Italy pics (image heavy)

Ooh, I have forgotten to post any photos from Italy or Paris. Italy first, starting in Milan. Here is the Duomo, that we so loved. Isn't it pretty? It looks like a piece of starched lace, it has such a lightness about it. Sadly the interior is quite gloomy and one can't take photos...ooops...how did those get there?

This is the Victor Emmanuel Galleria (with the McDs inside). It had the usual beautiful floors. Don despairs of me taking photos of ceilings and floors, but I am a slave to beauty.

We were in Milan for Fashion week. There were lots of Beautiful Young Things sloping about. Purple is very big at the moment, and even the men's shops were full of purple pants and shirts (and of course the usual Italian obsession with red pants, or mustard pants for men...shudder). You would have loved it, Stomper. We found supermarkets and ate al fresco and had a lovely dinner in a little restaurant. The clothing stores were many and varied, and they even had a big girls shop, but sadly we didn't have time, or room in the case. I survived.

Then off by train to Stresa. We skirted the mountains we had flown over the previous day and arrived at our little hotel, with a second floor walk-up room. It was really nice. This is the view from my pillow. It was Italy folks. Lago Maggiore was quite, quite lovely. There was a small chain of islands, the Borromeo islands near the shore at Stresa and we went over to them by water taxi on our last day. Just looking at them was really nice, especially in the dusk light. This is the restaurant cafe where I accessed the internet during my stay, and we had dinner there on the first night. It was delicious.

On my rambles around the town(s) I saw gorgeous stone walls and buildings. I saw really sweet lizards (Note, no lizards were licked to back this statement). I even found a junkyard that I itched to fossick in, but restrained myself, more from lack of sufficient Italian to explain myself as a junk obsessed Aussie whose Dad had a great shed, and how it makes me nostalgic for him ..... oh, and the suitcase thing. Sigh.

I had to amuse myself while hubby was away at his conference somehow! I took a cable car up a mountain. I saw enormous tadpoles in an alpine pond. I saw cows and goats in a forest from the air. I rested in a lakeside pirate cove with pretty stones.

The conference dinner was held in a lovely ballroom. See? I am in the pic somewhere. We came home to the news of Michael Jackson's death. Funny heh? The associations that we will always make with that night. I met some interesting people, ate from silver plates and had great food. The floorshow was an interesting piece of cabaret - a shadow maker who depicted famous people - so simple, so ... weird ... but very effective. Almost every photo from that night has a silver line across people's faces from flash bounceback off the silver plates. One of the unexpected drawbacks of wealth (cough) and privilege.

The next day we went to the islands. They were gorgeous. Of course. Interesting little winding streets, old, old buildings. One island, Isola Pescatori, had a cat sanctuary for homeless cats. We found this motheaten old moggy who looks like an older, sleeker version of our cat at home, Phoenix. Puss was nobly ignoring the taunts of these cheeky swallows. When you used the public loos the contributions went to support the cats.

The largest island, Isola Bella, had long been a playground for the rich and powerful. The Duke of Borromeo (or was he a bishop.... anyway), he had a palace on this island which was open to the public along with the very famous terraced gardens. The palace contained one level that was all 'underground' and stone covered, a grotto, for use in the summer. It still contained amazing pieces of sculpture. Napoleon slept in this bed. There was an enormous tapestry gallery. The amount of money to build this place must have been staggering. Mussolini has dined in the restaurants, along with many famous actors and even a Pope. The views from the gardens looked back towards the mainland and the village of Stresa. It was really pretty gorgeous, if a bit OTT Italian style. We were impressed, but cool about it.

Are you getting sick of photos yet? Sorry. It is very hard to whittle it all down. There were interesting things in many place: gardens, tree stumps, views, angles, attention-seeking ducks, inebriated husbands....I'll spare you that one, but I do have lots of photos of him hooting like a monkey.

Next time, Paris!

Many and varied

Hello Monday.

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

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

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

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

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

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

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

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

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

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

I love being a midwife.

Reflective practice

I am surfacing after a weekend of night shift. Only 3 nights, but what a 3 nights.

I have worked my bum off and been in the deep end, with back-up from colleagues so I wasn't alone, but it has been a very difficult stint.

