The whirlwind returns- now with photos

I'm back!

I feel like that's been the opening line for a number of posts this year. No, I'm not going to check.

The conference was great! It was a co-badged event with the Australian College of Midwives, The Royal Australian College of Obstetricians and Gynaecologists and the Australian College of Rural and Remote Medicine. There were guest speakers from Canada and the USA, and all over Australia. There were some ugly, shameful statistics and some stories of hope and inspiration. Most of all there were stories that traced the pattern of the erosion of normal birth, and these are steps that can be reversed to a large extent to reduce the interventions in normal birth, reclaim the skills that have been lost (i.e. vaginal breech birth) as a result of overestimation of risk and to increase 'parturient autonomy'. This will also free up midwives to practise more fully with women within the full scope of their skills that they already have. We heard the terms VBAC (vaginal birth after caesarean), NBAC (next birth after caesarean) and GBAC (Give Birth A Chance!!), industrialised birth, and in an hilarious debate heard an obstetrician challenge anyone to approach a woman labouring on all fours (as her pelvis would dictate) and to perform a CS 'doggie style'. Ah, it was an earthy crowd! (BTW, I have no idea who that fat chick is on the right wearing my clothes).

The Gold Coast of Queensland is an area I have never been to before, but it has a lot to offer. I was picked up by my dear friend Kate (who was married on the beach in March) and we drove back into northern NSW to see her little town where she started work this week. What a lovely spot. She and her husband have just bought a beautiful property backing onto two national forests and plan to birth their first child at home on the property in March next year. Kate has just started to 'pop' - so exciting- can you see the bump? After a bit of lunch we headed back over the border and checked into the hotel and had a nanna nap. Then off to the reception and opening speeches which really set the scene well for the next few days.
We ate well, especially the conference dinner on Friday night sponsored by the Northern Territory crowd which featured Darwin market food - such delicious variety! Asian influenced, bush tucker, kangaroo and emu, oysters, limes, fish, absolutely fanastic food. The hotel was good, and catered well for milling crowds of midwives and others without long queues. It was really great to get a chance to meet others from my state and elsewhere, and share info from the concurrent sessions that we had attended. The program was really well organised, not a dud among them. A great success. I even put my plump toes into the Pacific Ocean at dusk on the last night, and collected some tiny rocks and shells for my collection. So Natalie, if you go and have a toe-dip in a few weeks time - we'll be sharing wading water!

On Sunday I headed to the airport for the trip to Melbourne to see my niece perform for her graduation concert. She was really lovely, and in good company. There were 14 dancers graduating and each was featured in various ways and within larger ensembles. Without bias I can say she was in the top group of performers that night. She certainly deserves good things to come her way. I hung out with my sister, niece and Mum and because accomodation was a bit squashy I lobbed in with another niece for the night, so got to see her, her partner, and her sister and husband (the Melbourne wedding of March this year) for brekky the next morning. What a gorgeous group of young people they are! SO interesting. They all went off to work and I returned to my sister's place for the day.

We went to see Wall-E which I had been looking forward to for ages. I confess I was slightly disappointed. I got the concept from the start, but found the rest of it predictable. I laughed out loud at some bits. I was touched, but not deeply moved as I had expected to be from the hype. There was nothing terrible about it, it just didn't rock my world as I had expected. Palpable waves of boredom from the seats alongside probably didn't enhance my aesthetic experience. I think the rest of the party were annoyed for having been persuaded by me to go! Sigh. Choosing a film is such a responsibility!

The last leg of my jaunt was to get to the airport early - never usually a priority for me. Why? WHY? To have my first blogmeet! It was so exciting! How would I recognise them? I had seen a few photos of Frogdancer, but never one of Widget (deliberately). But having spoken on the phone to Froggie a few times I was quite sure I would know that voice anywhere! And I knew she would be carrying a bag containing a QIP (a Quilt in Progress). So I was looking for a shortish woman, carrying a bag, talking a blue-streak with a woman who looked like a 'thirty-something' blogger who could be a music teacher. I look pretty much the same as my photo up in the corner. And I had texted them to tell them where I was sitting. But I spotted them first! (I think).

It was like meeting old friends, in many respects, except I had 'forgotten' what their faces looked like. I won't again. We had a really easy time together, within the culinary confines of the airport, although we didn't have to resort to Hungry Jacks (phew). We discussed the pros and cons of Pierce Brosnan vs Daniel Craig as 007 (verdict: neither would be turfed out of boudoirs), mutually confessed our mucousy reactions to the deaths in the last 2 Harry Potter books (it was all too close to the surface for, ahem, some of us) and talked employment history and how nannying really is a rehearsal for teaching.

