Temporary absence

Can't blog.

Am still reading blogs x 103. (updated 105, hello William Horner)

Lots of work.

Child 'round neck constantly.

Re-reading Harry Potter 7 (still sooking about it 4 reads later). Updated -Finished AGAIN

House is a (garbage) tip. (updated - get real, still a tip)

Must. Do. Tax. (updated - Done! for two!)

Later!

What do I know?

What do I know now that I didn't know this time last week? (Will I love this question?)


Well, I know that keeping labour normal is not always a job for which one will receive thanks. Not that I expect any in particular. But in the case I'm thinking of, should I have done so?


The unit was crazy, like....Crazy! There had been 10 inductions started the night before and they were all coming home to roost, so to speak.



I had already seen the couple I had been caring for the previous evening (one of the inductions), who had just had their baby at lunchtime, an hour or so before I started. He was a whopper! 9lbs 14oz (4.485kg - the same as my son!) it was a pretty yukky birth in the end (he had a REALLY big head!) and she was being stitched up pretty extensively. I spent an hour or so in their room, cleaning up the chaos post-birth, and organising some solid pain relief for her immediately and planning the next few days worth of it too! There was pressure to get her up to the ward quickly as labouring women were piling up in the corridors and there was a room crisis.


So I was removed from the first couple (their morning midwife took them up to the ward) while I was allocated to another room - their third midwife of the day in all the shuffling around. There was a young woman of 25, labouring spontaneously, hot and heavy. Just holding it together with the use of gas. Oh, and she'd had a shot of morphine too. The husband was in and out of the room, and was clearly quite anxious and unsure of his role. She was attended by her Mum and sister, who were in a great rythm with her, and she sought them as each wave came. She was really focused, eyes open and intense with each contraction, membranes intact. Just how we midwives would expect it to be. Woo-hoo I thought, another spontaneously labouring primip! I know normal birth! I can keep birth normal! I can do this!


I introduced myself softly between contractions, watching quietly as the labour continued thick and fast. Checked the room quietly, gathered a few things ready to meet a baby in the next hour or so. She was so in the zone, sitting cross-legged on the bed. I was just in awe, in fact at one point I was moved to tears by her beauty and strength, she was that amazing. I almost never cry at births, and this is certainly the first time I had cried watching someone labour! Her mother and sister were a little surprised, but I decided to be unashamed about my damp face and silently pointed to her and gave a pat of my heart, acknowledging her effect upon me. They whispered to me "are you always like this?" to which I shook my head- but she is that good.


Every now and then she would rouse and speak, I took her BP every 2 hours, someone came and took the CTG machine (we weren't using it, I could use the Doppler). At one point she asked for an epidural, and her Mum asked her to wait another half-hour, which she agreed to. She sailed through that and on and didn't ask too hard again. Her husband was worried, will she be strong enough to push the baby out after all this pain now? I can't stand seeing her in pain like this. I told him that women were so much tougher than they looked, that's the way God made 'em and that his wife was an absolute Goddess and doing it all superbly.


The madness outside was not getting much better. I was asked to 'prang her' (i.e. rupture the membranes) and get her going and out of there! Well, no! I decided. She was in spontaneous labour, the cervix was dilating steadily (I was watching the line), the waters were intact and she was only just coping with the pattern of contractions now, without bringing them harder and faster, not to mention the effects on the baby - who may need those waters to help him turn to a good position for birth. There was no indication that an ARM was necessary. I regretted performing a belated ARM on staff request on a 34 weeker a few weeks ago who shot into a less than favourable position and ended up being born abdominally via CS. I was not keen to go back there again. I felt I would make the decision for the preservation of normal. So I ignored the request.


The woman refused to reposition, or get up for a wee. When she asked again for an epidural I offered to examine her and see if she was near the finishing line and that may help her decide if she wanted one or not, if the birth was going to be soon. After a wait of a few really intense contractions, she was 7cm dilated. There was a brief discussion of pros and cons of epidural, and I stated that of course she could have one if she wanted one, but that it would be a shame to turn a normal labour into an abnormal one - with a monitor and bells and whistles etc. She was doing so well. The contractions were so powerful, she was so focused .... she lost herself in the next one and kinda never brought the subject up again for a while.



