This year, I have been a parent for exactly half of my life.
Wow, what a journey. I am certain it has been the making of me, and I can't imagine my life without them in it, but I'm beginning to understand that daily contact is not necessary!
Our eldest moved away from home last December, 3000km away. Where all the cool people live. (waves at Melbourne). He is back at the moment for my birthday, and it is actually strange having him under the roof again (yes, he still has the same squeeze). No flies on him though - at what age do they stop hoping to cadge free shoes from parents?
When he left home I was a bit of a sook for a while. I figured out that it was because I didn't know when I would see him again. In the past I had had a date on the calendar for when he would walk in the door again. I was quite bereft without him, and was struck by how much I missed his presence, his bulk, his hugs and his company. I realised how unnatural it was for me to not be able to picture where he was. I had given birth to someone who was now a large man, roaming the Earth in a different city, and being all . . . functional and adult and grown up. Someone would see my son walking down the street, and interact with him, appraise him, like him or not, and it was out of my ken. I was not a face in that particular crowd. I was not breathing that same air with him any more. He was not returning to me. I felt the apron strings come undone. I had underestimated the lump it would make in my throat.
Once I figured out that it was a lack of a calendar entry that was troubling me I had to mentally commit to a visit to Melbourne mid-year. The separation then became easier to bear, and I settled down, and could think about him without become teary. I enjoyed my mental image of a confident capable adult son out in the world.
When I arrived home one day in late-March after a super day at work, with TWO births I was as high as a kite and bursting to share the fantastic day I had had. It was also our daughter's birthday, so all in all a great day, with a restaurant meal to look forward to. My key was in the door when I heard an adult male voice talking in the kitchen - he had been brought home on FF points by the squeeze as a surprise for his sister's birthday! He had been in town for 2 days already, lying low for a surprise! He scooped me up in a huge hug, and was really very tolerant of me patting him reassuringly all evening. I was so surprised, and so delighted. It was brilliant.
Our youngest is still home, and likely to stay here for some time, although she is keen to move out, in principle. She is not working at the moment, had to resign her job due to terrible eczema/dermatitis on her hands. Her health has been quite challenging in the last 9 months, with one thing and another, and the appointments are very frequent. We thought we were off all that frequent flyer stuff, but she has had 2 operations and not too many answers, although it is reassuring to have ruled some stuff out. She is doing one afternoon of maths refresher stuff at her level, and other than that sits on the computer/ watches DVDs, plays her music (Glee anything) and obsesses about the cat. She finds it really hard me being out all day with this new job, coming and going as much as I do. She has few friends and doesn't go out much, and is not nearly as independent as most people her age, although that is improving. She really needs to meet a sweet boy, but doesn't go anywhere to meet any :( She has however taken up the challenge of cooking dinner one night per week, which is a help. Now - how to trick her into taking up the rest of the housework! Well, thats not strictly fair, she does do a bit of food shopping as well during the week. However she has NO idea how to plan major stuff, and we are frustrated by her passivity in this matter. If she moved out next week it would be a fast-track to boredom, anxiety and malnutrition. . ..with added cats. We are starting to look into future options.
DD was away for a fortnight in April and we experienced the wonder of the empty nest.
And we want MORE!
Showing posts with label mothers. Show all posts
Showing posts with label mothers. Show all posts
Sunday, June 5, 2011
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.
Friday, June 18, 2010
A quiet life
Well, we've had 'the talk'.
I made it quite clear that it was unacceptable to know so much about their intimate life. And for our visitors to hear so much about it even at the other end of the house.
Would she make that much and that kind of noise at her mother's house? I was boldly told 'Yes, I do actually'. So I encouraged her to do it there instead, because I never, ever wanted to hear these sounds from her again. All luck to her for her talents, good for her, I had no objection to them engaging in sex, per se, at all. I just didn't need to hear it. Nor did his sister on the other side of the wall. Nor did his dad, his aunty, or I need to hear it. I was NOT kidding. I was approaching her directly about it because seven discussions with our son had been ineffectual.
There was no apology, from either of them.
They couldn't skedaddle back to his room quick enough and stayed in his room all evening, only emerging after my husband had gone to bed to have a 30 minute shower and talk loudly in the echo-y bathroom right next door to where hubby was sleeping. (insert grinding of teeth here)
They stayed in his room all day until 5pm, undoubtedly trying out silencing methods which must have worked because I didn't hear a peep out of them apart from talking and laughing occasionally. She left late in the day.
He wandered into my bedroom and asked if I was happier with the course of the day. I reiterated the level of distress that had built up over the last four months, and how I was quite clear about this being non-negotiable, about how it had been widely discussed with all and sundry in the suburbs and how I was by no means an island in feeling so alienated by their behaviour.
I described the advice about suitcases, buckets of water, ultimatums and unpleasantness on upcoming trips and the remainder of the year, and the undesirability of such courses of actions when compared to the relatively small price of cohabiting as adults while remembering our manners. I told him how much their voices carried. Especially in bathrooms late at night. How inconsiderate they had been. I described how my holiday period had begun with the frustration of being constantly hemmed in the house with a caterwauling young woman invading my personal and mental space being not at all what I had planned and now my final day of potential alone-ness was gone and I was pretty annoyed.
I wanted him to truly understand not only which side of his bread was buttered but how thick that butter was for a relatively small price of civility. The time was coming when he would be buttering it for himself, and it was important that he not take our butter for granted, and that would require some consideration for this final period of time we would be living together.
I think we have reached a new level of understanding. He said he was glad we had had it out. We had a few chuckles. We remain friends, but with a new, non-negotiable boundary.
Phew.
I made it quite clear that it was unacceptable to know so much about their intimate life. And for our visitors to hear so much about it even at the other end of the house.
Would she make that much and that kind of noise at her mother's house? I was boldly told 'Yes, I do actually'. So I encouraged her to do it there instead, because I never, ever wanted to hear these sounds from her again. All luck to her for her talents, good for her, I had no objection to them engaging in sex, per se, at all. I just didn't need to hear it. Nor did his sister on the other side of the wall. Nor did his dad, his aunty, or I need to hear it. I was NOT kidding. I was approaching her directly about it because seven discussions with our son had been ineffectual.
There was no apology, from either of them.
They couldn't skedaddle back to his room quick enough and stayed in his room all evening, only emerging after my husband had gone to bed to have a 30 minute shower and talk loudly in the echo-y bathroom right next door to where hubby was sleeping. (insert grinding of teeth here)
They stayed in his room all day until 5pm, undoubtedly trying out silencing methods which must have worked because I didn't hear a peep out of them apart from talking and laughing occasionally. She left late in the day.
He wandered into my bedroom and asked if I was happier with the course of the day. I reiterated the level of distress that had built up over the last four months, and how I was quite clear about this being non-negotiable, about how it had been widely discussed with all and sundry in the suburbs and how I was by no means an island in feeling so alienated by their behaviour.
I described the advice about suitcases, buckets of water, ultimatums and unpleasantness on upcoming trips and the remainder of the year, and the undesirability of such courses of actions when compared to the relatively small price of cohabiting as adults while remembering our manners. I told him how much their voices carried. Especially in bathrooms late at night. How inconsiderate they had been. I described how my holiday period had begun with the frustration of being constantly hemmed in the house with a caterwauling young woman invading my personal and mental space being not at all what I had planned and now my final day of potential alone-ness was gone and I was pretty annoyed.