But the piece-de-resistance was seeing the progress on the quilt. A while back Frogdancer was having a pretty crappy time, so I decided that she needed a quilt and should raid my (considerable) stash and derive some comfort from it. It was such fun putting together the package for her in pinks, greens and neutralsand sadly didn't even make a dent in the stash, but I can now reveal the result! Its just lovely. So beautiful. From 66 different fabrics for scrappy quilt, Froggie has produced this. Tah-dah! Take a bow Froggie! She's done a wonderful job with it all, and there was enough fabric leftover to make a potholder for Widget and me as little side presents. I'll treasure it - and its not going NEAR a pot I can tell you! These are Widget's hands displaying pressies, with her rings removed for de-identifying purposes. I gave them each a tiny bracelet with red and green beads with butterflies, and I have one too. We're a team!Widget takes her anonymity seriously! But will see me in Perth again in December when she is in WA for a holiday. Woo-hoo! Next blogmeet my place! I was a bit self-conscious at first, but my plane was delayed and it was just as well - we got on so well we could have talked for ages! It was really nice to meet them both - I wish Froggie had been able to bring her boys too! Isn't the internet an amazing medium?
So here I am, back at home and loving it as I have a week off work now. And a daughter home to keep me company (I didn't plan for that). I did have plans for creating and crafting in my jammies all day, but its Wednesday already and we have appointments together and .... rats. I'm still catching up on all the bloglines to read (208 on return - yikes!) Still I will definitely be making more Wild Women brooches for upcoming birthdays and the like, and if I could just get Blogger to cooperate with uploading photos (3 tries with no luck) I would be well happy. We did a bit of craft together yesterday, and I plan more today. Its good for both of us.

The news on baby JJ is that he has been moved to the children's hospital and is not fabulous. I will probably see them this week too. I am their midwife, and want to see this through.

Must dash! Please de-lurk and leave a comment and say hi, and maybe where you are from! Its the nearest I can come to putting the kettle on!

Have a good week!

Learning the hard way

A brief hello before I dash to the airport in an hour's time.

I have been on night shift and busy between since I last blogged. There has been another night away with my dear one (sigh, happy sigh) and some very challenging shifts, Monday night in particular.

Its a very long and traumatic story, and some of it would leave you incredulous. It did all of us staff and the couple themselves, along with their extended family. Suffice to say it was a very late discovered first pregnancy(near term), a very thick GP, some unfavourable maternal factors for an unknown little passenger, a pretty unwell baby, no amniotic fluid, an eventful attempt at labour, a long and interesting discussion with the top doctor about the language of CS and 'failure to progress', followed by a trip to theatre and the most traumatic CS I have ever taken part in. The little fellow was in a pretty bad way after an enormous and heroic struggle to birth him, and after a full resus his battered little self was transferred to the nursery where he struggles on, but he doesn't look fabulous.

I found his Dad wandering the corridor dazed so I arranged for some phone calls to put through for him while I dashed back upstairs to do the minimal I could to get out of there. We sat outside in the dawn light after my shift finished, as he waited for his Mum to return. The doctors were quite hopeful of his outlook at that stage, only just over an hour since birth..... Dear little JJ. I have my fingers crossed and am sending prayers for a gentle life for you and your sweet parents.

I'm tottering since that night, reeling from the events, and still reflecting on it and will for some time. What his poor parents must be feeling is beyond my comprehension, but I worked really hard during the labour to prepare them for anything, and any outcome. I addressed it quite specifically, trying not to scare them any more than they already were, but not painting sunshine and roses either. Sunshine and roses will be a great bonus for this couple, but they've had one hell of a 4 days. This time a week ago they didn't even know they were going to be parents, and now they have an express ticket for the rollercoaster of special needs parenting.

I'm heartbroken for them. I wish it could be different for them. What a shitty deal.

The team at work have been really supportive of me, wussing my way around on the next shift (and even now), but the whole hospital is aghast at the events and I was the only midwife present. It was so hard to fill out the paperwork documenting his injuries.... I had also had a medical student with me for that shift (geeze, you think they would avoid placing them with me by now - I seem to be a bit of a shit magnet when paired with a med student!). She was taking photos in theatre initially, but as it went down she got selective about what the parents may have wanted recorded. No-one needs photos of 2 doctors and a midwife doing CPR on their newborn.

I had a good shift last night, with a lovely calm gentle and normal spontaneous birth with a student midwife who was a delight to supervise. The woman birthed just before midnight, and stayed with us for a few hours, then there was paperwork to complete from the previous night on JJ's birth.

Just before knockoff we received a woman labouring thick and fast with twins. There is a lot to be done for a twin birth (are you surprised?) and it was nice to have a student to show the ropes to for her first exposure to a twin birth. We didn't get to see them born, but wouldn't have missed them by much!

