to make any promises one can't keep. Coping with emergencies. Hooley dooley, we had one really big one last weekend, there were just two midwives present and my colleague saved a woman's life, literally, with bimanual compression. She kept it up while I called in for help again after the initial stuff had seemed to work, then I lifted her onto the bed so it sould continue all the way to theatre. It was mind-boggling, but she survived. Its never dull in our place, but a bit more peace would be very welcome.
• At home, my daughter has now spent her second week home alone since her workplace closed unexpectedly. BUGGER! She had made such a lovely start and was really gaining confidence, now she is job-hunting again, back to filling in heaps of forms and getting to know a new bunch, and they her. Sigh. And she needs company alot so I am unable to get any time alone to craft etc. Sigh. It gives me cabin fever, but she suffers it too, especially when I am sleeping on night shift. Double sigh.
• My hubby has been unwell with a bad elbow joint, septic bursitis they are calling it. He was admitted to hospital for IV antibiotics yesterday and is now home, although the area of redness and swelling is re-growing (i think) since he came home. He still feels quite unwell, but as he hates hospitals with a passion he was very keen to be discharged. He unfortunately won't let me fuss over him too much, much as I want to. I hope he doesn't have to be re-admitted, cos that might mean surgery.
• While he was in hospital I got to visit a friend who has been in for a fortnight and I have barely been able to see her due to nightshift. She needs a bit of TLC, and I feel bad not being available to provide it except by text.
• While Don was being ferried back and forth and admitted etc, I took Steff to swimming, and then attended a fundraiser I had committed to helping with a month or more ago. My mind was not quite with it, I must confess.
• And then we (Steff and I) went out to my sister's for dinner. We had a roast which was very yummy, and Steff had made a dessert while Don was being diagnosed. My brother-in-law was disappointed to be missing his drinking buddy. I came home just after 9.30 and couldn't settle and went to bed way too late, sleeping heavily in the end alone in the bed.
• Don is home now, and still not terrific, but on oral antibiotics, and sleeping currently. We have made cake to feed to visitors who will NOT find him in hospital and will drop in at home. He most determinedly spent the day prowling around his garden, revelling in the sunshine, and now he is knackered. I'm off to take his temperature and be his nurse and give him drugs.
• Its been a strange weekend, after a lost week on nightshift.
• 
  Sorry about that. You can fill in the blanks....

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!

Many and varied

Hello Monday.

Another weekend on night shift was had. Friday night shift will go down as a bit of a doozy, for busyness, for grace under pressure and under fire, for teamwork. I'm not sure how many babies were born, but it was probably about 10 on Friday night alone, and around 22 all up over the 3 shifts I worked. There were Code Blues, abruptions transferred in from other places, flat babies, newly birthed women being shipped back to hospitals closer to home, lists of which hospitals could take what cases (antenatal women, postnatal women). There were births in the assessment unit, successful VBACs, unsuccessful VBACs, and more. There were tears (sniff, sniff), and tears (ouchy). It was pretty mad!

I had a tough situation on Friday night where my woman ended up with a CS after a long and difficult labour. By God she was brave and tried so hard to get that baby out, but in the end it was a good decision to bring her out 'through the sunroof'. Such a beautiful baby, such a lovely couple, so close and a great team, very practical and down-to-earth, after a long few nights. I lost the plot briefly, very emotional about the decision for CS, but the family were great as I returned to the room, red-eyed, and accepted my warning stop-signed hand 'DON'T talk to me about it' gesture as a sign of solidarity as we just got on with it, and I was fine after that. It was a good decision, and I feel much better about it all in retrospect than I did at that moment. It was a rare thing for me. Once again, although we had threatened to have words with that baby when she was born, young Bella was too beautiful and soon had us all completely under her spell with no hard feelings.

Saturday night was pretty hectic as well. Arriving at work feeling slightly anxious about the thought of another stressful and emotional night, I walked into my room expecting to get a baby as the coordinator had said I would be getting one soon in that room. The curtain was drawn and I waited behind it to be invited in after announcing myself in a low voice. I could hear the familiar sounds of instruments being handled and clamps being applied, but no words of encouragement, or congratulations, or, worse, baby crying. I peeked around and asked if they had a baby yet and was told tersely 'Yes at 2104' I could see a purple baby and grabbed some gloves and followed the second midwife to the cot in the corner behind a tangle of the woman's possessions. The heartrate was low, bloody low, so I got started on cardiac massage without delay as we called for a code blue paediatric. The baby was very blue, but had some tone, and responded well to the CPR. At 3 minutes she was just starting to gasp a bit, and with the improved cardiac output was starting to pink up as we pumped the oxygen around her little body, and the team were arriving as she started to cry a little. By 4 minutes she was breathing independently, with some facial oxygen. By the time she was 8 minutes old she was in her Mum's arms, although she needed to go down to the nursery for observation.

Phew! That shook the cobwebs out! And restored my confidence in my skills. Phew. The woman was a tricky and complex case with a major history, and it took a bit of time to sort out the whole backstory, but she was up and showered and on the ward by 11pm.

As I returned at 11.20pm I was almost mown down as a trolley containing a young woman was brought around from assessment, her eyes wide with shock. I was available and thrown in to a just vacated and clean, but unreplenished room with her as she screamed in panic for an epidural. It was her second baby and it was determined to be born by midnight it seemed! Each contraction brought on a fresh bout of ear-splitting and sustained screaming. As it subsided the young Mum turned her bulging eyes on me and begged for an epidural. Then the next wave came and she would scream again in panic and say 'what do I do?'

The other staff were great. I asked for a doptone, and if there was another midwife who could stay for 20 minutes (there was, luckily) so she opened delivery sets, and drew up oxytocics, and within 2 minutes we were ready for a birth, and after 5 minutes we were ready for anything. While they organised the technicalities I stayed seated at Mum's knee, soothing her in a gentle voice, reassuring her that she was very clever, and very good at this, she didn't need to do anything, just let it happen. I could see some twitching and unflowering (accompanied by a bit of freaking out) and gradually she settled down and surrendered to it. It was actually a very nice birth once she let go of the panic and stopped trying to hold it in. Once the irresistible pushing reflex kicked in she was superb, and listened really well to guidance and at 2343 she gently pushed out a daughter (with a compound hand tucked under her left ear) with an intact perineum. The baby was vigorous and was chirping before she was fully out. Mum was a bit shocked and her first instinct was to say 'yeah great take it away, I'm tired' but after a minute or so she took a look at her and showed a bit more curiosity. She had heaps of black curls and big dark eyes, and was very interested in looking around, so soon had her stunned Mum under her spell.

