Another fantastic day. Heard an awesome inspiring speaker, Rangimarie Rose Pere. She gave us all plenty of food for thought.
I won a prize draw. It's rather exciting, but I haven't seen it yet and it's not the Sonicaid.
At the hangi dinner the atmosphere was much more relaxed then the dinner the previous evening. I enjoyed it, but couldn't get into the dancing after the Pacific Island group and the Maori culture group. I missed Adrian, and felt lonely and shy.
I love today. So much to see and do and participate in.
I found it completely confounding that we had men speaking on behalf of the women for the powhiri.
It was fantastic meeting Sarah and Sheryl from the midwives list.
I was really disappointed in the dinner as the quality and quantity of the food was not satisfactory value for the price paid for the meals.
It's amazing to see midwives let their hair down and have fun. I can imagine I'll be like that in a few years. As Sandy and I have discussed, there is a definite culture of midwifery, and as students we feel as though we have a taste of it, but are on the outside looking in.
We made it here without too many problems. I'm disappointed that none of the other first-year students are staying at the school dorms, but I'm definitely pleased to be here because it's the more economical option.
It is obvious that there are sub-cultures in this culture of midwifery. N* suggested that to get peer support as a practitioner the student and midwife needs to be aware of, and absorb, all aspects of midwifery culture.
I need to work on my literature review and tonight looks like the best night to get some good work done.
The material presented today has been fascinating. The workshops are really more of a lecture, but in smaller groups.
I purchased Spiritual Midwifery and hope I can get Ina May Gaskin to sign it. We'll just have to wait and see.
Like the Optimal Foetal Positioning workshop, the information we are getting makes me question practices that are considered normal and check my experiences.
I often feel in this midwifery student role as though I am a passive observer watching and learning by standing back and absrobing interactions and culture.
What a glorious day! I truly experienced the joy a midwife must have at being able to provide continuity of care with final postnatal visits for two of the women whose births I attended.
Our first visit was to L* who is due in February. She has already finished work and is happily homemaking and preparing and making beautiful items for baby. Her house is absolutely gorgeous. Perfect design and decor. If L* had a hand in it I thought she should go into business, but they bouight it that way.
S* had a look around the hospital to figure out what the plan was for her birth. It looked and felt to N* as though both babies were head down, with one baby firmly descended. This looks good for S*. While N* thought it would be good for me to be at the birth, I fielded the idea with S* so that she could think about it.
V* is doing really well. We me B*'s parents. B* and V* gave me the disk back with the photos which is fantastic. I will have to wait for a copy of the other photos fom the camera so I can show other students the birth chair. N* and I don't think they realise how close that V* was to a serious haemhorrage.
J* is a character. Once again we caught her in the shower. She is being pampered by her mother in classic Indian tradition. Even though baby was premature, he is really thriving.
It was wonderful seeing D* again. As I told her in a slightly humorous way that I'll never forget the first birth I attended, and what a privilege it was. I would love to be able to keep in touch by email. The final visit offers closure for the midwife and the woman to move on to their next endeavours.
I was really stunned that L* and G* had given me a card and a box of chocolates because they had already given me a gift by allowing me to attend J*'s birth. I guess it's more to recognise the special connection I will always have with them and their baby.
I gleaned lots of practical information from N* today about midwifery practicalities to how a new practitioner might build up their practice.
I was so lucky to be able to attend a wonderful home birth.
V* and B* had planned a home birth. I must have had a feeling the night before because I went to bed at 11pm and told Adrian that I needed my sleep just in case V* had her baby early.
N* was phoned by V* at 6:30am. V*'s waters had broken around midnight. When N* arrived V* was 9cm dilated. N* phoned me at 7:20am. I missed the actual phone call, but once again that intuition kicked in and I got up and checked the caller display and rang the number.
The adrenalin kicked in and I got dressed, put my hair up, grabbed my stethoscope, sphygmomanometer and digital camera and flew to V*'s house. I managed to get there at about 7:45am and arrived before C* who was travelling from Island Bay.
When I got there V* was in the birthing pool in her kitchen/dining room. The atmosphere was warm and steamy and everyone was relaxed.
