Clinic is never dull! Last week, we had a day of SROM (spontaneous rupture of membranes) checks...when a Mama thinks her water may have broken, so she comes in for us to verify one way or the other. Something was in the air, and tricking ladies into thinking their water broke, cause none of them were. I had one lady tell me she never thought that hearing she had peed her pants would be good news! Ah, pregnancy and the sheer glamour of it.
Today, I wrote my first prescription for the NuvaRing! I know, kinda silly. Our client population doesn't usually vote for hormonal based contraception like the "pill" or "patch" or "ring", instead we do A LOT of IUD's, Natural Family Planning and diaphragms. But for this Mama is was just the right fit. We all had a chuckle that I had to look up how to write out the script.
Palpating a glorious 37 week belly and finding the baby to be breech...argh! Supporting the family through this discovery, encouraging and educating about the options...positional interventions, acupuncture, external version. And talking about what happens if these things don't work. We are blessed to have an OB in our area who does vaginal breech births and I am eternally grateful to be able to send these Mama's his way.
Meeting all the soon to be big brothers and sisters. Having them help "check their baby" by holding the doppler and having them palpate that crazy belly. Meeting soon to be grandparents and reassuring them that the birth center is "legit" and alleviating their worries.
Having to tell a Mama that she has Gestational Hypertension and can't have her babe with us. Comforting her and her family, explaining why this means she "risks out" and what that all entails. Answering her questions and giving her lots of TLC.
never, never dull
Thursday, February 17, 2011
Monday, February 14, 2011
argh...
Call shift induced insomnia is so lame!!! I had a lot of trouble with this months ago, but had managed to mostly cope with it....until last night!! I was a rare evening when I actually didn't get many phone calls and therefore could have slept.....ah, well I gues that it comes with the territory....
Sunday, February 13, 2011
the sunny side
I had been at the birth center alllll day and was TIRED. (We had had two gorgeous little ones in the morning, more about those births later as they were both difficult.) Since the previous births had been tough...I had had some serious adrenaline highs and then crashes...which makes for a tired that is a little more intense. The nurse was also on the same boat.
It was the typical labor of a first time Mama. Her first stage took almost 15 hours, but had progressed at a nice steady pace and flow. Mama's spirits had remained intact and positive throughout. She came to the center at the appropriate time and labored well. Being with her definitely helped to wake us up...along with some super caffeine charged tea that the nurse compared to crack! (And it was quite effective.) Mama had a mild urge to push so I checked her cervix; barely a rim of cervix and a bulging bag of waters at +2 station, with a baby head close behind. In my exhaustion, I offered to AROM, in my mind I wanted to speed things up....something I am not proud of! Wisely, Mama declined. Then, a short time later while sitting on the toilet, her water spontaneously ruptured and she was ready to push for real. Her second stage was 39 minutes, a couple of times the baby heart tones dipped a touch so we changed positions with good results and ended up semi-reclining in the bed. Then there was a lovely crown, followed by the birth of a direct OP baby! The nurse said, "I thought something looked funny and then realised it was because the baby was looking up at me!" Her labor had progressed so nicely, she never had any of the classic "OP labor" symptoms...it was amazing. I have heard of this happening, but had just never seen it myself. So, it does happen! Believe me, I have experienced, many times, the classic "OP labor" and all of the associated dysfunctions and extra pain. And then, there is this one that just kinda snuck up on us. I could see why they are sometimes called "sunny side up" cause that sweet little sunny baby face was lookin right up at us!
It was the typical labor of a first time Mama. Her first stage took almost 15 hours, but had progressed at a nice steady pace and flow. Mama's spirits had remained intact and positive throughout. She came to the center at the appropriate time and labored well. Being with her definitely helped to wake us up...along with some super caffeine charged tea that the nurse compared to crack! (And it was quite effective.) Mama had a mild urge to push so I checked her cervix; barely a rim of cervix and a bulging bag of waters at +2 station, with a baby head close behind. In my exhaustion, I offered to AROM, in my mind I wanted to speed things up....something I am not proud of! Wisely, Mama declined. Then, a short time later while sitting on the toilet, her water spontaneously ruptured and she was ready to push for real. Her second stage was 39 minutes, a couple of times the baby heart tones dipped a touch so we changed positions with good results and ended up semi-reclining in the bed. Then there was a lovely crown, followed by the birth of a direct OP baby! The nurse said, "I thought something looked funny and then realised it was because the baby was looking up at me!" Her labor had progressed so nicely, she never had any of the classic "OP labor" symptoms...it was amazing. I have heard of this happening, but had just never seen it myself. So, it does happen! Believe me, I have experienced, many times, the classic "OP labor" and all of the associated dysfunctions and extra pain. And then, there is this one that just kinda snuck up on us. I could see why they are sometimes called "sunny side up" cause that sweet little sunny baby face was lookin right up at us!