What a remedy for my soul. A quickie! Just what I needed! I skipped off to tea with number 52 on my mind. I spent the next 2 hours sorting out her paperwork, and getting her up to the ward (where she apologised for being 'rude' to me - nothing of the sort - and admitted her throat was sore some screaming). She had been visited by her family including hubby and her 1 year old - who was incredibly beautiful with the same dark curls, big blue eyes and the most incredible eyelashes I have ever seen - she looked like she had been in a beauty parlour all afternoon!

The rest of the shift was spent on paperwork from the previous 2 births that had been unattended while we dashed around. I then went down to the nursery to see some twins I was caring for 3 weeks ago, and sadly the smaller twin had died. It was not unexpected, but still I was a bit tearful. His parents were very pragmatic about his chances of survival, and were grateful to have a few hours with him, not expecting him to survive the birth, and he lived for just over two weeks. I visited him and his twin brother 3 times, and will never forget him. He was the smallest living little person I (or any of us) had ever seen. He was such a fighter. Our nursery staff really are terrific. They managed to have the surviving twin attend the service in an incubator on portable breathing support, an accommodation that I know will mean alot to his family. They have been very brave. I hope to see them soon.

As we prepared to leave there was a birth underway where the trace had looked really crap for the last 40 minutes. We were gloved up outside the door to rescuscitate again if necessary, which would have been a fitting bookend to the night, but the day staff arrived before the birth and shooed us out the door. I wonder what happened.

Back to the real daylight world this week. I will miss the night staff. All our staff are great and we have terrific teamwork, but the night girls are a special crew. I will see them, and work with them again, in a few weeks.

I love being a midwife.

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.

About that piece of patisserie...

Never boast on your blog that getting to an airport is going to be a piece of patisserie.

I am now at home in my own cluttered study. We walked through our door just before 5am, drooping with weariness after a very long journey home.

We boarded the RER train in plenty of time to hit the airport well ahead of our flight. Then the train stopped before emerging onto the second station. I immediately felt Don's panic rising as we sat in a tunnel, with PA announcements not to open the doors. Eventually we crawled into the station where people were exchanged, then after a short delay we set off again. Approaching the next station this was repeated with additional announcements about a known delay at a stop 2 further along. We sat and waited. And waited. There was another announcement confirming significant delays of unknown duration due to there being a person on the track at Stade de France. Don went from jittery to practically whistling like a newly boiled kettle! I had already offered to get off and get a taxi, which he had declined. Now I just stood up and grabbed the cases. It was no longer an offer but a certainty. The track was blocked. There was no way around the obstacle because there would be no further trains beyond the blockage to pick up.

We emerged onto the street to an empty taxi rank. Don was swearing and hypercrabby about every jolt of the cases over every bump. I ground my teeth and picked up my guide book (that I had nearly packed in the suitcase) and my mobile phone (with the battery failing fast) and called a taxi company. Just as she was promising me a cab in 7 minutes one pulled up (in front of a bus)in response to Don's frantic hailing. We piled in gratefully as the phone battery died. Eighteen minutes later we arrived where I was left as hostage to the taxi driver while Don entered the airport to find an ATM. He emerged after 10 minutes with 60 euros which he thrust at the driver for a 48 euro fare. When you tot up how much our initial tickets had cost as well, it was a very expensive airport ride!

We checked in easily, in plenty of time and headed to the gate where our seats would be allocated. The girl at the counter assured me we would have good seats but the flight was full. We queued dutifully and passed through all the security checks and got on to our bulkhead seats the centre two of four, with no-one on our outsides. Until ... 5 minutes prior to closing the doors a man with a cute baby appeared on one side, with many bags and trying to hold the kid while he stuffed things into overhead lockers. I beckoned for the baby who flirted very appealingly with me. As I was mid-flirt, a young woman appeared from the other side, looking curiously at me and frowning at the man across us. I then noticed that she had put down a baby carrier at the exit row. As she dumped more bags in the seat next to me it was quite clear that the baby had a Mama. And a sister. And that Don and I were somehow seated between parents of 8-month old twins. Two babies! Yes, I'm so lucky to be on a long flight with two babies, Mama moaned. We offered to move so they could sit together. Our offer was rejected irritably. It seemed she was just quite irritated. Full stop.

Papa had retrieved his little guy from me and was struggling to get him double seat-belted in place for take-off. Mama had settled the sleeping little girl to her chest under many floaty drapes without noticing the need for a double seat-belt. She turned her head and tried to feign sleep, while sniffing away tears. Okay.....

As we taxiied she leaned forward and saw the extra seat-belt stuffed into the seat pocket. She clucked her tongue and curled her lip as I offered to help. It would have been nice to know of this earlier she snarled. I applied my soothing never mind, it won't take a minute voice as she lifted the draped sleeping baby from her chest and I groped for her seatbelt, unfastened it, added the baby bit and reclipped it onto her, then clicked it around the baby. There, there. We took off to the loud wailing of baby boy, dummyless (it was in one of the many bags). Sigh.

It didn't get much better from there, in fact it descended into some level of hell for the first 8 hours of the 12 hour flight which left at midnight. As soon as the seatbelt sign was switched off the flight staff assembled the bulkhead bassinets for the babies, but only after they put up our screens on stalks from the armrests of our seats, effectively trapping us in our extremely hard seats for the duration of the flight.

(edited to add:If it sounds like I am hard and unsympathetic to families flying with two babies across the world...um....I don't mean to be. My heart did sink for them, a bit, as soon as I saw them. But it sank for us a trifle more, especially when I realised that the bassinets meant we would be trapped in our seats. They themselves had asked to be seated in that configuration. They did refuse to be sat together, and frankly it would not have made much difference. Someone had to sit next to them. Besides, my ass wouldn't fit into one of the aisle seats anyway. And I do like babies, so ... I suspect I was somewhat reluctant partly because I had a cold-sore healing on my face, and I couldn't snuggle and drool on them as I would ordinarily like. I looked like a leper. It was a drawback.)


Am I painting an effective picture? A bulkhead seat never gives quite enough legroom anyway with the seatpockets blocking full knee extension. The seats were rock-hard from the moment we sat down. They didn't tilt back much, and we couldn't extend our legs anyway. The aircon was set to inferno. The seats were so narrow my hips were cemented in the forward facing position. The couple tutted at each other across us, each dealing with their own baby. And Don and I tried to get some sleep (who am I kidding) It. was. not. good. Because of the bassinet barriers we had to climb up onto the seats and walk over the armrests to get out to go to the toilet. I managed it twice on my side and had to wake Mama up from her deep sleep (in those 5 mins) to get back in.