I wanted him to truly understand not only which side of his bread was buttered but how thick that butter was for a relatively small price of civility. The time was coming when he would be buttering it for himself, and it was important that he not take our butter for granted, and that would require some consideration for this final period of time we would be living together.
I think we have reached a new level of understanding. He said he was glad we had had it out. We had a few chuckles. We remain friends, but with a new, non-negotiable boundary.
Phew.
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!
Tuesday, December 22, 2009
A few baubles for you
So.... its nearly Xmas. Had you noticed?
I'm getting in the mood now. The tree is decorated.
The pressies are chosen, wrapped and under the tree
The MRI is all clear. The dizzies are mostly gone. The medication is working. 
I am wearing Xmas earrings and a tinsel halo to work most days. Its fun. Work has been lovely. Interesting and brave Mums. Sweet babies. I've even had two thankyou cards and chocolates this week! That never happens! One was from the family I met before my holidays. The other twin is doing well.
Why do funeral companies have cookie cutter services with patronising overstated sentiment? Am I a bitch for asking? I attended the funeral of our colleague who died. It was about as wretched as expected, there were so many people there. Naturally there was a very notable turnout from work, nearly all the ward were there, and half the rest of the hospital. Her Dad spoke, heartbreakingly, followed by her sister, stoic and loving. They were a markedly smaller group as a family of 3, compared to the family of 5 they had been only 13 months ago. There is no easy or un-trite way to say goodbye in these circumstances. It all just sucks. 
Is there such a thing as turning up to heaven uninvited? I'm sure she would be welcomed anyway, she was a kind girl who earned her wings in many ways. Her death, and the circumstances of her death have been very confronting. Once again we are starkly reminded, depression is a serious illness. How desperately 'not-thinking-straight' must she have been to make that choice. Such a waste. 
I haven't been so active around this blog of late, but it doesn't mean I'm not thinking of you. Swings and roundabouts. Most bloggers I read report slow patches, and I am fascinated to realise that I have been blogging, and blog-reading, for more than 2 years now. 
In case I don't get to post again pre-Big Day may I wish you all a very happy Christmas season.
A toast: To old friends who have weathered the years, and to new friends who were strangers but yesterday. Merry Christmas.
I just know that 2010 will bring good things.
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.
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
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.
Monday, May 11, 2009
Report card
The bathroom now has some black floor tiles. Tomorrow there will be some plain gloss white wall tiles. The feature tile of cut green marble chips was sealed today (stinky and sticky work). It looks FABULOUS!!!!!!!! The colour is divine. I'm very excited. It will be another week or so until he is all finished, then the ceiling and door must be painted. Luckily the weather is holding and the outdoor shower (hot) is not palling yet.
Mother's Day was had. I have a lovely double yellow hibiscus in a large pot. I will try not to kill it. The gardener (not me) has made a similar vow. I arranged a picnic at Matilda Bay for my family. Some of them came. Long story. Food was eaten, photos were dutifully taken (but not yet uploaded). The Bag was much admired. No comment was made, or the 'feature' even noticed by the recipient. The lining was a special hit. Contractual obligation met. Tick.
My husband chivvied one of my offspring into delivering breakfast in bed. I walked past my hibiscus and the cards 9 times before they were actually proffered towards me. Sigh. One of them had other plans for lunch that involved playing cards, with like minded men. I cooked the picnic lunch, texted everyone madly to arrange a meeting point and tried not to cry that my family will never all be together again. It was all quite pleasant in the end, if smaller than I had pictured. Everyone brought their manners, which is not always guaranteed. Long story.
I went home and had a nap. No, not just a nap, an excellent nap. Dinner of lamb chops was cooked by the guys (now home from playing cards) and I watched some TV before retiring to bed and reading the last of the 4th Twilight book, which series I have just enjoyed re-reading.
I am now reading a charming midwifery memoir set in London's East End in the 1950s.
Today I have cut out a bag for a friend's birthday next weekend. Much planning involved. I also plan to give her a lovely vintage frock that I just know will suit her beautifully. She's having a rough time lately, and needs a boost.
Its only 5 weeks until we go to Europe. EEEKKKKKKKKK! DO I have the right shoes to stomp around Amsterdam?
Ah, the perpetual question....and I'm lovin it!
Where has the midwifery content gone, I hear you ask? Well, to be honest I barely feel like I have been at work lately, but I promise there will be some soon.
I did save a baby from a sticky name last week. It was an entirely culturally appropriate name for this little girl...but I'm sure her parents wouldn't have willingly named their daughter anything that sounded remarkably like "Shitty", even if it didn't look like that when written down. I carefully broached the subject, and made the comparison for them, clarifying the implications. They were very practical about it, and quite horrified at the near disaster. Phew. Welcome baby Lakshmi, nice name!
In other news on the naming responsibilities faced in the world..... I really look forward to hearing what twin boys 'Lefty' and 'Righty' resolve into when they are named by their sweet parents.
Be good, or good at it!
Mother's Day was had. I have a lovely double yellow hibiscus in a large pot. I will try not to kill it. The gardener (not me) has made a similar vow. I arranged a picnic at Matilda Bay for my family. Some of them came. Long story. Food was eaten, photos were dutifully taken (but not yet uploaded). The Bag was much admired. No comment was made, or the 'feature' even noticed by the recipient. The lining was a special hit. Contractual obligation met. Tick.
My husband chivvied one of my offspring into delivering breakfast in bed. I walked past my hibiscus and the cards 9 times before they were actually proffered towards me. Sigh. One of them had other plans for lunch that involved playing cards, with like minded men. I cooked the picnic lunch, texted everyone madly to arrange a meeting point and tried not to cry that my family will never all be together again. It was all quite pleasant in the end, if smaller than I had pictured. Everyone brought their manners, which is not always guaranteed. Long story.
I went home and had a nap. No, not just a nap, an excellent nap. Dinner of lamb chops was cooked by the guys (now home from playing cards) and I watched some TV before retiring to bed and reading the last of the 4th Twilight book, which series I have just enjoyed re-reading.
I am now reading a charming midwifery memoir set in London's East End in the 1950s.
Today I have cut out a bag for a friend's birthday next weekend. Much planning involved. I also plan to give her a lovely vintage frock that I just know will suit her beautifully. She's having a rough time lately, and needs a boost.
Its only 5 weeks until we go to Europe. EEEKKKKKKKKK! DO I have the right shoes to stomp around Amsterdam?
Ah, the perpetual question....and I'm lovin it!
Where has the midwifery content gone, I hear you ask? Well, to be honest I barely feel like I have been at work lately, but I promise there will be some soon.
I did save a baby from a sticky name last week. It was an entirely culturally appropriate name for this little girl...but I'm sure her parents wouldn't have willingly named their daughter anything that sounded remarkably like "Shitty", even if it didn't look like that when written down. I carefully broached the subject, and made the comparison for them, clarifying the implications. They were very practical about it, and quite horrified at the near disaster. Phew. Welcome baby Lakshmi, nice name!
In other news on the naming responsibilities faced in the world..... I really look forward to hearing what twin boys 'Lefty' and 'Righty' resolve into when they are named by their sweet parents.
Be good, or good at it!
Thursday, May 7, 2009
Blogging bliss
My favourite husband has an old laptop. He spent hours last night configuring it so I could use it instead of the limping desktop. Internet, printer, email - you name it. Sigh. He is my favourite (and only) husband. I still keep automatically reaching for the mouse, but I'll get used to it.
