Soooo Thursday my client was confirmed to have two boys in uteri! Breech, breech Thus far she, the client, has held stud fast to the idea of a homebirth.
OK, babies appear healthy in so far as growth 2.10 and 2.11 by ultrasound estimation. Unfortunately one baby appears to have what is possibly a dilated renal pelvis, however it is located low in the pelvis, which begs the question “is it really a dilated renal pelvis”. Anyway client has a consult with neonatal medical specialist soon, as well as a second ultrasound.
My prospective? Scared, yes, I said scared! Concerned, excited. I want to risk her out now! I what to give her every opportunity to have a good healthy birth and provide personalized care, provide nutritional counseling, I want to scare her into transferring care. I want to tell her she can do this. I want to see her make it to term with her precious baby’s. Do I emphasis all the rare but possible risk that could leave her babies’ dead, or worse, severely injured during an out of hospital birth? I want some one to mentor me through the experience, someone to hold my hand.
So, just say that I fail to transfer care and she goes into preterm labor next week. Well If I did transfer care she could still go into labor next week, end result will be the same, they will either stop the labor in a hospital setting or not stop the labor and she will have preterm boys. At this point I’m resolved to just taking it one day at a time. After all nothing is wrong till it’s wrong, right!
Sunday, July 13, 2008
Friday, July 11, 2008
Unfinished/unresolved thoughts
The Circumcision Argument
OK here goes. Over the pass year I have had a few clients choose to circumcise their baby boys. Both sets of parents were educated and well informed, and both seem to have made up their minds on the subject. I did not dissuade them in any way.
As a midwife I do not think that it is my place to pass out anti-everything-that-I-disagree-with-literature or raise an eye brow or show my disapproval unless it directly affect the pregnancy outcome and can result in my ass going to jail or losing my license. I do not feel the need, nor do I have a desire to fight every battle that crosses my path.
I want the families I serve to feel safe, to be supported in their choices.
I told another midwife this a few months back and was told that it was my job as a midwife to provide info to help keep babies safe, honestly you might think I had told her that I was no longer going to suture client who suffered lacerations, or that I had decided to circumcise these babies myself.
The Big Disappointment
The hardest part about being a midwife is not the difficult, or occasionally, disgruntled client. It’s not the worry and concerns that are encountered from time to time when a pregnancy is slipping outside the bounds of normal.
It’s not the second-guessing yourself during those difficult births nor the time or money spent educating and expanding your knowledge base. It’s not dealing with the powers that be or the heartache that comes from neither the occasional fetal demise nor the fear associated with the possibility of losing a baby, or the worst-case scenario.
For me the difficulty has come from other colleagues in my area, the midwives who, if you’re not in their click, insist on outing you. It’s the rumors and back talk that you hear through the grape vine that makes you heart ache wondering why other midwives want to be so mean. It’s the fear that when things go wrong and others in your profession gets wind of it they’re not likely to give you support nor compassion and would be more likely to take pleasure in giving you a few swift kicks in the chest when your down, simply adding to your pain.
Yes I have seen it here where I am. A midwife has a bad birth outcome, and when she’s most venerable her fellow colleagues aid in deepening the pain.
Ya that pain suffered at the hands of colleagues can sure as hell turn to anger, and bitterness!
OK I've taken my nightly dose of 100% Natural Vertebral fortifier, I'll go to bed now.
OK here goes. Over the pass year I have had a few clients choose to circumcise their baby boys. Both sets of parents were educated and well informed, and both seem to have made up their minds on the subject. I did not dissuade them in any way.
As a midwife I do not think that it is my place to pass out anti-everything-that-I-disagree-with-literature or raise an eye brow or show my disapproval unless it directly affect the pregnancy outcome and can result in my ass going to jail or losing my license. I do not feel the need, nor do I have a desire to fight every battle that crosses my path.
I want the families I serve to feel safe, to be supported in their choices.
I told another midwife this a few months back and was told that it was my job as a midwife to provide info to help keep babies safe, honestly you might think I had told her that I was no longer going to suture client who suffered lacerations, or that I had decided to circumcise these babies myself.
The Big Disappointment
The hardest part about being a midwife is not the difficult, or occasionally, disgruntled client. It’s not the worry and concerns that are encountered from time to time when a pregnancy is slipping outside the bounds of normal.
