Snapshots from my 'place of birth'
A final week of madness on the ward. The hospital is in crisis mode, with a serious bed shortage and a staffing shortage to boot (I have not offered to work an extra shift this weekend).
I was lucky enough to work the same 4 rooms for 4 days, and saw 9 different women through those rooms, and 5 different babies. Some babies were in the nursery, some hadn't come out to play yet. All but one of the babies were great feeders, with sensible practical mums. It really makes a difference.
I can't tell you how many bells I answered, but it was a LOT. I have a sore foot currently and am limping alot of the time, which makes my other hip and my back sore. I was not pleased with frivolous ringing of bells, but I did take a certain pleasure in seeing that I would not be answering bells next week. Just mobile phonecalls.
I had my last late-early split. Bliss. I am well aware that I will be on call and I may long for the life of a rostered day off, but just let me enjoy this tiny fantasy, will you?
I worked a late, early, early, early, and was in a meeting from 9.30-1.40 today. Hubby was away on business and I had to walk/limp to and from work all week as I have no parking permit at work, and I live pretty close anyway so its not worth taking a car for an 8 minute walk. Unless you're limping. This part of the week DID suck.
Word was still spreading about my departure, so I have broken the news and said goodbye to many people all week. I have enjoyed much goodnatured ribbing about people making me hand-embroidered placenta bags if they'd known (my reply? Frankly my dear I'm bloody insulted you hadn't already wrapped it ready for me, what's the holdup? You've had 4 weeks notice!).
I have had 2 avo teas, with cake, wherein I received a lovely gift from my home ward, and many many good wishes, acknowledging my long-held desire to work in this field. Students and former students professed to have enjoyed birthing and working with me, saving lives with me, and laughing with me. I cried. I laughed. We hugged. I assured them I would not be far away, and would not be a stranger to them.
This morning I handed in my uniforms to the cheerful Julia in the hospital laundry/uniform section. She asked where I was heading and was delighted to hear that I was going to be a homebirth midwife. She regaled me with tales of her mother giving birth to 12 babies at home, including one caught by Julia herself when she was 13 years old. Her brother had come really fast and her dad was still away fetching the midwife!
This afternoon I had a final engagement with labour ward. Over two hours staff staggered in and out and asked for information about my next job. Some of them almost seemed to be giving grudging permission for this career move, but were greatly outweighed by those assuring me I would love it, and that it would be a great fit for me. There was much discussion about knowing me, and my capabilities, and knowing that I would understand their expectations if transfer occured. There was more ribbing about me phoning in to transfer primips who had been pushing for 7 hours (c'mon girls, you KNOW my minimum time limit before transferring is 8 hours) and much curiosity about details, which I was largely unable to furnish, as I have yet to be oriented. I caught up on the gossip, who was pregnant (3 of them), who was planning to be and who had got new roles. It was great to touch base with these fantastic bunch of hardworking and talented midwives again. I have missed them over the last 6 weeks and was a little sad not to finish up with them on Labour ward. But I am sure I will see them from time to time, and I know it will be a warm welcome.
Lastly I handed in my security pass. I cried again, suddenly, and couldn't speak as the man took it from my hand, and I left the building with tears rolling down my face for the umpteenth time that day.
The tears are ones of recognition of the importance of that place in my life. Of gratitude to my colleagues who have taught me and shared so much. Of grief to be leaving their daily lives. I have been delighted to work there, to become the midwife that I am. My tears are also of pride in my accomplishments so far. The tears of transition.
Most of all, over the last 4 weeks, I have been humbled by the warm support of mentors. They have been open in their joy for me. I am certainly standing on the shoulders of giants. I mentioned before that I felt like I was at Everest base camp, still with one heck of a climb ahead of me, but Oh! The view!
Who knows what sort of midwife I am yet to become?
Showing posts with label midwife. Show all posts
Showing posts with label midwife. Show all posts
Friday, September 10, 2010
Thursday, August 19, 2010
Everest Base Camp
I have had one hell of a week. In a good way.
I had a job interview on Monday with a publicly funded homebirth program, one that has led the way for their model of care, one that has been replicated across the country. It has always been my goal to work for them, when I had enough experience. I was encouraged to apply. I applied with my fingers crossed. I thought 'well, if I get an interview I'll be pleased, and I might be a chance, but I will be hysterical if I truly get it'.
I got the job.
Yep. You read it right.
I got the job, my dream job.
And now the climb, the steep learning curve really begins.
I am skipping with happiness.
I wrote my resignation letter, and handed it in person to all my managers. Then I howled on and off about leaving all my lovely workmates that I have shared so much with. Each day since, I have broken the news to a new set of people. Its very exciting.
And then, yesterday to top it off, and just when I was lamenting that I would not catch another baby at my hospital, one of my women on the ward went into precipitate labour while I was at tea. I returned to hear her distressed behind her curtain in the shared 4-bed room. She nearly clawed my arm off and it was clear she was nearly ready to push. Which was a bit of a shame ... because only 2 hours before she had signed for a repeat CS, especially if she laboured. I notified the coordinator that we needed to move, like NOW, and returned to her with a pair of gloves, just in case. She was in the throes of another contraction. She clung to the coordinator, who talked her through it, then she allowed me to examine her - wa-hey! Fully dilated and a breech close to the world. Seemed a shame to waste a perfectly good CS on a baby who had plans for exit via an alternate route.
We ran with her on the bed to LBS and shanghaied a passing consultant as we skidded around a corner. I found the first empty room and we pushed the bed through the curtain, pulled a warm baby blanket bundle out and threw it on the heater. Then I changed gloves and returned to the woman still on her ward bed and peeked under the sheet - and there was a breech on view. She crawled across onto the birthing bed. I waved my ward coordinator goodbye, and volunteered to stay as the only other midwife around was having her first day at work. The LBS coordinator assembled a team of paediatricians and spare hands, and I urged her to ignore everyone else and focus on me, which she managed really well, and I spoke quietly and encouraged her to go for it, and praised her to the eyeballs. The consultant stood next to me, and talked me through the birth, giving a small hand here and there. And so . . . . I caught my second VBAC breech baby! All pretty textbook. This one was close to term so the maneuvres were harder than last time, but it all went smoothly. I would have preferred a hands off approach, but in that setting it was never gonna happen, and honestly it was an excellent result.
I was utterly thrilled! The woman was shocked but delighted. I handed over to the afternoon staff and tottered back to the ward to pick up the threads of my day, after a very adventurous 90 minutes away! The staff were all agog, it was the talk of the hospital that a midwife had done this birth! The young doctors were high-fiving me, and were delighted to have seen a vaginal breech birth. My manager came back from lunch and told the tale, only to find out it had happened to one of her ward patients with one of her midwives! She then got the full story straight from the horse's mouth.
I saw the woman again today and she is glowing, just radiant that her body worked and that she could give birth vaginally, and that she could be up and about and so well, rather than recovering from surgery. Baby was in nursery for a day or so, but he is nearly ready to come up to the ward! 2.35kg nearly 36 weeker. We congratulated each other on our cleverness, and had a big hug. She is such a darling, and was so brave during her 'amazing experience'. My sixty-ninth baby. Her second. Unforgettable.
I'll miss this place, but I'm looking forward to exploring the big world outside and I know that whatever the setting....I love being a midwife.
I had a job interview on Monday with a publicly funded homebirth program, one that has led the way for their model of care, one that has been replicated across the country. It has always been my goal to work for them, when I had enough experience. I was encouraged to apply. I applied with my fingers crossed. I thought 'well, if I get an interview I'll be pleased, and I might be a chance, but I will be hysterical if I truly get it'.
I got the job.
Yep. You read it right.
I got the job, my dream job.
And now the climb, the steep learning curve really begins.
I am skipping with happiness.
I wrote my resignation letter, and handed it in person to all my managers. Then I howled on and off about leaving all my lovely workmates that I have shared so much with. Each day since, I have broken the news to a new set of people. Its very exciting.
And then, yesterday to top it off, and just when I was lamenting that I would not catch another baby at my hospital, one of my women on the ward went into precipitate labour while I was at tea. I returned to hear her distressed behind her curtain in the shared 4-bed room. She nearly clawed my arm off and it was clear she was nearly ready to push. Which was a bit of a shame ... because only 2 hours before she had signed for a repeat CS, especially if she laboured. I notified the coordinator that we needed to move, like NOW, and returned to her with a pair of gloves, just in case. She was in the throes of another contraction. She clung to the coordinator, who talked her through it, then she allowed me to examine her - wa-hey! Fully dilated and a breech close to the world. Seemed a shame to waste a perfectly good CS on a baby who had plans for exit via an alternate route.
We ran with her on the bed to LBS and shanghaied a passing consultant as we skidded around a corner. I found the first empty room and we pushed the bed through the curtain, pulled a warm baby blanket bundle out and threw it on the heater. Then I changed gloves and returned to the woman still on her ward bed and peeked under the sheet - and there was a breech on view. She crawled across onto the birthing bed. I waved my ward coordinator goodbye, and volunteered to stay as the only other midwife around was having her first day at work. The LBS coordinator assembled a team of paediatricians and spare hands, and I urged her to ignore everyone else and focus on me, which she managed really well, and I spoke quietly and encouraged her to go for it, and praised her to the eyeballs. The consultant stood next to me, and talked me through the birth, giving a small hand here and there. And so . . . . I caught my second VBAC breech baby! All pretty textbook. This one was close to term so the maneuvres were harder than last time, but it all went smoothly. I would have preferred a hands off approach, but in that setting it was never gonna happen, and honestly it was an excellent result.
I was utterly thrilled! The woman was shocked but delighted. I handed over to the afternoon staff and tottered back to the ward to pick up the threads of my day, after a very adventurous 90 minutes away! The staff were all agog, it was the talk of the hospital that a midwife had done this birth! The young doctors were high-fiving me, and were delighted to have seen a vaginal breech birth. My manager came back from lunch and told the tale, only to find out it had happened to one of her ward patients with one of her midwives! She then got the full story straight from the horse's mouth.
I saw the woman again today and she is glowing, just radiant that her body worked and that she could give birth vaginally, and that she could be up and about and so well, rather than recovering from surgery. Baby was in nursery for a day or so, but he is nearly ready to come up to the ward! 2.35kg nearly 36 weeker. We congratulated each other on our cleverness, and had a big hug. She is such a darling, and was so brave during her 'amazing experience'. My sixty-ninth baby. Her second. Unforgettable.
I'll miss this place, but I'm looking forward to exploring the big world outside and I know that whatever the setting....I love being a midwife.
Thursday, June 17, 2010
See that thing on the right?