The bathroom is proceeding fabulously. Ooh, hang on, I'll see if I can get some photos off the camera.....talk amongst yourselves.......Done.
View from outside as the window is enlarged.
After - 3rd row down, second from the right. Laid by yours truly.
The bathroom is proceeding fabulously. Ooh, hang on, I'll see if I can get some photos off the camera.....talk amongst yourselves.......Done.
For the first few days after demolition I felt like I was seeing a maiden aunt naked. It just didn't seem quite right, too exposed, like I was looking up her dress. We can even see into the roof space throught the exposed cornices.
Before -the old timber cabinet and window. This frame was incredibly solid.
View from outside as the window is enlarged.After - 3rd row down, second from the right. Laid by yours truly. The bath in position. It was bricked in today.
Now don't show Mum...but here's the bag I've made for her for Mother's Day. 
I hope she likes it, it looks a little more sombre than I expected. The lining fabric is really lush.
When I photographed the bag at night there seems to be an angry person hiding among the big pattern central to the bag. Can you see it when you squint? 
Tell me NOW if you think it is a bad omen and I shouldn't give it to her....I'm not kidding. I'm on days off now. 
I'll still have time to make a different one.
I hope she likes it, it looks a little more sombre than I expected. The lining fabric is really lush. When I photographed the bag at night there seems to be an angry person hiding among the big pattern central to the bag. Can you see it when you squint? Tell me NOW if you think it is a bad omen and I shouldn't give it to her....I'm not kidding. I'm on days off now. I'll still have time to make a different one. The kids indulged me and allowed me to take some photos on Tuesday. I'm quite pleased with them. The snootiest cat in the world was even restrained briefly to pretend to be a real cat.
Today Stephanie has had some minor surgery. It is her first operation in about 5 years (and her 18th one) and she was not looking forward to it, but was really brave. The anaesthetist was very kind and understanding (and well briefed) and it went well. She slipped off to sleep briefly, and all the scary stuff was done while she was asleep. She was back with me within an hour, with a bandage on her arm where the stitches are. Hopefully that pesky mole will be benign, but its best to be safe!
Today Stephanie has had some minor surgery. It is her first operation in about 5 years (and her 18th one) and she was not looking forward to it, but was really brave. The anaesthetist was very kind and understanding (and well briefed) and it went well. She slipped off to sleep briefly, and all the scary stuff was done while she was asleep. She was back with me within an hour, with a bandage on her arm where the stitches are. Hopefully that pesky mole will be benign, but its best to be safe!
Our anniversary dinner was lovely. 
We went to a French place in Nedlands, old and family owned. Wonderful food and terrific service. Only one small glitch, a freebie appetiser of seafood bisque cappucino! Served in a little espresso cup with foam on top! It looked cute, but unfortunately tasted vile. We both love seafood bisque normally, but the balance was really off. I mean really off. All the stuff from the prawn and lobster heads that one normally ...washes out... was obviously left in there and had flavoured the bisque much too heavily, so basically it tasted like....well...the stuff you would normally wash out. We had one sip, nearly gagged, and pushed it aside. We sent it back. The rest of the meal was superb. Utterly superb. Highly recommended.
We went to a French place in Nedlands, old and family owned. Wonderful food and terrific service. Only one small glitch, a freebie appetiser of seafood bisque cappucino! Served in a little espresso cup with foam on top! It looked cute, but unfortunately tasted vile. We both love seafood bisque normally, but the balance was really off. I mean really off. All the stuff from the prawn and lobster heads that one normally ...washes out... was obviously left in there and had flavoured the bisque much too heavily, so basically it tasted like....well...the stuff you would normally wash out. We had one sip, nearly gagged, and pushed it aside. We sent it back. The rest of the meal was superb. Utterly superb. Highly recommended.I've also made another Wild Woman (in yellows and orange) for someone special. No, you can't peek.
Lesley and I are nearly finished Jarryd's quilt. If I'm not remaking a bag this weekend (cough, but seriously, tell me if I need to) I'll be stitching on the binding. Then it will be off!
The outdoor showers are going well, the coldest morning has only been 9C, so not too bad so far. Everyone is still enjoying it.
Woo-hoo! Days off and a quilt to finish, craft to do and a bathroom to enthuse about! See ya!
Monday, March 30, 2009
20 years ago
This time twenty years ago I had started contracting after my waters were broken carefully, so no cord slipped through. The doctor was trying to induce me at 41 weeks and 2 days, but the baby was having none of it (below, 38 weeks, with my son, and friends)
I laboured all day, then when assessed at 3 pm-ish was not very dilated, but more effaced. Having had a v-e-r-y long latent phase with my first child I agreed to having some syntocinon put up to get things moving. I had a shower first, put on my favourite pink parrot earrings, then held out my arm for an IV and labour began again. I agreed to intermittent monitoring and refused to get on the bed at all.
Two hours and 16 minutes later...there she was. (above, 8 minutes of age, yes that is a Janet Jackson moment) 
A daughter, how delightful, a pigeon pair. A bit different (above, aged 6 months) a new experience for us, but our much wanted second child. (below - First day at school aged nearly 7, brother aged 10)
A daughter, how delightful, a pigeon pair. A bit different (above, aged 6 months) a new experience for us, but our much wanted second child. (below - First day at school aged nearly 7, brother aged 10)
And now she is 20. We are so proud of her (below, taken this morning, aged 20)
Happy birthday darling.
Sunday, March 22, 2009
Asking the question
I've had a very full few days at work. Steadily busy, but not madly so, yet the women I have seen have been so interesting.
I do like meeting women. And men. I s'pose I just like people really.
We've had students through, as is common in any area, but this time I have more actively been seeking them out and keeping them company. I am beginning to feel I could show them stuff, finally, after a few years in the field.
One of my objectives for working in clinics was to gain experience in abdominal palpation. I'm very pleased to feel I have gained confidence in this skill. I have picked up a number of breech lying babes, a few transverse, and become more confident in understanding attitude - i.e. the full position the baby is lying in, including head positions. Phew. Filling in the gaps. It feels good.
I have also wanted to better understand antenatal education given at the visits, and the tests at various stages, and I think I have got that down now. I'm not fast at it, but I understand it much better. I had visits with interpreters, both in person and via the telephone, adolescents, first timers, and grand multips, new migrants from other counties or new settlers from other states in Australia. We track down results from everywhere, even different time zones across the world. It is quite astounding how many phone calls we make and questions we ask over the course of a clinic session.
Some of questions we ask are the hard ones. Domestic violence. Depression screening. Any history of unwelcome sexual contact. This last one is often difficult to broach, and I confess we don't ask it of everyone, although we are alert to the possibility of it in any woman we see.
This week I have referred two women to our psychology services for raised depression screening scores with positive answers to questions of thoughts of self-harm in the last week. I'm so pleased we have these services so readily available. They are vital supports for vulnerable women. One teenager, in a very difficult position, was especially in need and I was hopping from foot to foot as I waited for the clin psych to be free. She was seen within 20 minutes, and will be followed up with a psychiatrist and a visiting midwife for adolescents and social workers and will hopefully be feeling much safer, more stable and supported soon. She was really brave, very private and reserved but clearly in a bad place, and feeling there was 'no happy place'. Poor kid.