After 8 hours we possibly lost all sensation to our backs and lower limbs, because it seemed we were marginally less uncomfortable, but it could have been that our spines were now permanently remoulded. I'll let you know about that.

Breakfast was served about 1.5 hours prior to landing and both parents had their hands full. After we finished Papa was struggling to get a mouthful with a wriggling little guy who was yelling his head off so he came to sit on my lap again for a while and I fed him a breadroll which kept him very amused for 20 minutes as he gummed and sucked it to death and rained crumbs down the two of us. Mama had disappeared for a while but when she came back her little girl decided that she wanted some of the roll too so we passed it around and all got crumby together. It was a fun way to end the flight.

They live in Singapore so were not coming on to Perth (shame) but we landed to the news that the homeward flight was delayed by 2.5 hours, so we had 4 hours in Singapore. That left us with time to scour the terminals looking for a replacement hat for a fantastic little number that Steff had lost in Melbourne after only 2 weeks last year. It was such a good hat that it needed to be replaced. We found it in the last terminal we searched. It was so worth it.

Finally our flight boarded and we had a row of four to ourselves. There is a God. A bit of sleep then an hour of immigration, baggage waiting, customs and taxi queues.

We crept into the house and put the kettle on (its been 2 weeks since we've seen a kettle) while I jumped into the shower. Then I got out hurriedly to let Don in to cool off a burn to his groin from a hot cuppa he had slopped straight from the kettle. Bugger. It was not too bad but it stopped him from sleeping in bed as he needed a cold compress to stop it blistering. Luckily it missed all the interesting bits of anatomy, but it made him think twice about sleepily getting naked in anticipation of a shower while manoevering boiling water! Its OK today, although for a minute there I could see myself heading straight to the hospital at 5.30am before we'd even slept.


The house was in good shape. Presents have been given and well received. I'm heading out to the shops to get a roast for dinner. I've seen both of the kids only now- Steff went to work while I was crashed this morning and Don only saw her briefly before he fell back asleep on the couch, and she has just arrived home. Mum is blogging...what else is new - in my defense I had hoped to be finished with it but got interrupted with a phonecall I couldn't get out of. Our reunion was very happy nonetheless.

I haven't downloaded any photos yet. You'll see them when I do.

Oh My

We apologize for interruptions to this service...

It seems my computer is dying. GULP. (quells panic). I really hate seeing 'dumping core memory' blue screens and endless loop messages. sigh.

Typing on daughter's computer. Off to call Dell.....

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.

Lookin' through old stuff

I am here. Not hiding, just thinking.

Starting some things and not finishing them. So many competing demands.

Completing some long-unfinished tasks.

Finished the advanced fetal assessment course and passed. Yay!

Struggling a bit with fragile hope. About many things.

Listening, loving, waiting. Feeling.

Uncovering old stuff. Wishing I hadn't. Damned core beliefs (again).

Reframing painful things. Forgiving myself. Naming guilty parties.

Headaches. Just tension. Tears near the surface.

Doing for others. Should I be?

Learning to do for me. First, for a change.

Letting others help me. Its been a long time.

Hearing old voices and emotions. Do they belong here, now? Fighting and reframing their influence.

Feeling judged. Need I anymore?

What can I let go of? Do I need all this clutter? This baggage. Literally. Its weighing me down.

Freedom in the moonlight. A new way forward?

Much to think about...

A fortunate life

It seems irrelevant to tell of my gallivanting last week in the face of such tragedy afflicting our country at the moment.

It is all so shocking, a staggering level of destruction in the firestorms, an enormous and incomprehensible loss of life. We were in that region last year for our niece's wedding at Healesville, and can well imagine the leafy communities and winding rugged roads that have become death traps in the thick smoke and terrible conditions.

We have made immediate donations of money where requested, and I plan to make a quilt to send to the comfort efforts. It seems such a small thing ... We watch with tears in our eyes, and pray it doesn't get worse.

My husband's family lost a home to the Hobart fires of 1967. It is still discussed how Uncle Bob drove into the little cul-de-sac to fetch Mother and Auntie Marj, and drove away as the firestorm raced up the valley to claim the house behind him. He saw it in his rear-view mirror as he floored it uphill to take them both to safety with the clothes on their backs.

My heart is with all those affected.

We were very lucky last week to spend a four night break in the bush and beach setting of Eagle Bay, near Dunsborough on the South West coast. Thanks so much to the Zeds for the loan of a fabbo house, metres from the water through a tiny fringe of scrub. See the turquoise bit?

The house was ideal. Simple floors, huge rooms, fully equipped...heavenly. So comfortable. We kicked back and unwound. A lot. There were just the three of us, we could have had rent-a crowd with us.

Don was beside himself with delight. Give the man a beach close-by and he is there morning, noon and night. Give him a fishing pole and he is even happier. I know people have always felt this way about this house. I remember, now bittersweet, the happiness Lesley describes of sharing time with other friends there over the years. I was thinking of K, Les. And his family. Savouring the joy and simplicity of watching my husband fishing. This one got thrown back, but I was tickled to have been there to see it briefly. (edited to add - he caught another fish, a whiting, that became Steff's breakfast the next day)

I made his day on the first afternoon by joining him on the beach (I tolerate beaches, but I'm really more of a pool girl). And not just joining him, but swimming with him, topless, as I have forgotten my bathers (D'Oh). We wandered up and down the beach, slowly making our way in through the shallows, just us, well - apart from that solitary man in the distance, who walked past eventually, my back to him as he approached. As I was unable to find any full bathers to fit all of my gorgeousness, I ended up buying a tankini bottom and a new black bra and wearing it as a two-piece for the rest of the stay. Its been years since my tummy saw any sun! I kinda liked it.

The bush was lovely, we visited Meelup Beach - scene of the first of the wedding frenzies last year (ooh, my hair was really short).

We went to the lighthouse at Cape Naturaliste - a whole post for another day. I love lighthouses, yet somehow this was the first I have ever been inside. It won't be the last.

I was terrorised in the shower by a very large spider on my last day. A Large, LARGE spider. Large amounts of screaming were involved. All lived to tell the tale (including the spider, maybe on his spider-weblog). A quick drop in to Busselton for a coffee on the way home and we headed back to Perth. An early birthday dinner that night with our son before he headed off to Melbourne.

Steffie started work today. It seemed to go well. She is taking sticky-date pudding to work on Thursday! I hope she won't get lost and phone me in tears again on Thursday. My heart was in my mouth, from 15 miles away, talking her through the backtracking to the station and taking the right way through to the place 200m away. Little steps. I'm so glad she came home cheerful.

Welcome to Holland

I wonder if you have read or heard of this piece before?

It has been in my mind lately for many reasons.