How do these things get handed out?
I ignored it for a bit, thinking it was a viral phishing code, but as I have barely posted anything this year I thought it would make for another post! Desperate huh?
Anyway, I have really mixed feelings about any such thing. You've probably noticed that I don't write so much recently about work and individual births. This is because I was heavily warned off by a series of events, including a lecture on cyber-presence and how one is vulnerable to 'flaming' if radical groups find you and take you on. Examples were given and my blog was used (among others) to illustrate the talk. This blog IS in the public domain, so it IS fair game to such things. No permission was necessary. But it made me feel vulnerable.
I also received a few comments accusing me of breaching confidentiality. Just a few, scattered over one or two posts, mixed with many times more comments appreciating the posts. But coupled with the warning lecture it put me off. I didn't enjoy writing it anymore, even though I still felt the same way, and reflected just as much as I always had, it was just in my head, instead of on the page and shared with readers.
I wondered if I could leave stories to 'cool off' for a while before telling them. Then days became months, and so many stories fell away from my memory. And I got out of the habit of sharing them with you. I felt silenced, but safe from criticism.
There have been many, many stories I wish I could share.
I haven't actually seen a baby pushed from a vagina in months. Truly. I did have a woman pushing with me two weeks ago, a first timer, but after an hour it became clear she was going to need a hand to get her baby out. But the doctors were busy. So even though I stayed late after a nightshift, I still didn't see the baby emerge.
I had another woman, another first timer last week. She was being induced for post-dates at 11 days after her due date. The balloon catheter hadn't budged after 18 hours. We deflated it and applied hormone gel high in her vagina near the cervix to help ripen it. My shift ended and I handed over to another midwife and student, who were between 2 rooms. I could see she was contracting a bit, but I went home. I thought I would have her again the next day (our third day allocated together for continuity). But she was left alone for a long time on that shift as they got busy in the other room. She called the bell later that evening and was attended by a different midwife who, finding a woman in some distress and contracting a fair bit, examined her. She was 8cm and proceeded to push her baby out two hours later!
So, a good result in the end, and a relatively uninterfered with 'natural' birth after a second induction attempt. I saw her the next day and they were a bit stunned but delighted with their daughter. They were pretty lucky that the docs were busy elsewhere, and that she was able to be undisturbed, even if they felt abandoned. I was sad they felt under-supported in the building labour, but thrilled for her that she achieved a vaginal birth, against the suspicion that her induction would be deemed a failure.
After a summer in the homebirth arena, well...at the shallow end of it....it is still chafing to find myself in a high-risk environment. Yet I am largely proud of the work we do in that world. We see a lot of stuff. A LOT of stuff. Big Stuff. Confronting and complex stuff. Life threatening stuff. And we do it, and deal with it, and do it well a lot of the time.
There are some who don't cope or thrive in that environment. There are some who have forgotten it can ever be any different. And there are some who have a bare minimum of exposure to complexity and emergency, and pooh-pooh those who work in those environments. I've met them all. Birth can turn in an instant. Recognising the instant is the art.
As a midwife I want to experience it all. I don't want to become so indoctrinated to swimming with sharks that I forget to take off my chainmail when dealing with goldfish. Yet I don't want to forget that birth (and life) is bigger than the goldfish bowl of homebirth. Most of the world sits somewhere in between. Its a tricky balancing act.
Yet despite the tightrope act....I love being a midwife.
I ignored it for a bit, thinking it was a viral phishing code, but as I have barely posted anything this year I thought it would make for another post! Desperate huh?
Anyway, I have really mixed feelings about any such thing. You've probably noticed that I don't write so much recently about work and individual births. This is because I was heavily warned off by a series of events, including a lecture on cyber-presence and how one is vulnerable to 'flaming' if radical groups find you and take you on. Examples were given and my blog was used (among others) to illustrate the talk. This blog IS in the public domain, so it IS fair game to such things. No permission was necessary. But it made me feel vulnerable.
I also received a few comments accusing me of breaching confidentiality. Just a few, scattered over one or two posts, mixed with many times more comments appreciating the posts. But coupled with the warning lecture it put me off. I didn't enjoy writing it anymore, even though I still felt the same way, and reflected just as much as I always had, it was just in my head, instead of on the page and shared with readers.
I wondered if I could leave stories to 'cool off' for a while before telling them. Then days became months, and so many stories fell away from my memory. And I got out of the habit of sharing them with you. I felt silenced, but safe from criticism.
There have been many, many stories I wish I could share.
I haven't actually seen a baby pushed from a vagina in months. Truly. I did have a woman pushing with me two weeks ago, a first timer, but after an hour it became clear she was going to need a hand to get her baby out. But the doctors were busy. So even though I stayed late after a nightshift, I still didn't see the baby emerge.
I had another woman, another first timer last week. She was being induced for post-dates at 11 days after her due date. The balloon catheter hadn't budged after 18 hours. We deflated it and applied hormone gel high in her vagina near the cervix to help ripen it. My shift ended and I handed over to another midwife and student, who were between 2 rooms. I could see she was contracting a bit, but I went home. I thought I would have her again the next day (our third day allocated together for continuity). But she was left alone for a long time on that shift as they got busy in the other room. She called the bell later that evening and was attended by a different midwife who, finding a woman in some distress and contracting a fair bit, examined her. She was 8cm and proceeded to push her baby out two hours later!
So, a good result in the end, and a relatively uninterfered with 'natural' birth after a second induction attempt. I saw her the next day and they were a bit stunned but delighted with their daughter. They were pretty lucky that the docs were busy elsewhere, and that she was able to be undisturbed, even if they felt abandoned. I was sad they felt under-supported in the building labour, but thrilled for her that she achieved a vaginal birth, against the suspicion that her induction would be deemed a failure.
After a summer in the homebirth arena, well...at the shallow end of it....it is still chafing to find myself in a high-risk environment. Yet I am largely proud of the work we do in that world. We see a lot of stuff. A LOT of stuff. Big Stuff. Confronting and complex stuff. Life threatening stuff. And we do it, and deal with it, and do it well a lot of the time.
There are some who don't cope or thrive in that environment. There are some who have forgotten it can ever be any different. And there are some who have a bare minimum of exposure to complexity and emergency, and pooh-pooh those who work in those environments. I've met them all. Birth can turn in an instant. Recognising the instant is the art.
As a midwife I want to experience it all. I don't want to become so indoctrinated to swimming with sharks that I forget to take off my chainmail when dealing with goldfish. Yet I don't want to forget that birth (and life) is bigger than the goldfish bowl of homebirth. Most of the world sits somewhere in between. Its a tricky balancing act.
Yet despite the tightrope act....I love being a midwife.
Tuesday, June 15, 2010
My life in dot points
Its all I can manage... But here are some questions Life has thrown at me lately.
- Is it wrong to expect 24 year olds to silence their girlfriends during sex? Its been going on for 4 months now. When I was a girl I would have been mortified to think anyone would hear my activities....let alone be able to determine exactly how many orgasms constitutes a multiple event. Don't want to repress anyone's sensual life. Teensy bit of pride in son's ... um ... talents. Don't want to engender shame. It wouldn't be my shame anyhow. Just DON'T. Want. To. Hear. It. Any. More. Someone I was lamenting the situation to told me, "Laura, some women will come in a stiff breeze". Yes. So I hear. (sigh). Terse SMS war already on the issue. Repeated approaches to son to keep it down. Will I still be seeing this young woman at family meals with my grandchildren in 40 years time? Son's final university exam tomorrow. Am I a Bad, Disloyal, Enabling Mother? Or am I just being 'dissed'? Discuss.
- Just how much stuff does one really need? Is it in inverse proportion to the amount of floorspace available for the purposes of walking around? (phew, moved out 4 crates of Stuff today, it helps already).
- How long does one wait for midwifery models of care to shift? How does one bite one's tongue at the backroom discussions undermining women's desire for non-interventionist birth? Will I be happier in the long run just going independent and taking the blood pressure pills, being my own boss, and paying through the nose for PI insurance. Should I just move to New Zealand? How long is a piece of string? You get the idea. I'm doing a major review next week to take a snapshot of my career/practice so far. Why does one always feel ready to be shot down in flames. Am I trying to run before I can walk?
- How will we face another major surgery for our daughter? This will be a biggie with the potential to really improve her life, but it won't be easy. It has come as a surprise, sort of. She's had similar surgery twice before, but doesn't remember it. I do. Gulp.
- How good is it to have friends who love and support you? And listen to your whining. And write loving things about you. And share bookclub with you. And paint with you. And go to Vegas with you. I truly am blessed.
- On a lighter note.....How good is this? Now these girls really know how to shop. And I thought I had good op-shops near me.
- Will we all be fit and well enough for our trip? All four of us are limping or crippled in some aspect. This is lame (literally). We are all ready to feel well again. I am certainly sick of keeping the doctors in business, nice people though they are. I will keep taking (all) the tablets. Calm blue ocean. Calm blue ocean.
- How will I pack? For 4 people, heading in 3 different directions at the end, for Sydney, Melbourne and Central Australia.
Bearing in mind that one must be alive to complain, and that we live in a well resourced country, with no war, and plentifully stocked supermarkets, and that our children have survived childhood, and that we have careers and sufficient income to service our whining whitebread world, and that I may just delete this whole post because I am so sick of the sound of my whining......answers on a postcard please.
Monday, April 19, 2010
This and that, the update.
Dear blogfriends, please forgive the subheadings, there's a lot to tell.
MIDWIFERY
I made arrangements for me to back up at some planned homebirths early this year. That period has now ended and the score is: Homebirths occurred 3, homebirths attended by me 1.5.
Yeah I know....bummer eh? I was ready, willing and waiting, sleeping with the phone by me and knew they were on. The first I managed to see all the way through as you saw in my previous post. It was stripped back and simple and lovely. The second went into labour overdue by a couple of weeks. The primary midwife attended and was in communication with me, I was ready to leave at a moment's notice, the house was 40 mins from my place. She laboured quietly apparently and was well attended by family. There was radio silence for a while, then an "uuummmm, she went from nothing to pushing and 2 pushes later....ta-da!" So great for her, a first-timer, to birth so well, I'm thrilled for them all, really. But......
