Friday, June 27, 2008
Great beginnings
I was assigned to a couple having their first baby, 10 days overdue, and being induced. I took handover from a lovely midwife who assured me the cervix was really soft and favourable, the head was low and now the waters were broken. They were really excited and smiley and chatty.
"So, this is the kick-off, eh?" the husband asked. I assured him they would not be getting out of this labour suite without a baby, and I planned to catch it before morning. She was having a few niggly contractions before I started the drip, but as I turned it up gradually over the next 2 hours the contractions started to get her attention and she became restless. She moved really instinctively, circling and rocking her hips, remaining upright, alternating standing with sitting and moving on the birth ball. He was a bit unsure of himself at first, and she kept assuring him she was fine, and there's nothing I need you to do yet, thanks hon. He settled into a chair and dozed briefly, but kept getting up and walking over to her. I encouraged him to stand behind her at the back of the ball in case it scooted out from under her, and to touch her between contractions.
We had discussed their birth plan, and they were really not keen for any analgesia other than a shot of opiate perhaps, and really didn't want an epidural at all. I asked her how many times she was allowed to beg me for one before I gave in. "Five" she stated very firmly. OK its a deal. We talked about how things were going to get hot, heavy and pretty intense at various points with smiles wiped off faces. Thats fine, they said. I told them I would do my level best to encourage her through the tough bits, and would let them know about the next bits as they approached. There would be a phase where she was gonna lose the plot for a bit, and swear and beg, feel shaky and sick and want to go home, but that it was normal and that I would be glad to see it, because it would mean she was progressing well. OK? Yep, that's OK, we agreed.
It was beautiful to behold. The only downer was that she had to be monitored due to the induction and drip and post-dates, but she was just marvellous, and didn't complain once about the monitoring. It was my problem, and my shoulder was pretty sore from reaching out to keep contact but it was worth it.
About 2.30am she started drawing within. By 3.30am she started saying that it really hurt and that she may need some analgesia. At 3.45 she asked for an epidural. "That's once" I said. She was starting to really dread the next contraction. We went into drawing her out mode, lots of praise and encouragement as she was starting to lose the plot. To hold her off I got all the equipment out for an epidural insertion. She had asked 3 times by now. It was becoming more difficult to monitor the baby with her movement and agitation, and the coordinator was hovering wanting to know why there were big areas of poor trace. As soon as she entered she could see why.
"I don't know yet if I can offer you an opiate shot or epidural - how about we examine you and see where we're at?" She readily agreed. Onto the bed for the first time. A quick examination and I attached a scalp clip to reduce the number of belts she needed - 5cm dilated - slightly less then I had expected behaviourally, but I really felt she was cracking on. Get up and go to the loo, keep that bladder empty, yes do a poo if you need to, make room for the baby. Hmm electrode not reading too well, and there's a lot of fetal heart changes with contractions. A passing middle rank doctor was called to review the trace and the electrode positioning on baby's head.
"Ahh, you're almost there" he smiled. 9cm now, 30 mins after the previous examination! Sorry hon, I grinned, no epidural - you'd be sitting on the baby's head before we could get it in! She was not quite amused, and was quite frowny for the next 10 minutes.
Then she started holding her breath and involuntarily pushing with contractions. It is quite something to witness, and to experience. You know how when you need to throw up and you have a few dry retches first? It is just like that. Irresistible. We had talked about this sensation, and I assured her she would know when it was time to push. Go ahead hon.
It didn't take long before there was bulging and twitching and unfolding occurring. It's wonderful to see. She was less impressed. Its often quite hard to push effectively at first, and to get into the pattern of understanding the downward/forward progress of the head within you. And she was still feeling pretty ripped off about having asked for analgesia and not getting any. So as the unfolding occurred she was not sure she liked it at all! We changed position regularly, encouraging her by reminding her that it was all in their birth plan to push in these positions! She found it hard to coordinate her breathing with pushing, and would let her energy go between pushes, which meant the head would slip back and she covered the same ground 3 times each contraction! Finally she got the hang of it, and asked how it could be speeded up. "By doing the scariest-feeling thing, and then going further!" I replied. "I'll tell you each step of the way what to expect next." Within the next two contractions we had head staying on view between bouts of pushing.