***************************************************
WELCOME TO HOLLAND
byEmily Perl Kingsley.


c1987 by Emily Perl Kingsley. All rights reserved

I am often asked to describe the experience of raising a child with a disability - to try to help people who have not shared that unique experience to understand it, to imagine how it would feel. It's like this......

When you are going to have a baby, it is like planning a fabulous vacation trip - to Italy. You buy a bunch of guidebooks and make your wonderful plans. The Coliseum. The Michelangelo David. The gondolas in Venice. You may learn some handy phrases in Italian. It's all very exciting.

After months of eager anticipation, the day finally arrives. You pack your bags and off you go. Several hours later, the plane lands. The flight attendant comes in and says, "Welcome to Holland."

"Holland?!?" you say. "What do you mean Holland?? I signed up for Italy! I am supposed to be in Italy. All my life I've dreamed of going to Italy."

Nevertheless, there's been a change in the flight plan. They have landed in Holland and there you must stay.

The important thing is that they have not taken you to a horrible, disgusting, filthy place, full of pestilence, famine and disease. It's just a different place.

So you must go out and buy new guide books. You must learn a whole new language. And you will meet a whole new group of people you would never have met.

Its just a different place. Its slower-paced than Italy, less flashy than Italy. But after you've been there for a while and you catch your breath, you look around.... and you begin to notice that Holland has windmills....and Holland has tulips. Holland even has Rembrandts.

But everyone you know is busy coming and going from Italy... and they're all bragging about what a wonderful time they had there. Moreover, for the rest of your life, you will say “Yes, that’s where I was supposed to go. That's what I had planned."

And the pain of that will never, ever, ever, ever go away... because the loss of that dream is a very, very significant loss.

But... if you spend your life mourning the fact that you didn't get to Italy, you may never be free to enjoy the very special, the very lovely things ... about Holland.
************************************************

Its true. Some families only ever get to speak Italian. They never think twice about it.

Some commute back and forth from Italy (that can be very confusing). An Italian kid and a Dutch kid in the same family. Some of us have Dutch uncles :)

We become bilingual. Its a talent. An art. Not one we aspired to from an early age, but still...

For those who find themselves in Holland - welcome to the club.

And congratulations to my little Dutchie, my little spekulaas, for landing a job. Woo-hoo!

I wouldn't change you for all the pasta in the world.

A day in the life

So, our girl is back from Melbourne and BUSTING to see HSM3 with her bestie, they've been planning it for months, only there is no reply to the phone messages left on Monday.

As I leave for work on Tuesday I call again, and her Mum answers the phone, sounding shattered. Downplaying any problems. Sorry, A is in the shower, we're only just back from the hospital. WTF?

Turns out she has been cutting herself for the last 6 months. Long back-story, not mine to tell. But we see her regularly and care deeply for her. She went further this time and got a vein. No surgery, but sedation and patching up. She will be OK, but the battle for her tranquility goes on.

We are all absolutely gutted. Our daughter is devastated and very fearful. I call work, and hubby (who knew about the cutting but hadn't told me) and he comes home. We send flowers with a big message of "WE LOVE YOU".

I go to work an hour late. To be sent to an area I have never worked in. With a very sick young woman who has just had a stillbirth, and who doesn't speak much English, and whose family oppose many of the practices we commonly do around stillbirth and creating memories. She is very sick, but after a big sleep wakes up feeling a bit better. Her hubby has spent time with the baby while she was sleeping, and has been supported by us to take photos and have them, even if keeping them private from the family.

She is very emotional to hear that her hubby has seen their baby, but is encouraged to think she could see her baby, even in the middle of the night, and the extended family doesn't have to know. Its important that her needs are met. She asks for her immediately. And wants photos, and holds her, and loves her. The couple drink their sweet little one in, and begin to talk about themselves as mother and father to this baby.

Unleashed from restriction the parents want to see her in their favourite outfits, and photographed with things they will keep as mementoes, an urgency to it all. Shuttling back and forth (to the usual area with all the camera, supplies and equipment) and it takes time to dress her and undress her and make her look peaceful, tidy and beautiful, although she is a very pretty baby. All this in a ward area where deceased babies are rarely seen, passing through public areas with a veiled cot. Its a tricky day.

I end my shift handing over the parents and the baby to a night staff member who is quite unused to providing bereavement work, and a bit daunted about the requirements of it all. But I need to get home to see how my own family is.

They are doing OK. They have spoken to A on the phone, the girls had a good long talk, and our daughter is reassured that her friend will recover and they made plans to see the movie when she is feeling up to it.

When I explained what I had been doing at work all day my husband was a bit freaked out. What - a dead baby? You've been dressing up a dead baby? And they've been holding it? And you've been taking photos? He was a bit on edge after dealing with confronting issues all day, and then told me about having the conversation with A, describing it as a conversation with a living person. And how diagnoses of mental illness are all just labels, and this poor kid didn't need more labels, she needed someone to just love and support her.

I slipped quietly into the house, hugged our girl and was grateful to see her reassured and not teary-eyed as she had been when I left. I was in a bit of a daze after a fairly intense day, but realizing that although work was challenging it had kept my mind off the horror and grief of the news of A's hospitalisation. I went to bed early, choosing not to watch the ridiculousness of Brad Pitt and Angelina Jolie trying to kill each other in the "Smith" movie - it just didn't appeal somehow.

And now I should get off the computer and get myself ready for another day at work.

What will it bring?

JJ update

I saw them yesterday at the children's hospital.

First of all, JJ is doing well, or not good, depending on who you talk to. I was met with a warm hug from his Mum who is doing pretty well, although not getting enough rest.

The staff, some of whom I know, are quite pessimistic about his prognosis. He has had renal failure and has had some really major brain bleeds. That never bodes well. However when I saw him yesterday his urinary catheter had been removed and they were watching for a natural urine output. He was breathing independently but shuddering and jerking a lot. And his broken legs (both of them) were still splinted and causing him some pain when he moves (he reportedly cries), although he was being carefully monitored for pain on an hourly basis.

His parents declare that he is doing great and they look forward to taking home home in about 3 weeks. His room has been painted and recarpeted and his parents are looking like doting parents totally in love with their son and encouraged by his every breath. He is theirs come what may, and they will face the brain injury/ walking /talking stuff when they have to.

Good for them.

To me, JJ looked heaps better than when I last saw him. The bruising has gone down significantly although there is still a lot of moulding evident, but that could be due to brain swelling. He is much better hydrated and his skin is pink and clear and he no longer looks like a small dessicated lizard with crumbling dried out vernix.