It’s not the second-guessing yourself during those difficult births nor the time or money spent educating and expanding your knowledge base. It’s not dealing with the powers that be or the heartache that comes from neither the occasional fetal demise nor the fear associated with the possibility of losing a baby, or the worst-case scenario.
For me the difficulty has come from other colleagues in my area, the midwives who, if you’re not in their click, insist on outing you. It’s the rumors and back talk that you hear through the grape vine that makes you heart ache wondering why other midwives want to be so mean. It’s the fear that when things go wrong and others in your profession gets wind of it they’re not likely to give you support nor compassion and would be more likely to take pleasure in giving you a few swift kicks in the chest when your down, simply adding to your pain.
Yes I have seen it here where I am. A midwife has a bad birth outcome, and when she’s most venerable her fellow colleagues aid in deepening the pain.
Ya that pain suffered at the hands of colleagues can sure as hell turn to anger, and bitterness!
OK I've taken my nightly dose of 100% Natural Vertebral fortifier, I'll go to bed now.
Surprise Breech
Second breech I took part in unfolded just like this.
Surprise Breech
We put her in a room
While patiently waiting
It wasn’t long
she began dilating
We refused to do exams
For fear of intruding
A mere four hours later
she began to start pushing
The midwife checked the cervix
Proclaimed there was none
But to her surprise
found labia and bun
Call the other midwife in
She said with a shout!
Forget EMS
This baby wants out!
Across town and taking a break
The telephone rings
What’s this about?
A breech on the way?
You dare say!
She Jumps in her car
her heart is a racing
She speeds across town
Her hands are a shaking
The midwife arrives breaking
OSHA rules
With her feet well exposed
blood, poop, germs and all.
and possibly
one hell of a fall
She gives one good check
And finds only bum
Pick up the phone
and call a code one!
Up in the clown room
A vag to begin
When the intern hears
“birth in the bear room”
it comes to an end
She tosses her gloves
in the trash
In all the excitement
she makes a great dash
One midwife is calling
the head of the clan
But the number escapes her
With the phone in her hand
The butts almost out
Fetal heart tones are good
The perineum is stretching
just as it should.
The baby moves backward
The feet hit the bed
Bruising is minimal
As we wait for the head
One intern is sleeping
She missed the birth
No rest for the intern
Is what it was worth
The baby is laid gently upon mom,A little bit blue
One minute goes by, not a moment to late
The midwife turns and says give her an eight
We examen her bottom
and find not a scratch
The breech made it through
Perineum intact
Then birth the placenta
what a photo op
As there are arteries and veins
that run straight to the top
They’re big, they’re gnarly
Velamentous indeed
A major danger to baby
So says the OBs
So remember my midwife friend
When your sure your moms complete
Make her pant through ten
Just before she pushes, check her again
Don’t forget to breath
As you are worthless too
Should you hold your breath,
pass out or turn blue
Keep your hands off the breech
They will make there way through
Be a good patient midwife
So the head will fit too!
nadahfmidwife
Sunday, June 15, 2008
Anxity during third stage
So today I’m 3 days post midwife at the birth of my wonderful clients on the morning of the June 9. Great Water Birth! My clients were truly very happy and amazed by the entire experience. From my prospective, if I had to truly be honest with myself, it could have been better (I could have performed much better as the midwife).
Let me start with saying I manage and over manage 3rd stage. I’m not sure why only to say that it may have been that El Paso training.. I had some sense of fear instilled in me when it comes to third stage of labor that I have yet to work through it. But whatever the reason I must over come and conquer this irrational need to get the placentas delivered.
The placenta and third stage let me recap my knowledge.
Mom delivers the ultimate prize package. Moms thrilled, she looks into the eyes of her newborn and marvels at the wonder of her accomplishments.
With pain of labor no longer present, quickly becoming a distant memory and those around her waiting on third stage to end, and if it is me, sensing a potential bleed.
OK it’s clear from that comment that I have a heightened sense of anxiety, and clearly lack trust in my ability to manage third stage 3rd stage or moms body to do what it is suppose to do.