On the first night I was with a woman who began experiencing a lot of bleeding while in labour with a very prem stillbirth. I really felt for her as her tiny baby was suddenly born in the midst of a roomful of medical and midwifery staff swinging into action to prepare for fluid resuscitation and transfusion. She was fairly calm, but I am so sad that she was unable to have due privacy at that time. She remained brave and dry-eyed, but the drips in inconvenient places meant it was difficult to hold her baby and touch him as he lay on her chest. It was my fiftieth birth, and although I am very fussy about what I call 'mine', and this one was half caught by the doctor during the emergency, I am honoured to claim this little one as a milestone birth, my first time to receive a stillborn. I had cared for his Mum before, during and after the birth and I am touched by our time together. She had left by the time I returned the next night, but for that ten hours I was 'with woman' with her.

The second night I received a woman having her second baby. She had been having a long early labour and was really tired, but it looked like she was kicking into gear and we were ready to catch the little one. Sleep is not really an option when in labour, but she was really keen to do so. She was labouring spontaneously, and coping well. She had had her first child with no pain relief and I was expecting her to do the same. I felt sure there was a baby not far away, and so did a colleague giving a tea relief. She felt the need to urinate frequently so her husband would half-drag her to the bathroom, as she was swaying on her feet. We encourage mobilising in labour so I wasn't concerned. She seemed to 'hit the wall' after a while, and suddenly stopped speaking English, or at least making sense, except for whining and saying 'I can't'. Her blood pressure was creeping up, nothing particularly extreme but she was quite uncooperative, and behaving like a dead duck. She wouldn't even acknowledge questions or make eye contact. I never start an assessment, especially an internal assessment without explicit verbal consent including eye contact permission. I felt myself withdrawing from her emotionally, which rang alarm bells for me, as it is unusual for my patience to be bested. She was going off the boil, but we were all keen for her to have a normal birth with this spontaneous labour, and she wasn't playing the game. She started vomiting, usually a good sign of transition, with a baby not far behind. She was begging for pain relief, as is common, but transient for most women near the end. However she kept vomiting, and I suddenly felt she needed some fluids. But first I checked the BP. It was suddenly high, things were not right, and giving her fluids might not be the right thing. Could she birth quickly and it would be over, or was something going wrong? This was more than me being 'over her'. I felt she'd taken a bad turn, and called for her to be reviewed by the doc.

Within half an hour she was bled, examined, diagnosed with pre-eclampsia, had an epidural underway, monitoring and all the bells and whistles. But it was hard work, as she would/could not engage with staff. Her husband kept trying to speak for her and give consent, but that it not quite good enough. If she is to agree legally to these invasive procedures, such as epidural, and internal assessments, she must give proper consent, or it is assault. And still no baby in sight. I was relieved to get a meal break as it was 8 hours into my shift and I was at the end of my tether, and I really needed sustenance and to regroup. The other staff were all saying what hard work that room was, so I felt a bit better about being so out of sorts with the atmosphere. When I returned, the epidural was in situ but she was still in a bit of pain, but after a top-up we started winning that battle too. The baby was tricky to pick up through her abdomen, and she had a rapid pulse herself that was easy to interpret as the baby's. All in all a very trying night, and I thought I wasn't going to see this baby at all. Just before the end of the shift the doctor came to review her again, and to see whether she had dilated fully or not, and lo and behold she had. She was quite reluctant to push, 'I'm too tired', but this time I did speak quite plainly to her and insist that 'yes you can, then you can rest, so stop making a fuss, lets get this job finished'. We repositioned her for pushing and had her begin the job. We couldn't do it for her! The next shift arrived and a student midwife gloved up and bustled up expectantly. Rarely, I said 'actually, I'm catching this one, I've worked bloody hard all night for this baby. Catch with me, but this one has MY name on it!' The baby was born just before 7.30 am, and although I had vowed to have stern words with her, she was really just too pretty to be cross with her for long. She was quiet and alert, big dark eyes and a head of curls, and her Mum was all of a sudden chatty and interactive and full of thanks, and delighted to have a second girl. I earned my sleep, but didn't sleep well. More's the pity....