I'm off for 5 days to Queensland for a conference, and Melbourne briefly to see my niece graduate from the Australian Ballet School. My Mum will be in Melbourne for the event too, and I get to see my dear sister who misses us all so much (and we miss her too). I will stay with another niece, meet her sister for breakfast, and squeeze in a blogmeet at the airport on the way home with Frogdancer and Widget! Then I will have the rest of the week off. Phew! Its all go!

See you when I get back.

Conferencing with the in-crowd

Yesterday was the conference for National Caesarean Awareness Day (NCAD).

It was organised locally by a fantastic group called Birthrites (link now repaired) who support woman after caesarean birth, and supported by a number of other sponsors including the Australian College of Midwives WA branch. It was attended by 77 registrants and held in the UWA Club in Crawley.

The theme of the day was "Getting clear about fear" and the speakers all discussed aspects of fear: women's fear of birth, professional fear, the illusion of control, the illusion of choice, experiencing a caesarean, planning the next birth after caesarean, psychophysical manifestations of fear, mythbusting the statistics used to deny women VBAC and so on. It was a marvellous day, very thought provoking, clarifying and inspiring. We all got to hang out together and have great discussions, great food and boost each other's energy.

NCAD Prizes were awarded to a midwife of the year, Sally Westbury, an independent midwife for her support of a woman wanting a VBA2C (a vaginal birth after 2 CS) which was achieved at home in a very culturally specific environment. The citation was superb. I was lucky enough to work for a few days with Sally in 2004 and greatly admired her down to earth style, I learned a lot from her. A second award was made to an obstetrician of the year for sensitive handling of a woman pursuing a VBAC in a hospital environment who, even though she ended up birthing by a repeat CS, felt Dr Sara Gibberd had been very kind, thoughtful and respectful of the woman at all stages of the labour and birth. The awards were well deserved by both.

Later this month I will be attending the national conference of the Australian College of Midwives in Queensland on the theme of Keeping Birth Normal. I'm sure it too will be invigorating and stimulating to take part in.

Work has been very busy this week. I only worked two shifts late in the week and will be on night shift from this Monday night. I worked with some really interesting couples, both overdue, one going for VBAC who ended up with a repeat CS after the cervix hadn't dilated after 9 hours of contractions. They were fairly OK about it, and were delighted that at least this time the husband would be present and the woman awake! Last time, in Korea, it was a general anaesthetic and she didn't see the baby for 2 days! The other couple were having their first baby and she was labouring spontaneously really well then got a bit stuck at 6 cm for 8 hours. I stayed as they were short staffed until after midnight, at which time they were going to put up some synto, but was pleased to see when I came the next morning that she pushed her baby out with no help just before 3am. Thank goodness it did the trick! I'm so pleased for them. They were such a nice couple.

Speaking of GA CS... young Zachary and his parents are doing well. I saw them all on Friday afternoon and he was being offered the breast! Both his chest tubes were out and he was nuzzling up and having a bit of a go. The SCN are taking such good care of them, I have seen the same nurses with them every time, they really could not be in better hands.

I also got to see an external cephalic version performed on Friday - where the doctor gently strokes and flips the baby from a breech position to a head-down position. I have always been elsewhere when one is happening, or the baby has been found to have already turned! It was really interesting to see performed, and it was good to palpate a breech so clearly. I wish there was more opportunity to get some breech experience in birthing, I've never attended (myself as primary accoucheur) a woman birthing a breech, although I have seen them done by others. I may have to wait a while :)

This time around I have been less distressed by working on LBS than I was when I first rotated there. I am certainly finding my feet. I am really enjoying being part of a team environment. Not team-style midwifery (although that would be great too), but feeling like a functioning member of staff. I'm really pleased to be getting to know my colleagues, and seeing how we all fit together and pull together in any crisis, or quiet time. I have taken pleasure lately in letting them know that I respect their skills and enjoy working with them. Some are surprised, but all are touched to be acknowledged. Not in a flashy way, just an aside to a patient (when seconding) about being in good hands, or 'I can't think of anyone I would rather have in a room in a tight spot'. I hope they don't think I'm weird that I give them this feedback. Maybe I come across as an over-thinking-brain (sigh, story of my life), but I do actively reflect on my practice and how I feel about each shift. Its important to give credit where it is due, and in a work environment where we are often under enormous pressure it is a small but vital courtesy to support one another.

Anyway.....I've been asked if I will consider doing some shifts in the Next Birth After Caesarean clinic at our hospital and I am very tempted. It is an area I am interested in, involves some antenatal work, and could lead to some caseload work, where I would be the primary midwife for a (bunch of) woma(e)n and follow her wherever she was in the hospital. It would mean less time to make Wild Women, and I have been commissioned to make 3 of them...I'll be having further talks I think. I could ease my way in.