Another woman I didn't refer set off all sorts of alarm bells as we had a chat. She was clear that she was going to try breastfeeding again (this was her second child) but that she would not be putting the child to the breast. No thankyou, its not my thing, my body is private and I don't like people touching it. (ding-a-ling-ding), No, I don't want to be referred to a psychologist even though I have a history of postnatal depression and I was medicated but took myself off it because my depression is not related to my baby (ding-a-ling-ding), yes I have a long-standing history of depression, no I don't discuss my depression with my family, they've got enough to be coping with (ding-a-ling-ding), I'm alright. I don't want anyone touching me (she wants a vaginal birth after CS last time) (ding-a-ling-ding). I took a deep breath.
Hmm. Many of the things you're telling me make me wonder... Have you ever experienced unwelcome sexual contact? Perhaps in the past?
She dropped her eyes and with a deep sigh made a decision to break her silence....
She had never told her mother, a former heroin user, because so many people would end up 'down there' she said, indicating a low level with a horizontal wave of her hand. It would tear my family apart. Maybe one day when some people were dead she would tell her family, but for now she chooses to keep it to herself to protect the greater whole. He is still around. She sees him frequently. She never discusses it with him. It stopped, she doesn't know why. She doesn't think it happened to her younger sisters, or is happening to anyone in her circle now. It wasn't her fault. Or his probably. He was not right in the head. But it stopped and she was content to leave it alone. Let sleeping dogs lie. She would only struggle and get all stirred up if she allowed herself to think about it. I've never told anyone else apart from my partner, and two friends, she said, through tight lips and with raised eyebrows as if unable to believe she was telling me now. But she was determined that she did not want any intervention or referral, and to leave it alone.
I was not surprised. She asked what had made me ask the question. I explained the signs I had seen in her tough, fiercely independent and private defence system. Most brick walls are not so high, or so tough. These kind of walls are built extra strong for a reason. A good reason.
We tossed around some of the connections and ramifications of her experiences. I joined a few dots, she joined a few, and we acknowledged her survival. Her choices. But it was important that she knew that she was not alone in her walled community. I reminded her that we had people who were able to support her if she wanted to knock out a few bricks in the wall.
One wonders about the ability of young women living these tightly wound and edgy lives to grow a well nourished baby to term. Last time her baby was small and growth restricted and she ended up with a CS due to concerns about the prem baby's ability to cope with labour. I'm not sure what her chances are like to achieve a VBAC this time around. Labour will not be pleasant, and she will be quite challenging to care for, as women pursuing VBAC are closely monitored, and vaginal examination will be extremely threatening for her. I hope she is able to labour well at home and stay away from the hospital for a good while, and arrives almost ready to push. And that the midwives pick up the subtext of her behaviour and are able to leave her alone as much as possible. And that her baby is better grown than the last one and able to cope well with labour. That's a lot to hope for.
I do like meeting women. And men. I s'pose I just like people really.
We've had students through, as is common in any area, but this time I have more actively been seeking them out and keeping them company. I am beginning to feel I could show them stuff, finally, after a few years in the field.
One of my objectives for working in clinics was to gain experience in abdominal palpation. I'm very pleased to feel I have gained confidence in this skill. I have picked up a number of breech lying babes, a few transverse, and become more confident in understanding attitude - i.e. the full position the baby is lying in, including head positions. Phew. Filling in the gaps. It feels good.
I have also wanted to better understand antenatal education given at the visits, and the tests at various stages, and I think I have got that down now. I'm not fast at it, but I understand it much better. I had visits with interpreters, both in person and via the telephone, adolescents, first timers, and grand multips, new migrants from other counties or new settlers from other states in Australia. We track down results from everywhere, even different time zones across the world. It is quite astounding how many phone calls we make and questions we ask over the course of a clinic session.
Some of questions we ask are the hard ones. Domestic violence. Depression screening. Any history of unwelcome sexual contact. This last one is often difficult to broach, and I confess we don't ask it of everyone, although we are alert to the possibility of it in any woman we see.
This week I have referred two women to our psychology services for raised depression screening scores with positive answers to questions of thoughts of self-harm in the last week. I'm so pleased we have these services so readily available. They are vital supports for vulnerable women. One teenager, in a very difficult position, was especially in need and I was hopping from foot to foot as I waited for the clin psych to be free. She was seen within 20 minutes, and will be followed up with a psychiatrist and a visiting midwife for adolescents and social workers and will hopefully be feeling much safer, more stable and supported soon. She was really brave, very private and reserved but clearly in a bad place, and feeling there was 'no happy place'. Poor kid.
Another woman I didn't refer set off all sorts of alarm bells as we had a chat. She was clear that she was going to try breastfeeding again (this was her second child) but that she would not be putting the child to the breast. No thankyou, its not my thing, my body is private and I don't like people touching it. (ding-a-ling-ding), No, I don't want to be referred to a psychologist even though I have a history of postnatal depression and I was medicated but took myself off it because my depression is not related to my baby (ding-a-ling-ding), yes I have a long-standing history of depression, no I don't discuss my depression with my family, they've got enough to be coping with (ding-a-ling-ding), I'm alright. I don't want anyone touching me (she wants a vaginal birth after CS last time) (ding-a-ling-ding). I took a deep breath.
Hmm. Many of the things you're telling me make me wonder... Have you ever experienced unwelcome sexual contact? Perhaps in the past?
She dropped her eyes and with a deep sigh made a decision to break her silence....
She had never told her mother, a former heroin user, because so many people would end up 'down there' she said, indicating a low level with a horizontal wave of her hand. It would tear my family apart. Maybe one day when some people were dead she would tell her family, but for now she chooses to keep it to herself to protect the greater whole. He is still around. She sees him frequently. She never discusses it with him. It stopped, she doesn't know why. She doesn't think it happened to her younger sisters, or is happening to anyone in her circle now. It wasn't her fault. Or his probably. He was not right in the head. But it stopped and she was content to leave it alone. Let sleeping dogs lie. She would only struggle and get all stirred up if she allowed herself to think about it. I've never told anyone else apart from my partner, and two friends, she said, through tight lips and with raised eyebrows as if unable to believe she was telling me now. But she was determined that she did not want any intervention or referral, and to leave it alone.
I was not surprised. She asked what had made me ask the question. I explained the signs I had seen in her tough, fiercely independent and private defence system. Most brick walls are not so high, or so tough. These kind of walls are built extra strong for a reason. A good reason.
We tossed around some of the connections and ramifications of her experiences. I joined a few dots, she joined a few, and we acknowledged her survival. Her choices. But it was important that she knew that she was not alone in her walled community. I reminded her that we had people who were able to support her if she wanted to knock out a few bricks in the wall.
One wonders about the ability of young women living these tightly wound and edgy lives to grow a well nourished baby to term. Last time her baby was small and growth restricted and she ended up with a CS due to concerns about the prem baby's ability to cope with labour. I'm not sure what her chances are like to achieve a VBAC this time around. Labour will not be pleasant, and she will be quite challenging to care for, as women pursuing VBAC are closely monitored, and vaginal examination will be extremely threatening for her. I hope she is able to labour well at home and stay away from the hospital for a good while, and arrives almost ready to push. And that the midwives pick up the subtext of her behaviour and are able to leave her alone as much as possible. And that her baby is better grown than the last one and able to cope well with labour. That's a lot to hope for.
Friday, March 13, 2009
There but for the grace of God...
Busy week.
An unexpected shift on LBS on Wednesday instead of clinics. I had a very busy shift, a challenging shift. I am looking forward to returning there at the end of the month.