I went for a meal break, ex-HB midwife relieved me and persuaded her up for a wee. Hooray! I was expecting her to report feeling pushy any time. She did report rectal pressure with the peak, but not overwhelming. There was a bunch of mucous - a good sign. It was all really intense, but 7pm came and no baby.



Back to sitting on the loo, listening in to the fetal heart regularly, noticing that the rate is always in a similar range - definitely fetal, but not widely varying, during or after a contraction. I encouraged her to drink fluids, which she did. She was getting really exhausted and desperate and whiny (its typical transitional behaviour) and I was pretty sure she was fully or close to. She agreed to be examined - I thought it was 8-9cm dilated, but there was a pulsating bit off to one side that i was sure was a front fontanelle, and a gap at the left back - bugger! She nearly hit the roof during the exam, which I apologised for, but it was important that I rule out the pulsation as NOT being due to a cord presentation. She stayed on her back, gasping as the next contraction hit, and just lay there. It was horrible to watch. I did that to her. She was coping before and now, for this one, she wasn't. When it passed I helped her immediately to a sitting position and reminded her that she was comfortable in this spot and she would be again, lets regain that working formula.


At this point I had some decisions to make. I felt that with a deflexed or neutral positioned head, even with membranes still intact, it may be a bit longer yet until she was ready to push this baby out. As I had tried to tuck the baby's head down to chin on chest, it had almost risen away from me - yet on abdo palp it felt well down, although in the pelvis it was barely at spines. Her blood pressure had also crept up, not startling, but a sign of prolonged pain/stress. The fetal heart rate variability told me that the baby was either asleep or starting to get stressed. I was getting concerned about her and felt that with all these factors I should have her reviewed. I had kept her normal, but I also recognised that this was deviating from the norm and starting to add up to needing a second opinion. The first step before any further assessment would be possible was to get her out of pain, so as not to cause her trauma.


I apologised again for the stressful VE. Then I suggested she have an epidural, as although she was progressing well, I felt it may be a while yet due to the baby's position and she may need break from pain before the effort of pushing (funny how we can couch the same words as the husband in our favour when we have to, eh?). She readily agreed. Gratefully agreed. Almost kissed my feet agreed!


So then we waited for an anaesthetist. And waited. Finally after 45 minutes (the longest 45 mins in her life I bet) a consultant comes in from home. He is fast and good, considering we don't even have IV access yet. I had everything assembled, the machine, the epidural stuff, the IV stuff. It is in quite quickly, just in time for the night shift staff member to come on. I was attaching the trace as she entered, doing BPs, the woman was smiling, hubby smiling, the intensity was all altered. We were saying that we had waited for a while to meet this baby and the night midwife was going to catch him instead of me - yet I would have bet good money that I would see this baby before the end of my shift! Oh well.


And then we saw the trace. Gulp. It was pretty awful. Late dips all over, pretty crappy variability. Still contracting frequently but oh my, that baby was not coping well. It was the first time we had put a trace on him - there was no reason to - this woman was normal, low risk, and now look at it! The night shift midwife scooted me out the door as I had a morning shift the next day. She is a very capable new midwife with ICU experience, and loves a challenge. So I went home.


I slept really badly. I woke up at midnight and couldn't get back to sleep until 2-ish, and then only fitfully. My alarm was going off at 6, and so when I woke up and started tossing again at 5.30 I gave up and got up.


I dragged my yawning butt into work, where I found out that the baby was born by vacuum extraction at 1.26am, and needed a bit of resus with Apgars of 4 and 9. They had ruptured membranes not long after I left (when she was comfy and in no pain) and there was thickish meconium. Followed by fetal blood samples every hour or so, which weren't too dire, so she was allowed to push for a while before they dragged that 4kg baby out of her when the trace got too terrible to watch any more. Baby was sent to nursery for a while due to respiratory distress. I saw them briefly the next day, still with the whole entourage in tow, and trying to breast feed the baby with 6 people in the room. Sigh - what are their chances of establishing that?