In other news, we have a new side wall. Next-door is renovating and part of it involved the removal of a falling down asbestos fence and the building of a new you-beaut limestone wall for most of the length of the block. With the building demolition we have had no fence on that side for more than two months now, and in the last week it has been all go with the wall-building effort. There is now 300 tons of limestone between us and the neighbours, and a 150 ton hole in the bank balance, but it does look lovely. Next-door wanted their side to be flush faced and Perfect, especially at the part where they will have an outdoor room and eating area - close to our back door. We wanted our side to look more rustic and traditional. We both got what we wanted.

Hubby is beside himself with Spring delight planning the garden and patio renovations. Even I have had a look-in (and I don't do gardens or get my hands dirty) because it involves Entertaining and Roses - both of which I am entitled to an opinion on. The upshot is that the back patio - which looks HUGE - is to be gussied up with a pizza oven (long-term) and a new spot for the BBQ, with lighting etc, and the close patio will be reclaimed as a summer eating area, with a rejuvenated rose garden in between along with new ground covers and a wall-feature in the eating area. It is so nice to have our backyard privacy again. And I did get my hands slightly dirty today as I went to the nursery (gasp) and chose a new rose, and then helped to plant it!!!! I even chose some fun sunflowers to put along the western fence and planted those seeds too. You have now heard the sum-total of my gardening effort for the next 5 years. Seriously. I get to choose the wall-feature - I am thinking an old garden gate or an old wrought-iron shape/screen/something against the wall - I'll have fun visiting some scrap yards this week.

Have a good week!

Many birthdays later...

Hello world.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

This and that, ici et la.

I am still alive. I am still in slacking mode too (could you tell?).

I've had some nice shifts - very busy, laughably busy, but great for teamwork busy, where we're all so pulled in every direction we just shrug and laugh and pull together. BYO sense of humour, really. Its been good.

At home I've just been running errands, cooking a bit (winter roasts on the menu a lot lately, mmmm). Phone calls to back up our daughter as she starts a new job placement for technical college. Eating delicious bread she bakes at college!

Eating w-a-a-a-a-y too much chocolate. It is a separate food group, right?

And also spreading the joy of Wild Women! I got a package from Artchix this week, similar to Artgirlz with more spare parts for my lovelies. I have been trotting them around to all sorts of places with me, I just love them. Woman and Polly have each been worn for outings and were much admired. Bluebell (previous post) has been sent to her new Mummy, who gasped at her name and told me that bluebells were really significant to her and how did I know? Aaahh, the universe works in mysterious ways! I also gave Bluebell's Mum a kit to make her own WW, which was received with much glee. A future pleasure present indeed.

I caught up with one of my oldest friends who I haven't seen for a good natter (or even a short natter) for ages (she lusts after a WW brooch for her upcoming birthday too). We ate Italian biscuits over coffee by the fire, then I dragged her to her computer and showed her the online world of fabric shops....I hope she forgives me....meanwhile the economy may experience a temporary surge!

And because I have had such a creative week, I also dropped in on my old church craft group the 4Cs - Creating, Care and Compassion through Craft. I just love this bunch of women. I am the youngest by far, they are all old enough to be my mother, but they accepted me with open arms when I was a busy, busy SAHM with wa-a-a-y too many committee duties who needed a creative outlet. It is always so good for the soul to walk through that door and be greeted like a long-lost favourite daughter! Many hugs, lots of chat and laughter, news, gossip, catch-ups, who's got a new grandchild, its great to see them. Sometimes I even get to sit down and do some craft too! We bounce off one another, and seek second opinions from each other, and lead and follow and share so much. I made this WW there this week. Her name is Serenity. She is on the same needle felted merino and cotton muslin base as Bluebell. With some ribbon from a new WW kit that arrived this week. She looks mellow and serene, just drifting and sinking back into a midnight and purple haze and watching the dragonflies meander through the flowers. Her hands are open to the universe. Last night I sat watching So You Think You Can Dance (SYTYCD - I love that show) and I just need a hand stitching project. So I needle felted a new base with silk, merino wool and cotton and fussy cut a new WW, leaving the beautiful new textured base to be seen much more than any other WW I have done. Does she look more wild? She's got presence I think. Her name is Dowager. I just know she's seen a bit of life and sorrow, but has a wisdom from it. She's crowned with it. I'm really taken with her. Her colour haunts me, I dreamed of her last night. Call me strange. Another section of her background has a landscape quality to it, I have trimmed it to a pleasing shape and will explore embellishing the surface. Mmmm, it feels really good to be exploring a new technique.

I am also quite keen to get my Etsy shop up and running. I am creating way too much stuff to be sensible, so might as well bite the bullet and stock it up! Would I get any customers? I don't have that many readers to send there....oh well, I can but try. It feels a bit fraudulent to consider myself as Etsy worthy, but the point of Etsy is to provide an avenue for the small creator. I buy stuff from there and absolutely LOVE that it is a one-off. Let me know what you think.