"OK," I said "this next bit is going to sting and burn. It will feel pretty crappy, but I'll talk you through it, so try to work with me and stick it out. It won't last long. And then there'll be this really great bit where the head is out and the relief is sensational. And then there's this fantastic bit where the rest slips out and it is the best feeling in the world. Ready?"
And it was just like that. God- she was wonderful. What a champ. At 5.29am her baby surfed out on a wave of amniotic fluid, to her gasp of triumph. I helped her lift him to her chest where she welcomed him with an introduction of "Hello my darling baby, I am your Mummy". After a minute or so she and her husband thought to ask, "Oh - is it a boy or a girl?" I helped her to reposition the babe so she could see his beautiful rosy scrotum. "Its a boy!" they cried to each other.
She needed a few stitches, which another midwife performed, and after an hour or so we weighed him - 3.670kg - 8lbs 1oz. She was as high as a kite, the baby was alert and calm, and they were all so proud of each other for making and birthing such a beautiful baby. A triumph all round.
"So ... you never did get to asking me five times" I said to her with a hug. "You are very good at this birthing business, you should do it again!" She laughed and said that the head just out, and the slipping out bits were just as I had described them! Fantastic!
It was such a delight to look after them, and I saw them again on the postnatal ward the next night. Baby was starting to feed quite well, and she was really calm and confident, and still on a high after the birth.
And so was I. I am starting to feel like I can function as a midwife now. I've seen 7 births since my return to LBS, 5 x CS (! - although 4 of those were when I was working on the section list) and 2 normal vaginal births with no analgesia. Plus my friend's homebirth. I know which births I prefer.
I really am keen to work in the community, or at least in a model of care that offers continuity of carer/midwife. I was chuffed that morning to have the coordinator ask me if I could see myself working as a community midwife. When I readily answered yes, she said I would be good at it, and that it had been a lovely birth. I couldn't help but feel all warm inside. A beautiful labour and birth, and a compliment. I have been qualified a year, and working for 9 months now, and I really feel like I am finding my feet as a midwife. There are now 2 groups of midwives who are less experienced than me. I am sucking it up and getting on with it more, but still very ready to ask for guidance.
Of course as a rotational midwife I don't stay in one area for too long, but move around every 2 months or so. The next shift I was sent unexpectedly to the postnatal ward, where I had the care of 6 women including 3 women less than 24hrs postpartum, 5 babies including a 36 weeker twin, a withdrawing 37 weeker under phototherapy and a 3 week old baby whose Mum was very ill and was unable to care for it safely. The other staff were very kind and helpful, and cuddled and fed and answered my bells when I had my hands full, but it was a bit of a rude shock after the idyllic previous shift!!
They were both good shifts (in the end) and made me realise how much I have learned as a midwife in a short space of time. Two more night shifts to go in this stretch.
I still love it.
Monday, June 23, 2008
Picture diary
Which leaves more time for sewing!!!! I have been going a bit mad lately and loving it!
Here is a very bad shot of the Michael Buble concert, which is badly out of focus but conveys something of the atmosphere. Jeez it was a great concert.

Friday, June 20, 2008
Busy busy
Its hard to maintain a blog on night shift, my bed is sooooo appealing.
I've had a busy week on re-entry.
I've caught ONE baby (very cute).
I've made ONE super bag (pics to follow)
I've seen ONE movie (Sex and the City - I liked it immensely)
I've been op-shopping (pics to follow)
I've got people coming for dinner in 4 minutes.
I haven't packed for journal, belly dancing and doll-making camp - and I leave at 6.30 tomorrow morning! YIKES!!
Later, friends!!!
Sunday, June 15, 2008
Hubba hubba Buble
The Michael Buble concert was BRILLIANT!!!
I was a fan before, but now I am completely smitten. What a voice.
Truth be told, he was singing just for me. I don't know who the rest of the people were at the venue tonight, but their intrusion did add a concert atmosphere. Nice of them to turn up really.
And the support act, Naturally 7? Also very, very good. Not a hardship to listen to at all. Here's a clip of them with an impromptu (?) performance on a Paris subway train.
Three hours of pure entertainment. Just a great night.