Wednesday, February 9, 2011
never a dull moment...
Of course, its not only about catchin babies. I have to admit that I do have the "baby catching bug" and it was originally what brought me to midwifery. However, I definitely love the rest of my job as well.
Clinic days are often fast and never boring. I love meeting with our families for thier prenatal visits. I am blessed to be in a practice where I am able to spend time and get to know our clients. Meeting families for thier very first visit and welcoming them to our practice. The postpartum visits for the new families...the 2 day, the 1 week and the 6 week...being witness to the transformation of the mothers and fathers and family. Preconception visits to help women plan a healthy pregnancy from the very beginning. Well woman and contraception visits to help women learn about and take control of thier health and fertility. How can I not love this work? never a dull moment and always fulfilling....sometimes exhausting!...but worth every minute of it!
Clinic days are often fast and never boring. I love meeting with our families for thier prenatal visits. I am blessed to be in a practice where I am able to spend time and get to know our clients. Meeting families for thier very first visit and welcoming them to our practice. The postpartum visits for the new families...the 2 day, the 1 week and the 6 week...being witness to the transformation of the mothers and fathers and family. Preconception visits to help women plan a healthy pregnancy from the very beginning. Well woman and contraception visits to help women learn about and take control of thier health and fertility. How can I not love this work? never a dull moment and always fulfilling....sometimes exhausting!...but worth every minute of it!
Thursday, February 3, 2011
epiphany
The labor can best be described as full of grace. The Mama was focused and serene in her power, her husband was loving. She progressed steadily and evenly, spending time in the pool, walking, on the birth ball and in the bathroom. While on the toilet, she started pushing and we were witness to a shining crowning bag of water, which eventually broke on its own.
At some point during the second stage, the baby had some difficult moments. It was a time when I had to pull out the "inner drill sargent" and strongly coach mama through some intense directed pushing and position changes. Baby was talking and telling us that the birth time needed to come sooner rather than later. It is interesting to me how, in times of stress like these, the mind can compartmentalize different thought trains. In my heart, I knew that this mama and this baby could do this and that we were safe in pushing through. I also knew that 6 months ago, I would have "called it" and taken them to the hospital. This was an epiphany for me and one that I have been pondering for days. During some of my musings I have been fearful that I was "cowgirling" it...felling too cocky and being unsafe. Other times, I have been proud of myself for staying the course and helping them through. I spent time discussing all these feelings with my fellow midwives. It is a fine line and one that, now, I feel I did not cross in this situation.
In the end, a happy and healthy mama and dad took home a happy and healthy baby....which is always the goal of course. It is crucial to learn from experience, but to not let that experience get the best you...always a balancing act....
At some point during the second stage, the baby had some difficult moments. It was a time when I had to pull out the "inner drill sargent" and strongly coach mama through some intense directed pushing and position changes. Baby was talking and telling us that the birth time needed to come sooner rather than later. It is interesting to me how, in times of stress like these, the mind can compartmentalize different thought trains. In my heart, I knew that this mama and this baby could do this and that we were safe in pushing through. I also knew that 6 months ago, I would have "called it" and taken them to the hospital. This was an epiphany for me and one that I have been pondering for days. During some of my musings I have been fearful that I was "cowgirling" it...felling too cocky and being unsafe. Other times, I have been proud of myself for staying the course and helping them through. I spent time discussing all these feelings with my fellow midwives. It is a fine line and one that, now, I feel I did not cross in this situation.
In the end, a happy and healthy mama and dad took home a happy and healthy baby....which is always the goal of course. It is crucial to learn from experience, but to not let that experience get the best you...always a balancing act....
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