One of the challenges was working with a woman with significant drug issues. She was stable, and had birthed already when I met her, but it really gave me an insight into the chaos and consequences of her lifestyle.
Her teenaged children were present following the birth, and were quite loud, and demanding but were obviously keen to be there and to see their new sister. Dad was there too, and her Mum, and then her brother-in-law, his wife, her kids, another friend all turned up and could barely be persuaded to leave while she was being sutured up. They hung around outside her room (not ideal) and were just...really LOUD. The 14 year old daughter was all whiny and demanding "Mum said i could bath her first, when can we bath her, i want to pick out her clothes, how much does she weigh? Blah blah, blah" Her 13 year old brother was all "she's prettier than you Sis" then Sis would whine and protest to Mum....am I painting a picture?
The woman was trying to referee from the bed, Nanna was all "I'm gonna take this baby back to Melbourne with me, she's so cute" It was pretty full on. I was completely over them all within half an hour. The woman was paranoid about her teenagers not walking with the baby so would yell at them if they twitched on the lounge with her. In the end I suggested we weigh the baby and do her top-to-toe check. Everyone agreed that would be a lovely thing to see.
I brought the warmer over to near the woman - she declined to hold the baby for the check - and lowered the side so she could see more clearly. I usually talk through the check, doing an inventory of eyes, ears, etc, turning the baby gently from side to side and telling her how pretty she is and pointing out the features to all present. We examine the reflexes, the spine, and demonstrate the stepping reflex of the newborn, which is always entertaining. The last thing we do is a genital inspection and check for an anal wink - where we lightly touch the sphincter and expect to see a 'wink' reflex tightening, if the spinal reflexes are intact. Hers was a little buried in a crevice and I gently separated the cheeks to better see it. I also checked a dimple in her butt crack to check it had a bottom to it, not a hole through to the spinal space. It didn't, all was well. But while I was carefully doing this I forgot to talk and explain my actions.
The woman spoke really aggressively to me - hey, what are ya doing? That must hurt her! I stopped immediately and considered what I was doing, then realized it must look strange. I explained my actions very simply, and gave her the commentary I had omitted. Oh, thats alright then, she said. I see now. But I felt bad, and completely understood how it must have looked to her in those brief moments. Sometimes we don't know fully the background of a woman in our care, and I wondered if I had accidentally hit a sore spot, that made her especially protective.
I weighed the baby and, with her permission, dressed the baby in our clothes for now (to save family fights) and sent everyone out for some peace and quiet. I gave her the baby to cuddle for a while. She was really worried about some blood on the baby's head, and I imagine it was about blood-borne contaminants, although she never said this out loud. She was in pain, and fed-up, and exhausted and aggressive, but was so sweet with her new baby. She freaked out about every drop of blood, although I was completely unphased by it. I recognized the risks of exposure. We wear gloves for those aspects of care for every woman, this one was no different, but she and her family were really grossed out by every smudge. It was quite trying. I gave her as much pain medication as I could, and resolved not to be offended by her manner towards me.
I wouldn't want her life.
Not the stressful, demanding, anxious, whiny teenagers; not the addiction; not the prospect of bringing up another baby in those circumstances. I could see she was trying hard with behaviour management of the kids. She was trying to control so much it was bound to do anyone's head in. She snapped and bit readily, the next 3 hours with her d.r.a.g.g.e.d to be honest. She was proud, and had limited mobility, and hated being dependent. I offered small amounts of practical assistance in the tight spaces of the bathroom. It was a huge effort to get her showered, redressed, epidural out and transferred up to the ward. I was sweating bullets by the end. She had mountains of luggage, and was snapping at her partner to NOT carry it, No, the kids aren't carrying it either, she'll get a trolley (meaning me). I got the trolley from the other end of the ward, sagging in the sluice doorway as I asked the support staff to please, pretty please, locate a large trolley for All. The. Stuff. Soon.
After corralling the energetic entourage at the far end of the postnatal ward, I settled her in to her fresh new room, which she complained about (its too small, smaller than my other one - Actually they're all the same. I said evenly, Oh well, we'll just have to make do). She had found fault with so many trivial things that day. I wished her a speedy recovery, and I walked away from her, exhausted. The receiving midwife's brows were furrowing at the prospect of the remainder of the shift.
I returned to LBS, answered an assist bell and scribed for a brief emergency. I did a tea relief for another very challenging patient with specialised complex needs. Then after my dinner I received another woman who was to be induced. She was delightful and the rest of the evening was spent sorting out her very complex medical needs and 'doing the shopping' i.e. restocking the room so it was ready for anything.
I was pretty knackered but satisfied with a full day's work. I slept well that night.
I have learned alot in clinics and now have a much better idea of education and resources, tests, abdominal palpation at all gestations, depression screening, how the clinics run and results and charts get to people (doctors and women). I have had busy shifts and very quiet shifts. I have met many new midwife colleagues, and enjoyed meeting students and showing them around a bit. It has been a break from the madness and overwork of the ward. And I have had a chance to really become comfortable providing antenatal care, especially to women pursuing VBAC.
I was delighted last week to see a woman I met in January, who asked for me again on Friday. We had a great visit together. She was near term and I offered her a stretch and sweep to help things along. We took our time and her cervix felt very favourable and I was confident her pregnancy was nearing the last days. I was feeling really bubbly and excited for her, and showed it readily, which she thought was hilarious. She had a vaginal birth 24 hours later. It was really special to hear - I had a feeling she was in labour and called LBS - she was. I was as high as kite.
I look forward to sharing this with many other women. Of all walks of life. Even if they are challenging.
I love being a midwife.
An unexpected shift on LBS on Wednesday instead of clinics. I had a very busy shift, a challenging shift. I am looking forward to returning there at the end of the month.
One of the challenges was working with a woman with significant drug issues. She was stable, and had birthed already when I met her, but it really gave me an insight into the chaos and consequences of her lifestyle.
Her teenaged children were present following the birth, and were quite loud, and demanding but were obviously keen to be there and to see their new sister. Dad was there too, and her Mum, and then her brother-in-law, his wife, her kids, another friend all turned up and could barely be persuaded to leave while she was being sutured up. They hung around outside her room (not ideal) and were just...really LOUD. The 14 year old daughter was all whiny and demanding "Mum said i could bath her first, when can we bath her, i want to pick out her clothes, how much does she weigh? Blah blah, blah" Her 13 year old brother was all "she's prettier than you Sis" then Sis would whine and protest to Mum....am I painting a picture?
The woman was trying to referee from the bed, Nanna was all "I'm gonna take this baby back to Melbourne with me, she's so cute" It was pretty full on. I was completely over them all within half an hour. The woman was paranoid about her teenagers not walking with the baby so would yell at them if they twitched on the lounge with her. In the end I suggested we weigh the baby and do her top-to-toe check. Everyone agreed that would be a lovely thing to see.
I brought the warmer over to near the woman - she declined to hold the baby for the check - and lowered the side so she could see more clearly. I usually talk through the check, doing an inventory of eyes, ears, etc, turning the baby gently from side to side and telling her how pretty she is and pointing out the features to all present. We examine the reflexes, the spine, and demonstrate the stepping reflex of the newborn, which is always entertaining. The last thing we do is a genital inspection and check for an anal wink - where we lightly touch the sphincter and expect to see a 'wink' reflex tightening, if the spinal reflexes are intact. Hers was a little buried in a crevice and I gently separated the cheeks to better see it. I also checked a dimple in her butt crack to check it had a bottom to it, not a hole through to the spinal space. It didn't, all was well. But while I was carefully doing this I forgot to talk and explain my actions.
