Student Midwife

I'm beginning to wonder if I'll ever stop being a student midwife. The more I learn the more I realize I don't know.

I've decided to drop AAMI. I'm not happy with some of the ways Carla has handled things, but more importantly I'm not happy with the curriculum. It's a lot of busy work, things that I really don't think are needed, like writing a Childbirth education workbook for your clients. There are so many great books out there, I can see evaluating several and choosing one you would recommend but writing an entire one??!! Some of these authors have spent years doing that! Why reinvent the wheel. I also feel like the add-ons for the Philomath are not nearly worth what she's charging for them. I paid for the Great Start-4 and am disappointed with the AEU's. The fetoscope one asks for the four ways to hear heart tones and then gives you a chart to record them. Hardly what I would call educational. The 4 year study calendar is printed calendar pages, anybody could create one themselves, I was hoping for something with goal planning and such on it. I haven't requested the NARM study questions yet so I can't comment on those.

So on my preceptors recommendation I'm going through "Becoming a Midwife" by Carolyn Steiger. Much more realistic IMO and things that will actually be useful to my clients and my education. I started on the skills checklist and realized I really need to start using a fetoscope during prenatals. I also want to order a pinard horn. I'd love to find a beautiful hard wood one that was hand crafted, I'm such a sentimental.

I'm struggling with my preceptor. I feel like she's not wanting to call me for births, now maybe they've all just been fast lately, but I don't know... I'm sure it's my own insecurities. I need to talk to her about when she calls me. It seems she doesn't call until after she gets there and decides if I have enough time to make it. I'd rather she called when they called her, especially if they call and put her on alert. I just don't know how to bring it up, I'm so incredibly afraid of offending her, there are no other options for me here. Don't get me wrong, she's far from tyrannical and I agree with how she practices (mostly)so in the grand scheme of things she's great and I couldn't have found a better preceptor. I'm just not sure how to tell her I need more direct teaching and I want to see more births.

I don't feel like I'm learning anything new, but I also don't feel like I'm doing very well at perfecting my clinical skills. I think I've got blood pressure down, but I still struggle with hearing it over the movement of the tubes and such especially if mom is talking and moving her hand. I'm having difficulty with fundal height on many women, especially the fluffy, newly pregnant ones and I haven't memorized FHT chart so I'm always looking like a fool with that.

Gas is getting insane, and it's a 160 miles round trip for every clinic day and then where ever the birth is. I'm sure this has alot to do with why my preceptor doesn't call me, it seems a waste of gas to drive up there to miss a birth. I don't know what to do.

Births Update

This is going to be long, you've been warned!

I only got called to two January births...

A, young, first baby, lives an equal distance from me as she does from Margarett, so when she suspected labor I (the lackey) got called to see how she was doing. (In M's defense she thought I was closer) I get there and she tells me her water broke. She's working through contractions, seemingly difficult ones, so after a bit I checked her, she's a fingertip and not at all effaced and baby is still floating very high. I suggest she try Benaydral to get some sleep, she opted for Valarian root capsules. I left about an hour later with her and her hubby sleeping. The next day Anne and I go out there after clinic and find that she's still contracting pretty hard, but she's not making any progress. After verifying that her water was broke the decision was made that she should go to the hospital, OU was chosen after her doctor told her that he'd section her right away if she came to the local hospital. Anne went with her to the hospital and I went home. She got Pit. and IV antibiotics and had a healthy baby boy on her hands and knees the next afternoon.

J, also young, also first baby. We barely made it to J's birth and I love to tell the reason why! She called Margarett when labor started but assured her she wasn't needed yet. M talked to her a couple of times and each time J said she didn't need her yet. Well after we got there and Anne caught the baby 5 mins after we walked in the door, we asked J why she didn't call \us to come sooner and she said "I kept waiting for it to get horrible" Oh how I love that!! She had heard such horror stories that she thought for sure labor couldn't be as easy as it was for her. She had a healthy boy, at home, on the birth stool. She had a small tear that we decided to just leave alone.

February....

M, another young first time mom birthing at the center showed up a 3 with a whole entourage. We fully expected her to take all night so I brought with me a whole host of things to do. Well M apparently is more comfortable with her family than we expected and went from 4 to 8 in an hour! She spent about an hour on the birth stool but she was just beautiful. It all went really well and she had a gorgeous baby girl.