For whatever conincidental reason each midwife was wearing a blue top which blended perfectly with the gorgeous blue walls. V* made use of her recent vocal lessons and during a contraction she made a ululating musical la-la-la-la sound as a coping mechanism. It sounded amazing, and must have really confused the neighbours.
V* got out of the pool when she was no longer able to relax and cope with the contractions. B* was amazing at applying acupressure. N* also had a go so that B* could get dressed. J* was a wonderful support person with providing water, cups of tea, hot and cold flannels, towels. She was really unphased by everything, but I really think that the actual birth was very emotional for her.
The strength and speed of V*'s labour really tired her out. V* spent some time on the amazing birth chair (which reminds me of a captain's command console from Star Trek) and also semi-reclined on the floor.
One point to note about helping a woman birth on the floor is that it is excruciatingly painful for your knees if sustaining the pisition for a period of time. Maybe midwives should have kneepads underneath their trousers. I also got dreadful cramp and had to carefully change my position a dozen times.
It was funny to see V* reach the stage where she felt she couldn't go through with the birth. I can remember feeling that way with Lucas. I can remember feeling like I wanted to climb out of my body and away from the pain.
It was really good to see N* suggesting and V* using different positions during the labour and for second stage as well. I can remember reading somewhere in a pregnancy book that once the labouring woman is in second stage and pushing that she should stay in one position. Jean Sutton's Optimal Foetal Positioning gave me the information about varying positions to facilitate baby's passage through the birth canal. The one I still have to figure out is the knees up and pushing while semi-reclined. I'm looking forward to giving the book to N* at the end of our clinical time together.
I could see as baby was emerging that V* had torn. Although the damage looked like a lot more because of swelling. Baby came out quite pale and with loads of vernix covering her. V* and B* were incredibly emotional and I was really moved by it.
I also witnessed a close call post-partum haemhorrage. The blood flow was continual and seemed to pulse. C* drew up more Syntocinon and N* vigorously massaged V*'s fundus. They were both so calm that until I actually spoke to N* about what happened, I wasn't sure how close it was. B* had to leave the room as he was feeling faint. J* held baby. I'm not sure if B* and V* realise how close it was. If the midwives had panicked the place would have been a real disaster zone.
I was doing V*'s blood pressure and pulse and everything was okay. I looked at the stitching and really had no idea how N* knew what to stitch. I noticed the smell of blood reminded me of what a butchery smells like. And there was certainly plenty of blood.
We kept V* warm and kept monitoring V* and cleaned up around her. V* breastfed and we were able to relax with a cup of tea. Then when V* was ready we helped her up to the shower.
In hindsight N* thinks that the haemhorrage had two causes. The fact that V*'s bladder wasn't empty and she hadn't been to the toilet for at least 2 hours before the birth, as well as the way the placenta separated from the uterine wall. This certainly gives me food for thought and demonstrates the importance of an empty bladder. If the bleeding hadn't stopped then N* said that they would have had to give V* ergometrine and call an ambulance.
What an amazing learning experience in so many ways. Every birth gives me a unique connection with all of the people there. I feel as though for a moment my life is inextricable linked with the life of the baby.
It was lovely to have S* ask if I would be at the birth. N* is going to see about me being there for S*'s as well. Sometimes when I am out with N* I feel an incredible flow where everything seems natural and right. I feel discomfort when N* pushes me to do something new that I haven't done before. I know that's what I'm there for but I still get nervous when I'm trying out new skills, because other than possibly just looking stupid, I'm dealing with people's health.
I feel quite confident about the Guthrie test. I felt that my notes provided more detailed information than the pamphlet and the research process equipped me better in informing the parents. I discovered my bias and view that after finding out more information I would want all parents to accept the Guthrie test. I am interested to hear another midwife explain the purpose. I don't recall how the test was explained in the hospital, or even if much detail was provided.
I must write too much, because I'm just not keeping up.
I got an A for my Partnership in Practice assignment, which will dictate my grade for the course. I am really pleased because after all, midwifery is what I'm here for. Hopefully, I do as well with the essay I handed in today.