The third was a second baby and the first had been really quick. Less than an hour quick! So I was poised to possibly be the first one there as I live closer to her. I am still doing my regular job as well, and we have been trusting to the universe that it will all work out. Phut! The universe clearly didn't get my memo about a late/early split shift last week followed by eight days off which were coinciding with the due date. So when the phone rang at 5.10am I thought it was the alarm gone off early.......Then slammed upright when I blurrily saw that it was the first midwife calling! OOoh, decisions, decisions - she was really quick with the first one, I've got time for her to pop it out and still get to work on time. I committed and dashed out. I got there at 5.27 and she was labouring, but still smiling. Things hotted up, then quietened down, as they do, but my start time was approaching.....I called in that I would be late, and mentally made up my mind that I would stay for now, but that if the birth wasn't imminent at 7.30 I would slip away and the other midwife would call a different midwife to back up. And so it went. Bummer. The baby was born at 9.13am. It would have been too much of a stretch to be that late for work.
So the experience I have gained is of providing antenatal and postnatal care in the community, and also intrapartum care in the woman's own home. I have witnessed one homebirth (my second). It was good. I can see the learning curve before me should I choose to continue to work in this field. I need to gather a lot more equipment. I could easily become used to doing less with women, as they take a lot more responsibility for their own issues than women I usually see through the hospital setting. There is less 'routine' assessment and more reliance on behavioural changes in labour. Spontaneous and physiological, just the way it should be. All the usual assessments are there, just less VEs and when they were done (by the primary MW) they were at points when I would have done them to clarify issues as well.
There is no shortage of work out there. With upcoming changes to maternity service provision by the federal government there are many opportunities for midwives to set up in group practices with Medicare provider numbers and limited prescribing rights, as long as they are deemed 'eligible' (a nebulous description, yet to be fully defined but being worked on furiously) and hold professional indemnity insurance, which will not cover them to birth anywhere but in a hospital. This has recently been released for a cost of $7500 per annum full time cover. Stay tuned! I do plan to become eligible - in fact if I was doing my PD instead of blogging it would happen sooner.
I have also been continuing to work with a group planning the commencement of a midwifery group practice in our hospital, hopefully by mid-year. It has to be signed off by roughly 47,000 people including doctors but I think we're up to 35, 766 signatures and the work is all downhill from here! This would be groundbreaking in this state, and I have seen my name on the sample rosters so it may come true! Can't wait.
HEALTH
Twice this year I have had my life flash before my eyes and prepared for my imminent death.
I wish I was kidding.
What I have learned from this is that my husband really needs a cell phone. So the kids CAN in theory contact him when he is in Sydney for a conference and Mum has died of a stroke. As it was I managed to get an appointment with the GP and get a presciption for antihypertensives just before it blew out any blood vessels in my brain, but I suspect it was close. It was extremely unpleasant. I then developed an attractive rash from the meds and changed them a week later. They remain effective.
The second time was when I was woken by upper abdo pain and thought I was going to throw up. I decamped to the loo whereupon I had an 'episode' of tingling, profuse sweating, pins and needles in my face and arms and extreme lightheadedness and a sense of impending doom. Visions of Elvis abounded and I was convinced I was about to have a heart attack. This was in the very early hours of the morning after our daughter's 21st party, so waking a still inebriated husband was quite challenging, as I swooned on the toilet and resorted to banging the glass screen repeatedly while moaning. After a while I managed to croak out his name loud enough and he stumbled out to find me. An ambulance was called and I was whisked off. It turned out to be a vaso-vagal event (they think) as my heart was fine and my blood pressure was elevated but not catastrophic. Phew. I felt sheepish, but would have felt worse if I hadn't paid attention to it. I have seen someone have a fatal coronary and I felt how they looked....so I did the best I could to get help. It lasted about 10-15 minutes (I think) but it was really scary, and I'm grateful it was something benign.
I have discovered that I am not ready to die.
BIRTHDAYS
My son turned 24. He is a sweetie and good company. Please God, let him pass this last semester at uni. He has a girlfriend. There is much 'noise' coming from his bedroom. There is often another mouth to feed. It is OK.
My daughter turned 21. We had the party we planned except for the fact that the pizza oven was too wide to fit through the gate (or the gate was too narrow for the oven to pass). We were flexible about this and luckily had a wide driveway and a paved frontyard that could be rapidly put to use as the pizzeria. A Good Time was had by all, pizza was made, cooked and consumed with gusto if not in the same square metreage of yard. Tromping through the house was expected anyway. The back patio was gorgeous and people mixed and mingled at the tables we set up. We did two big photoboards for her which were fantastic to do. She received some lovely gifts. People continue to wish her well. This is good.
STORM DAMAGE
The skylight is fixed. A Man came from 50km away to do it. The SES had arrived a few days after the storm and covered and secured it with thick black plastic for which we were grateful. The car remains dented. This PITA is likely to continue to be so for a while as I am too busy to submit a claim.
TRAVELS
WE are taking a family holiday in June to Sydney and Uluru. It will be great! 3 nights in Sydney doing tyouristy things, then a 3 day camping safari around Uluru, The Olgas and King's Canyon. The family will then leave from Alice Springs while I stay there for a national conference. Its all good.
SILVER
Somehow it seems I will have been married for 25 years on May 5th. To the same man. Lucky, eh? Preparations abound for a celebratory dinner. Followed by our trip a few weeks later.
PHOTOS may follow for all the above, but right now I have to go to work. Which was evacuated a few nights ago due to a fire. I wasn't working, but it looked like a nightmare! I'll hear all about it today.
Its all go around here!
MIDWIFERY
I made arrangements for me to back up at some planned homebirths early this year. That period has now ended and the score is: Homebirths occurred 3, homebirths attended by me 1.5.
Yeah I know....bummer eh? I was ready, willing and waiting, sleeping with the phone by me and knew they were on. The first I managed to see all the way through as you saw in my previous post. It was stripped back and simple and lovely. The second went into labour overdue by a couple of weeks. The primary midwife attended and was in communication with me, I was ready to leave at a moment's notice, the house was 40 mins from my place. She laboured quietly apparently and was well attended by family. There was radio silence for a while, then an "uuummmm, she went from nothing to pushing and 2 pushes later....ta-da!" So great for her, a first-timer, to birth so well, I'm thrilled for them all, really. But......
The third was a second baby and the first had been really quick. Less than an hour quick! So I was poised to possibly be the first one there as I live closer to her. I am still doing my regular job as well, and we have been trusting to the universe that it will all work out. Phut! The universe clearly didn't get my memo about a late/early split shift last week followed by eight days off which were coinciding with the due date. So when the phone rang at 5.10am I thought it was the alarm gone off early.......Then slammed upright when I blurrily saw that it was the first midwife calling! OOoh, decisions, decisions - she was really quick with the first one, I've got time for her to pop it out and still get to work on time. I committed and dashed out. I got there at 5.27 and she was labouring, but still smiling. Things hotted up, then quietened down, as they do, but my start time was approaching.....I called in that I would be late, and mentally made up my mind that I would stay for now, but that if the birth wasn't imminent at 7.30 I would slip away and the other midwife would call a different midwife to back up. And so it went. Bummer. The baby was born at 9.13am. It would have been too much of a stretch to be that late for work.
So the experience I have gained is of providing antenatal and postnatal care in the community, and also intrapartum care in the woman's own home. I have witnessed one homebirth (my second). It was good. I can see the learning curve before me should I choose to continue to work in this field. I need to gather a lot more equipment. I could easily become used to doing less with women, as they take a lot more responsibility for their own issues than women I usually see through the hospital setting. There is less 'routine' assessment and more reliance on behavioural changes in labour. Spontaneous and physiological, just the way it should be. All the usual assessments are there, just less VEs and when they were done (by the primary MW) they were at points when I would have done them to clarify issues as well.
There is no shortage of work out there. With upcoming changes to maternity service provision by the federal government there are many opportunities for midwives to set up in group practices with Medicare provider numbers and limited prescribing rights, as long as they are deemed 'eligible' (a nebulous description, yet to be fully defined but being worked on furiously) and hold professional indemnity insurance, which will not cover them to birth anywhere but in a hospital. This has recently been released for a cost of $7500 per annum full time cover. Stay tuned! I do plan to become eligible - in fact if I was doing my PD instead of blogging it would happen sooner.
I have also been continuing to work with a group planning the commencement of a midwifery group practice in our hospital, hopefully by mid-year. It has to be signed off by roughly 47,000 people including doctors but I think we're up to 35, 766 signatures and the work is all downhill from here! This would be groundbreaking in this state, and I have seen my name on the sample rosters so it may come true! Can't wait.
HEALTH
Twice this year I have had my life flash before my eyes and prepared for my imminent death.
I wish I was kidding.
What I have learned from this is that my husband really needs a cell phone. So the kids CAN in theory contact him when he is in Sydney for a conference and Mum has died of a stroke. As it was I managed to get an appointment with the GP and get a presciption for antihypertensives just before it blew out any blood vessels in my brain, but I suspect it was close. It was extremely unpleasant. I then developed an attractive rash from the meds and changed them a week later. They remain effective.
The second time was when I was woken by upper abdo pain and thought I was going to throw up. I decamped to the loo whereupon I had an 'episode' of tingling, profuse sweating, pins and needles in my face and arms and extreme lightheadedness and a sense of impending doom. Visions of Elvis abounded and I was convinced I was about to have a heart attack. This was in the very early hours of the morning after our daughter's 21st party, so waking a still inebriated husband was quite challenging, as I swooned on the toilet and resorted to banging the glass screen repeatedly while moaning. After a while I managed to croak out his name loud enough and he stumbled out to find me. An ambulance was called and I was whisked off. It turned out to be a vaso-vagal event (they think) as my heart was fine and my blood pressure was elevated but not catastrophic. Phew. I felt sheepish, but would have felt worse if I hadn't paid attention to it. I have seen someone have a fatal coronary and I felt how they looked....so I did the best I could to get help. It lasted about 10-15 minutes (I think) but it was really scary, and I'm grateful it was something benign.
I have discovered that I am not ready to die.
BIRTHDAYS
My son turned 24. He is a sweetie and good company. Please God, let him pass this last semester at uni. He has a girlfriend. There is much 'noise' coming from his bedroom. There is often another mouth to feed. It is OK.
My daughter turned 21. We had the party we planned except for the fact that the pizza oven was too wide to fit through the gate (or the gate was too narrow for the oven to pass). We were flexible about this and luckily had a wide driveway and a paved frontyard that could be rapidly put to use as the pizzeria. A Good Time was had by all, pizza was made, cooked and consumed with gusto if not in the same square metreage of yard. Tromping through the house was expected anyway. The back patio was gorgeous and people mixed and mingled at the tables we set up. We did two big photoboards for her which were fantastic to do. She received some lovely gifts. People continue to wish her well. This is good.
STORM DAMAGE
The skylight is fixed. A Man came from 50km away to do it. The SES had arrived a few days after the storm and covered and secured it with thick black plastic for which we were grateful. The car remains dented. This PITA is likely to continue to be so for a while as I am too busy to submit a claim.