I don't know what to hope for for them all. They are so new to all this, and adjusting so well really. Once again I was quite specific about acknowledging their new role as parents of a really special baby, and how brave they were. They truly do look OK with things. I hope they get to keep him. They are already talking about having a brother or sister for him, after a while when they have a better idea of what he will be like. At least she is sure she will recognise the symptoms of pregnancy for herself this time, and not rely on the GP!!!

I left them with a small gift of a blanket, and a card containing wishes for a peaceful and joyous life together, what ever that journey may entail. It had been a privilege to be their midwife on that eventful night and I will never forget them.

As I was about to leave another woman approached me with recognition. I had been their midwife too, for their birth 3 or 4 weeks ago when I was practically railroaded into a room by their private obstetrician. The woman was labouring fast, prematurely and had been transferred to our hospital from a private hospital due to threatened pre-term labour. She was 'settled down' for a few days while some steroids were got into her, but then labour started again at 33-ish weeks, irrevocably and it was all systems go for an epidural (but she was coping so well!) and then an ugly intrumental birth (!) with an episiotomy which was not pretty. Oh my. So their sweet little girl Sophie was born quite violently and went down to SCN as a premmie. She had been transferred to the children's hospital as a penultimate step before going back to a private hospital to finish cooking. They were pleased to see me, and I them, and as they were in the room next to JJ the 2 sets of parents were quite incredulous that they had each managed to see me again within the one visit! Its a small world!


Being back in the neonatal unit brought back many memories for me as we spent 39 days there, Stephanie and I, in early 1989. I lived in with her, expressing full-time and adjusting to the idea of who this special child would be. Nineteen and a half years later I know, quite clearly, who she is. She is herself. Just, and uniquely, herself. Special indeed. Still challenging, still her Mum and Dad's girl. She has brought me many things that I cherish in this life. Many things.

I know JJ and Sophie will do the same for their parents.

Many birthdays later...

Hello world.

It has been 10 days my last confession and I have not been idle.

I have just completed a five day stint where we have alternated between being quiet, and crazy busy, or at least my allocations have been. Some of those shifts I have been scuttling as fast as my feet will carry me, and I pass the various desks where staff gather and I will see a full house of midwives all chatting, unallocated, rooms all checked and ready and cleaning done, waiting for the next woman to come through the door. For an hour or so, some days, that has been me too. Then I will be sent off somewhere, or given a job to do which leads to something else.

If there has been a theme to my 5 days it is meconium stained liquor. I haven't seen a nice birth (myself) for days. They have happened though. To others. Sigh. I've seen some pretty yukky births actually. (Reading back - I just remembered that I supervised a nice normal birth with a resident doctor that was pretty nice on Thursday, that seems so long ago. Oh hang on, that was a fast birth where the baby's face was really bruised, and then she had a PPH.....oh bugger, welcome to my world this week) .

Last Friday (my sister's birthday - hope you're feeling better hon) I was allocated to two rooms with a newish student midwife, almost half way through her course. We had the care of two nulliparous women, one aged 16, and one aged 24. The younger one was quite complex, with many issues that were going to need some tactful handling including a very intrusive mum who had, umm, 'boundary deficits'. The background was quite tricky, but I was a bit relieved when Mum announced she was going home to get some sleep and she was going to leave her daughter to feed herself if she was interested (as opposed to mummy holding the spoon for her). Phew. I left the young couple to go for a walk and do their own thing as she was not in established labour and knew to return if anything interesting happened.

We scooted into the next room to meet an emo-looking couple and their friend. The woman was contracting frequently and quite vocal, growly and frowny with the pain. She was quite funny really, and would say things like 'rrrrr, I hate your dick! Its NEVER going near me again!' Her husband was really shy and quiet, I never heard a voluntary peep out of him, literally not a peep. He just blushed and cringed and slunk away, poor guy, but she would demand his hand with each contraction so he had a role! Their friend was a cheerful and practical young woman, expecting her second child in 2 months time so had some experience and was very encouraging. We introduced ourselves and got the story on the pregnancy and the labour so far. She was 10 days overdue and had presented with reduced fetal movements and a greenish discharge. ? Waters had broken? There was not much fluid around baby so she was offered a gel induction straight away to get things going. The trace was good, baby was apparently in healthy shape, but there was nothing draining in the way of fluid... I left the student midwife with her, to settle in and help her cope with contractions for a while, before she was due for assessment.

I shuttled between rooms for a while, sorting paperwork into piles in case of rapid need, getting more background on each woman. We went to tea, said goodbye to the morning staff and settled in for an evening shift. Would either of them birth before the end of the shift? Would the student midwife get a catch? I was just in seeing Miss 16 when the student midwife came for me at a run, 'come now'.

I sprinted after her, the trace showed a serious dip in heart rate. Over we go sweetheart, onto your side, no? Not improving? Other side then. Ah there we go, its coming back up now. The woman's eyes were bulging in panic, she was praying and urging her son to be all right. She was a big girl and couldn't move fast, and was quite feisty and highly strung. I didn't want to scare her, but we discussed what had just happened, possibly due to there being less fluid around the baby and his cord may/likely have been compressed and caused the drop. The trace had been fantastic, the consultant had just been in to see them and commented how good it all was, and now it was time to reassess her cervix. She asked me to do it rather than the doctor, yep, no problem. There was very little change from 6 hours previously. This was disappointing, but the decision was that the hormone drip should go up for a while, and that we hoped it would help the cervix open. Yes there were plenty of pain relief options, we would discuss those when the time came. She'd coped really beautifully up to now, lets see how she got on. In the meantime I reminded the student to press the assist bell if the heartrate dropped like that again and I wasn't with her. We had a brief but honest discussion about what may happen if the heartrate dropped again, and the possibility of CS was raised if there looked like a serious compromise of the baby. Mostly it doesn't happen too frequently, and hopefully you will tick along nicely and push this baby out in this room, into our hands. That's our plan!

It took a while to get the hormone drip organised. The doctors were having their round, communications were slightly delayed. The hormone drip was eventually started really slow. In the meantime the other young couple were waiting for an assessment, and maybe some pain relief as she was contracting more frequently, and she was due for some antibiotics. Every time I picked up my gloves the phone would ring, or she was in the toilet, or something would crop up. I had the antibiotics made up ready to give Miss 16 and was just inviting her to come over to the chair when the assist bell went for the other room.

I shot across, it was another serious dip, the room was filling up and the woman's eyes were wide with panic again. Hormone drip off. I fought my way to her side and talked /coerced her into cooperating with the docs for a quick internal assessment as we struggled to find the heartbeat again, even with a scalp-clip. Crap! Right- said the doctors - we're going upstairs - call a code! I called the code through, hung up and grabbed Dad by the shoulder and said 'get your shoes hon, we're off to theatre, stick with me'. Within one minute we had left the room, the prepared notes bundled up en masse and we headed for the next floor.