And in final news, well, old news, this time last year we were in Paris. Yes Paris. Pinch me. God, it was pretty bloody fabulous, even though it poured with rain for the first 3 days, it was Paris people!!!!!! Notre Dame, gargoyles spouting rivulets of water, the Metro, the Louvre (a very cropped picture, removing the CROWDS of people around her)getting ripped off by a gypsy con-artist by the Seine, the Eiffel tower - Oh God it was all stunning. We stayed in a bijou hotel near the Luxembourg gardens, and walked and walked, and trained and bused, and ate and ate, and museum-ed and gallery-ed and took so many photos 'cos they let you! OMG! I would go back in a heartbeat.

I'm a lucky girl.

Introducing...

Introducing Bluebell.

She is the latest in the stable of Wild Women (WW). She is destined to be a birthday gift for a friend.

I have used different sizes and shapes of beads for her to create texture and to hint at hidden depths. There are many layers and facets to Bluebell that are not immediately obvious. She is going to a rather special friend. With hidden depths. And layers.

Here she is with her sisters Polly and Woman. They need more sisters. I know someone red, and someone green are just lurking somewhere. Maybe someone bluesy. Someone even more wild (did you see the comment that their original designer/creator left on the first post I did about them?). I spent a bit of time online choosing accessories for more WW -I'm trying to challenge myself to make someone genuinely wild, instead of pretty or elegant (I never thought my work being described as elegant would make me feel I'd been safe).

Anyway, when I'm not creating elegant Wild(ish) Women I have been to work, where I had a day as section queen, and then a lovely shift with a primip who seemed to warm to me instantly and declared herself very keen to push her baby out into my hands.

Her story had me feeling slightly reserved about the possibility of this happening, as she had had an epidural at 1cm dilation (!), was a fairly large lady and had collapsed and spent a while on the floor until she got feeling back in her legs. The trace looked pretty dodgy as soon as I saw it, and I was quite sure that the docs would be hovering and keen to use any excuse to chop her.

However we bonded nicely, and she was quite unaware of the concerns we were feeling in the background. The synto was on at a reasonable level, and the baby was moving heaps - always a good sign. The docs were busy with a string of other emergencies, so they had enough to keep them busy while I just kept her calm and distracted, and we chatted and laughed, and talked and I answered her questions and it was all sweet. When it was time to examine her I felt she was very well dilated. almost fully, but the head kept moving and swinging from side to side as if baby was jockeying for position for descent. Its a strange feeling, but you know baby has a bit of room and energy to move well, so its usually good.

We positioned her on the side to await the last little bit of dilation and to allow the baby to descend as completely as possible before she started pushing. The woman had a medical condition where it was preferable to avoid prolonged pushing effort. There was a lot of rectal pressure pain, but a bit of epidural tweaking helped with that. In the end, she only pushed about 4-5 contractions worth and pushed out a very sweet little girl, creamy and pink with fair hair. The medical student (the one who had got such an eyeful on her first birth [forceps, very ugly] with me in early July) got a lovely catch and we couldn't praise little Aimee's Mum enough. So clever. What a complete genius she was to labour so beautifully, and push out such a splendid baby with so little fuss. Her mother and husband were thrilled to bits, as was she herself. It was such a love-in. Baby Aimee went skin to skin with Mum while she had a few stitches put in and was calm and alert and cooing and communicative. It was gorgeous.

So I skipped home, glowing with delight at having helped to create such a positive birth experience for this young woman. Those kinds of births really help sustain one's energy. Even though there was an epidural, and augmentation of labour, and a continuous trace, and fluids and catheters and blood in the urine, there was a pretty normal birth behind it all. In the end her cervix dilated really smoothly and she birthed beautifully. I just know her next birth will be even better, with the confidence that she now has in her body and her abilities.

I love being a midwife.

Caesar Queen

I'm home after a knackering day at work.

I was the midwife attending the elective CS today (a.k.a. the section queen). You carry a pager and run up and down to the wards and get to meet the women beforehand.

I was as busy as a bee, even though there were only 3 CS booked. I picked up an undergraduate nursing student too, who was meant to be in the day surgery unit, but it was quiet so she hung out with me instead. She wants to be a midwife, so she had a good time (I think).

The first baby was really big. Over 4kg, and it was a bit of a struggle to persuade him to come out! What a whopper, a welcome second son named Angelo. His Mum was unattended in theatre as her husband was minding the 3 y.o. outside. That was a bit sad, but we helped her to have a long cuddle with him before taking him to the ward. He was plump and gorgeous.