The third night was the last straw. We arrived to some devastating news of the death of a young doctor in a car crash. She was a vibrant talented young woman, and we were all reeling in shock. Red-eyed, we made our way into our allocated rooms and tried to quietly compose ourselves. In my room a woman had just started pushing, and her midwife stayed to complete the birth. I was happy to be the background second midwife witnessing. There was some blood on the emerging head, a sign of a vaginal tear somewhere that can't be helped until the baby and placenta is out. The baby was born after a massive effort, a lovely girl welcomed with crows of delight and rejoicing over who had won the bets. Followed by bleeding. A lot of bleeding. Blood started pouring onto the floor. I was reminded of the first time I had seen such a thing, and I had a rough idea that it took about a litre on the bed to do such a thing....Call in the storm troops, get it all happening, the family still on the phone as it unfolds, baby in arms, Mum sweating and feeling the effects. 2.2 litres measured so far. Off to theatre with no time for a breastfeed.

Word kept coming up and down from theatres. She would be a bit longer, still bleeding, baby was frantic, skin to skin with Dad, the drop of colostrum I had managed to express as we were preparing for theatre not satisfying her at all. Dad asked for a bottle, and we had the discussion about breast first, second and third, but he asked a lot of good questions about breast stimulation that I was happy to answer that skin to skin and breastfeeding could be resumed within minutes of the reunion...whenever that would be. We weighed and measured the baby, she had some more skin to skin time with Dad and he fed her a small amount of formula while she was on his chest, so there was the association with skin. It was definitely a compromise, but a realistic one given the condition of the Mum. I took them to the special care unit to wait for her, then popped into theatre to see how things were going. The bleeding was now controlled with some 'big guns'. I told her about the baby's weight, and praised her bravery, and reassured her that the baby was skin to skin with Dad and waiting for her.

There was a big bag of linen waiting to be weighed for blood loss. The total was large. Ten times the loss we normally expect. A massive PPH. I mean massive. Out of the blue, in a first timer with a spontaneous labour. Once again, we saved a life today.

One of the doctors spent the rest of the shift speculating on what would have happened in the case of such a catastrophic haemorrhage if she had birthed at home, and the answer was clearly not favourable. Does one take the risk of first-time birth at home and take the consequences in these outlying cases? Or does one practice in caution, perhaps risking over caution, with no belief in normal birth and physiology. It is easy to see the slippery slope to constantly defensive practise that has led to the over medicalisation of birth such as we see today.

In three nights I had seen a normal unmedicated birth of a very prem stillborn, with bleeding complications. I had seen a spontaneous labour blow into pre-eclampsia within hours, followed by a normal birth. And another spontaneous labour and normal birth followed by major bleeding. These are among the emergencies midwives prepare for, and when one works in a big hospital one can expect to see a higher rate of complications. But it is sobering nonetheless.

I continue to believe that women should be offered a choice of place of birth, and I hope one day to work in a model of care that allows me to provide the full continuum of care to women including labour and birth wherever they choose, or it is collectively deemed safe. Not 'dominated by fear of the outlying event' safe. That said, I can't imagine how awful it would be to be faced with such a PPH at home with 2 midwives present, without the extensive range of PPH drugs, waiting for an ambulance to transport, without a theatre with the equipment that saved that woman's life. It would certainly shake, if not permanently scar, one's confidence, whatever one's faith in women's physiology and normal birth.

I have seen way too much blood this weekend. But I still...love being a midwife.

Wild weather = wild women

Its been a while since I showed you any Wild Women. Wanna see the latest batch?

My previous WW are found here and in mid-April archives. The latest girls have been a while coming as I have been quite stop/start with them.

Here is Nymph. You've met her before, but she got finished with some extra floral embroidery and is now ready to take off to her new home.

This is Regina. She is a queen of Rio, and dresses in the colours of the carnival.

Below is Minnie. She took her time to reveal herself, and was bald for quite some time. It didn't suit her. But when she claimed some sorbet-coloured locks she came alive. Her arms and legs are 'milagros' and have a lovely textureand she has vintage crochet lace as her skirt. I think she is doing the Twist.