My goodness there were a lot of people in the theatre! It was an unfamiliar theatre to me, and I had trouble finding the fetal heart monitor, but eventually we found it and the FH was still pretty low. The surgeon made a decision for a general anaesthetic (GA). It was an agonising wait, with the student midwife and I focusing on the woman as she went under, promising her that we would look forward to meeting her son soon. When it is a GA dads are not allowed in theatre. The student went out to tell him of the progress, and we would be out again when his son was born.

It was not pretty. The surgery was fairly straightforward, and our hospital has a method for holding up a big girl's gorgeousness to help them get to the CS site without another person being scrubbed to hold it up. The surgeon needed me to apply upward pressure on the head to release it from the pelvis, which is tricky to do while crawling under the sterile drapes. I was apologising to the woman as I did it, but it only helped a little. After a struggle the surgeon finally released the baby from the thick meconium filled uterus. She was white with the effort, and told me later it was the most difficult release she had ever done. Baby was limp and green.

The baby went straight to the crash team, who finally got him breathing after 5 minutes, but his lungs and stomach were pretty full of mec and he was stained with green from head to toe. He headed down to the SCN on a ventilator, but fighting it already. His young Dad went with him, crying quietly, but relieved to see him alive. We went back in to see his Mum again and tell her (even though she was still asleep) that her boy was doing pretty well so far, and then returned to LBS.

The surgeons emerged shortly afterwards, all a bit subdued, and knees knocking from the aftereffects of adrenaline. We all felt it. I hope I don't experience it again for a long time.

I have seen the parents once and baby twice since. Young Zachary had a good evening and even came off the respirator that evening and was in the bath getting the mec scrubbed off him when he slid back into respiratory distress. Both lungs collapsed within a couple of hours and he has been a pretty sick young man, but has improved significantly today, although he will be in the nursery for a few weeks at least. Mum was chirpier than I expected and was recovering quite well in herself, and proud of her son's fighting spirit, and was reassured by each tiny step off the machines again. We had a long debrief chat and rehashed the events, and I filled in some bits of the picture for the two of them. I hadn't slept well since that night, and was so grateful for the chance to see her and give her a hug, and tell the two of them how brave they had been in the emergency. She said she had initially been angry, but as soon as she saw him about 10 hours afterwards she felt it melt away when she saw how sick he was. I think they will be OK, after a very close call.

The student midwife played a really important part in that birth. She hit the assist bell at the right time, and kept her head and stayed focussed on the woman, and has visited them as well. I couldn't have asked for more of her, and made sure she knew she had acted very well in the emergency. She got a lengthy comment in her book detailing her actions.

So, that was a long story about part of Friday's shift. (Sheesh what is it with me and students? They sometimes get more than they bargain for!) We had dinner and then focussed on Miss 16, giving her antibiotics, running her a nice bath for pain relief, eventually assessing her and finding she had cracked on with a bath and hotpacks for comfort, plus two panadol! It was the end of our shift.

The night shift midwife reports it was a beautiful birth on all fours, her Mum arriving loudly just as the head was crowning and being firmly shushed, and not spoiling it too much. Everyone was most pleased with events, and very proud of her. The midwife got a second quick birth that same night, where a woman walked awkwardly in to the LBS and said "I don't think I can get on the bed" and when encouraged to push where she was standing, proceeded to deliver her baby into the midwife's waiting hands 3 minutes later. Aaaahh, how yummy. The midwife was all glowing and teary describing it to me in the morning. Half her luck.

I'll tell you the stories of some other birthdays another time.

Teaching tools

It had to happen one day.

On each of the last two night shifts I have been assigned a senior medical student. One hopes these students witness an easy, natural, spontaneous labour and birth, with no dramas, bells or whistles. Sigh. You want to make God laugh, just tell him your plans.

Night ONE. Enter the room to a very young woman, unaccompanied, in spontaneous labour with first baby. Progressing well, has an epidural in place, which means there needs to be fetal monitoring. The fetal heartbeat is a bit fast, just above the normal range, but Mum has a slight temp and this is often the cause. I was still taking handover when the heart sounds took a dive. And kept diving. From 170 beats per minute to 55 bpm. Roll over, take pressure off the cord, roll the other way, no recovery, its been a minute, call for urgent assistance, warn the Mum, the team comes flying in, after another minute it starts to pick up and ticks along to its usual merry rate. Phew. Wide awake now and well on our toes. Explain to the med student that that is NOT a normal pattern.

Twenty minutes later it does the same thing. Stormtroopers re-enter, this time the recovery is a little quicker, hmm, little tricker baby. Where is that cord? Are you holding it? Is it wrapped around an arm? The cervix is dilating well, its nearly fully dilated now, it won't be long until this little one can be pushed out if necessary. Keep watch.

Dive three. Reposition and watch and wait, call the coordinator, ah yes, here comes the recovery, and the cervix is now fully dilated. Good, lets hope she can get some descent with just the contractions in the next half-hour or so, don't want to push too early with a primip. We top up her epidural as the pain was breaking through again and I'm sent to tea with another midwife covering in the room. I get a banana and half a cuppa into me when I am called back for another deceleration. It is recovering by the time I get there, but the coordinator is a bit concerned as the docs are all in theatre for emergencies, and this baby is still playing tricks that may need some urgent assistance. Bugger! We start her pushing just as a relative arrives, an aunt who looks as though she has had plenty of experience in childbirth. Yep, 9 babies, she tells us proudly. Oh, we are so glad to see you, you're just the tonic and company your niece needs right now. After 4 contractions worth of pushing the fetal heartrate takes another dive, and stays down this time. Get a senior-ish doctor out of bed as all the rest are still in theatre, and she decides to do a forceps birth there and then. We quickly get a strong top-up into the epidural, while the heart rate crawls back up. The medical student got an eyeful of a very confronting birth over the next 6 contractions, as we all worked together with the young woman, her aunt and the doc to bring the baby suddenly into the world. She, the baby, was not impressed! She was born in great condition and squawked loudly for the next hour. My back-up midwife was fantastic, very supportive and on the ball, encouraging me to stay with the girl and keep her on track and accepting all the delegation really efficiently. It was my first time seeing forceps in the room (instead of transferring to theatre) and it was not pretty. Somehow the draping of the operating environment seems neater, or something. There was a lot of blood, and flesh, and stitching required. Poor kid. She was pretty shocked. I think I was too. The med student told me later she was surprised you could pull so hard with forceps, but didn't seem particularly phased by the experience. She was called to theatre a little later to witness an emergency CS, so had a fairly full night of viewing!