The second birth was from pregnancy number 11 for the next woman. She had a long and tragic obstetric history with two miscarriages, two ectopics, a neonatal death at 8 days and two stillbirths plus 3 livebirths, two of these by CS (including one classical section at 26 weeks). All babies but one of the stillbirths had been girls. In this pregnancy her cervix had been supported by a special stitch to help keep the internal door (the os) closed. She and her husband did not know the sex of this last baby, saying "It is up to God, this is our last child even if it is another girl". We were all most delighted to welcome a little boy mid-morning, who seemed vigorous at first, but started to struggle a bit with breathing after 8-10 minutes. Luckily I had hung on to the paediatrician for a bit longer, and she called her registrar to review him. His oxygen levels were only at 80% and he was pushing in his abdominal muscles to exhale and grunting and 'singing'. We took him down to the nursery where he was given CPAP to help keep his lungs from collapsing. Mum and Dad were pretty brave about sending him off so soon, Dad came too, and we were all agreed that God was actually pretty good to give them a son, and for there to be facilities to help him when needed. He was just a bit undercooked at 37 weeks and a few days, and I'm sure he'll be fine in a few days or so.

The student was getting quite an education about the role of the midwife! Today when little Mohammed went off, I had just finished talking with her about how the midwife is essentially in theatre for the emotional support of the mother, and the physical support of the baby, as the theatre staff are there for the clinical support of the Mum. I would in no way consider myself as flash in the neonatal support area, but today I knew a baby with respiratory distress when I saw one. Phew. I was glad I had the paed with me as we put the monitors on him and gave him oxygen, then the registrar took over the oxygen CPAP from me as he arrived.

One of the medical students I had last week mentioned how she saw me keeping tabs on so many things at once- blood loss, neonatal adaptation and respiratory sounds, guiding her hands, noting times and obs mentally while doing other things. I was grateful and slightly surprised to hear her observation, because I realized that she was right. All of a sudden I am doing all those things at once. Multi-tasking - Woo-hoo!

So, back to the day. I ran up and down stairs between theatre and LBS all day, retrieving paperwork, getting ice for blood gases, taking placentas to the fridge, getting changed, seeing women, taking babies to wards, all interspersed with standing for long periods waiting for surgeons to enter and go through adhesions etc, while teaching their own more junior staff the finer points of CS techniques. It makes my back ache to stand in theatre!

Our third baby of the day was another big baby, a near to term girl, who also needed to be squeezed out of the incision! In the end they used forceps. She was snuggled on to her mother's chest for a while before we headed up to the ward. Baby Sairharni weighed just over 4kg too, and joins her big brother in the family. She has the longest eyelashes I have seen for some time.

Back to LBS, paperwork, weighing placentas, showing the student the finer points of placenta examination, entering all the many details in the birth register, sending paperwork all over the hospital and then it was time for home.

It was a lovely day, but I am a bit achey. I've had some panadol, now its time for a cuppa, and a good sit down.

I feel another brooch coming on.....

Wild Woman - correction Women

Hot off the needle. I can see a few of these being made while watching Olympics coverage! And now I have made the second one too!

This is Polly. She has a brooch back and is about 4 and a half inches high.

I needle felted the base from hand-dyed merino wool and pink chiffon. The hair/ruff/mane is from a trim I'm fond of and it made a great textured base for the embellishments.

The skirt is individual lace motifs stitched together, coloured and embellished. She took about 4 hours to make.

Ah, I do like a hand stitching project. Even if it does involve a few seed beads being spilled. (At this point I shall apologise for Blogger being most uncivilized about formatting and ignoring my paragraph marks. Just pretend I have been educated and formatted this correctly. OK?)

She was most satisfying to make. And I just know she'll need some sisters. I can barely sleep for all the images of them in my head. Shame I ever have to go to work really. I kinda miss being a full time crafter, but just as well that I LOVE being a midwife too eh?

Well, who have we here? A sister already? Why yes, her name is simply Woman. She was my first one nearly finished, then Polly butted in. Woman is patient. She didn't mind that her woolly minded sister jumped the queue.

Isn't her face beautiful? These faces (along with the arms & legs) are bought pieces, from Artgirlz. I coloured them with some groovy special marker pens. Variegated threads work wonders with these kinds of stitcheries. As you can see, they sometimes make just the hair you need. Just what I needed. Woman is about 4 inches tall, including dangles.

In other news ... Steph has got a laptop computer, wirelessly connected, so by default - I have this computer all to myself, and coincidentally that also means that no-one else need come in this room for computing (or any other purposes really) but me. Yes- just me. So I rule this room! My cunning plan to clutter it up so badly that no-one else could find a thing has worked! Total world domination is only a heartbeat away!!!!!!! I may get delusions of grandeur and start calling it a studio soon. I have plans y'know :)

This time a year ago we were coming to the end of our week in London. The weather was divine, the art was superb, the city was like a childhood story and a Monopoly board come to life. We went to the Proms (terrible program), we ate like royalty at my aunts' house, we tubed and walked, and M&S'd and Westminster Abbeyed in pure delight. I'm so pleased I've been there and can't wait to go again. I can scarcely believe I have been to (and enjoyed) so many of the world's greatest cities. I am a very lucky girl.