TRAVELS
WE are taking a family holiday in June to Sydney and Uluru. It will be great! 3 nights in Sydney doing tyouristy things, then a 3 day camping safari around Uluru, The Olgas and King's Canyon. The family will then leave from Alice Springs while I stay there for a national conference. Its all good.
SILVER
Somehow it seems I will have been married for 25 years on May 5th. To the same man. Lucky, eh? Preparations abound for a celebratory dinner. Followed by our trip a few weeks later.
PHOTOS may follow for all the above, but right now I have to go to work. Which was evacuated a few nights ago due to a fire. I wasn't working, but it looked like a nightmare! I'll hear all about it today.
Its all go around here!
Friday, March 5, 2010
Just birth
A candle-lit night of struggle, with nothing but grit and determination and loving support.
Just after dawn, as little ones stirred and sat cuddled on laps, a new family member was born in their own family room.
No bells, no whistles, quite ordinary, yet profound and timeless in its simplicity. A testament to the strength of woman.
Welcome to the world baby boy.
Just after dawn, as little ones stirred and sat cuddled on laps, a new family member was born in their own family room.
No bells, no whistles, quite ordinary, yet profound and timeless in its simplicity. A testament to the strength of woman.
Welcome to the world baby boy.
Wednesday, February 24, 2010
Hearing the call
Did I ever tell you how it was that I became a midwife?
photo from National Geographic August 1999
I had always been interested in birth. I watched my cats give birth to their kittens. I noticed pregnant bellies. I avidly watched nature films with birthing. As a high school student I saw a birth film in year 10 and clearly recall the crowning, and seeing a small tear occur, but knowing that I was seeing something sacred, and mysterious, and rarely seen.
When I had my first child I didn't understand what a midwife was. I have recently reconnected with the midwife who attended that birth, and my son turned 24 last week and we reminisced together. With my second child I had a friend who was a midwife and I read some of her books and came to better understand the role of the midwife.
As you know, that second child led me to a whole new world of discovery. I began to attend women's weekends for mothers of children with disabilities and special needs, where I was introduced to journal processing. This has been a tool to having a life, an inner life, all of my own. It is where I learned to love the questions in my life, rather than feeling I had to have all the answers.
On November 3rd 2001 I did a session where we looked at the personas we held within. The idea was to have a dialogue with one of these inner selves and uncover truths.
Now, a caveat here. Journalling is a very private experience. I have always been taught that it is never to be shared except with ones own voice. It is a private thing that can be shared with others, or done in a group, and the opportunity exists to share through reading. Listening deepens the experience, we often find resonance in other's words. Hearing oneself saying the words that have come out the end of your own pen is confronting, and affirming, and scary sometimes. It deepens the understanding, beyond just having written the words. It is a message from your soul. It is often moving beyond all measure. I have had some of the most profound experiences in my life in a journal room. Journal is secret and respected and a safe place.
So ... This is my blog. This is my erstwhile voice. And I choose to share with you some of this session, and I trust you with this sharing.
******************************************************
My Secret Selves
My list: the dancer, the midwife, the counsellor, the clear thinker, the love force of the Universe
Come out, come out, whomever you are
Here I am, coming as you have called, inside you, waiting for my time to begin, talk with me, come to know me, name me, put me up as a goal in your life, DO something to reach me.
Who are you? What is your calling? Will I like you? Will the path to reach you be long and hard? Will I have to make the journey alone?
I cannot answer that question. Any path is hard. Nothing will fall in your lap. But if you want to hold the shape of a ripe belly beneath your hands you will have to give up some things. To be a midwife will be 4 years of dedication. Set a date. start towards me, you know you want to. The coursework is not beyond you.
You were born to use your hands in this way. The power of birth, the hovering of life yet unbreathed is calling you. You talk of wanting a job which encompasses all your unique set of skills...this could be the thing. It is the sensuousness of the dance, the skills and knowledge of midwifery, the feminism, the ear and shoulder and warmth of counselling, the celebrator of life and the deliverer of fully formed perfection wrapped in death. The midwife births not only joy, but sometimes sorrow and you are well equipped to accept that challenge with grace and wisdom. Be an empowerer of women, deliver them to joy and peace, treasure their bodies and their new life, nurture the family, comfort and share with them.
******************************************************
Does that sound like the universe giving a wake-up call? Yeah. I thought so.
A few weeks later I told Don, and his first words were "you'd make a bloody good midwife". And the rest is history.
I love being a midwife.
Saturday, December 5, 2009
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.
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.
Friday, November 20, 2009
Not drowning, waving (again)
Did I say not drowning? Well.... its probably accurate.
I have been watching too much TV, playing way too much Bejewelled on FB, attending work back on the postnatal/antenatal ward and had a random night shift thrown in to the middle of a dayshift fortnight (I know) which has completely thrown my body clock for a loop and I lost close to 2 days in sleep disturbance. Sigh. I'm back on days this weekend for 4 days but then I have a week of rostered days off, before working for 4 days then having 15 days on hols before Xmas. Woot! I love to be back on the ward with all the darling staff members I was mentored by when I was a student. I am also working with my own mentee, which is a lovely change as our rotations have not coincided frequently at all and it is good to see her functioning clinically, even though our relationship flourishes mostly outside the workplace. She is so bright and buzzy, a real individual.
The workload is as full-on as usual, challenging physically and emotionally as well as an organisational challenge. To top it off the ward has been renovated since I was last there, so nothing is where I expect it to be. I am being a big girl and sucking it up. I'm just very lucky, I repeat to myself. But it does make me think of how different things might be in a year's time, in a different style of care. I am scared. But I am determined. Why does it matter to me what people think? I have good reasons for taking the path less travelled, and everyone I have mentioned it to seems to think it is an excellent move, but I suppose I must suck it and see. It may not be for me. I will be quite happy being a plain midwife out there, but how big will my envelope be? How far will I push it? There will be stuff I can only learn out there. I am not fearless, but nor am I fearful. I have a very healthy respect for the process, and the risks. I must keep my clinical judgement about me and distinguish between space for evolution and recklessness. There's a lot going on in my brain. But in the end - Megan says it well here.
I also saw New Moon on Thursday morning bright and early - its not bad, I found it very absorbing and the performances were much better this time, with less of the trembly, changing half-formed mouth movements from Kirsten Stewart that gave me the pip the first time around. She really is much better this time around, more natural. Its certainly one for the fans, but it ends a bit suddenly! There is almost the case for editing books two and three together to shift the action along, but it was still satisfying and beautifully done. The three leads were less wooden +/- overacting. The Jacob character was good and well performed. There were funny bits. The Edward character was much better made up although for a perpetual 17 y.o. someone carved from marble-like perfection he somehow looks haggard and older and a lot more manly, which was very appealing. Am I an Edward or a Jacob girl? Hmm, I think I prefer manly, but a bit of exuberant animal buff is good. The rest of the Cullen clan could have done their shots in less than a week, apart from Alice. Thinking back, they are mostly only shown in asembled set shots, with little dialogue. All in all 8/10.
Today I have a lunch with fellow midwives before the long awaited head MRI to see if there is any sinister reason for the dizzies - we suspect not, but lets rule it out. The medication is really helping and they are 90-95% gone. Edited to add - I'd forgotten how LOUD those MRIs are! Even with earphones it was like having my head trapped inside the DJ desk at a really bad alien robot techno rave, with error messages going off. Geez! 20 minutes of it!
The Big Picture tour by a Canberra ACM staff member, Abby, is going really well. She is such a dynamic presenter, and has been really flexible and super-organised and great fun as well. It is half over now, and this time next week will be all over, but it was well worth the effort. We had lunch yesterday, and she is tired but happy so far, and on days off now down south with her family. I look forward to next week.
So, I wish I had some new craft to show you, but I don't. I c.b.a. (can't be arsed) getting the camera from the other room to even show you a pic of the gorgeous Abby from Canberra. I have no excuses, I just know that if I left the computer now something bright and shiny and completely unecessarily random would catch my eye and it would be 3 o'clock before I remembered the unpublished post on the computer....so, really, we'd better play it safe and hit publish now. Yes, really.
I have been watching too much TV, playing way too much Bejewelled on FB, attending work back on the postnatal/antenatal ward and had a random night shift thrown in to the middle of a dayshift fortnight (I know) which has completely thrown my body clock for a loop and I lost close to 2 days in sleep disturbance. Sigh. I'm back on days this weekend for 4 days but then I have a week of rostered days off, before working for 4 days then having 15 days on hols before Xmas. Woot! I love to be back on the ward with all the darling staff members I was mentored by when I was a student. I am also working with my own mentee, which is a lovely change as our rotations have not coincided frequently at all and it is good to see her functioning clinically, even though our relationship flourishes mostly outside the workplace. She is so bright and buzzy, a real individual.
The workload is as full-on as usual, challenging physically and emotionally as well as an organisational challenge. To top it off the ward has been renovated since I was last there, so nothing is where I expect it to be. I am being a big girl and sucking it up. I'm just very lucky, I repeat to myself. But it does make me think of how different things might be in a year's time, in a different style of care. I am scared. But I am determined. Why does it matter to me what people think? I have good reasons for taking the path less travelled, and everyone I have mentioned it to seems to think it is an excellent move, but I suppose I must suck it and see. It may not be for me. I will be quite happy being a plain midwife out there, but how big will my envelope be? How far will I push it? There will be stuff I can only learn out there. I am not fearless, but nor am I fearful. I have a very healthy respect for the process, and the risks. I must keep my clinical judgement about me and distinguish between space for evolution and recklessness. There's a lot going on in my brain. But in the end - Megan says it well here.
I also saw New Moon on Thursday morning bright and early - its not bad, I found it very absorbing and the performances were much better this time, with less of the trembly, changing half-formed mouth movements from Kirsten Stewart that gave me the pip the first time around. She really is much better this time around, more natural. Its certainly one for the fans, but it ends a bit suddenly! There is almost the case for editing books two and three together to shift the action along, but it was still satisfying and beautifully done. The three leads were less wooden +/- overacting. The Jacob character was good and well performed. There were funny bits. The Edward character was much better made up although for a perpetual 17 y.o. someone carved from marble-like perfection he somehow looks haggard and older and a lot more manly, which was very appealing. Am I an Edward or a Jacob girl? Hmm, I think I prefer manly, but a bit of exuberant animal buff is good. The rest of the Cullen clan could have done their shots in less than a week, apart from Alice. Thinking back, they are mostly only shown in asembled set shots, with little dialogue. All in all 8/10.