From my perspective I was disappointed she saw such a violent emergency with so much drama preceding it. One aims to show a woman moving and coping well with contractions, with minimal monitoring, as a role model of a normal physiological process. It is too easy for the medical model to be seen as the norm, and there is such limited opportunity for them to see a normal birth, so they may never know the difference between the physiological and the managed. They will rarely see the way it can be. As an advocate for normal birth it is frustrating. But the vicissitudes of working in a large high risk hospital mean that it can be weeks between us midwives seeing one of those too. Sigh.

So, night TWO. Assigned another student, pick up a woman from the assessment area in early labour with baby number 3. Waters broken 12 hours ago, meconium stained fluid draining. Needs monitoring and a drip to get things established as the baby may be compromised. She had had two previous vaginal births with minimal analgesia, both over 9lbs and this one was a similar size. Should be a straight forward labour and birth with continuous monitoring required and a paediatrician at birth due to the meconium. Do you hear God starting to chuckle?

She was attended by her teenage sister, and her hubby was on his way back to the hospital. The woman herself was really cheerful and positive, a short round young woman who had complete confidence in her ability to just get on with it. And so we started. The baby was initially in a posterior position and a bit tricky to monitor with that lovely plump tummy. Bub was really active, and turning to a more favourable position for descent, and unfortunately the need for monitoring meant she had to be near or on the bed with me holding the heart thingy all the time. She didn't complain, and I gave her frequent toilet breaks to apply gravity and some hula dancing to shake things up. Hubby was back by midnight and sat dozing in a chair, but could be encouraged to apply sacral pressure as long as he didn't have to see anything gory. He wasn't good with body fluids or hospitals. At one stage he threw up in the bathroom, and stayed a bit pale, but came back to do his bit with the back pressure. He was full of praise for his wife's talent at labour and birthing, and was most assured things would be well over by dawn. The sister was soundly asleep.

By 2am things were getting pretty full on with contractions. Gas was being used and she was really hilarious under the influence, but it helped immensely. We encouraged her to position herself for comfort, and examined her for the first time. 5cm dilated. Hmm, a little less than we expected but steady and not that surprising given the non engagement yet of the head. The fluid was getting a bit thicker and I asked a more senior midwife to come and check my abdominal palpation. She agreed with my assessment, and confirmed the fluid was thicker. The trace was good, heart-rate good. Just as she was leaving the dad tried to cross the room to go to the bathroom. I heard a thump. He had fainted. It was a bit busy in there for a while as I organised oxygen and some staff to attend him, and the woman was pretty desperate and calling for me to apply back pressure with each contraction as the sister slept on. My hands were full. Hubby was taken away and not keen to come back, and I was under pressure to take a tea break, but she pleaded with me to not go. I felt sure she would start pushing very soon, in fact she had a lot of involuntary pushing with contractions, and was shaking in a transitional way. Another assessment showed 7cm so we got her up again for another plie and hula dance, and had her climb up on a higher than normal bed, and kneel up and down repeatedly to encourage the last bit of rotation and engagement of the head. Finally another midwife came in and insisted I leave for a meal break at 3.55am. I reluctantly agreed, assuring the woman I would come straight back if called.

My backside had just hit the toilet seat when I heard the phone ring - Laura - get back right now! I finished my wee and ran.

I entered the room to find a green head between her legs and a wide-eyed look of shock on her face. Clever girl, that was quick! I pulled some sterile gloves on as others called the paeds and I eased the rest of the head out. The face was slow to emerge and people were passing me suction to suck the meconium from his mouth and nose. It all seemed to happen in slow motion. I could sense the activity behind me. His head slowly rotated to Mum's left thigh and I got her to push but he wouldn't come out. No cord around his neck, but he was stuck pretty tight. Call for assistance. Legs went up, knees to nipples, more pushing, normal traction, no progress. His head was turning a deep shade of violet, and I could see his white neck. I called for supra-pubic pressure which was applied, and I carefully kept the traction on. After about 15 seconds he started to budge and slowly corkscrewed in stages from his mother's body. It was nearly two minutes from head to body delivery and I was very relieved to guide him out in a rush of fluid and meconium and blood. Clamp and cut, hand him to the paeds and he started gurgling and crying within 20 secs. Phew.

It was my first shoulder dystocia birth, and I had anticipated it as a possibility with this birth. He was a really big baby 4720g - or 10lbs 6 ozs plus change, and really long too. The placenta was pretty tricky as well and Mum lost a bit of blood initially, but was soon well contracted. A doctor had arrived with the assist call and helped get the membranes out and confirmed the bleeding had stopped. We were shocked to see that the perineum was intact! OMG! After hauling that toddler out of her! Holy crap!

There was a lot of mess, which we just threw a sheet over, as the sister was taken from the room in a wheelchair as she had almost fainted. It was quite some 10 minutes really. And once again my medical student had got more drama than we bargained for! Oh dear.

After 15 minutes and a quick cover-up of the mess, Dad was brought in to meet his son, and praise his sweet little wife who was recovering from the shock of it all. Baby JJ was a bit pale and shocked, but admired by all. He was so big he was almost hanging over the edge of the warming cot, and the wraps seemed tiny. They were all pretty pleased with themselves and he got stuck in to a feed fairly soon, and pinked up nicely, even if he did have green hair!

I got to have some dinner about 5am while bub was at the breast. They were up on the ward by 6.15am, after we had photos together to celebrate our joint achievement. The sister and the med student were de-briefed about the events, and assured that although the last 2 minutes had been a bit hairy for all concerned we were pleased with the outcomes, and were they OK? The sister was pretty freaked out by the green head appearing so suddenly, but was reassured that it was fairly normal when a baby had done a poo before birth. She had a cuddle alone with the baby while Mum was in the shower and was interacting well with him and telling him all about it. The med student was going off to learn more about shoulder dystocia and emergency drills!

It had been a real effort, that labour and birth. It was the first time a woman had really leant on me so heavily during labour, and called my name so repeatedly. There was a lot to balance - the positioning, the trace, the meconium, the fainting family, the documentation, the assessments, the being with woman in a tight spot. I was grateful to be very well backed up by other staff who supported everything I was doing, and without whom I would have felt a bit scared. It was a challenging shift and I learned heaps.

I'm getting the hang of this.

Picture diary

Thanks for the comments. I read and appreciate every one. When I asked if anyone was still there it meant I hoped you hadn't stopped visiting because there was nothing new to read! I must say since I started using bloglines my blog reading has been greatly simplified. Instead of rabidly going to every site just in case I missed something new, now I can see instantly who has posted and I can relax about all the rest. I am spending less time on the computer, but am still in touch and up-to-date. Phew.