So, in terms of normal childbirth, what did I preserve? Was I all misty eyed about my ideals for her birth? Everything I did was on her birth plan. Should I have said YES, Certainly! when she first asked for an epidural? Which wasn't on her birth plan, and of course she can change her mind, although could she have known that she would cope so beautifully that her midwife would see such beauty and cry, for fuck's sake? Was I so busy singing Kumbayah and reassuring the husband that 'this is all normal' that I ignored danger signs? Was it that dangerous? If I had blindly followed orders and 'pranged her' at 3.45pm and given her an epidural at that time would the mec have been picked up earlier? Was it there then? Did she actually care about having a normal birth? Or does her idea of a normal birth include an epidural? Cos it technically isn't...and introduces all sorts of interventions that can start the cascade of interventions that lead to CS ...oh for God sakes...you KNOW all this!


I'm a bit frustrated and bewildered. Is this a win some/lose some situation? Cos if it is, I could have just saved her all the trouble and pain and got her an epidural 5 hours earlier - even though it would have meant finding a spare CTG machine in a full LBS with all the women on all the monitors already...sigh. Has anyone been done a favour here? Answers on a postcard please.


In other news - something else I know now, that I didn't know last week, is how to suture perineums. I did a workshop yesterday. It was fun! Yes, really. I can now be Really Useful. I took to those knots like a duck to water. It was fun having a trial run on a piece of mutton. It took a while, but I think I am willing to do it under supervision this weekend when I am working 5 shifts in a stretch. (We then had to undo all the stitches so the demonstrator could take it home for her dog! )


Be good.

Second stage

Hello again world.

I had 2 lovely shifts with a student midwife earlier this week. Yes, really, and no drama was attracted! It was such a wonderful change (for us both). We were both just delighted with our birth together on Monday.

We entered for an afternoon shift to an 18 year old primip who had just achieved full dilation about 30-ish minutes ago. Her morning midwife was gentle and very low-key and non-interventionist, and has recently returned to the hospital after a long stint working with homebirths, so I knew she had really good assessment skills and faith in the natural process. It was a spontaneous labour and the room was calm, and the only attachments were the CTG because the woman had opted for an epidural. She was standing at the foot of the bed as we entered and the bed was arranged as a big low armchair for her to sit upright in if she wanted to. It was good to see it like that, I had forgotten that it could be put in that arrangement.

We were waiting for the contractions to do the work of inching the baby closer to the exit for the next hour before starting any active pushing. So we just encouraged her to stay upright and rest as she was comfortable with her epidural and quite mobile as well. Its a good combination when you can get it. She had her Mum and a sister-in-law with her, her partner was quite squeamish and was waiting outside by mutual consent. This was women's work.

After a while it was time to start having a push. It often takes a long time to get the hang of pushing a baby out, especially in a woman with an epidural. They don't get the same sensations of the baby within that an undrugged woman does, nor do they get the expulsive reflex that is just irresistible and almost pleasurable. The midwife uses words to guide her pushing efforts, or gives feedback as she can see the progress (or lack of it) of the push. It is a tricky process. I usually start by describing what I'm looking for - a flowering open of all the bits that are usually tucked up, as they expand in the way Nature designed. I will see an expansion of the perineal area, a parting of the labia, a pouting of the bottom, a tiny bit of stool pushed out in advance of a descending head - these are the signs we look for that tell us descent is happening. Most women are (understandably) reluctant to think of the appearance of poop as a 'good thing' but we midwives are very encouraged by it.