Today I have a lunch with fellow midwives before the long awaited head MRI to see if there is any sinister reason for the dizzies - we suspect not, but lets rule it out. The medication is really helping and they are 90-95% gone. Edited to add - I'd forgotten how LOUD those MRIs are! Even with earphones it was like having my head trapped inside the DJ desk at a really bad alien robot techno rave, with error messages going off. Geez! 20 minutes of it!
The Big Picture tour by a Canberra ACM staff member, Abby, is going really well. She is such a dynamic presenter, and has been really flexible and super-organised and great fun as well. It is half over now, and this time next week will be all over, but it was well worth the effort. We had lunch yesterday, and she is tired but happy so far, and on days off now down south with her family. I look forward to next week.
So, I wish I had some new craft to show you, but I don't. I c.b.a. (can't be arsed) getting the camera from the other room to even show you a pic of the gorgeous Abby from Canberra. I have no excuses, I just know that if I left the computer now something bright and shiny and completely unecessarily random would catch my eye and it would be 3 o'clock before I remembered the unpublished post on the computer....so, really, we'd better play it safe and hit publish now. Yes, really.
Thursday, October 15, 2009
Night shift news
Hello world. Phew. Night shift and labrynthitis are a bad combination.
It was getting better until sleep disturbance and nausea kicked in, or they kicked each other in....or, oh heck who knows? Anyway I'm on the second of 3 days off, before I lose 5 days of my life with 4 nightshifts over the weekend. Sigh.
I did three shifts with two nights early this week. Good shifts, if slightly mad. Really busy on Monday night. Dementedly so, poor coordinator was tearing her hair out. I happened to be in the rooms in her eyeline so every time I walked past I would get another little job to do. "quick - 29 weeker coming in, wants to push, you're it!" The woman arrives, screeches to a halt in a room with a big resus unit hastily assembled in a just cleaned room, not very distressed or labouring particularly, a little pain arrives, doesn't palp too strongly, yes waters have broken...or have they? The story is convincing with a witness. Ooh, baby's coming! she wails. Can I check? May I begin? Cervix long and closed and tucked away behind baby's head, just where it belongs. Excellent. Good news! You're not going to have your baby in the next hour. Lets take you back around to the assessment unit, where you can get sorted and admitted. Its too late for a fetal fibronectin test (which will indicate if she's likely to labour in the next week) as I have examined her, but it turns out she is known to staff as a 'frequent flyer' with every little thing and vague twinge. Ambulance guys have to take things on face value and bring em in, and if things were as presented we were ready to deal with it. As it was the floor of that room could now continue to dry undisturbed.
I had been sent to theatre on arrival for a breech CS. Lovely couple, sweet baby, wet and steaming to her chest, alert and responsive. Great photos, happy relatives. I was happily present when the grandparents learned the sex of their newborn first grandchild and saw him, travelling with us to the ward. Joy all around. Told her about a clinic at our hospital for women experiencing second birth after CS, so she could start planning her next birth. Back to LBS and had a cuppa.
Technically had 2 women at this point, being induced. Gave antibiotics to one of them. The other one was snoring. Got given another woman, a multip in early labour at 4cm, contracting irregularly...but who knows, sometimes multiparous women only need half an hour of good contractions before they produce the goods. Settled her into a room on my corridor (yeah, I had a whole one to myself by this time) and went in search of a listening lead for my CTG. Bloody hell, none to be found. Grabbed a handheld Doptone and made use of that instead. Major language barrier, my Mandarin is not that hot, but we established a pleasant simple rapport as I listened in and then made tea for her and her mother. I left her to it and popped in each half hour. She went off the boil, well....was never really simmering in my time with her anyway. She went on to birth at 11-ish in the morning.
In the meantime I was still dogsbodying my way through the night, attending an imminent birth of a 7th child, there was thick meconium so I called a paed for the birth and prepared the cot in case he didn't make it in time. The fetal heartrate dropped dramatically, and the baby was not coming despite vigorous pushing from the experienced mum. Sunny-side up, we all said, but the heartrate was getting really low. We'd called a few docs when the FH dropped and they quickly attached a simple suction device and helped baby out, covered in mec. He was floppy and flat as a tack, but we didn't stimulate him immediately, as the paed needed to suck out his airway so he didn't breathe mec into his lungs. HR was 40 while we poised ourselves ready to commence chest compressions, right, GO! A minute of compressions and oxygen saw his heartrate improve but he was still completely non-responsive and floppy, I ducked out to grab an oximeter from the room next door (where the 29 weeker didn't deliver) and when I came back baby was squawking and starfishing and protesting at his awakening. Poor little mite, it was all a bit sudden, but he was down and on the way out, and as much as I promote gentle birth, I was quite glad to see him yelling. I stayed there for another half hour, to get him settled and cuddled up and fed, and documenting the resus, then returned to my odd jobs. I was most grateful to get a dinner break, then I received another semi-labouring second-timer who had a quick birth last time. She too was not quite ready to labour, but I made her comfortable, hubby re-parked the car (during which time she didn't have a single contraction) and she went on to birth at 5.30 later that day. I handed over 3 women to 3 different midwives and staggered home, literally walking home half asleep.
The next night I was allocated to first-timer who had been stuck at 2 cm, on stacks of synto. Everyone assumed she was for the chop, but my student and I breezed in with positive attitudes and explained about cervical effacement and assured her that the cervix was ready to get on with it now and start dilating. And it came true! Her epidural had been working really well, and continued to do so. The trace had been really good, and was mostly good still, it just had a pattern of decelerations one sees with head compression, followed by a period of sleep where the trace looks quiet. We worked our butts off in that room, keeping the trace well monitored, adjusting the receivers, keeping the epidural well topped up, fending off doctors who kept showing up and scaring the woman, talking about 'heart rate dips, can only do it for so long, then they get tired' wanting to do fetal scalp samples, but every time that dear little baby showed a fabulous acceleration when it was needed and warded off intervention. In the end she was born easily and quite beautifully, despite the doctors inviting themselves into the room and standing at the end of the bed and itching to get their hands in there, and asking if we had episiotomy scissors. We held them off, almost literally, and the little one emerged via the student and I to her stunned and thrilled Mum and grandma, after a mammoth effort. The doctors disappeared like magic, and the student and I dealt with a snapped cord and got the placenta out without them, whole and intact, although we did invite the doctors back to do some straightforward suturing and assist with management of a slow PPH, which had been anticipated after that much synto. There was no CS. There was no transfer to theatre for placenta removal, there was a beautiful healthy 3.7kg baby and her Mum staying in the same room, where they had stoically borne their labour together. It was a great result really.
I was sad that the docs felt they had a right to come in uninvited and stand at the end of the bed, scolding her at her to 'push into your bottom' (as if any of them had ever done it themselves). If we hadn't been there they would have held her vagina open so they could see the descent and crowning better! I feel sad that they so rarely see the way a midwife conducts a birth, with gentle encouragement and positive language. We see their way of work frequently, and frankly it can be pretty brutal sometimes. It is noteworthy when its not. Sometimes it seems that they know no other way but fear and mistrust of birth, and litigation, and invading the privacy of the moment in their relentless quest for accountability. We will call them in if we need them. We do, honestly. Just like we did for the little one with thick mec and the really declining heart rate. I like having docs there to expand the skill level if need be. They are our back-up. We work together. I don't mean to doctor-bash. This is more a doctor-whinge maybe. But when they come in uninvited I can sometimes hear myself sounding a bit terse as I respond to their appearance, at which time I politely and pointedly introduce them to the woman and her family as if they had entered the woman's home, which in effect, the birthing space is, or should be. I try to believe that they KNOW this is the case, but somehow they don't behave that way. I'm sure they think I'm a grumpy cow towards them some days. Thats to the ones that aren't arrogant. When they are being mentored by the insufferably arrogant, they are just asking for terseness.
But I can guarantee them this. If, and when, any of them are in my care when they are labouring and birthing I will protect their rights to privacy and advocate just as strongly on their behalf as I do for any woman I care for. And I will use my clinical judgement to call for back-up when the situation warrants it.
Because I love being a midwife.
It was getting better until sleep disturbance and nausea kicked in, or they kicked each other in....or, oh heck who knows? Anyway I'm on the second of 3 days off, before I lose 5 days of my life with 4 nightshifts over the weekend. Sigh.
I did three shifts with two nights early this week. Good shifts, if slightly mad. Really busy on Monday night. Dementedly so, poor coordinator was tearing her hair out. I happened to be in the rooms in her eyeline so every time I walked past I would get another little job to do. "quick - 29 weeker coming in, wants to push, you're it!" The woman arrives, screeches to a halt in a room with a big resus unit hastily assembled in a just cleaned room, not very distressed or labouring particularly, a little pain arrives, doesn't palp too strongly, yes waters have broken...or have they? The story is convincing with a witness. Ooh, baby's coming! she wails. Can I check? May I begin? Cervix long and closed and tucked away behind baby's head, just where it belongs. Excellent. Good news! You're not going to have your baby in the next hour. Lets take you back around to the assessment unit, where you can get sorted and admitted. Its too late for a fetal fibronectin test (which will indicate if she's likely to labour in the next week) as I have examined her, but it turns out she is known to staff as a 'frequent flyer' with every little thing and vague twinge. Ambulance guys have to take things on face value and bring em in, and if things were as presented we were ready to deal with it. As it was the floor of that room could now continue to dry undisturbed.
I had been sent to theatre on arrival for a breech CS. Lovely couple, sweet baby, wet and steaming to her chest, alert and responsive. Great photos, happy relatives. I was happily present when the grandparents learned the sex of their newborn first grandchild and saw him, travelling with us to the ward. Joy all around. Told her about a clinic at our hospital for women experiencing second birth after CS, so she could start planning her next birth. Back to LBS and had a cuppa.
Technically had 2 women at this point, being induced. Gave antibiotics to one of them. The other one was snoring. Got given another woman, a multip in early labour at 4cm, contracting irregularly...but who knows, sometimes multiparous women only need half an hour of good contractions before they produce the goods. Settled her into a room on my corridor (yeah, I had a whole one to myself by this time) and went in search of a listening lead for my CTG. Bloody hell, none to be found. Grabbed a handheld Doptone and made use of that instead. Major language barrier, my Mandarin is not that hot, but we established a pleasant simple rapport as I listened in and then made tea for her and her mother. I left her to it and popped in each half hour. She went off the boil, well....was never really simmering in my time with her anyway. She went on to birth at 11-ish in the morning.