The hotel on Saturday night was a great idea. We haven't been so relaxed for months. The room was really comfortable. We had a 2-person spa, and a walk through the evening streets and a browse in a bookshop before a delicious dinner for two in a swish restaurant up the road. Slept like logs. Plans for another wander in search of breakfast was somewhat curtailed by pouring rain and wind, so we breakfasted at the hotel instead, which was pretty average.
And then back to the real world. It was such a lovely oasis. I think we'll make it a regular date. Sigh, contented sigh.
I start night shift tonight. It should be OK. I haven't done any for a few months. I might get to see a baby born (well, duh).
I'll catch you when I can.
Friday, June 13, 2008
47 years young


Monday, June 2, 2008
The Game

Laura's game mosaic
Originally uploaded by Laura 61
1. Laura y el aire, 2. Meyer Lemon Tarts, 3. Mirrabooka, 4. Purple Euphoria, 5. George Clooney in Dolce e Cabbana, 6. Lighthouse (and a little help), 7. Last day in Paris, 8. My wifes todays artwork: Schwarzwälder Kirschtorte (Black Forest gateau), 9. The Sahel Good Giant (Le grand baobab - The African Tree of Life), 10. Soft purple, 11. Cat Conspiracy, 12. havenCreated with fd's Flickr Toys.
Here is my contribution to the game.
Seen over at Craftapalooza, Pea soup, and Chapter III ; (oh and at Life in General and Muppinstuff too - its really catching on!!!)
The concept:
a. Type your answer to each of the questions below into Flickr Search.
b. Using only the first page, pick an image.
c. Copy and paste each of the URLs for the images into fd's mosaic maker.
The Questions:
1. What is your first name?
2. What is your favorite food?
3. What high school did you go to?
4. What is your favorite color?
5. Who is your celebrity crush?
6. Favorite drink?
7. Dream vacation?
8. Favorite dessert?
9. What you want to be when you grow up?
10. What do you love most in life?
11. One Word to describe you.
12. Your flickr name
You can play too.
Its not too hard, you just need to have two windows open and switch between the two.
Its sometimes surprising to see the photos that come up in response to a keyword. That makes it a little difficult to discern the answers to the questions, but I think that preserves a bit of mystery.
Enjoy! The photos on Flickr are amazing!!!!
P.S. I'm so stoked to find the mosaic photo maker tool! I've seen these amazing mosaics on other sites (esp. My Happy Little Life) and thought I had to pay to have a Flickr Pro account or something...I'm not cool enough, or so organised to upload all my photos on Flickr. My account is so understocked, but it is useful to be able to send a photo to my blog from there.
Friday, May 30, 2008
A special day
I zoomed down the freeway to a far distant suburb and arrived at 2.30-ish to hugs and a household full of women. We began folding washing and preparing the bed for postpartum duty. The birthing pool was filling, the house was dimly lit and the labour was stopping and starting.
Around 4am she settled into a rythm of contractions and it seemed it would go quickly, so the second midwife and another friend was called. Naturally things went off the boil, toddlers got out of bed, the mother got chatting and lost her focus, but things came and went.
I worked yesterday and I had had less than three hours of sleep. We all snuggled up in various chairs during the quiet patches, but got no more shut-eye, while the labouring woman found her Zen space in the warm water, and then chatted some more. The contractions spaced out and went off the boil a bit. It was becoming clear many attendants were going to be late for their day jobs. No pressure! We made discreet calls to our co-workers as dawn appeared, the midwives agreed to the maternal request to break the waters to speed things up a bit. Cervical dilation was not as far advanced as we had expected. There was a bit of frustration on the woman's part as this was her fourth birth. The last two had been born quickly! We all had a cuppa and recharged our batteries by taking turns sitting quietly with the woman in the pool, on the loo, and in the shower.
Around 7.30am I felt I should make a move to get to work with traffic, but was reluctant to leave. This was not something one got to take part in every day! By this stage Mum was clearly transitional, but there was a stubborn anterior lip to clear. The woman was mobilising freely in the pool, the midwives tried other positioning but in the end the answer was an internal examination to push the anterior lip back over baby's head within the birth canal. Hallelujah!Fully dilated at last.
Back to the pool. By this stage Granny was getting the others up and ready for school. The six-year old was coming in for short periods and running out like a shot when his Mum screamed with frustration and splashed the water. He doesn't like yelling.