At 1.45 she started pushing. Her contractions were quite short, and it was difficult to get much momentum going with the pushes as they would die away just as she got to full push power. There was nothing visible after half an hour of pushing. One of the docs came in and suggested a bit of synto to help strengthen and lengthen the contractions, as she was well covered by the epidural and it shouldn't distress her. So we all agreed on that, and stopped pushing for 45 minutes to let them build up and for more descent. She walked to the toilet, remained upright, and saved her energy while we went to tea.

At 3pm we started again. The woman was really mobile and I was confident that she could position quite freely to assist descent. The baby wasn't huge, but the other midwife felt the head was sitting a little tilted off to one side instead of presenting the central back of her head to the exit. I hadn't examined her at all, but trusted the assessment, and the slow progress with pushing backed it up. The answer in this situation is positioning. Keep moving. Have three contractions in that position - if no progress - CHANGE something. Free mobility is really so useful in second stage - e.g. walking up stairs, crawling up or down stairs, lunging or clambering like a bear up on the bed or over a chair can shift the angles of the head in relation to the pelvis and provide that 'give' that gets things moving. So in this case, with a young fit, mobile young woman I was determined to give it a go, and keep birth normal!

I can't do it, its not working she cried. Nonsense - it just hasn't worked yet sweetie. You're doing so well, you're really actively giving birth here, not having it taken from you. Pull it out, suck it out! she moaned. No, we may need to ask for a hand in a while, but first we need to know you have tried everything! Leave no stone unturned for you to give birth unassisted and push this baby out on your own. She agreed that was worth doing.

By this time I had her standing on one leg with her other leg kneeling up on the bed at near right angles. I was kneeling behind her, gently stroking the base of her spine and hips, encouraging her to rock in wide circles while I spoke soothingly to her, encouraging her to sway her pelvis to shake that baby loose. She was in a bit of a trance. With each push she would strain, and then hold back as she sensed something shift. She didn't want to poop or fart. I told her quite plainly that I would cheer if she farted in my face! It would mean something was moving. We all had a laugh and with the next contraction a teeny bit of poop came out - hooray we were on the move!

The morning midwife was due off shift, but was keen to see a bit of this baby's head. Alas that bit of poop was all we could manage for the next 15 minutes. She went off after giving a top-up of the epidural as the woman was feeling the contractions again and we felt the relaxation of less pain for her would help us all out if it was going to be a long process, and frankly, with such slow progress it was likely she would end up with an assisted birth. She left at 3.35pm.

A bit more poop. Change position. Back onto the bed to push sitting back a bit, on the side now. More poop. Finally we had some labial parting, but then she would hold back when it moved forward - it does feel a bit freaky, but I remind women that if it feels scary you're doing it right! I encouraged her to feel inside and tell me what she could feel. She was reluctant, but I could do it if I wanted to. There was a little head about an inch inside. Swollen on top but finally close to the world. With the next contraction she had a go and felt it too. Eee-ew! she said and wiped her finger- but her eyes lit up a bit - it was real. There really was a baby coming! It was 3.45pm.

The contractions were still quite short, but I would get her to do 'one more push for luck' as it was easing off, which unless I asked for it she would try and get away without doing it. 18 year-olds are so cheeky! It became a running joke. At 3.47 there was enough labial parting to get a peek of the head with pushes. Head on view. At last. The trace never looks good with pushing especially at this late stage. It is physiologically normal for the heartrate to reduce with the contraction and expulsive effort, and to recover between contractions as the squeeze is off, but it is watched nervously nonetheless and with central monitoring there are often many people watching. This means that there will frequently be someone at the door asking if things are alright, or actually entering the room and tempted to intervene if they don't quite trust that things are well or moving fast enough.

That little head stayed elusively away from the exit. She just wouldn't crown. I started to mentally prepare for a shoulder dystocia (as is often preceded by slow descent) and quietly communicated this to the student, planning which side we would apply suprapubic pressure from and getting the bed controller at the ready for fast maneuvring in case of emergency.