In the meantime I was still dogsbodying my way through the night, attending an imminent birth of a 7th child, there was thick meconium so I called a paed for the birth and prepared the cot in case he didn't make it in time. The fetal heartrate dropped dramatically, and the baby was not coming despite vigorous pushing from the experienced mum. Sunny-side up, we all said, but the heartrate was getting really low. We'd called a few docs when the FH dropped and they quickly attached a simple suction device and helped baby out, covered in mec. He was floppy and flat as a tack, but we didn't stimulate him immediately, as the paed needed to suck out his airway so he didn't breathe mec into his lungs. HR was 40 while we poised ourselves ready to commence chest compressions, right, GO! A minute of compressions and oxygen saw his heartrate improve but he was still completely non-responsive and floppy, I ducked out to grab an oximeter from the room next door (where the 29 weeker didn't deliver) and when I came back baby was squawking and starfishing and protesting at his awakening. Poor little mite, it was all a bit sudden, but he was down and on the way out, and as much as I promote gentle birth, I was quite glad to see him yelling. I stayed there for another half hour, to get him settled and cuddled up and fed, and documenting the resus, then returned to my odd jobs. I was most grateful to get a dinner break, then I received another semi-labouring second-timer who had a quick birth last time. She too was not quite ready to labour, but I made her comfortable, hubby re-parked the car (during which time she didn't have a single contraction) and she went on to birth at 5.30 later that day. I handed over 3 women to 3 different midwives and staggered home, literally walking home half asleep.
The next night I was allocated to first-timer who had been stuck at 2 cm, on stacks of synto. Everyone assumed she was for the chop, but my student and I breezed in with positive attitudes and explained about cervical effacement and assured her that the cervix was ready to get on with it now and start dilating. And it came true! Her epidural had been working really well, and continued to do so. The trace had been really good, and was mostly good still, it just had a pattern of decelerations one sees with head compression, followed by a period of sleep where the trace looks quiet. We worked our butts off in that room, keeping the trace well monitored, adjusting the receivers, keeping the epidural well topped up, fending off doctors who kept showing up and scaring the woman, talking about 'heart rate dips, can only do it for so long, then they get tired' wanting to do fetal scalp samples, but every time that dear little baby showed a fabulous acceleration when it was needed and warded off intervention. In the end she was born easily and quite beautifully, despite the doctors inviting themselves into the room and standing at the end of the bed and itching to get their hands in there, and asking if we had episiotomy scissors. We held them off, almost literally, and the little one emerged via the student and I to her stunned and thrilled Mum and grandma, after a mammoth effort. The doctors disappeared like magic, and the student and I dealt with a snapped cord and got the placenta out without them, whole and intact, although we did invite the doctors back to do some straightforward suturing and assist with management of a slow PPH, which had been anticipated after that much synto. There was no CS. There was no transfer to theatre for placenta removal, there was a beautiful healthy 3.7kg baby and her Mum staying in the same room, where they had stoically borne their labour together. It was a great result really.
I was sad that the docs felt they had a right to come in uninvited and stand at the end of the bed, scolding her at her to 'push into your bottom' (as if any of them had ever done it themselves). If we hadn't been there they would have held her vagina open so they could see the descent and crowning better! I feel sad that they so rarely see the way a midwife conducts a birth, with gentle encouragement and positive language. We see their way of work frequently, and frankly it can be pretty brutal sometimes. It is noteworthy when its not. Sometimes it seems that they know no other way but fear and mistrust of birth, and litigation, and invading the privacy of the moment in their relentless quest for accountability. We will call them in if we need them. We do, honestly. Just like we did for the little one with thick mec and the really declining heart rate. I like having docs there to expand the skill level if need be. They are our back-up. We work together. I don't mean to doctor-bash. This is more a doctor-whinge maybe. But when they come in uninvited I can sometimes hear myself sounding a bit terse as I respond to their appearance, at which time I politely and pointedly introduce them to the woman and her family as if they had entered the woman's home, which in effect, the birthing space is, or should be. I try to believe that they KNOW this is the case, but somehow they don't behave that way. I'm sure they think I'm a grumpy cow towards them some days. Thats to the ones that aren't arrogant. When they are being mentored by the insufferably arrogant, they are just asking for terseness.
But I can guarantee them this. If, and when, any of them are in my care when they are labouring and birthing I will protect their rights to privacy and advocate just as strongly on their behalf as I do for any woman I care for. And I will use my clinical judgement to call for back-up when the situation warrants it.
Because I love being a midwife.
Friday, October 9, 2009
In a spin
Thankyou for all your best wishes on the blogiversary and the MIPP thing.
I am putting some plans in place to gain some experience in a different style of midwifery. I have some role models, some contacts. Approaches have been made.
I have been a bit flat out: with work, illness, resting (snort), planning and organising for a major event on November, overseeing my daughter in a work experience placement and the transport training for that. I've been reading a bit (Russell Brand - My booky-wook- fascinating 8/10, and the new Dan Brown ' The Lost Symbol' - formulaic 6/10). Trying to stay relaxed. Taking the tablets. Can I just say that labrynthitis sucks. Big time. I like having my head and my world steady. Without drugs. Its most weird. But at least I know that I don't have a brain tumour, or was not having a stroke at that time. Despite very raised blood pressure for a short time (its absolutely fine now). That's a good thing. Phew. Sigh. Did you notice some of the mutually exclusive things on the above list?
And don't talk to me about mobile phones that go all independent of thought. Mine keeps turning itself off. Just without warning. Its most inconvenient, when there is so much to do.
Its been a strange week.
Finally, Frogdancer and Victoria - there are presents on the way to you both by the end of the month. That's as good a deadline as I can deal with at the moment.
Right, work have called, they are short of an idiot / midwife, and my number came up. So much for extended days off.
See ya.
I am putting some plans in place to gain some experience in a different style of midwifery. I have some role models, some contacts. Approaches have been made.
I have been a bit flat out: with work, illness, resting (snort), planning and organising for a major event on November, overseeing my daughter in a work experience placement and the transport training for that. I've been reading a bit (Russell Brand - My booky-wook- fascinating 8/10, and the new Dan Brown ' The Lost Symbol' - formulaic 6/10). Trying to stay relaxed. Taking the tablets. Can I just say that labrynthitis sucks. Big time. I like having my head and my world steady. Without drugs. Its most weird. But at least I know that I don't have a brain tumour, or was not having a stroke at that time. Despite very raised blood pressure for a short time (its absolutely fine now). That's a good thing. Phew. Sigh. Did you notice some of the mutually exclusive things on the above list?
And don't talk to me about mobile phones that go all independent of thought. Mine keeps turning itself off. Just without warning. Its most inconvenient, when there is so much to do.
Its been a strange week.
Finally, Frogdancer and Victoria - there are presents on the way to you both by the end of the month. That's as good a deadline as I can deal with at the moment.
Right, work have called, they are short of an idiot / midwife, and my number came up. So much for extended days off.
See ya.
Thursday, October 1, 2009
Happy October
Its the first day of October. How did that happen?
This (above) is Marina, she lives with Kelly now. Below is Jaune, who lives with my sister Helen. In response to a question....Jaune is legless, as is Marina if one looks carefully. Thanks Kelly for looking carefully.
I have two announcements.
First - I missed my blogiversary on September 28th. Gasp! Very few of you would remember this, my first post, two years ago. But looking back at the posts from the end of 2007 they are not too appalling, probably better then the whiny dross I have dished up lately, but with less Wild Women.
This (above) is Marina, she lives with Kelly now. Below is Jaune, who lives with my sister Helen. In response to a question....Jaune is legless, as is Marina if one looks carefully. Thanks Kelly for looking carefully.If I were better organised I would have a draw or something, with a prize. But as I haven't yet sent the de-stash prize won by Victoria in February- because I never actually DID the de-stash and therefore never identified the said goods- I feel bad, because you couldn't be said to be at the head of the queue. Yes that's right, it means I am still sitting in the same craft room mess (the very same) as I was in February. Was that TMI? Deal with it.
Anyway, I'm sure I could be persuaded to have fun with a creation of a random small gift for a commenter, and whatever it is I will send an identical-ish item to you, Victoria. One that won't clutter up your 'packing to move house' dilemma. Making small items is a pleasure, and is the only way I get to craft much these days.
So, it seems this IS now a giveaway situation (can you see this evolving before your eyes? Yeah, me too) with the leaving of a comment as the entry point.
In other news, as of today I am registered as a midwife in private practice.
I have no clients, have not advertised, and no particular plans, but have assembled some equipment so I can do antenatal and postnatal visits only at this stage, and I'll take it from there. 
It was out of a sense of solidarity with private midwives that the govt was threatening to outlaw homebirths and claiming it only affects about 200 midwives. Dammit! How dare they remove women's choices like that and ignore the wishes of women to choose homebirth with a known midwife, I thought, I'll make it 201 and stand with them........and besides, it never hurts to ruffle a few feathers. I know the Australian College of Midwives is working very hard behind the scenes to turn this situation around. I truly believe this battle will be won in the medium term. The evidence is just too strong. So . . . I filled in a form to notify the WA Health Department of my intention to practise as a midwife in private practice as of this date. and. sent. it. off. Many others have done similarly with less experience. I have people to guide me. I have trust in my knowledge and women's bodies. Antenatal and postnatal I can do. Its a start.
Gulp.
Wednesday, September 30, 2009
Whattup?
Hello? Anyone still there? (sounds of crickets chirping)
I have had some more plane related mishaps and hiccups. As a consequence I have had only one day at home in the last 9 days...yeah, yeah, excuses excuses, and a to-do list a mile long. .. in the next 2 days before I work for 5 further days. I really do have a lot to tell you. But typing time. . .. . is short. I met Kelly and her family and had a delicious dinner (see her account of it here). I attended 4 full days of information about national registration, MidPLUS, Midwifery Practice Review, MBS and PBS, and other practical midwifery stuff. I talked, I schmoozed, I ATE, I shopped, I danced, I laughed and cried. It was really super. Photos WILL follow, I promise.
Check out this you-tube clip for an upcoming video....it looks really interesting. I saw it on Public Health Doula, a little blog I have just started subscribing to. Its about how the media shapes one's view of birth, but this film shows the real deal. The real site it's from is here. It seems you can order a DVD.
http://www.youtube.com/watch?v=V9Gd7pqeESE&feature=player_embedded
And....Tomorrow is a special day. That's all I'm saying.
I have had some more plane related mishaps and hiccups. As a consequence I have had only one day at home in the last 9 days...yeah, yeah, excuses excuses, and a to-do list a mile long. .. in the next 2 days before I work for 5 further days. I really do have a lot to tell you. But typing time. . .. . is short. I met Kelly and her family and had a delicious dinner (see her account of it here). I attended 4 full days of information about national registration, MidPLUS, Midwifery Practice Review, MBS and PBS, and other practical midwifery stuff. I talked, I schmoozed, I ATE, I shopped, I danced, I laughed and cried. It was really super. Photos WILL follow, I promise.
