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Saturday, August 13, 2011

the last PHX-PMW connection

sitting here at my gate, reflecting on the fact that this will be the last time i make the trip to school from sky harbour.

i'm excited to see my sister students and see where they are all at. 

this is the beginning of our second year. 

all things have changed. i wish we had some documentation to compare where we were this
time last year. a green group of aspiring midwives have learned so much, touched so many lives and our lives enriched by many.

i think this is the first time i've more or less had school in a place where i wasn't freaking out. 

i only have the small task of packing to loom over me. thankfully i have a mother. i don't need her to pack, but she's come to depersonalize? not sure how i feel about that, but my lovely place will have the tracy taken out of it while i'm away at school.

the weather in phx has been absolutely gorgeous these last few days. i've managed a few good monsoon rains this season, and lately the below 100 temps have allowed for a lot of outdoor galavanting.

over the last 6weeks or so, since my last session up in maine, i've driven the coast to the shores of puget sound. i put my feet in the pacific and have dugs my toes into the desert. 

i've had the rain fall from a shining sky and i've seen it unleash a fury of rain,  replenishing the parched earth.

i studied studied studied. 

so much research and online discussions with students from around north america. i think i amused a few people along the way.

i purged some belongings.

i met new friends and am saying good-bye to the ones i love.

so bittersweet. the closer the time comes to leave, the more i am falling in love with this desert wasteland. this sprawl that defines america.

i'm sad. in a confused way. 

this will be my last commute from sky harbour, but this isn't the end of the journey. 

Friday, August 5, 2011

sleep and PROM - prelabour rupture of membranes

Sleep is elusive.

I want it, but it doesn't come. too many thoughts running through my head.

it has been a productive day. a sad day. a day filled with seeing lovely people, a nap and a good amount of school work. i should be sleeping.

i'm thinking a lot about PROM. no. not that american tradition i am still trying to understand (is it only important in  your senior year, or every year?), but premature/prelabour rupture of membranes.

i've been reading the washington state guidelines and i'm exited to see that there are three levels of considerations a midwife has.

1. discussion
2. consultation
3. transport

in regards to PROM, in AZ midwives must have active labour within 24hrs. this is pretty limiting to say the least and is more in line with the obstetric model, though better to an extent than what is offered in hospitals.

i've been reading a lot on PROM and i have no idea where AZ got their information from, but they may want to get with the times. in 1996, 1996 the TermPROM study was published. in this study women were allowed to labour for up to 96 hours. FOUR DAYS!!! in a HOSPITAL. granted all the data comes from outside of the USA, but still. i am simply amazed at this.

they did find there was an increase in neonatal and maternal infection the longer birth occurred after ROM, but this was more a factor of GBS status and the number of vaginal exams that occurred...not ROM itself. also the only significant finding in regards to the latency period after ROM was the frequency of neonatal admittance into the NICU unit...and this was based on hospital protocol, not on an increased occurrence of neonatal sepsis or other infections. 


so back to washington, reading their guidelines, midwives must have a "discussion" at 48 hours and transport at 72 hours.

i haven't figured out what "discussion" means, i.e. with the client or physician, but the fact that women are allowed to actually go into labour naturally is fantastic. by 72hours most women will be in labour (i'll write a more detailed post on PROM later). with these guidelines, midwives and mothers don't need to be worried about a clock.

all this though brings up questions.

  1. at what point should a midwife start monitoring clients- with ROM or active labour?
  2. do we put mothers and babies at risk if left unmonitored (expect for mothers taking their own temperatures) or is it better to leave things alone and wait for active labour?
  3. what affect does a midwife and clinical monitoring have on the labour process?
  4. at what point should we consider home inductions/augmentations of labour, and what are the best methods?
  5. do midwives (CPM) or should they have access to prostaglandin gels to help ripen an unfavaourable cervix?'s things like these that keep me awake.