I heard the door open as she was pushing again. I spoke more loudly than I usually do and said "good girl, yes, thats much more head than we've seen so far, ooh look at that hair! Good pushing, nearly there" as the feet at the curtain identified themselves as the consultant. A quick peep around the curtain to glimpse the vertex for himself and he melted away again with encouraging noises. It was 4pm.

With the next contraction there was a little more head to see, but still not too much. I examined her to see if there was a band of tight tissue, considering an episiotomy, and feeling only a smallish band of the hymenal ring, but a lot of moulding of the head and it was still a bit tilted. It was a tightish fit (what you would expect really) but I could slide my finger all around the head and couldn't feel a hand as well or anything, so we would just wait. Maybe consider legs pulled right back, and recline back a bit more. Ah there we go, thats the best we've seen, we are nearly crowning now. The shortish contractions inched along but came frequently enough. The woman was getting desperate despite our encouragement - can't you suck it out? No honey - its honestly not worth opening the sterile packs - baby is right there. Don't give up, she'll be here any minute. She could shoot out like a pea with the next contraction. It was 4.15.

I heard the sound of the vacuum trolley being wheeled outside the door. At 4.17 the door opened again. It was the young female doctor who started the synto. Ah very clever, she cried as she could see the almost crowning head. Our eyes met and we were thinking the same thing. She came in for backup- we both prepared for a shoulder dystocia by dropping the head of the bed, with legs pulled back. Finally the head crowned, followed slowly by the face and then the chin. We waited for a turtle sign, where the chin pulls back into the vagina as the shoulders hook up on the pelvis. No turtle sign, feel around for a cord at the neck, no, no cord, ready student? Its all yours, OK hon one last push now - here she comes! It was 4.20pm and cheers erupted in the room, the young Mum was sobbing with relief and joy, her Mum was misting up and SIL too, and she came forward to cut the cord. Little Aliyah was a bit stunned but soon had a brief yell and then lay frowning and blinking on her mother's chest in the afternoon light as she was cuddled and wiped.

What an effort! A three hour fifty minute second stage. Admittedly with an hour and a bit for descent initially, followed by another 45 minute rest, but it was still pretty prolonged for a hospital birth and she still managed to push her baby out. We were all absolutely rapt. I felt like a Midwife! It was rare to get the space to conduct such an active second stage, with minimal intervention from docs or others, and the woman herself was just terrific. She tried so hard, and pushed so hard, and cooperated, and hung in there despite collywobbles at times. It was such a group effort. We were all just thrilled to bits. And an intact perineum with minimal blood loss. Baby number ten for the student midwife, who was just tickled pink. She too felt we had dodged a bullet, no assisted delivery, a truly active second stage even with the epidural. She said she learned so much about positioning, and moulding and understanding the principles of descent and pushing with an asynclitic presentation (the tilted head). It was just great.

Dad came in within minutes and was suitably delighted and misty to meet his daughter. Baby Aliyah saddled up for a feed promptly, and boy could she suck! What a talent. Her mother had great nipple shape too so it was easy to put it all together with minimal assistance from us. We couldn't praise them enough.

I saw them again the next day and they were doing just great, all smiles, very comfortable and pleased with themselves. What a lovely start for this little family. I'm so pleased for them.

The morning midwife saw me the next day and was skipping that we had achieved a spontaneous birth. I was still grinning too! I swear I must have had the Jedi mind control that day - to talk soothingly to all the docs and others, reassuring them and having them melt away while we had that head on view for so long. It was fascinating, and I suppose that they must have had confidence in me to call them if we needed help. I was completely fine with the backup of the doc at the last minute, in cases of shoulder dystocia you don't want to muck around, but the student midwife got the catch after all her hard work that afternoon. It was win-win.

Our next shift together was also terrific, a lovely woman and her husband and Mum, where she had had a shoulder dystocia with her previous birth, so it was certainly the flavour of the week! She laboured really intensely with us all shift, and we were sure we would get to see her little one, but she went on to birth an hour or so after the end of our shift. The birth was straightforward with no emergency, so we were pleased to hear that even though we didn't get to see her baby.