S, second baby, they chose to not find out gender She labored so beautifully! She came to the center a little early, but they wanted to settle in and get comfy. I got called around 5am. She labored slow but handled it beautifully. She would sway and breathe with each contraction and laugh and chat between them. She really was having a good time and though it took about 12 hours it was wonderful. She labored in the pool for a bit and just stretched out and laid there like she was on a tropical vacation. Then her water broke and with it came a small trickle of blood. Almost immediately she felt a very strong urge to push, she came up out of the water and we sat her on the birth stool. Heart tones were irregular and slow. She pushed hard for two or three pushes and out came her baby girl, very bloody, a little limp but all in all well. Then the blood started. It just poured out of her, like she was peeing it into the bag under the stool. I threw pads on the bed and Anne told her we needed her to lay down *NOW*. She didn't think anything was wrong and never felt light headed or anything. 3 droppers of Shepard's purse later and lots of fundal massage and she finally slowed to a reasonable amount. Within an hour her bleeding was nearly non existent.

March so far...
Marie, another young first time mom, she was very excited and optimistic about a homebirth. She called Margarett early Tues morning as contractions had started. We talked to her again around 11:30 when her water broke and there was meconium in it. We headed out right away, got there and she's a 1 with light to moderate mec. We encouraged her to get some sleep, she was obviously exhausted and having a hard time. We left to find a pool and took our time, hoping she would get a couple hours of sleep. When we got back around 3 she was still a 1, baby was still high, still a good bit of mec and heart tones were flat. By 4 we had made the decision to transfer. Baby's heart tones just were not responding and it just didn't feel good. So we went to OU where they essentially did nothing for 7hrs!! I stayed with her through the night. They didn't want to give her pitocin because of baby's heart tones, even though she was making very little progress (she dilated to a 3 by 11:30, 24hrs after her water broke) she desperately wanted and epidural as she couldn't sleep and couldn't deal with being in bed and not making any progress. They didn't want to give her an epidural for fear that her contractions would peter out. So she laid there and beg for pain relief they wouldn't give her and cried about the little progress she was making. It was heart wrenching, I felt so bad for her and helped her through the contractions as best I could. They finally gave her an epidural at 8am and I left at 9 since she was sound asleep and I needed some rest myself.
At 11:30 she called, they had decided to do a c-section. Baby's heart tones never got better, neither did the mec. There are so many things I think this hospital should have done that they didn't. I love that it is generally a non-interventive hospital, but in this case, intervention was exactly what we needed. I'm glad she had a healthy baby girl and in the end everything worked out for her.

The holidaze

Whew! Glad that's over!
December is usually pretty busy for me, I tend to make it that way, but adding in the apprenticeship and busy soon escalates to crazy.

I decided I wanted the bathroom re-tiled before my in-laws came for Christmas on the 2nd, and of course putting in new tile means new paint! Our bathroom before was wallpapered in a stripe with navy, forest green, cranberry and white. It looked nicer than it sounds, the counter is cranberry and the tile is gray marble. The tile was never sealed and I wasn't aware that was necessary so after 4yrs with 4 boys using it daily you can imagine what it looked like, much less the lingering odor that never seemed to wash away.

I found a warm clay colored tile with hints of burnt sienna and pumpkin in it. I went with a pumpkin color for the walls and it looks totally different, very warm. But painting with 6 kids in the house is near impossible much less trying to do tile so the tile isn't finished. In fact the toilet was re-installed a mere 15 min before my husbands parents and sister arrived! Talk about pressure!

Heaven sent had 3 ladies due in December, one went early in late November and one went Christmas eve and one Christmas Day! Margarett, bless her heart, didn't call me for the Christmas birth as I would have just pulled in my drive when she got called and it was 3.5 hrs from me so I probably wouldn't have made it anyway and I would have been dog tired when I got there. I also had one doula client who was planning a hospital birth in Lawton.

Our Christmas eve baby went well.... S was planning a center birth, so when she called thinking this was the real deal Margarett called me right away, around noon. Margarett was trying to help Anne clean and move so she was already tired and I hope, glad she had an apprentice to labor sit. I got there just before S, when she got in she was a 3 maybe a 4. Not terribly encouraging to a mama who was ready to be done four weeks ago, but she was sure this was it and she wanted to stay. I stayed with her while Margarett went back to try to get Anne's house livable in time for Christmas. S had her sister and a good friend with her. She was in good spirits for most of the labor, laughing and telling jokes between contractions. They watched movies and talked and I got a ton of cleaning done. S spent some time on the birth ball and then the tub. She asked me to check her and I thought she was a 5 but still pretty high, I don't think Margarett or Anne was very happy with me doing that, but she just seemed to really need assurance that she was indeed getting somewhere.
She walked around, rocked on the ball some more and then threw up, that's when things changed. She got a little more serious and started to concentrate more on the contractions. And she found her rhythm and ritual. With each contraction she would lean on the ball, put her head down and sway her hips. She was quiet during the contractions though she complained between them. It was a little like Jekyll and Hyde. During her contractions she seemed so peaceful and serene, as if she was enjoying them. Between contractions she complained about how uncomfortable she was and how long this was taking. I think she just wanted to be done and holding her baby. Well it wasn't much longer and she was. She got back in the tub for awhile and when Margarett got there she got out and got on the bed within an hour her 10lb baby boy was born. I stayed at the center until they left, and cleaned up the laundry and trash and headed home.