Our next stop (Aug 12) was Edinburgh and a few days in Scotland which was also absolutely wonderful (even if drizzly in an entirely appropriate Scottish way). I'll catch you up on those when next I post.

Ciao.

Telling tales

So, I have finished this stint of nights and it was pretty good really.

On Saturday night I had the care of a woman having her second child. She didn't speak a lot of English and seemed to be coping fairly well with labour but it was getting tough. For a change, it was a spontaneous labour with no risk factors that would necessitate continuous monitoring so I just listened in each 15 minutes for the length of a contraction or so to check the baby out. When she entered the transition phase she became very vocal and thrashy and grabby. I hadn't examined her for a few hours and when she started involuntarily pushing and started asking for an injection for pain relief, I offered to examine her to see if it was safe for the baby to receive a drug so close to birth. I was fairly sure the cervix was fully dilated and it was, and the head was quite close to the world, so the answer would be no (to drugs). She was disappointed about the drugs, and I'm sure swore a bit in frustration in her own language. I just smiled encouragingly. Within 5 pushes the baby was out and the medical student with me had half-caught another one for her book. It was a girl, there was much delight in the room, and they couldn't dress her in pink from head to toe quickly enough! Dad hadn't seen the birth of number one, so was pretty impressed with his wife. And the baby was such a cutey, little Ishmeet.

Across the hall an hour later, around 3am, a shocked, and shivering woman was wheeled in by ambulance (shaking is fairly normal after birth). The ambo walking after her had a silver wrapped bundle in her jacket...it was a baby! I briefly congratulated her on the little one and went back to my room, but soon I was called in to be another pair of hands in what turned out to be quite a drama. It was a cold night, expected to be 3 degrees C, and the woman had been asleep alone in the house with her 2 year old when she was woken by sudden strong labour pains. The contractions were coming so thick and fast she couldn't get to the phone to call for help. The baby was born 30 minutes later in the bathroom as Mum sat on the loo, splash, clunk! Poor woman. She pulled baby out and wrapped him in a towel and struggled to the phone where she called an ambulance and her Mum. She then had a big bleed, and ..and..oh dear, it would not have been pretty. The woman herself was still sobbing in hysterical shock and really seriously cold. We kept taking her temperature and not quite believing it was so low, but I called for a special warmer from theatre, and warm IV fluids to raise her temperature as soon as we could. The baby was also seriously cold. We are taught that babies must be warm, pink, sweet and clean. Meaning they must be ideally between 36.5-37.1C, have good circulation and heart rate, adequate blood glucose levels and be kept free from infection. Between being so cold, and banging his head at birth he was not in fantastic shape. He was taken to the nursery pretty quickly where he was in a pretty bad way for a few days. I haven't heard how he is today. Mum continued to bleed, and with a poor circulation due to low body temperature it was hard to get it all under control. We kept having to remove the blankets from her to assess her loss, put in catheters, new drips, massage the fundus. Her mother arrived after finding someone to look after the 2 year old, and was still beside herself with shock. She said the house looked like a murder scene, and was clearly very traumatised even by the aftermath. She shuttled up and down to the nursery seeing the baby, and then the woman, who was moved to special care once she had been slightly stabilised after 3 hours of constant attention. It took 12 hours or so to get her temperature back up. It was quite a night.

I was pleased to work with a homebirth family requiring a CS last week. The baby was in a persistent and damnably unfavourable position for a homebirth and there was a very clear plan to transfer for CS after a bit of labour, which is what happened. Baby was born just after midnight and went skin to skin after the resps were established at 30-40 seconds. She was pretty squished from the labour and the unusual position in the uterus. They had half an hour together on the table, then she went to Dad and returned to Mum in recovery 10 minutes later, where she had the first of many feeds as she remained skin to skin for essentially the next 6 hours. There were no beds for postnatal care so she came back to LBS with me and I looked after them for the rest of the night. Baby Ryder didn't even get weighed until 6 hours of age because she just fed from side to side for all that time. It was really nice, a lovely family, so gentle and calm with their baby (who could suck for Australia if a place came up on the national team!)