The baby wasn't descending readily - why not? Maybe try semi-recumbent as that position had worked for the lip push-back. Finally there was a bit of movement at the station, and gradually a little head appeared. The lights were low, a torch was being shone (by me, I was delighted to have a tiny job to do) through the side of the specialized blow-up birth pool, casting enough light on the area of interest to see the steady emergence of the head. It stayed there for another contraction. The midwife checked very carefully for excessive cord at the neck - no cord, but a hand covering the left ear! Ahah! The culprit revealed! Finally after a third contraction and a mighty push the baby slid forth, unfolded and starfished up to meet her mother, who scooped her up with a gasp of relief and a triumphant grin.
'Its a girl' she announced to the wide-eyed crowd, who all teared up with delight and a multitude of other emotions. It was 8.05am.
I don't know how much she weighs. It doesn't matter. I suspect around 3.4 kg (edit - 3.5kg) . I left 3 minutes after the placenta was out at 8.20am after a physiological third stage. The cord was still pulsating slightly, providing stem cells for the pink and perfect little girl.
The six-year old thought the baby was interesting, but it had all been a bit loud! The two-year old just wanted to hold the baby on her own lap - but we explained that it was still attached to Mummy's insides, but she could have a hold soon. The four-year old was quite blase about the fact that his Mum had just given birth to a new sister in a pool of water in his living room. Surrounded by three midwives, a student midwife, his Granny and Mum's friend. One thing was for sure - the kids trooped off to school with a very big story for show and tell.
I zoomed back up the freeway to my place, got changed, cleaned my teeth, and picked up my work car, went to work, got my co-worker and went out on my rounds to see 6 clients in a 97km circuit.
Now I'm home . . . and a bit tired to tell the truth. But it was a lovely night and day.
Welcome to the world baby Alira. Your birth was the first homebirth, and second waterbirth I have ever seen. It was so special to be a part of it, however small. Your Mum was brave and beautiful, and strong.
Birth as it should be. Spontaneous. Unmedicated. Responsive. Active. Magnificent.
Thursday, May 29, 2008
Catch up
Here is my reprobate son sunning himself in Hollywood on his balcony at a 5 star hotel. Any resemblance to a movie star is purely contrived (but he is a bit good looking).
His 12 year old birthday cake was a reproduction of a Magic card - a Shivan Dragon!! Good Lord he actually worked at it, and he won the qualifier tournament. He is now ranked 348th in the world (I think). He is capable of buckling down sometimes...I wish he displayed the same discipline at all his studies .... sigh ... although he is improving. He has reached that interesting age where (finally) he is putting in above minimum effort and getting back better grades - Who'd have thought? He is back BTW - with gifts! He's learning!What else? I have made Steff a hat.
You know I promised to be good at the craft fair? Well . . . . I was! I did buy some stuff, but it all fitted into my handbag! Are you impressed? I was. You can see how crowded the craftroom is getting. It looks a bit better currently than it does pictured below. I'm not showing you the worst corner.
I bought a stitchery pattern stating the completely obvious. Can you read it?
It says 'You can never have too many handbags or too many friends'. But of course!
I couldn't resist some little beads from a Chinese bead man. And some fun necklace kits made entirely of buttons. I couldn't decide between the black one or the red one so guess how many of them came home with me?
I saw some yummy bags and patterns, and only bought ONE small collection of fabric - I'm a bit drawn to chocolate and pink at the moment.
I have been using buttons a bit lately - I found a handspun, handknitted cardigan in an op-shop recently for $4, yes FOUR dollars. It was too cheap to leave there. Someone had made it with love, and skill, and had taken pride in it, so it had to come home with me.Cream is not really a colour that looks fabulous on me, but I honour its creation.
I am in my last two weeks of VMS now. I think I will miss the autonomy of zipping about the suburbs, consulting on my own. I will miss the yummy babies. I have had some completely edible ones lately. Oh, young Mohammed today melted my butter completely, I actually asked his Dad for a spoon so I could eat him all up!!!! I'm glad I get to see him again tomorrow. His four big sisters are unlikely to let me get too far down the street with him though. Sigh. Ooh - he really was adorable. I am quite a connoisseur of babies and he is a very fine baby!