Dec 22nd my doula client tried a natural induction, she chose to take some herbs and homepathic and I applied some acupressure... nothing happened. I went home and checked on her periodically over the next couple of days. So on her due date, because no one ever goes on their due date, the husband and I decided to take the kids to the Omniplex and the OKC Downtown festivities. We took two vehicles just in case, and it's a good thing we did. Towards the end of the evening, right after we got hot cocoa to warm us up before going home, A called, B's husband, to let me know they had gone to the hospital to get checked and she was about a 4 but they seemed to have forgotten about them. B was really struggling with the contractions so A got a speed class in Doula 101. He did great!! He helped her to relax and let go and by the time I got there (2hours after their call) she was doing really well, a little too well some might say. When I got to the floor and asked for her the nurse seemed confused, apparently they really had forgot about her, even though at last check she was 5cm they never admitted her, so she was in their "receiving" room, a large room with three beds separated by curtains and one bathroom. I got in the room and B was laying in bed, fairly well relaxed for a first time mom giving birth in a hospital. She would chant "open, open" during contractions, earlier on the phone, she was saying "ow ow ow" with each one I suggested A start saying open and suggest her to do it as well as it's a much more positive thought than ow. She would curl her toes and squeeze the sheet but otherwise was doing okay, I tried to help her relax through two contractions and then she needed to use the bathroom. Once there she had a ton of bloody show and lost a large amount of mucous, I thought "great, this show is really on the road!" We worked through about 5 contractions coming about 4mins apart and lasting just under a minute when she started to grunt. I thought it was way to early to start grunting, I mean she's a first time mom and has been laboring actively for only about 2 hours. She said it was burning and I kept watching her vagina, looking to see the swelling that usually accompanies the burning, there was none but she kept grunting. We talked about pushing against an incomplete cervix and I had her pant with her head back to try to keep from pushing, when I seen her belly bear down even though her chin was up I asked if she wanted me to check her. Sure enough there was a head, less than an inch inside the vagina. I sent her husband to the nurses station to tell them we needed a real room now. -I struggled for just a moment with whether or not I should have her moved and alert the staff. I knew that 10 more minutes of sitting on the pot and she'd have a baby in her arms, no risk of epsiotomy, no policies to argue, just a healthy baby and mama. The reasonable, responsible person won out.- The nurses dashed in as A had told them she was crowning. The first nurse in couldn't check her on the toilet and wanted her to lay down on a sheet on the floor! I convinced her that she could check her standing up and she agreed, we needed to move her now! They put her in a wheel chair and we raced down the hall to a room. The nurse said she had an anterior lip, I don't think that's possible with how far down the canal the head was, but who am I to argue. We panted through about 4 more contractions and then she was given the go ahead to push. I think it was about 4 good pushes later and we had a 6.14lb baby girl.
There was an argument over an IV (yes less than 10min till baby and they wanted to start a bag of water), the doctor cut the cord and suctioned before giving the baby to mom then proceeded to pull the placenta out and do a bi-manual exam. I think she'll consider a homebirth for the next one.

Wow this got really long so I'll tell you about the long awaited new year's date in another post.

The test continues....

Friday was apparently a continuation of our earlier testing of my husband and the midwifery lifestyle...

My husband manages the developer team for his company, it's a small team and we decided that we would very much like to show our appreciation for the great work they do and the friendships that he has there. So I planned a delicious Christmas luncheon party, I had a full menu, ham, twice baked potatoes, spinach salad, homemade rolls.... the works, even a fabulously creamy, rich pumpkin cheese cake. I had purchased these beautiful plates with a very artistic reindeer on them, decorated in plum, evergreen and gold. I had plum napkins, gold colored flatware, I made beautiful centerpieces, I fully expected this to be "an affair to remember"....

I got up at 7am Friday morning so I could get the ham in the roaster and the rolls started after staying up until 2:30 to get the cheesecake finished. Margarett called at 8:11 am. She has her own ring tone so I knew from across the house who it was. My heart sank and lept at the same time. I knew she would only have been calling at that time of day if someone was in labor, but I also knew that meant my party was down the drain. I hesitantly answered the phone, hoping against hope that she just wanted to chat, but no, C was in labor.

