Midwifery Outside Normal

I have moments of assurance and moments when I have crises of confidence. It is all about knowing what I am doing and what direction I should choose for next year. I feel that I am equipped for normal births which I will get plenty of next semester, but I am unsure about the realm of abnormal. Admittedly what I am seeing that is abnormal does not always fall under the care of the independent midwife, but there are many instances where care is not transferred and the independent midwife has to manage the abnormal process in consultation. I feel that I would benefit from the relationships I would build and the experience I would get by going through the postgraduate programme. My feelings about this fluctuate depending on my experiences during the day.

Yesterday I went with one of the hospital midwives to take a full-term stillborm baby to morphology for post-mortem. The baby looked very peaceful. I felt sad at the circumstances for the family and that this peaceful baby never experienced life. I was shocked at the way the doctor handled the baby. She let the head flop. I guess this broke the illusion of a peaceful sleep. It wasn't that she didn't treat the baby with respect, but that the illusion was broken and the baby didn't need to be handled in the same way as a live baby. I don't think I could handle a dead baby like that.

Bugs to iron out

I still haven’t ironed out the bugs from shifting MT from my old host to my new one. It all has to do with the templates. I won’t have time to fix it up until about the 9th of July…

Delivery Suite

It was really wonderful to be called in as second midwife for a birth with N*. I checked the suction and oxygen and really felt that if I had to, I would be confident to use them. One thing I didn't check which I am kicking myself for is syntocinon. I even got a little time to quickly check F*'s blood group and booking sheet.

I was not extremely organised or quick, but I got everything done that I needed to do. I hope I got everything in the right order in the notes.

Diagnosis of Stridor in Children

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DATE: 11/14/2004 12:11:00 am

Antenatal Ward

I have investigated a few areas and put them into my online journal. This is invaluable and I should continue to do this.

I thoroughly enjoyed the time I spent on the antenatal ward. The variety was confusing, but posed a good challenge. I achieved some consistency in working with the same women. Of particular note was my learning curve in applying the CTG to a woman pregnant with twins at 25-26 weeks gestation. I was also able to follow the mother through with her ultrasound and her caesarean section. The caesarean section was for IUGR of one twin who had absent end diastolic flow on doppler which was then changed to reversed end diastolic flow.

The experience that day was invaluable. To see a woman through an antenatal complication who then delivered, and knowing that in about two weeks the babies will still be in the neonatal unit, I will have the opportunity for real continuity of care in some respects.

Areas I need to investigate further are pre-eclampsia, blood results, infections, haemorrhage, and embolisms.

I managed to accomplish care according to my objectives in blood glucose monitoring, CTG monitoring, blood results, infections, pre-eclampsia, and ultrasound.

One thing that is glaringly obvious to me from working in a high-risk area is how much I don't know. I've never doubted whether midwifery is the right thing for me to be doing, but sometimes I wonder if I really know enough to be competent. I guess I am really relating that to a hospital setting. However, knowing the type of person I am, I like to be competent in all areas of a field I am working in to the best of my ability.

One thing I dislike is the conflict between the hospital and the independent midwives. Working through the post-graduate programme at the hospital would certainly prepare me better in those relationships as long as I don't lose track of normal.

Write a better weblog

A List Apart: How to Write a Better Weblog provides advice on how to write a better weblog. The purpose of my weblog is for my benefit, and a readership is a bonus but not my objective. This should be apparent in the frequency and content.

Primary Facility

L*'s birth yesterday was great for wetting my feet again and getting used to the Birthing Unit.
L* was in labour with her second baby. On visiting her at home she was found by B* to be 3 cm dilated with a very soft cervix and contractions were regular and lasting for more than 60 seconds. I hadn't met L* previously, but she was happy for me to be there.

We drove into the hospital and set things up for when L* arrived. I have quite a learning curve ahead in getting oriented to the processes of a different unit to where I am used to working.

On a subsequent examination baby was still high, and B* did an artificial rupture of membranes. When she said the head was still high I offered to apply fundal pressure. A small amount of clear fluid leaked.

The intensity of contractions slightly increased and L* was wanting to try entonox. This provided some relief. L* was upright and walking throughout first stage.

B* determined second stage commencing from L*'s uncontrollable urge to push. Her pushing was not as effective as it could have been. L* was standing, leaning into the raised bed. So a change of location to the toilet was suggested. Pushing in this position was very effective and after about 4 contractions the baby's head started to stretch the perineum.

It was certainly awkward having the birth in the confined space of the toilet, but cleaning up afterwards was much easier.