The woman spoke really aggressively to me - hey, what are ya doing? That must hurt her! I stopped immediately and considered what I was doing, then realized it must look strange. I explained my actions very simply, and gave her the commentary I had omitted. Oh, thats alright then, she said. I see now. But I felt bad, and completely understood how it must have looked to her in those brief moments. Sometimes we don't know fully the background of a woman in our care, and I wondered if I had accidentally hit a sore spot, that made her especially protective.
I weighed the baby and, with her permission, dressed the baby in our clothes for now (to save family fights) and sent everyone out for some peace and quiet. I gave her the baby to cuddle for a while. She was really worried about some blood on the baby's head, and I imagine it was about blood-borne contaminants, although she never said this out loud. She was in pain, and fed-up, and exhausted and aggressive, but was so sweet with her new baby. She freaked out about every drop of blood, although I was completely unphased by it. I recognized the risks of exposure. We wear gloves for those aspects of care for every woman, this one was no different, but she and her family were really grossed out by every smudge. It was quite trying. I gave her as much pain medication as I could, and resolved not to be offended by her manner towards me.
I wouldn't want her life.
Not the stressful, demanding, anxious, whiny teenagers; not the addiction; not the prospect of bringing up another baby in those circumstances. I could see she was trying hard with behaviour management of the kids. She was trying to control so much it was bound to do anyone's head in. She snapped and bit readily, the next 3 hours with her d.r.a.g.g.e.d to be honest. She was proud, and had limited mobility, and hated being dependent. I offered small amounts of practical assistance in the tight spaces of the bathroom. It was a huge effort to get her showered, redressed, epidural out and transferred up to the ward. I was sweating bullets by the end. She had mountains of luggage, and was snapping at her partner to NOT carry it, No, the kids aren't carrying it either, she'll get a trolley (meaning me). I got the trolley from the other end of the ward, sagging in the sluice doorway as I asked the support staff to please, pretty please, locate a large trolley for All. The. Stuff. Soon.
After corralling the energetic entourage at the far end of the postnatal ward, I settled her in to her fresh new room, which she complained about (its too small, smaller than my other one - Actually they're all the same. I said evenly, Oh well, we'll just have to make do). She had found fault with so many trivial things that day. I wished her a speedy recovery, and I walked away from her, exhausted. The receiving midwife's brows were furrowing at the prospect of the remainder of the shift.
I returned to LBS, answered an assist bell and scribed for a brief emergency. I did a tea relief for another very challenging patient with specialised complex needs. Then after my dinner I received another woman who was to be induced. She was delightful and the rest of the evening was spent sorting out her very complex medical needs and 'doing the shopping' i.e. restocking the room so it was ready for anything.
I was pretty knackered but satisfied with a full day's work. I slept well that night.
I have learned alot in clinics and now have a much better idea of education and resources, tests, abdominal palpation at all gestations, depression screening, how the clinics run and results and charts get to people (doctors and women). I have had busy shifts and very quiet shifts. I have met many new midwife colleagues, and enjoyed meeting students and showing them around a bit. It has been a break from the madness and overwork of the ward. And I have had a chance to really become comfortable providing antenatal care, especially to women pursuing VBAC.
I was delighted last week to see a woman I met in January, who asked for me again on Friday. We had a great visit together. She was near term and I offered her a stretch and sweep to help things along. We took our time and her cervix felt very favourable and I was confident her pregnancy was nearing the last days. I was feeling really bubbly and excited for her, and showed it readily, which she thought was hilarious. She had a vaginal birth 24 hours later. It was really special to hear - I had a feeling she was in labour and called LBS - she was. I was as high as kite.
I look forward to sharing this with many other women. Of all walks of life. Even if they are challenging.
I love being a midwife.
Friday, January 23, 2009
From chocolates to boiled lollies
We are encouraged to ask women about their intentions re contraception prior to discharge from hospital.
One of the consultants stood at the desk and urged us all, loudly, to keep it up because we see some pretty sick women (well, we do) who are not doing their bodies any favours by imposing a pregnancy upon it. Parturient autonomy anyone?
On that topic, I had one such woman in my care on the postnatal ward the day after my dreamy day on LBS. She was 30 and had just had a premie baby, her first. She had a number of underlying conditions and I was having the talk with her about her contraception plans.
I won't be needing any.
Are you sure? Unplanned randomness can happen you know.
I'm seeing a woman, so it won't be a problem.
Oh, I see. Fair enough. Were you seeing a fella for a while to get your baby or did you make other arrangments to conceive?
Whaddya mean? (frowning)
Well, women with female partners sometimes arrange for a friend to be a semen donor and they turkey baste to get a baby, or they will have a short term arrangement in order to conceive. You did say you were seeing a woman didn't you? That you have a female partner?
I said I'm a single woman. A S-I-N-G-L-E woman. That's why I won't be needing anything. And I don't like no oysters! Geez!
D'OH!
She saw the funny side of it.
I'm very inclusive. So sensitive. And a bit deaf it seems.
My bad.
One of the consultants stood at the desk and urged us all, loudly, to keep it up because we see some pretty sick women (well, we do) who are not doing their bodies any favours by imposing a pregnancy upon it. Parturient autonomy anyone?
On that topic, I had one such woman in my care on the postnatal ward the day after my dreamy day on LBS. She was 30 and had just had a premie baby, her first. She had a number of underlying conditions and I was having the talk with her about her contraception plans.
I won't be needing any.
Are you sure? Unplanned randomness can happen you know.
I'm seeing a woman, so it won't be a problem.
Oh, I see. Fair enough. Were you seeing a fella for a while to get your baby or did you make other arrangments to conceive?
Whaddya mean? (frowning)
Well, women with female partners sometimes arrange for a friend to be a semen donor and they turkey baste to get a baby, or they will have a short term arrangement in order to conceive. You did say you were seeing a woman didn't you? That you have a female partner?
I said I'm a single woman. A S-I-N-G-L-E woman. That's why I won't be needing anything. And I don't like no oysters! Geez!
D'OH!
She saw the funny side of it.
I'm very inclusive. So sensitive. And a bit deaf it seems.
My bad.
Wednesday, January 21, 2009
Number forty six
All good things come to those who wait. (Yes bold Em, I'm talking to you).
Today I was unexpectedly sent to LBS.
I arrived 4 minutes after the birth of a little one, to a primip who had laboured beautifully and quickly, a few stitches (not by me), done and dusted. I had a student midwife with me who was just terrific, really efficient with obs etc. The couple were pretty pleased with themselves, baby fed promptly, gave him his top to toe check on Mum's tummy, he was really relaxed. All was good.
Mum was in the shower and almost ready to go to the ward when I was called to another room.
It was another labouring primip, already 7cm dilated. I took handover and she stayed standing up at the windowsill. She was attended by husband and mother who were doing really well with massage, and she was rocking, not making much sound.
After a while she informed me there was 'something there'. I peeped and there was a pouting bottom, that went away with the contraction's end. But I knew there was a baby not far behind!
I kept peeking up her dress with contractions, seeing a bit of poop here, a bulge there. She was trying not to push, just let the contractions do the work.