This is Jaune. Someone I know is having a special birthday soon and guess where Jaune is going to live?

Finally, you have also seen this sweetie before but she was shy and hadn't told me her name yet. She has just whispered it to me...May I introduce Flora. She likes violets.

She was nervous for her close-up, but I think it turned out, don't you?

Cold off the press

WOW!!!!WOW!!!! There has just been the most incredible hailstorm come through here!

The front yard, looking toward the veggie patch

The back yard adrift.

I'm glad I'm not showering outside here today!
This is the back lane , with runoff through the drifts.

I can hear the little guy next door whooping in delight as he discovers another pile.

This is the neighbour's verge. Ice rinse for the washing, anyone?

Let's see if I can upload the footage I took of it hailing from the back door.

WOW!!!!! It happened nearly an hour ago and its still in drifts.(edited to add it lasted 7 hours, it has only just melted, but Don and Steff both got to see it when they came home)

I have never seen such a heavy hailstorm, I'm grateful there was no damage, as the hailstones themselves were not too big, but I'm glad I took photos.

And there's a bowl of it in the freezer!!!

Because...

To satisfy the curiosity of a certain friend, I gave Harry Potter and the Half Blood Prince 8/10 because...well its difficult to explain. Maybe I'd better just evaluate it as is.

The plot is not strictly according to the book. In the way that film 3 was condensed, with scenes from the book taken slightly out of sequence, or rolled into one for brevity. This film does the same, and it works and removes some of the tedious repetition. There are also completely new scenes and dialogue not from the book. Mostly these work, but one or two give away bits of the plot that one does not come to understand until later. There is a particularly menacing scene set at Xmas. Some characters don't appear at all. Some lose their lines to a different character in one scene then regain them later.

Snape and Draco Malfoy are both played with much more sympathy than previously seen. Some of the Draco stuff is touching. Dumbledore is really good in this, his scenes at the end moving but understated -just the way he would like them, really. Michael Gambon is terrific this time, he approaches Richard Harris for gravitas at last.

The main trio are all really good, and growing up beautifully. They each carry their scenes without too much mawkishness for a change, although Ron Weasley is a bit of a dope. He also has some funny scenes, with Harry, who has a delightful scene alone while under the influence. Teen hormones are raging! And boy, does that Ginny Weasley know what she wants.

Cinematography was good. The mood was amazing, no sweetness and light here. And the scenes in the cave were well realised. Great tension towards the end of the film. Slightly disappointed to have no funeral to sob over further, with a strangely awkward bit of editing that shifts the mood a bit prematurely for me, ending with a very obvious ribbon tying class for loose ends and demonstrating the way forward. If it had gone a bit harder with the grief work I may have been more satisfied, but the romance and comedy was great. Luna Lovegood was delightful.

It didn't drag in the slightest, in fact I would have been happy to sit for another 10-15 minutes to include a scene or two more. I especially missed one of the opening scenes from the book involving Fudge and the muggle Prime Minister, although the atmosphere was well and truly established by brief scenes of London under attack.

Once again I was frustrated by how much Dumbledore knew and didn't teach Harry. What a waste!

Maybe eight is a bit mean. Its possibly a nine. I can't wait to see it again!

Multitasking

Happy Harry Day!

We are going to see the latest HP flick tonight and we are sooooo excited! There is jumping up and down! And that's just with ME!

Also on my to-do list for today:

Colour my hair (in progress, be grateful I don't have live webcam)

Hang out washing (done) before men come to pull down the back fence adjacent to washing line (only found out about this one 30 minutes ago)

Hopefully have hair and shower achieved by the time men come to do said fence.

Fold a very large amount of washing.

Vacuum through.

Make fried rice and pumpkin scones for a pre-Harry large avo-tea, as the session goes over dinner time and I know I'm not gonna last.

Cut and colour my sister's hair.

Fuss over my Mum who is quite sick with a shocking chest, but insists on coming to Harry tonight. She can gawk at photos while I do hair.

Receive, feed and keep the hysteria down on 2, no, 3, no ....well, on all of our pre-Harry excitement. Oh who am I kidding? I can't wait!!!!!

Better get onto it!