Separation gush means that the placenta has started to detach, the bleeding generally stops as quickly as it started. Then the waiting begins. We wait patiently for mom to begin having contractions, this is an indication that the fundus is attempting to expel the placenta in earnest from the uterine wall. We may wait for cord lengthening then provide gentle cord traction (while guarding) if mom is laying supine, (Yes I do know moms who do not wish to squat their placenta out) or we may ask her to squat over a bowl to maximize her efforts
(I like a bowl because I can play with the blood loss and guesstimate how much, as can my apprentices). In either event if contractions don’t come then I get antsy if I know it has started to separate, wondering all the while where’s the blood. If you have a contracted uterus or one that is not yet contracting you sure better be familiar with how high that fundus is, feeling it is not fundus fiddling! As that uterus has been known to fill with blood while waiting for placenta, my perspective it that if you have more bleeding and more separation and no placenta then it is time to manage 3rd stage. I would do this by applying gentle cord traction (while guarding the fundus) Not that I really believe this is necessary mind you, but still for those die hard types I’ll add it. If I still had no placenta It pit time! With no bleeding or separation gush I can wait.
In the case of this particular client, she had that separation gush and here I go giving it cord traction with nothing more than a separation gush, nope I don’t even know if she was having a contraction. We get her to dry land tug a time or two then wait for a contraction, provide a little cord traction and viola, she delivers a dirty Duncan. Why all the premature pulling and tugging?
I can and do recognize this high anxiety I get during third stage I don’t like, my client sure as hell don’t like it, and maybe the whole aggressive behavior thing I do with the cord has simply become habit. Maybe I fear the big bleed so I rush this stage just so I can be done and breath again.
Ok so you’re asking yourself, wow how many bleeds have you caused? None! The few I have seen that were significant were the result of uterine atony, not the result of over managing third stage!
So my next birth, in about 3 week, will be a challenge. I will try to be more aware of this anxiety and use the physiological approach in the third stage.
Nadahfmidwife
Let me start with saying I manage and over manage 3rd stage. I’m not sure why only to say that it may have been that El Paso training.. I had some sense of fear instilled in me when it comes to third stage of labor that I have yet to work through it. But whatever the reason I must over come and conquer this irrational need to get the placentas delivered.
The placenta and third stage let me recap my knowledge.
Mom delivers the ultimate prize package. Moms thrilled, she looks into the eyes of her newborn and marvels at the wonder of her accomplishments.
With pain of labor no longer present, quickly becoming a distant memory and those around her waiting on third stage to end, and if it is me, sensing a potential bleed.
OK it’s clear from that comment that I have a heightened sense of anxiety, and clearly lack trust in my ability to manage third stage 3rd stage or moms body to do what it is suppose to do.
Separation gush means that the placenta has started to detach, the bleeding generally stops as quickly as it started. Then the waiting begins. We wait patiently for mom to begin having contractions, this is an indication that the fundus is attempting to expel the placenta in earnest from the uterine wall. We may wait for cord lengthening then provide gentle cord traction (while guarding) if mom is laying supine, (Yes I do know moms who do not wish to squat their placenta out) or we may ask her to squat over a bowl to maximize her efforts
(I like a bowl because I can play with the blood loss and guesstimate how much, as can my apprentices). In either event if contractions don’t come then I get antsy if I know it has started to separate, wondering all the while where’s the blood. If you have a contracted uterus or one that is not yet contracting you sure better be familiar with how high that fundus is, feeling it is not fundus fiddling! As that uterus has been known to fill with blood while waiting for placenta, my perspective it that if you have more bleeding and more separation and no placenta then it is time to manage 3rd stage. I would do this by applying gentle cord traction (while guarding the fundus) Not that I really believe this is necessary mind you, but still for those die hard types I’ll add it. If I still had no placenta It pit time! With no bleeding or separation gush I can wait.
In the case of this particular client, she had that separation gush and here I go giving it cord traction with nothing more than a separation gush, nope I don’t even know if she was having a contraction. We get her to dry land tug a time or two then wait for a contraction, provide a little cord traction and viola, she delivers a dirty Duncan. Why all the premature pulling and tugging?
I can and do recognize this high anxiety I get during third stage I don’t like, my client sure as hell don’t like it, and maybe the whole aggressive behavior thing I do with the cord has simply become habit. Maybe I fear the big bleed so I rush this stage just so I can be done and breath again.
Ok so you’re asking yourself, wow how many bleeds have you caused? None! The few I have seen that were significant were the result of uterine atony, not the result of over managing third stage!
So my next birth, in about 3 week, will be a challenge. I will try to be more aware of this anxiety and use the physiological approach in the third stage.
Nadahfmidwife
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