Achieving that birth on Monday has boosted my confidence in my 'normal birthing' skills, that are easy to lose in a tertiary hospital environment. I do recognise normal. I can model the normal to my student midwife. I can keep birth normal. I can recognise if things deviate from normal and am trained to respond appropriately, but all the time I am shaping my care and responding to the needs of the woman at the centre. It is good to have this experience after a few weeks of turmoil and drama (which is still playing out).

I love being a midwife.

And the winner is...

Wow- 14 comments!

I don't think I've ever cracked 10 comments before so I'm delighted to hear from you all and accept your good wishes as I enter my second year as a blogger. Technically there are 14 people subscribed to my feed through bloglines, but one of those is me, so I suppose a giveaway enticed a few people to de-lurk from random blog-visit world too. Welcome!

The winner is Suzy of the blog Identity Crisis, which I find very moving. She is one brave woman. I'm so pleased she has a gift coming her way. Suzy - Please reply to the email when you're up to it.

So, what have I been up to? Not much washing I can assure you as our only 7 year old washing machine has spat the dummy and stopped spinning. Its little electrics had it convinced it had an open lid, and nothing on God's earth would persuade it otherwise. I'm a busy woman with limited time in which to wash clothes, and I need the machine to be reliable and do its job. Not wuss around saying, wait, I'll finish it soon, really, even though it isn't rinsed, or spun, or even washed thoroughly. I've got teenagers for that.

So it was off to the big electrical retailer to buy an energy efficient, watersmart, rebate attracting new washer. Which of course they didn't have in stock. And wouldn't be getting until November (my clothes are dirty, like, NOW). No, sorry, the next model up isn't in stock either, same delivery date, and besides it may not fit through the space we need it to. Yes, maybe you can buy the one from the showroom floor for immediate delivery. Lets do that. All signed up, we'll follow you home - oh wait! The warehouse man has said he can give you one set aside for someone else who doesn't expect delivery until November, so we can allocate/substitute theirs in November and you can have that one NOW.

So here I am awaiting the delivery and installation of my new washing machine. Ooh! There's the doorbell, BRB.

Woo-hoo! Its here, all installed and they took the old one away too. Phew. I have read the instruction manual and crossed out all the pages that don't refer to OUR model to save swearing and frustration (See Widget, I'm systematic about some things). Said intruction manual will be displayed in a waterproof sleeve near the enw machine while all and sundry try it out. Then I will secretly set it to the usual settings I like and simplify it. It is a very clever machine, if such things can be asigned an IQ. But I can't use it until I go buy some special detergent for high-efficiency Nobel Prize candidate machines. Sigh. I'll let you know how it goes.

SO much to tell you. New wall photos? Here ya go. Nice huh? Long view. Here's the metally-y thingy I had to have on the end wall. As you can see its a 'room divider'. This is the view from the back door.It should look OK soon - where's the home improvement makeover teams who achieve wonders in 48 hours? Not in my back yard, sad to say.

Work? Very interesting too. Had a vague day on return to work on Monday, went for a booked CS with a woman, helped out a bit on return to LBS, flitted about, completely forgot what I was meant to be doing for an hour or so and kept myself busy doing something entirely different. Then remembered with a gasp (new woman in Room 3!) and reappeared in the room to the bemusement of the woman (how embarassing). Was thrown a bit by being invited in for a chat with a clinical midwife consultant about JJ, for a debrief and to clarify why JJ's Mum was so upset after my visit when she read the card with my honest words about having a different journey ahead of them. What do you mean I have a special needs child? was her question. Hmm, I thought I had been really clear with them, we had discussed it specifically in relation to his walking and talking and how it may be different for him and they would deal with it when they got to it. They have apparently not liked being at the new hospital, and don't like to see social workers or a particular senior doctor because he 'tells them bad news'. So I guess my card falls into that category too. I just feel sad for them. I can see where they are at. Its not a good place. Maybe in time to come they will look back and realise that I was the first to address the truth with them. Even before he was born I was talking about the reality of 'what if he's not healthy?'. Then again in time I, too, may be blanked out or shot as the messenger of a truth they didn't want to hear. It doesn't change the truth. I'm still really sad for them, but I won't approach them again. Poor family.