Check out this you-tube clip for an upcoming video....it looks really interesting. I saw it on Public Health Doula, a little blog I have just started subscribing to. Its about how the media shapes one's view of birth, but this film shows the real deal. The real site it's from is here. It seems you can order a DVD.
http://www.youtube.com/watch?v=V9Gd7pqeESE&feature=player_embedded
See if you can guess my favourite birth moment in the clip. I'd love to hear which snippet strikes you. (ooh, you commenters are good! You have picked two of my three faves, go for gold now and complete the trifecta)
And....Tomorrow is a special day. That's all I'm saying.
Sunday, September 20, 2009
Gotta fly!
HI gang
Sorry for the absence....Its been a madhouse in my house!
I am quickly checking in to say 'see ya!' I'm off to Adelaide for a conference, and I get to meet Kelly of Taurus Rising, who has kindly offered to pick me up and feed me dinner. Bless her heart. I don't know anyone else in Adelaide so it will be lovely to be met and oriented somewhat by a local.
Thereafter, from early Tuesday morning I will be bombarded with Stuff About Midwifery. I can't wait (no, honestly, I AM looking forward to it). There'll be a big bunch of us, so we'll have a bit of a laugh as well, but I will be boggled in the mind department by the time I leave.
Somehow I have got a few days off from work, but I've worked all this weekend, with the same woman, and the same student midwife. Its been really great. This woman had so many special needs with her complex medical care, and had been so brave despite panicky patches that we just had to see her through, so at 3.24pm this afternoon we witnessed her baby girl FINALLY emerge into the world via the surgeons. It was such a slog for her, and the baby was so sweet, and pink and pretty. The family waiting outside theatre were thrilled to bits. It almost made me cry. Almost.
I am in a mad state, haven't started packing yet, but washing is done (phew), presents to get ready, a few things at the shops, hubby wants to see a movie this evening, so I had better get off the computer and pull my finger out and get. it. all. done.
See you in a week.
Sorry for the absence....Its been a madhouse in my house!
I am quickly checking in to say 'see ya!' I'm off to Adelaide for a conference, and I get to meet Kelly of Taurus Rising, who has kindly offered to pick me up and feed me dinner. Bless her heart. I don't know anyone else in Adelaide so it will be lovely to be met and oriented somewhat by a local.
Thereafter, from early Tuesday morning I will be bombarded with Stuff About Midwifery. I can't wait (no, honestly, I AM looking forward to it). There'll be a big bunch of us, so we'll have a bit of a laugh as well, but I will be boggled in the mind department by the time I leave.
Somehow I have got a few days off from work, but I've worked all this weekend, with the same woman, and the same student midwife. Its been really great. This woman had so many special needs with her complex medical care, and had been so brave despite panicky patches that we just had to see her through, so at 3.24pm this afternoon we witnessed her baby girl FINALLY emerge into the world via the surgeons. It was such a slog for her, and the baby was so sweet, and pink and pretty. The family waiting outside theatre were thrilled to bits. It almost made me cry. Almost.
I am in a mad state, haven't started packing yet, but washing is done (phew), presents to get ready, a few things at the shops, hubby wants to see a movie this evening, so I had better get off the computer and pull my finger out and get. it. all. done.
See you in a week.
Wednesday, September 9, 2009
Correspondent's report
Hi Laura,
I hope these don't take too long to download for you.
cheers
I want to get on a plane right now and bring you all HERE!!!!!
Why don't you live next door? Why has my sister moved back to Perth so I don't go through Melbourne or nearby lately!!!!!! Dammit!
I am heading to Adelaide on Sept 21st for the conference, and wish you were coming too. Rats.
We truly need to live closer together so I can smooch your lovely children. (throbs with longing for those gorgeous kids....) Tom is unbearably beautiful, I bet he is such fun chattering away and dragging cats around.
The photos of him with Darwin are gorgeous, and Georgie is looking like a mini-you. 
I'm sure Andy was just moving too fast to be captured on film! I just can barely believe how much I love that Tom-Tom, and am especially thrilled to be the first to have seen his sweet face. This midwifery deal is a pretty special gig.
I have just surfaced today after a stint of night shift so will rejoin the land of the living...the work on LBS at night is very absorbing but can be torrid at times, last night was one of those, just pulled from room to room with IOL left right and centre, and the previous night's ones still lingering and only just producing the goods 24 hrs later, or failing and having CS. I had a nice baby at 5.53am by vacuum, compound presentation which meant the Mum's epidural wasn't as effective while she was pushing - you know how they really hurt that extra bit with a hand as well. OUCH. The Mum was so loving and gorgeous to her baby as soon as she was out, it was beautiful to see. Three minutes later, at 0600 was a birth (with another midwife) to a multip who I had cared for initially that night before being moved, and as I left at 7.40am I stopped by theatre to see another primip who had not gone into labour after a tough 24 hours of trying, and was about to meet her babe by CS. I had been caring for her as well last night, and she headed off to OT just as I was in the thick of things for the vacuum, so another midwife took her up. Its all go I tell ya!
Time is flying past. Tom-Tom now 2.5yo. Still cute, fun and full of energy. He's talking very well now.
I hope these don't take too long to download for you.
cheers
love Jo
***********************************************************************************
OOOHHHHHH JO!
Thankyou so much, I actually ACHED with longing when I saw that child in the photos and now I'm in tears cos I miss him (and you, my darling) so much.
Thankyou so much, I actually ACHED with longing when I saw that child in the photos and now I'm in tears cos I miss him (and you, my darling) so much.
I want to get on a plane right now and bring you all HERE!!!!!Why don't you live next door? Why has my sister moved back to Perth so I don't go through Melbourne or nearby lately!!!!!! Dammit!
I am heading to Adelaide on Sept 21st for the conference, and wish you were coming too. Rats. We truly need to live closer together so I can smooch your lovely children. (throbs with longing for those gorgeous kids....) Tom is unbearably beautiful, I bet he is such fun chattering away and dragging cats around.
The photos of him with Darwin are gorgeous, and Georgie is looking like a mini-you. I'm sure Andy was just moving too fast to be captured on film! I just can barely believe how much I love that Tom-Tom, and am especially thrilled to be the first to have seen his sweet face. This midwifery deal is a pretty special gig.I have just surfaced today after a stint of night shift so will rejoin the land of the living...the work on LBS at night is very absorbing but can be torrid at times, last night was one of those, just pulled from room to room with IOL left right and centre, and the previous night's ones still lingering and only just producing the goods 24 hrs later, or failing and having CS. I had a nice baby at 5.53am by vacuum, compound presentation which meant the Mum's epidural wasn't as effective while she was pushing - you know how they really hurt that extra bit with a hand as well. OUCH. The Mum was so loving and gorgeous to her baby as soon as she was out, it was beautiful to see. Three minutes later, at 0600 was a birth (with another midwife) to a multip who I had cared for initially that night before being moved, and as I left at 7.40am I stopped by theatre to see another primip who had not gone into labour after a tough 24 hours of trying, and was about to meet her babe by CS. I had been caring for her as well last night, and she headed off to OT just as I was in the thick of things for the vacuum, so another midwife took her up. Its all go I tell ya!
Has it really been 9 months since you moved in? Time flies! Any further midwifery work for you? What else you been up to?- as if those gorgeous monkeys aren't enough to keep you fully occupied.
Anyway...I will call you soon,
Thanks again so much for sending those pics (get Georgie to take one of you too!)
Much love, dear friend, I really miss you
Laura x x x x x
Friday, September 4, 2009
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!
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!
Monday, August 3, 2009
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.
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.
Monday, July 27, 2009
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.
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.
Thursday, July 9, 2009
Slotting back into it
Ahh, its nice to be back at work.
I was hanging around home for the last few days, after a stressful and emotional week at home post-holiday, wondering if I was bored and ready to go back to work. The answer appears to be YES!
Its lovely to be back! Back with women and babies, and boobs, and most of all my fellow midwives.
I have been pleasantly busy, certainly fully absorbed, for two shifts now, with a great variety of women, from all walks of life. Women with prem babies, who are doing really well and come up to the ward (less than 35 weeks!!!), women with babies with unexpected birth defects, taking it all in their stride. Women having their second baby but breastfeeding for the first time, or giving it another go with the second after a less than stellar first time around the block. Brave women, loving their babes, or terrified of their baby, or hoping the baby stays in and gets cooked a bit more if they can stop bleeding.
The ward is being renovated currently which makes for a slightly smaller number of women to care for, but a bit more chaos and rearranging of Stuff We Need. Instead of the neonatal assessment area being in a central location it has moved to one end of a long ward, and today when workmen set off the alarm for the nursery we all rushed to the new location....but luckily it was an accident and the sheepish workmen were unaware that they had even had midwives running. As if we needed the exercise!
The breadth of issues being faced and dealt with by women and their midwives on a daily basis continues to impress me. Today I had a work experience student with me, a mature age one, so my every move was shadowed by someone. Sometimes she was able to join in and have a little bit of hands on - listening to a baby's heartbeat with the stethescope, gently feeling a postpartum abdomen to feel the contracting uterus as it shrank back into the pelvis, but mostly she watched quietly and asked questions in the corridor as we whizzed off to the next room. She asked good questions, and I hope she was able to get a feel for the range of a midwife's work. I had a gynaecology patient as well so she got a bit extra thrown in! As she'd had 7 children of her own I felt there wasn't much could shock her (not that I tried at all) and at the end of the day she expressed her appreciation of the new perspective. For all that she'd had 7 babies she had never experienced an epidural, or a caesarean, or a premmie, or a sick or disabled baby so there is always something to learn from every situation and she showed alot of empathy.
She asked briefly about drug addicted babies, and stillbirths and 'what happens' and I answered her questions as honestly as I could without going into too much detail. Our hospital truly does offer a wide range of experiences, and I'm very grateful to be seeing so much, as well as being able to teach students coming through.
I got a lovely surprise on my return to work. There was envelope for me with an excellence notation for my portfolio, and a beautiful email from a great couple I had been with for their birth in late March. I've just gone back and checked and I didn't tell you about this birth, but the commendation and photo they sent have reminded me what a fantastic day it was.