What else? Hmm, lots of things. A young woman with a stillbirth, a 2.2L PPH and really high blood pressure - she really hit the bad luck jackpot, poor girl. Another couple of PPHs, 1.8L, and 800mls, that is always a fun way to start the shift! A really intrusive friend at a birth who just wouldn't shut up while she was pushing, and later while the mother and baby were bonding and trying to feed. I felt like saying - if I rip the baby from his mothers arms and weigh him (to give you the information you're clearly dying to be the one to spread) will you PLEASE shut up and f*** off? But of course I didn't. I just kept addressing the new mother directly in a quiet voice and ignoring her friend, or gently but firmly correcting all the negativity the friend was spouting that was all about her, not the precious moments she was intruding upon in the room she was a guest within. We did all sigh with happiness and the mother actually stated "oh its so quiet" as soon as the friend left. The Mum and Dad were so enraptured with their little fella, Jacob, who was extremely edible, all 8lbs 5oz of him. Quite, quite yummy he was.

There's been quite a bit of time on night shift to get to know some other midwives better, which has been nice. Some new staff, some staff returning from maternity leave. Some politics, some passion, some laughs and frustrations. Helping each other with the formal wording required in our competency documents for professional development. Sorting out the state of midwifery in Australia vs England. All sorts of things. Challenging and exploring each other's views on a range of topics. Burnout, job satisfaction, intervention rates, is normal birth possible in a high risk setting?

I was pleased to be able to see that doctor who had given me such grief over the woman wanting a VBAC. She assessed another woman whose cervix had not dilated over an 11 hour period and there was a fully agreed and harmonious collective decision to go for CS. When I asked her off to one side to give me some technical details related to reason for section, i.e urgency of need, and reason for CS she said 'failure to progress'. I took a deep breath and said 'actually - how about we put the reason as delay in first stage progress, so the woman doesn't start her mothering journey being labelled 'a failure' ". She looked taken aback a little, but said "well, its probably the same thing, but I can see how that would make a difference to the woman, so yes, fine". I was quietly pleased, and hope I have sown the seed for a change in her thinking. This step had been suggested to me by professor of midwifery who I had contacted after the first incident had distressed me. It was a really good idea from her.

I'm coming to the realisation that I have become comfortable as a midwife now. Maybe it is just feeling more consolidated in my skills. I feel this second stint on LBS, following from the stint in the community on the visiting midwifery service has seen me become so, and I can feel that I might be ready to start making some decisions in my future directions. Some of the clinical midwives I work with have been asking my intentions, and have all said they could see me working in the community, but I don't think I'm ready for that. However if the chance came up at a more caseload model of care - where a small practise of midwives are assigned the care of women and back each other up to provide antenatal, intrapartum and postnatal care that would be a good way for me to go, I feel. Maybe in a birth centre setting.The drawback of that model apparently is the on-call work, but there is one very near where I live, which could make the on-call work more manageable. I feel the time is right to start making plans to actively seek those opportunities, and to gain the skills I will need to be competitive when I apply.

I am still looking and reflecting within as I practise, but I am now more able to raise my eyes from the road, and look to the journey ahead. Its a big wide world out there.

Nightshift Haze

Hey all

I am alive, and on night shift, 2 down and 2 to go. I am not actually up right now, I'm just on the 'need a pee-go for a walk past the computer-if I don't talk to anyone I'll go back to sleep ASAP' break that night shifters do. Kinda the equivalent of sleep walking. Ooh, my son just arrived home and is in danger of talking to me too much....hug me and nick off boy!

I've been cruisin a bit, and still in lazy days mode (see last post).

I've been making bags. Yummy.

I've been to a craft and quilting show. Double yummy! Check out the Wild Woman brooches at this place. Uh-oh, a new obsession may lurk to go with healing dolls. I'm part way through a set of three already. I felted the base of part-felted merino wool and thread embellishment. Its very satisfying to do. And I love the name Wild Woman - so tempting.

Work has been really good. Caught a few, seen a few, interesting tales to tell for another day. Thinking a lot about hypothermia and circulating volumes etc - its been a physiology lesson for the last few days, plus the effects of hypothermia on the newborn - I've been hitting the books to revise my stuff.

In the meantime this time a year ago we were in New York. Sigh. It was a great few days in a fabulous city. I have not given you specific links for our time in the Grand Canyon, New Orleans, Little Rock Arkansas to see the presidential library of Bill Clinton, and unexpected night in Dallas Forth Worth and a compressed trip to Madison Wisconsion. But if you take the link (and look in archives under July and August 2007) you can see the little amount we wrote from these places, or the photo albums from there. It was really hard to find public internet in the USA. We won't make that mistake again.

Dear Lesley is back in WA for a few days following the death of a dear friend. So tragic. I will see her later in the week. I look forward to her moving home so I can see her without the thought that someone is seriously ill or worse when I see her.

Yawn, I will be back I promise......Oh bugger, there is cool reggae playing (softly) and I'm hungry. And I've got a friend coming for dinner for her birthday - it will have to be an IOU present - a future pleasure present. I just hope I can grab a banana and get back to sleep.

See ya