The next two shifts were better, with labouring women. Baby Rhys was born at 2043 on Tuesday night after a fraught last hour or so (looking at the trace, which was crappy because he had had morphine, but flap was raised nonetheless) where mum pushed him out in 8 pushes with the threat of fetal scalp sampling hanging over her head! Luckily she had achieved full dilation at shortly before, after some slow-ish progress and the docs backed off and let the resident doctor and I get the birth. Which turned out to be quite nice really if a bit beetle-y (lying on her back and pushing like mad, sigh). She was delighted not to need stitches after her first birth, and he was a quite, quite yummy baby.

Little baby Teresa entered the world early(34+ weeks) yesterday at 1406 to her young Mum, 16, after a steady labour that would not be denied. After opting for an epidural it didn't work very well so the woman was really struggling with no sleep and continuing pain with each contraction. Finally the anaesthetist adjusted it and gave some super-duper extra drugs that were really effective so she was really comfy but limited with mobility. I kept the lights down low, the mood light and the membranes intact despite pressure from outside. We all thought she would push this pipsqueak baby out easily, membranes were intact and everything, but the trace looked dodgy (gee do you think the machines could be fallible, or maybe we don't know everything about the normal range!) so the waters were broken an hour after full dilation to aid descent of the head into the pelvis. The head was still at spines, facing upwards with head tilted back, I could feel the anterior fontanelle. Deflexed OP. No pushing or anything, just awaiting rotataion and descent with contractions. Except it didn't. I positioned her to maximise descent, as she couldn't move well for herself. She wanted to sleep now that she was free from pain. So I left her to have a nap. After 2 hours we started her pushing and then the trace looked really crap and I called in the docs. Bugger.

Suddenly we were upstairs with a trial of intrumental birth. Which didn't work after a heroic effort and three pulls where she didn't budge, even with episiotomy. So they converted to CS. DAMN! We were all really disappointed, including the doctors. They were really upset. If there was anyone who needed a cut fanny AND a CS wound like a hole in the head it was a 16 year old girl!

I staggered back downstairs after taking Teresa to the SCN (she was fine, quite serene really and very pretty, but had a sore head, was breathing up a bit and needed some time to finish cooking) and wandered off home, after having a bitter laugh with the coordinator about my 'ability' to keep a birth normal and get a 34 weeker out without a drama. You win some, you lose some. The young woman herself was pretty unfazed by it all really, just delighted to see her little girl who she kissed and nuzzled on the table with joy. Her Mum was with her (she had had 3xCS) and she too was unfazed, and glad to have made the birth after flying down from 1200km away and arriving as we started pushing!

Its makes me wonder about the expectations of child-bearing women, that she could accept all that intervention and still be smiling and just be keen to have a sleep! Maybe if you don't overthink it you can just take it in your stride. It's when one agonises over the meaning in all such things that the potential for disappointment and bad experiences peak. I wonder how she'll feel when approaching her next birth.

And finally, because I do so love making them, another two Wild Women . These are for my best friend and one of my sisters who requested a blue one for her birthday (woo-hoo - pressies ready in advance!). This is Nancy. Fancy Nancy. With cute shoes and a handbag. And a heart on wings. Seems like a good concept to uphold.

And this is Sister. I adore her face. She catches fish. And leaves. And houses. And has wild hair.

So, enough of me, tell me about you...

One year later.

One year! Thanks for reading my stuff, my reflections, my ups and downs.

Blogging is another tool in the great toolbox of life.

Its a great medium for connecting to people from all over...but you knew that.

Leave a comment by September 30th for a giveaway.

JJ update

I saw them yesterday at the children's hospital.

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

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

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

Good for them.

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

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

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

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


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

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

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.