Young Ella last week had us in stitches, unfortunately at her own expense. She was yelling lustily, as most young ladies (and gentlemen) do when being undressed for weighing, and as I put her on the scales she somehow took a fistful of her own hair and pulled. And pulled again. And kept pulling. Poor little mite. I immediately tried to undo her tiny fist, but you know how babies just won't let go? Sigh, poor little chicken, she kept looking very surprised and indignant, and would then pull again - bringing on a fresh bout of screaming! It took about 30 seconds to gently unwind her fist, by which time she had caused quite a red patch on her scalp! OOOOWWWW! Her Mum was fantastic with her. She had had a really easy natural birth at term, was breastfeeding like a champion, very easily and naturally, nipples holding up well. The good news continued as Ella had gained 3oz in a day - which made the scale related ordeal worth it!
I had a little fellow last week who wasn't doing so well. Mum's third baby, she was nearly 40, her milk was taking a while to come in, his poo hadn't changed colour at four days of age. When I weighed him he had lost heaps of weight on day 5 of life (12.5%), and hadn't started gaining yet. I sent him in to the hospital to be checked out, as babies must be examined if they lose more than 10% of birth weight (most lose around 6-7%). It may indicate a heart condition, or a tongue tie that means they can't remove much milk from Mum's breast. I followed him up today and found he did have a tongue tie, and was only transferring 4mls of milk at a feed! That's why he hadn't been pooing the right colour - it was barely getting through! Yet Mum's breasts were full of milk. She started pumping to remove the milk for him, and shoved it down his neck with a teat that delivered it more easily into his mouth. He is to have a frenotomy next week (where a surgeon nicks the frenulum under the tongue) and will be reintroduced to the breast after that, when it should be much easier to move his tongue effectively. I feel bad that I missed it when I saw him on two visits. He wasn't damaging the nipple, so I wasn't looking for it, and when I observed attachment he was moving and sucking in an apparently effective way, and I observed swallowing too! I'm glad he is turning the corner.
I've learned heaps in visiting midwifery. Its a matter of putting it all together, which I feel I am getting better at doing. I've had student midwives, and today I've had a graduate midwife with me. We toss around ideas, and at each house (as we drive away) I ask them if they would say or do anything different, and we discuss the things we have just seen, or houses we have been at!
There are so many delightful families out there in parenting land from all different cultures. Pets getting to know the new baby, siblings squirming for a front row seat at the action, or by Mum's side as she feeds the new one. Half naked men answering the door sleepily, and leading us back to their bedrooms, where we then ALL roll about on the bed, observing feeds, feeling the fundus, checking out the stitches, weighing breasts in hands, with the man in bed too, helping them all to understand the new family member, encouraging a love-in in the early days that will hopefully carry over to a harmonious family life. Its an intimate job.
I love it!
Thursday, May 22, 2008
ABC
Wednesday, May 14, 2008
Boobs are my bag
Somehow I have forgotten to attend any conferences or workshops this last year. I am aghast, as I love going to those things. I wonder if its because of the rostering hassles of being a rotational midwife. I move around a lot, each 8 weeks or so, and am constantly unsure of whether I will be on nights, or whatever. I am also a bit vague and unorganised about making roster requests in advance, especially when I don't know the area I will be working in, or its a new area for me.
Its a big hospital, I am often a long way from where I must go to make the request (if I remember to do it). I am often tired. I don't have access to the computerised in-house rostering program either - what a nuisance. Some areas make rosters 6-8 weeks in advance, some only 2 weeks in advance. Its one of those health system workforce things that I haven't quite adjusted to yet. I am such a slow learner about some things. Sigh.
Anyway I have resolved that i will make roster requests to give myself ONE day at home per week with no 'kids', which means Thursday currently. Unfortunately, given that visiting midwives tend to need continuity of clients, that means that out of the last 8-9 weekends I have worked 6 of them - both days! Groan. I start again on Friday and work 6 days straight, then get a week off, including my first weekend in a month! There has got to be a better way! I have made requests for my first few weeks in LBS for mid-June. Lets see what I get!
Its fairly self-inflicted, and think of all the money I get working on weekends. Anyhoo.... I think I have finished whining about that. You're probably very relieved. (This is my daughter in 1993).