It worked. What a genius, what a natural she was.
On the fifth look, there was definite perineal bulging and .....a head on view! I got the hubby to push the bell to call another midwife for the imminent birth, and asked her if she wanted to stay standing up for the birth. No, I want to get on the bed. Then you'd better be quick! I replied.
The second midwife turned up, I got my gloves on and the head was there, then slipped back after the contraction. Just enough time for the student midwife to come skidding in the door and scramble into a pair of gloves. We caught the baby together after a slow and gentle crowning, then a quick restitution and baby slithered out in a hurry, with a hand under the chin.
What is it? Mum asked - I don't know - you tell me! Its a girl! she cried Yes! I prayed for this!
There were sobs of delight, repeated thankyous and much joy in the room. Baby A blinked and looked around at all the grinning adults, pink and perfect and alert. She was calm and observant and very pretty. Her parents were just delighted, and so they should be. We midwives were most fulsome in our praise for them too. Such a clever woman, such a fantastic labourer, she made it look easy. We were stoked.
Unfortunately there were quite a few stitches needed here and there, nothing catastrophic but a bit ouchy initially. She was really great again, and turned to me for support during the stitching, which doesn't often happen, but I was really pleased to be 'with woman' in this way. She slipped her hand in mine, our heads were close and she asked softly that I tell her a story...so I began.
Once upon a time...there was a lovely young woman who was having her first baby, and when it was time to labour she was really brave and strong and beautiful and stayed home for a long time while her contractions came thick and fast. And when she got to hospital she was already near the end. And so she kept labouring beautifully, talking to her midwife when she needed to and telling her when the baby's head was there. And then she pushed out her baby easily and calmly, and everyone was very proud of her, and she was proud of herself, because she had done an amazing job bringing her baby to the world. What a miraculous thing is the female body, and the process of birth. God is very good.
It was such a special thing. I have never had a woman ask me for that before, and I was surprised that I slipped so automatically into storytelling mode, as if she was a child. She wasn't of course, but it seemed right. And she responded shyly but with delight to hear her tale already the stuff of legend. I told her that she should think about having her next baby at home, or in a birth centre as she had done so well she was an ideal candidate.
The baby remained calm and alert, and fed well and easily. It was really special. Her prayers were answered...and so were mine.
How delightful to spend the day with two new mothers who birthed with such power and ease. With two sweet, calm babies who didn't fuss but just responded well to their natural instincts. And to work with a student midwife who was so competent and thoughtful. We had a chat at tea, about how moved we frequently are at seeing women birthing so strongly, trusting their bodies to follow the physiological process, and how it all can go so smoothly. It is a privilege like no other, to be a witness to these births.
To top off our lovely day, on the board where the women's names are logged room by room, and they are noted as 6cm, delivered, or whatever, next to our room the coordinator had written:
"Delivered, beautifully"
I love being a midwife
Today I was unexpectedly sent to LBS.
I arrived 4 minutes after the birth of a little one, to a primip who had laboured beautifully and quickly, a few stitches (not by me), done and dusted. I had a student midwife with me who was just terrific, really efficient with obs etc. The couple were pretty pleased with themselves, baby fed promptly, gave him his top to toe check on Mum's tummy, he was really relaxed. All was good.
Mum was in the shower and almost ready to go to the ward when I was called to another room.
It was another labouring primip, already 7cm dilated. I took handover and she stayed standing up at the windowsill. She was attended by husband and mother who were doing really well with massage, and she was rocking, not making much sound.
After a while she informed me there was 'something there'. I peeped and there was a pouting bottom, that went away with the contraction's end. But I knew there was a baby not far behind!
I kept peeking up her dress with contractions, seeing a bit of poop here, a bulge there. She was trying not to push, just let the contractions do the work.
It worked. What a genius, what a natural she was.
On the fifth look, there was definite perineal bulging and .....a head on view! I got the hubby to push the bell to call another midwife for the imminent birth, and asked her if she wanted to stay standing up for the birth. No, I want to get on the bed. Then you'd better be quick! I replied.
The second midwife turned up, I got my gloves on and the head was there, then slipped back after the contraction. Just enough time for the student midwife to come skidding in the door and scramble into a pair of gloves. We caught the baby together after a slow and gentle crowning, then a quick restitution and baby slithered out in a hurry, with a hand under the chin.
What is it? Mum asked - I don't know - you tell me! Its a girl! she cried Yes! I prayed for this!
There were sobs of delight, repeated thankyous and much joy in the room. Baby A blinked and looked around at all the grinning adults, pink and perfect and alert. She was calm and observant and very pretty. Her parents were just delighted, and so they should be. We midwives were most fulsome in our praise for them too. Such a clever woman, such a fantastic labourer, she made it look easy. We were stoked.
Unfortunately there were quite a few stitches needed here and there, nothing catastrophic but a bit ouchy initially. She was really great again, and turned to me for support during the stitching, which doesn't often happen, but I was really pleased to be 'with woman' in this way. She slipped her hand in mine, our heads were close and she asked softly that I tell her a story...so I began.
Once upon a time...there was a lovely young woman who was having her first baby, and when it was time to labour she was really brave and strong and beautiful and stayed home for a long time while her contractions came thick and fast. And when she got to hospital she was already near the end. And so she kept labouring beautifully, talking to her midwife when she needed to and telling her when the baby's head was there. And then she pushed out her baby easily and calmly, and everyone was very proud of her, and she was proud of herself, because she had done an amazing job bringing her baby to the world. What a miraculous thing is the female body, and the process of birth. God is very good.
It was such a special thing. I have never had a woman ask me for that before, and I was surprised that I slipped so automatically into storytelling mode, as if she was a child. She wasn't of course, but it seemed right. And she responded shyly but with delight to hear her tale already the stuff of legend. I told her that she should think about having her next baby at home, or in a birth centre as she had done so well she was an ideal candidate.
The baby remained calm and alert, and fed well and easily. It was really special. Her prayers were answered...and so were mine.
How delightful to spend the day with two new mothers who birthed with such power and ease. With two sweet, calm babies who didn't fuss but just responded well to their natural instincts. And to work with a student midwife who was so competent and thoughtful. We had a chat at tea, about how moved we frequently are at seeing women birthing so strongly, trusting their bodies to follow the physiological process, and how it all can go so smoothly. It is a privilege like no other, to be a witness to these births.
To top off our lovely day, on the board where the women's names are logged room by room, and they are noted as 6cm, delivered, or whatever, next to our room the coordinator had written:
"Delivered, beautifully"
I love being a midwife
Saturday, December 27, 2008
Down time
Well, the big day is all over for another year. I enjoyed mine - did you?
I worked until 7.30ish am and then was picked up and taken straight to my sister's place for breakfast. I had got changed at work into a sensational little black dress with pink sequins, nothing gaudy - just a modest sprinkling suitable for breakfast wear (;p) and I found my second wind after a long night shift.
I had had 5 women and 3 babies - all of whom were a bit antsy. Two were scrawny hungry babies (2.1kg, and 2.9kg), one was already on medically indicated formula top-ups, and the other was on pure breastfeeds, so the littlest one slept well in her room with Mum and the middle sized one sucked for hours before coming out for cuddles and a bath to relax her. She was so sweet in the bath, yelling at first and quite cranky, then suddenly after a minute or so in a deep and warm bath she flopped into a sleep, her head resting sideways in my hand, lower ear in the water, her body cradled on my wrist and forearm, legs stretched out. A different baby with no fight in her. I hardly ever get to bath babies alone, but I do like it. I humm and croon to them that they are safe and its ok to relax and sleep, and then I swaddle them up safe and snug in warm clothes and wraps and rock and pat them off to sleep. This little one, Amelia, ended up sleeping for another 2 hours, Handel's Messiah in the background, waking at dawn to greet her Mum with a hungry breakfast call.