Which leaves more time for sewing!!!! I have been going a bit mad lately and loving it!

OK I promised photos. First - from my birthday. Here is the cake. Black Forest Cake. YUM.

And my oldest friend called late in the day and came by to join us for dinner. We hardly ever get to see each other any more - she lives an hour or so away and now I work shifts with less holidays its too easy to let time slip by. But we manage 1-2 visits per year and it is always such a hoot to see her.

We met when she moved to our area at the start of year 5. For the only time in my childhood or since I was picked to choose a softball team. Such a responsibility! I was always picked last so I knew the anguish of waiting to hear your name spoken. So I chose all the kids who usually waited and waited, including all the interesting kids who were new or who had accents or different coloured skins. It is a decision I have never regretted, least of all because it brought Bobbie into my life. We were inseparable from that moment on. It still feels like that. Can you tell?

I was her bridesmaid at her first wedding. The first quilts I owned were made by her for each of my children - I still have them and treasure them. She is such an inspiration to me. She went back to uni to complete her high school, and became an environmental scientist. She is a grandmother now, and still her own self. I just love her. It was so good to see her.

Here is a very bad shot of the Michael Buble concert, which is badly out of focus but conveys something of the atmosphere. Jeez it was a great concert.

Here is a quick excited photo of my sister and I in the audience. Even though its crooked, I like this shot. She is not usually so pale, she's been unwell. Yep, that is the favourite pink cardigan of the moment getting another outing!

Something else exciting happened last week. I received my labels. See? Its a name that a family friend used to call me (my family call me by my middle name) I accidentally ordered iron-on ones (sigh) which don't necessarily suit every fabric I use to make a bag, but they still look very satisfying to have on my products. Even if sewn a little rustically.

Speaking of rustic, here is the bag I just had to make on Friday instead of doing housework (I don't recall making an active choice - was the housework ever a realistic option? ;P )

I had found the orange embroidered jeans in a favourite op-shop on Thursday. They fitted Steff but she felt she wouldn't wear them. Ditto the black chunky cord Diesel jeans we had found a few weeks ago. So....she requested a shopping bag. Et voila!

I was very brave and even put in an internal zipped pocket - my first time - piece of cake. Everything on this bag was chosen for recycledness (is that a word?). The outer fabric, the lining fabrics, the zip, everything had been used before. I'm really pleased with it. It wears my label outside and hers inside!

Which brings me to the weekend....sigh. It was an oasis. I took a healing doll that I had started back in February sometime, that I got stuck on. It was meant to be my inner child, but she looked so vulnerable that I just couldn't move forward with her alone. She needed longer arms to reach out to people. I was a long lanky kid (snort), and while the hair colour was about right, and she had big brown eyes I felt stuck. I knew that if I took her with me to a safe place she would be able to evolve into herself.

We chose messages from a set that spoke to us. Mine were about not believing and living old, negative messages, and how I could create new beliefs about myself, about how I am alright NOW. These tapped into some thought patterns I needed to change. Remember don't believe everything you think ..... So I set to work.

We learned about the orphan archetype and the pros and cons of examining the orphan within us all. We heard the story of "the Ugly Duckling". We journalled. The opening sentence was "I want..." A very powerful tool. We danced through a guided meditation through a four part garden with gates dividing the areas. We experienced the long hard winter that precedes transformation and growth. Rocks for grief, sticks for anger, water for despair, and sand for feeling depleted. We then went for a silent meditative walk about the bush. It was the winter solstice and people all over the world were also engaging in that exercise simultaneously. We were encouraged to see if anything called to us on our nature walk and to collect them for inclusion in our dolls or journalling. The sticks of anger had called me during the meditation. It was time to examine their purpose.

The other women had mostly not made the dolls before and we all had kits in front of us for a new doll. So did I. So I made a new one as well as working on my inner child doll. She had come with me as plain Jane. I was called that a lot as a child. This weekend I made her/myself blossom.

I used the sturdy sticks I collected to first of all give plain Jane a backbone. Next I entwined some curved sticks to her to give her longer arms to reach out for help and comfort. Next she needed to stand taller, so some very strong branches were bound to her short legs. These new limbs were bound in a tartan that reminded me of the little tartan pinafores I wore as a child - with a plain cotton top and a beautiful pleated skirt. They were worn with a pretty white blouse and a cardigan over the top. My new doll seemed more confident already. She had been mousy and brown before, and I look hideous in brown. She wasn't happy being brown. As the dove-grey and green tartan strengthened her she seemed happier. Suddenly I knew she needed more green. A scrap of sequinned green spoke to me. I bound this across her heart. There were some leaves that filled a gap or two, then she sighed contentedly. At last, you are getting to the heart of me. Returning to the treasure chest I found a small sculpted baby, painted gold. This touched a very deep chord. The little one was immediately tucked next to her heart. Scraps of green gingham, more layers of beautiful dyed green cotton with leaf prints, a few more sequins, a tie or two, more hair, a flower for blossoming happiness, a jewel or two, a few pearls, following our instincts. Then someone brought me an amazing gift. There, in a small velvet covered matchbox, was a tiny baby with a message in the box that read "I love you just the way you are". It was just the message she/we needed to hear. She held a stick to acknowledge the rage at her mistreatment, but it was softened by a growth of green, as she didn't want it to define her. It now looks like a wand to achieve transformation. A friend across the table said, you realize, don't you, that she is Mother Earth. A bell rang somewhere. Many people call me an Earth Mother midwife. Others have called me a Demeter figure. But of course. My inner child had blossomed into a manifestation of something that feels very natural to me. An earth mother. I was profoundly moved by the whole experience and can barely take my eyes off her. She is just right. I had never imagined that I would create something as beautiful as she is. As green as she is. But she is "No More Plain Jane" now. And I love her just the way she is.

The white doll I am holding is my midwife warrior I made in the first healing doll workshop I attended. She is full of symbolism and has a long story too. Her new red sister is also related to the meditation. She is a goddess of rage, who trails her anger behind her and has no problem expressing it. I think her story is one for another day....

Here is our group with their dolls at the end of the weekend. We all found it a very powerful and symbolic exercise, an oasis in our busy lives as mothers of children with special needs, some bereaved mothers. We had danced, including a belly dancing session, journalled, ate great food, talked, laughed, cried, discovered, meditated, slept and relaxed and shared an incredibly intimate weekend.

I am very lucky to have access to this type of workshop. It is a lifeline for me, a tool to have an inner life that allows my inside to match my outside. This doll making is a stunning exercise when taken as a whole 30 hour journey in a supported psychotherapeutic environment with trusted friends. And now I entrust the sharing of it with you, dear reader.

Peace and love.