I have had an interesting couple of weeks on the road, and met some interesting families. I have seen some incredibly large and engorged breasts!!! They could easily be feeding twins, but they each had only one small baby to deal with all that milk! Then later in the day I would see other scrawny babies whose mothers were a bit half-hearted about feeding them diligently, who were not gaining weight. I could have put them in my pocket and taken them to the next house and put baby to the breast of that over-supplied woman! If only I could do that! Or feed them myself!I have noticed that I am experiencing let-down again while on VMS. I used to get it on the postnatal ward, especially when I first started in midwifery. Its never really left me, even after more than 18 years since I last breastfed a baby. (ooh there it is again, just thinking about it). I don't mind. I don't leak or anything, but I still experience it. I feel it means that I am just very connected to this field, and that it means that my body is passionate about breastfeeding too! See what I mean - body and soul!! I am coming to realise that I know a lot about this area.
The photos throughout this post are mostly of a much younger me, from 1989, when I was breastfeeding my daughter. Above is our first mother-daughter photo - she is about 8 minutes old and I am having a quick cuddle before she went to intensive care. (Yes, I am on the floor. Yes I am naked. Be grateful I cropped out the cord hanging out! TMI?) She was born with a cleft palate as part of a syndrome, so was unable to feed directly. In fact she never went directly to the breast. Below is the breast pump I used in hospital - this photo was taken when Steff was a few weeks old, and we were still living in hospital together.
I am moved to see this photo of Patty, age 3, with his sister aged 3 weeks. Still being nursed on her stomach as all babies with her syndrom are (Pierre-Robin Syndrome). It was pretty hard for him to lose his Mum to this strange little sister. Maybe not much has changed in 19 years.
This one, with me being sooky, is of my last express, when she was 29 weeks of age. I always cry at big occasions. I was sad but triumphant, and baked a boob cake to celebrate my achievements. (My hair is pretty bad here, I had just got up, and it was shorter as it had all fallen out postpartum. Did that happen to you too? I always lost my hair after giving birth.)I did try to express directly into her mouth one time, but as she had a gag reflex from hell and thought every attempt to put anything into her mouth was a threat/an attempt to kill her, she retched and vomited straight away after the first few drops, losing far more nutrition than those drops had given her. Sigh. It was too confronting and directly wasteful/punishing to see this milk wasted in this fashion, and she threw up so much on a daily basis that her growth was severely compromised anyway, so I didn't try it again.

This photo is from one of those rare times when Stephanie actually fed orally in a coordinated fashion, where she cried with hunger and accepted her mouth being filled (delivered from from a soft-sided squeezy bottle because she couldn't generate the suction to get it from a bottle like regular babies), then swallowed - without gagging. It was a miracle to us to see her do it, hence the photo.
She only did it 7 times in her first year of life. It still brings tears to my eyes to think of those sessions.
So to see half a dozen little babies daily, attach at the breast and suck for all their lives are worth, and do it every two hours! Wow, what a miracle. What a privilege to feed your baby that way. I know ... I did it for nearly 18 months with Patty. He fed heartily, lustily, frequently until that time, and was still feeding to sleep most times, and waking to feed in the night when I decided I'd wean so I wouldn't be getting up in the night to him just to feed. It seemed like a good idea at the time. If I'd known that it would be the last time I would have a babe at my breast I would have gone on.....
I have breastfed two children. In very differing fashions. My only reason to have another child would have been to have another beautiful period of feeding. I did love it so. I think I did it well. This photo is from 1996, Patty 10, Steff, 7.So this is another aspect of my life that I can bring to my practise.Its not about me, and I rarely mention it to any mothers I care for, but when they are pumping to establish or boost supply I can genuinely identify with their task.
I remind them that growth spurts happen, and to let them happen, and to surrender to it. These are the periods where the baby wants to feed constantly, a mother will say 'I have no milk' or 'my milk dried up'. We hear it a lot. But with the right information and support from her family, and only if she wants to (because some women don't really mind whether they feed or not, and I'm not gonna force them) our imparted knowledge will mean that she knows how to maintain and boost her supply, and the lactation bond will continue.
I like boobs. And babies. And bumps. Lucky I'm a midwife, hey?