Santa came to the ward too! Just after midnight - with pressies for the midwives and a choccy or two. There were Xmas presents for all the mothers too, gift bags from the Body Shop -( I don't know if they were a sponsored thing or if the hospital purchased them) but it was a lovely treat - specially for many of our Mums who would never have the luxury of Body Shop stuff.
For most mothers our attempted gift was a bit of sleep, even an hour or two. My third baby was a big 4kg fella, with a tongue tie - which means he can't attach properly at the breast. He didn't even seem interested. He would just bite, and couldn't get his tongue under the nipple or finger to suck properly. This will spell disaster for the state of Mum's nipples. His Mum had laboured all the previous night (I had been on LBS the night before so remember his birth occurring near dawn) and he hadn't fed well all day. I assisted his Mum to express by hand - not a huge volume but we did it regularly and put it down his neck with a finger feed, so he was fed and Mum could go straight back to sleep. It will be a difficult few days for them, waiting for her supply to kick in. He sounded a bit mucousy too, so probably needed a chuck before he properly will attack a feed. In the meantime we kept the room quiet, and him fed as well as we could for now. I imagine there will be a BF plan for her quick smart, but the priority that night was to sleep.
Breakfast was yummy, unfortunately my camera was at the bottom of my bag and the screen has been damaged (aaargh) which will need to be fixed. I did take a few pics, but will need to be very tricky to get them off the camera, although the card should be OK....hmm. I hit the wall about 9.15am, so we opened some pressies - including some incorrectly labeled ones - oops- and scarpered home.
Back to our place and open presents again with our family - Santa was goooooooood!!! (photos to follow). The kids (nearly 20 and 23) each got a camera (thumbs up for power shopping) plus assorted other welcome delights. I got a beautiful surprise necklace of semi-precious stones and pearls - just gorgeous! And a book, gorgeous craft supplies, Body Shop White Musk yummies, chocolates, a quilt calendar and a Lighthouse diary (Yay, thanks Lesley!!) plus assorted other delights. Very lucky.
Then off to bed for me until 4pm, while hubby and kids joined his side of the family for lunch, then wake up to prepare for my side coming to ours for dinner. We had a BBQ (Reef and Beef) - very easy with desserts prepared by Steff - a divine sticky date pudding with butterscotch sauce, plus a Tiramisu. Charades, lots of merriment and a growing (up) tribe of teenagers running amok and clicking away on their collective cameras as they posed all over the house. They had a ball. Everyone left around 10pm, whereupon we fell into bed.
A quieter day yesterday, just attending a BBQ at a friend's house with many other choristers from our choir days. Singing was enjoyed in the backyard, along with much catching up on news, then home again and watched a movie on telly.
Cricket and a slow start, with jam-making all morning to use our lovely Santa Rosa plums and a few stray cherries. I now have MANY jars of jam. Along with a savoury apricot sauce from the last of the apricot crop.
Its summer....down time.....bring it on!
I worked until 7.30ish am and then was picked up and taken straight to my sister's place for breakfast. I had got changed at work into a sensational little black dress with pink sequins, nothing gaudy - just a modest sprinkling suitable for breakfast wear (;p) and I found my second wind after a long night shift.
I had had 5 women and 3 babies - all of whom were a bit antsy. Two were scrawny hungry babies (2.1kg, and 2.9kg), one was already on medically indicated formula top-ups, and the other was on pure breastfeeds, so the littlest one slept well in her room with Mum and the middle sized one sucked for hours before coming out for cuddles and a bath to relax her. She was so sweet in the bath, yelling at first and quite cranky, then suddenly after a minute or so in a deep and warm bath she flopped into a sleep, her head resting sideways in my hand, lower ear in the water, her body cradled on my wrist and forearm, legs stretched out. A different baby with no fight in her. I hardly ever get to bath babies alone, but I do like it. I humm and croon to them that they are safe and its ok to relax and sleep, and then I swaddle them up safe and snug in warm clothes and wraps and rock and pat them off to sleep. This little one, Amelia, ended up sleeping for another 2 hours, Handel's Messiah in the background, waking at dawn to greet her Mum with a hungry breakfast call.
Santa came to the ward too! Just after midnight - with pressies for the midwives and a choccy or two. There were Xmas presents for all the mothers too, gift bags from the Body Shop -( I don't know if they were a sponsored thing or if the hospital purchased them) but it was a lovely treat - specially for many of our Mums who would never have the luxury of Body Shop stuff.
For most mothers our attempted gift was a bit of sleep, even an hour or two. My third baby was a big 4kg fella, with a tongue tie - which means he can't attach properly at the breast. He didn't even seem interested. He would just bite, and couldn't get his tongue under the nipple or finger to suck properly. This will spell disaster for the state of Mum's nipples. His Mum had laboured all the previous night (I had been on LBS the night before so remember his birth occurring near dawn) and he hadn't fed well all day. I assisted his Mum to express by hand - not a huge volume but we did it regularly and put it down his neck with a finger feed, so he was fed and Mum could go straight back to sleep. It will be a difficult few days for them, waiting for her supply to kick in. He sounded a bit mucousy too, so probably needed a chuck before he properly will attack a feed. In the meantime we kept the room quiet, and him fed as well as we could for now. I imagine there will be a BF plan for her quick smart, but the priority that night was to sleep.
Breakfast was yummy, unfortunately my camera was at the bottom of my bag and the screen has been damaged (aaargh) which will need to be fixed. I did take a few pics, but will need to be very tricky to get them off the camera, although the card should be OK....hmm. I hit the wall about 9.15am, so we opened some pressies - including some incorrectly labeled ones - oops- and scarpered home.
Back to our place and open presents again with our family - Santa was goooooooood!!! (photos to follow). The kids (nearly 20 and 23) each got a camera (thumbs up for power shopping) plus assorted other welcome delights. I got a beautiful surprise necklace of semi-precious stones and pearls - just gorgeous! And a book, gorgeous craft supplies, Body Shop White Musk yummies, chocolates, a quilt calendar and a Lighthouse diary (Yay, thanks Lesley!!) plus assorted other delights. Very lucky.
Then off to bed for me until 4pm, while hubby and kids joined his side of the family for lunch, then wake up to prepare for my side coming to ours for dinner. We had a BBQ (Reef and Beef) - very easy with desserts prepared by Steff - a divine sticky date pudding with butterscotch sauce, plus a Tiramisu. Charades, lots of merriment and a growing (up) tribe of teenagers running amok and clicking away on their collective cameras as they posed all over the house. They had a ball. Everyone left around 10pm, whereupon we fell into bed.
A quieter day yesterday, just attending a BBQ at a friend's house with many other choristers from our choir days. Singing was enjoyed in the backyard, along with much catching up on news, then home again and watched a movie on telly.
Cricket and a slow start, with jam-making all morning to use our lovely Santa Rosa plums and a few stray cherries. I now have MANY jars of jam. Along with a savoury apricot sauce from the last of the apricot crop.
Its summer....down time.....bring it on!
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