I remember they were a couple in their late 30s, their first baby, who had been together for 20+ years. It was a spontaneous labour, term or thereabouts, and they were so intune with each other. Just leaning and swaying together. She would look for him with each contraction, an obvious touchstone for her tranquility and there was no fighting or reluctance with the strength of each wave. It just came, was accepted and went away. She was a slightly built woman with long light brown hair and a lively face, and just so calm, it was a pleasure to be with her. I had a student with me that day too, and was really pleased to see such a spontaneous unmedicated woman - it was her first out of 5 hospital labours she had seen.
The room was dark, the monitor was off, I just listened in every now and then, baby was steady and gorgeous. At transition she got a bit shaky, and didn't quite know what to do with herself, but I suggested she go into the loo to be by herself, or with her hubby and regroup, and to come out when she was ready or wanted to push. So she did. Often women don't know what sensations to respond to - the pressure in their bottom caused by the descending head, the nausea and shakes of transition - for some it is the welcomed last time they throw up in the pregnancy! SO a change of scene will often do the trick. Additionally, the walking and sitting/squatting helps melt the last bit of the cervix away....
And so it was. She asked to be examined and she was fully dilated with a bulging bag of waters which actually popped shortly afterwards. The pushing began, she felt more secure on the bed so we positioned and positioned to help the descent of the head, which was slow but steady. The end of the shift was nigh, but the afternoon midwife was working with us, and after 30 minutes we spied a little head in the dark depths. Yay! And there it stayed for a tantalising 10 minutes, and then took another 10 minutes to crown properly. I was getting a bit antsy, and considering a rare episiotomy to release the head as I couldn't hear the fetal heart very well with the baby so deep within the canal. At last the head fully emerged followed quickly by the rest of the babe who lay there like a stunned mullet. I scooped her up and popped her onto her Mum, who announced the sex as I gritted my teeth waiting for the first breath...and waited...rub, rub....waiting...rub, rub...cut the cord... over to the resus warmer.... bag and mask, rub, rub c'mon sweetheart come and take part....heart rate good.....nil respiratory effort.....puff, puff.....getting pinker.....heart rate still good.......eyes still wide open and staring......come on little one, rub rub, still floppy....come and play. The afternoon midwife and I were both working on her as she was pretty stunned after that prolonged crowning. After two and a half minutes she gave a splutter, then blinked and sort of screwed up her face and let out a weak yell of protest, then started waving her arms and pedalling while taking deep breaths. Within 30 secs she was with her Mum and Dad, where she stayed skin to skin, pink and pretty (for ages I'm told), so calm and alert after a slow start.
Just one of those days....It was the second resus I'd done in as many days, after a few months without any. I recall being grateful again for my skills, our constant training and updates that allow us to just act without hesitation, and her pink perfection was a wonderful reward. I recall feeling sad for them that they were to be separated, by her staying in overnight in hospital. They hadn't been apart for a night in 23 years. How's that for a strong team? She was so amazing in her labour, so little fuss, so stoic and accepting of the process and I couldn't praise her enough, and made sure the student knew what a lovely birth she had seen - although she had seen 7 homebirths (more than I have) and was happy to finally have seen a gentle spontaneous hospital birth! This woman really was very beautiful and very clever and an absolute natural. So clever. So good at birthing. She should definitely do this again!
I don't recall the resus being a big deal or drama in the room, or any particular anxiety from the parents, they just happily accepted her back into their arms...but they may have reflected on those first few minutes later and wrote to the hospital expressing their appreciation to the three of us for our labour and birth care. It was a most welcome reminder of a great day.
I love being a midwife.
I was hanging around home for the last few days, after a stressful and emotional week at home post-holiday, wondering if I was bored and ready to go back to work. The answer appears to be YES!
Its lovely to be back! Back with women and babies, and boobs, and most of all my fellow midwives.
I have been pleasantly busy, certainly fully absorbed, for two shifts now, with a great variety of women, from all walks of life. Women with prem babies, who are doing really well and come up to the ward (less than 35 weeks!!!), women with babies with unexpected birth defects, taking it all in their stride. Women having their second baby but breastfeeding for the first time, or giving it another go with the second after a less than stellar first time around the block. Brave women, loving their babes, or terrified of their baby, or hoping the baby stays in and gets cooked a bit more if they can stop bleeding.
The ward is being renovated currently which makes for a slightly smaller number of women to care for, but a bit more chaos and rearranging of Stuff We Need. Instead of the neonatal assessment area being in a central location it has moved to one end of a long ward, and today when workmen set off the alarm for the nursery we all rushed to the new location....but luckily it was an accident and the sheepish workmen were unaware that they had even had midwives running. As if we needed the exercise!
The breadth of issues being faced and dealt with by women and their midwives on a daily basis continues to impress me. Today I had a work experience student with me, a mature age one, so my every move was shadowed by someone. Sometimes she was able to join in and have a little bit of hands on - listening to a baby's heartbeat with the stethescope, gently feeling a postpartum abdomen to feel the contracting uterus as it shrank back into the pelvis, but mostly she watched quietly and asked questions in the corridor as we whizzed off to the next room. She asked good questions, and I hope she was able to get a feel for the range of a midwife's work. I had a gynaecology patient as well so she got a bit extra thrown in! As she'd had 7 children of her own I felt there wasn't much could shock her (not that I tried at all) and at the end of the day she expressed her appreciation of the new perspective. For all that she'd had 7 babies she had never experienced an epidural, or a caesarean, or a premmie, or a sick or disabled baby so there is always something to learn from every situation and she showed alot of empathy.
She asked briefly about drug addicted babies, and stillbirths and 'what happens' and I answered her questions as honestly as I could without going into too much detail. Our hospital truly does offer a wide range of experiences, and I'm very grateful to be seeing so much, as well as being able to teach students coming through.
I got a lovely surprise on my return to work. There was envelope for me with an excellence notation for my portfolio, and a beautiful email from a great couple I had been with for their birth in late March. I've just gone back and checked and I didn't tell you about this birth, but the commendation and photo they sent have reminded me what a fantastic day it was.
I remember they were a couple in their late 30s, their first baby, who had been together for 20+ years. It was a spontaneous labour, term or thereabouts, and they were so intune with each other. Just leaning and swaying together. She would look for him with each contraction, an obvious touchstone for her tranquility and there was no fighting or reluctance with the strength of each wave. It just came, was accepted and went away. She was a slightly built woman with long light brown hair and a lively face, and just so calm, it was a pleasure to be with her. I had a student with me that day too, and was really pleased to see such a spontaneous unmedicated woman - it was her first out of 5 hospital labours she had seen.
The room was dark, the monitor was off, I just listened in every now and then, baby was steady and gorgeous. At transition she got a bit shaky, and didn't quite know what to do with herself, but I suggested she go into the loo to be by herself, or with her hubby and regroup, and to come out when she was ready or wanted to push. So she did. Often women don't know what sensations to respond to - the pressure in their bottom caused by the descending head, the nausea and shakes of transition - for some it is the welcomed last time they throw up in the pregnancy! SO a change of scene will often do the trick. Additionally, the walking and sitting/squatting helps melt the last bit of the cervix away....
And so it was. She asked to be examined and she was fully dilated with a bulging bag of waters which actually popped shortly afterwards. The pushing began, she felt more secure on the bed so we positioned and positioned to help the descent of the head, which was slow but steady. The end of the shift was nigh, but the afternoon midwife was working with us, and after 30 minutes we spied a little head in the dark depths. Yay! And there it stayed for a tantalising 10 minutes, and then took another 10 minutes to crown properly. I was getting a bit antsy, and considering a rare episiotomy to release the head as I couldn't hear the fetal heart very well with the baby so deep within the canal. At last the head fully emerged followed quickly by the rest of the babe who lay there like a stunned mullet. I scooped her up and popped her onto her Mum, who announced the sex as I gritted my teeth waiting for the first breath...and waited...rub, rub....waiting...rub, rub...cut the cord... over to the resus warmer.... bag and mask, rub, rub c'mon sweetheart come and take part....heart rate good.....nil respiratory effort.....puff, puff.....getting pinker.....heart rate still good.......eyes still wide open and staring......come on little one, rub rub, still floppy....come and play. The afternoon midwife and I were both working on her as she was pretty stunned after that prolonged crowning. After two and a half minutes she gave a splutter, then blinked and sort of screwed up her face and let out a weak yell of protest, then started waving her arms and pedalling while taking deep breaths. Within 30 secs she was with her Mum and Dad, where she stayed skin to skin, pink and pretty (for ages I'm told), so calm and alert after a slow start.
Just one of those days....It was the second resus I'd done in as many days, after a few months without any. I recall being grateful again for my skills, our constant training and updates that allow us to just act without hesitation, and her pink perfection was a wonderful reward. I recall feeling sad for them that they were to be separated, by her staying in overnight in hospital. They hadn't been apart for a night in 23 years. How's that for a strong team? She was so amazing in her labour, so little fuss, so stoic and accepting of the process and I couldn't praise her enough, and made sure the student knew what a lovely birth she had seen - although she had seen 7 homebirths (more than I have) and was happy to finally have seen a gentle spontaneous hospital birth! This woman really was very beautiful and very clever and an absolute natural. So clever. So good at birthing. She should definitely do this again!
I don't recall the resus being a big deal or drama in the room, or any particular anxiety from the parents, they just happily accepted her back into their arms...but they may have reflected on those first few minutes later and wrote to the hospital expressing their appreciation to the three of us for our labour and birth care. It was a most welcome reminder of a great day.
I love being a midwife.
Sunday, May 17, 2009
So busy (now with photos)
Busy week! Work was good.
Seeing friends from (now) over East and meeting their new baby, Willow.
Delightful! 
Making a new bag. Very nice too. Great fun. I used some long stashed ingredients.
Attending afternoon tea for a friend. Delicious. She loved the bag. 
Dinner party for friends. A great success.
Attending the craft fair. Stash building never goes out of style. Plans abound!
It seems I didn't win the raffle quilt. Sigh.
Bathroom nearing completion.
All tiles applied. Oohs and ahs expressed by all visitors, especially after seeing the beautiful marble feature tile, which looks gorgeous after sealing.
This week will include: grouting, fittings, cornices, painting and finally...bathing!
Seeing friends from (now) over East and meeting their new baby, Willow. Delightful! Making a new bag. Very nice too. Great fun. I used some long stashed ingredients. Attending afternoon tea for a friend. Delicious. She loved the bag. Dinner party for friends. A great success.Attending the craft fair. Stash building never goes out of style. Plans abound!It seems I didn't win the raffle quilt. Sigh.
Bathroom nearing completion.
All tiles applied. Oohs and ahs expressed by all visitors, especially after seeing the beautiful marble feature tile, which looks gorgeous after sealing. This week will include: grouting, fittings, cornices, painting and finally...bathing!
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