L*'s birth was an induction on Friday 1 September. They must have arrived early because when I arrived they had already done the first examination.
L* had her GP as LMC. He seemed to be really involved to a greater extent than I expected, but N* mentioned that he was probably after brownie points because of a business relationship he had with G*.
CTG showed some worrying dips. As first baby, N*, was needing assistance immediately post-birth, and because of the dips it was decided to deliver in one of the theatres.
L* used a birth stool, but finally gave birth in a semi-reclined position. Baby had quite a lot of moulding from a long second stage.
G* quickly checked baby. He assisted me with controlled cord traction, then he stitched L*'s tear.
I was surprised that G* stood back instead of really getting in and standing by L*. I'm not sure whether it was because he didn't know what to do, or because he was nervous, anxious, or doesn't like blood.
During this labour I spent a lot of time observing L* and G* and trying to figure out how they were feeling about what they were going through. Did they understand the procedure? Were they coping with the pain? Were they anxious, relaxed?
The learning curve is steep when you make a mistake. When I was getting L* up for the toilet and a shower she bled and there was war paint from the bed to the bathroom. I learnt that the woman should wear the pinkie like a nappy for the first toilet trip!!! And I won't jolly well forget it.
It was certainly a busy day because we also did a hospital tour with V* who met C* who was to be her second midwife at her homebirth. V* invited me to her birth as photographer. I was really pleased and excited and felt very privileged that I had been asked.
N* and I were also caring for B* who was being induced the slow way because her midwife was out of town. I did a lot of the care for B* myself with putting on the CTG monitor and interpreting the printout as well as chatting with her and her partner about the reason for the induction.
And I had thought that would be my two births and my time with N* would be up. Luckily I was wrong. Now the births I'm attending are at the invitation of the women. V*, T* and S* have also invited me to attend their births and I feel very privileged at being asked.
Another busy day ahead of me so I'd better write up the births.
D*'s induction was on Tuesday 8 August 2000 and D* was being induced at term because she was worried about having a very fast labour and an unplanned home birth.
The hospital was full up in the morning so start time was rescheduled for 1:30pm. The first room D* was in was room 4 which is one of the cubbyholes. Initially D* was prepared with CTG tracing, IV leur, and the epidural was sited.
The vaginal examination and artificial rupture of membranes was done at 3:15pm. D*'s cervix was only 50% effaced. Following the ARM D* started contracting, but walking definitely got them going.
Nothing major happening so a further ARM done on noting on V/E that membranes not definitely ruptured. The ARM was very uncomfortable for D*. She actually needed entonox because of the fundal pressure N* asked me to apply.
This time the ARM did the trick and contractions strengthened. D* requested the epidural medication and she found that immediately after it she was not able to be upright without feeling nauseous.
When D* was able to, we walked around the ward. The walking was marvelous for getting things happening.
D* was fully dilated at 8:47pm and she started pushing at 8:55pm. Baby C* was born at 9:08pm according to N*'s watch.
Blood loss was practically nil and N* got me to help with controlled cord traction for active management of third stage.
Reflecting on the experience now I am able to say that I really feel that the epidural slowed things down for D*. She didn't think she would be able to deal with a fast labour without it. You're damned if you do, and you're damned if you don't.
I had thought I would be really emotional at my first birth, but I was more focused and practical and was watching for the placenta, and other signs that all was well.
I was amazed at the amount of documentation required. Epidural information, partogram, progress notes, drug chart can all contain the same information. And if things aren't written down immediately as they occur, often the time sequence can be forgotten.
Time is another thing - the birth time of the baby is determined by the midwife's watch. What if the time on her watch is wrong? That could be quite significant to some people with interest in astrological charts.
I learnt soemthing from experience about the variability of birth. Not all of them are like mine. Not all women want to be in control or see the pain as natural. Not all women will breastfeed because it's the best thing for their baby. I knew all of those things, but really understanding the variability of women and birth will develop as I get more experience.
D* and S* left the hospital to take baby home at about 10:30pm. I watched N* complete the paper trail and went to meet up with Adrian. What a day and what a great experience and memory to cherish!