I called to my husband, who was trying to find clothes for the kids, with a slight smile and a lilt to my head and sheepishly told him "I need to go to a birth." He asked what I thought we should do about the party, we couldn't really re-schedule because of projects his developers would be doing taking them away from the office, so it was kind of a now or never deal. I told him I thought he could handle it, I was of course lying through my teeth, but that's okay, it's what he need to hear! I started running through the list of finale preparation (thankfully I had precooked much of the meal) listing off dishes he would need for serving, where he would find serving utensils, how the table should look, I could see his mind trying to juggle all the information and make sense of the foreign language I was speaking to him. I assured him he could call me if he need me.

I ran out the door at 8:43, I had a two and a half hour drive ahead of me, I partially hoped that Maragarett would call around Chickasha and tell me I missed it not to bother, I could at least then make the party and ensure that it was as spectacular as I had planned. She didn't call, so I called Nathan to see how things were going. He was late getting the kids to the babysitter and sounded like he'd been put through the ringer. He was trying to keep the delicate dance I had started going, getting all the food timed right so nothing was sitting cold and nothing got forgotten. Considering he'd never done this before he was doing pretty good.

I walked in the door of C's house at 10:50 and found her on the birth stool, Margarett perched in front of her like a child waiting for the gumball to drop from the machine she has just put a quarter in. Anne was to her right not quite as enraptured by what was going on as Margarett seemed to be. They both smiled and I sat down on Margarett's left.

At this point I’m not sure how long C had been laboring or how long she’d been pushing. She sat on the birth stool at the foot of her bed, her head lopped from side to side as it laid against her husbands chest, she breathed heavy and was obviously exhausted. Her husband D sat directly behind her, his eyes shined bright, he was tired but the excitement just beamed from him. You would think he was the little boy getting the Red Ryder BB gun for Christmas.

We went on like this for nearly two hours. We tried flexing her hips which required Anne and I to act as stirrups. Oh let me tell you that was fun! At one point I had C’s foot high up on my shoulder with her mother in law standing behind me to keep me from toppling over! C had amazing strength, when she switched positions so one leg was higher than the other and her foot was resting on my thigh I thought for sure the pressure would cause my skin to just release and her foot to go straight through to the floor. Anne and I held feet and thighs, whispered and shouted words of encouragement. Margarett tried to help her understand just where and how to push, her Mother prayed over her through each contraction, C humpfed, yelled and moaned. It was anything but a quiet serene birth. Baby Boy J slowly emerged from his mother’s womb starting at 12:42, it took a full minute (maybe two) to get the whole body out. J is a chubby little boy weighing in at 8lbs 12oz, he has the biggest cheeks and square shoulders, it’s no wonder C had such a hard time pushing him out.

I managed to call my husband, he had tried to call twice while I was assisting. He pulled it off! They were eating when I called, of course the table cloth, glitter, center pieces and beautiful arrangements didn’t happen but they all enjoyed great food and lovely conversation and Nathan saved a piece of Pumpkin Cheese Cake for me.

It wasn’t a long labor by any means, just inconvenient timing, something that is a reality of the midwife. Sacrifices have to be made by the whole family and in this case sacrifices (though small and in reality unknown) were made by my husbands staff. It made me think how many times will I have to cancel a dinner engagement at the last minute, or how many weddings I may have to dash out of? The life of a midwife is unpredictable, and unstable, I’m already finding myself telling friends “I’ll be there if no one is in labor”

Thanks Jan

One Birth, One Woman at a Time I was reading this article, it's one I chose to comment on for my studies with AAMI I was inspired, Jan is such a wise woman, full of inspiration and support. This article is a wonderful reminder of why we do what we do. I’ve recently had a string of “bad” births, epidural and vacuum assist, 2 c-sections, and my preceptor had to call child protective services on a mother who refused to take her failure to thrive baby into the hospital. With all this I sat back and wondered what am I doing? What’s the point? But as Jan pointed out, I have changed people’s lives, even these women who had less than ideal circumstances, their lives, their ideas about birth were changed. Their family’s ideas were changed and I even think I made an impression on a nurse or two.
It’s hard to keep going when you feel like you’re stumbling along. But I look up from the dirt I’ve fallen into and I see the light in a woman’s eyes who sees something new, who has hope for something better and I have strength to pick myself up, dust myself off and get on with my work. This is the work God has for me, I often feel like He’s trusted me with too much, I can’t possibly live up to it, and then I’m reminded I don’t have to do it alone, I have all my sisters in birth working along side me. Together we can create a better world for the motherbaby dyad.