settling in with babies

i'm liking the life that is emerging up here.

there are so many wonderful people that i get to be around.

i've got two new midwives that i've been working with now. i had my first day with peggy the other day. it was fun. figuring each other out.

i have deficits. charting. palpation. physical exam. holding babies. i can be awkward. damn not giving birth can sometimes pose a problem.

tangent #1: i was talking with christine ( friend, house-mate, amazing woman, birther, mother, baker and oh so much more) the other day about choice of birth providers and about the ability of a provider to give care when they have not birthed themselves. christine conceded that giving birth doesn't qualify someone to attend a birth, to be a good midwife, but for her, the way her care provider birthed was important. interesting to think about what women want versus what they need.  


there are other skills i need to focus on. 


working it out with new teachers, mentors, preceptors, mother midwives (whatever you want to call them!) is interesting. 


louisa is great. she gives good feedback. both when i do something right or when i get it wrong. we get on well. sarcastic. dry. i probably bore her with my introvertedness. ahh. probably bore her no more than i do most people that are subjected to my awkward silences. 


i'm encouraged by the confidence that both peggy and louisa have given me. a testament to my former training and to my midwife shell. 


tangent #2: is a student's teacher her midwife? is that a strange or irregular reference? i don't know, but shell will forever be my midwife. 

most of all i'm having a lot of fun. i've been to two births now. the last was real sweet. i was still trying to figure out my place. my role, what is expected, how i can integrate into the practice and the way my new midwives practice.

both are very open to having me practice skills on our clients. i'm not charting directly into the chart as of yet, which is a wee bit strange, but i appreciate it. i knew my charting was lacks, now i'm being directly challenged.

because in washington midwifery is so much more integrated into the mainstream maternity care system, midwives have to practice that way. there are just that many more hoops and standards to abide by. for good or bad.

i don't mind it. much of it appeals to the side of me that needs to make sure all the boxes and checked. that is very important.

i like lists and crossing them off.

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"Childbirth is PAIN! It canbe the healthy normal pain of labor and birth. Or it can be medically "painless birth" through anesthesia and/or cesarean with subsequent weeks to months of painful recovery while struggling to care for our newborn babies.

There is no escaping the pain. The choice we have is to work with pain and experience the satisfaction of birthing our babies, or to fight the pain."

-  

The healthy pain of labor is natural, and a realization of our own personal power as women and mothers. It should be viewed as a milestone to be embraced, a rite of womanhood. The pain of major abdominal surgery is unnatural pain (a signal from our body that something is seriously wrong), and usurps our own power as women and mothers. It should be viewed as something to be avoided." 

- Barbara Brown-Hill, VBAC educator and birth assistant (in the vaginal birth after cesarean experience - Ed. Lynn Baptisiti Richards) 

new chapter

no this is not about prenatal vitamins.

i've been up in the pacific northwest now for two weeks.

i'm getting settled in. i finished last school session which was great. IV's, catheters, suturing....

for some reason i think i can manage a shoulder dystocia, assuming i can keep my shit together in that situation. again. growth after coming back from classes. it really is amazing how two weeks intensively spent with a strong group of women and wicked teachers can have that effect. very happy i'm in this program.


i'm in a different land now and attended my first birth.

meeting a woman for the first time in labour is something new to me. being welcomed into another families birth space is an honour. as an individual you can have a lot of influence over outcomes, attitudes and the energetic spirit of the birth room.

i met this family and melted. they were the sweetest couple. a couple in their late thirties having their first baby. a military family. not what i had expected.

i got the message in the afternoon. "want to come to a birth tonight?" me: "yeah"

of course i did!

i hadn't been to a birth in about two months.

i knew this was going to be a difficult birth. or a long one. one where the outcomes were unknown. baby was sitting really high. hadn't engaged. this isn't a normal situation for a first time mom. usually baby drops into the pelvis and gets comfortable at the end of pregnancy.

when i arrived the mother was in great spirits, but was definitely feeling her contractions. she was feeling it in her back. i never had a real good feel for baby, but it didn't seem posterior even though she was having classic signs of labour of posterior baby.

it was late at night, mom and baby were happy so we encouraged rest and privacy. there wasn't any need for monitoring yet. she was just beginning to efface and only slightly dilated.

she laboured over night and in the morning there had been little change.

she was in and out of the tub. she got active. she was a great sport. she walked stairs for 45min two by two. we chatted. she laboured on the toilet without complaint. she went for a half hour walk. no change in baby's position, not much change in her cervix.

both mother and baby were perfectly fine, but little sleep had been gotten, she was labouring hard and her ctx were 2-3 min apart and seemingly strong enough. but why weren't we seeing any change?

so my first birth up on the peninsula ended in a transport.

we needed access to more options. breaking her water wasn't really an option. i've gone from having three or four high level hospitals within 5 minutes of most home births to being out in the middle of no where, with the nearest hospital 45 min away and it doesn't even have a nursery, much less a NICU.

so this is what was amazing. i have never experienced a transport like this before.

the staff. one nurse. one doc. were fantastic. they were kind, welcoming, supportive. there was no sort of power struggle. everyone was sincerely on the mothers team. the staff an extension of the care she had been receiving. we arrived. the nurse got the mother in the tub, monitored the baby with a doppler and she didn't have a vaginal check for over an hour after arriving.

the tubs. the envy of any birth centre overlooked the harbour where there was a wooden boat festival. across the water were the cascade mountains and in the distance, canada.

seriously.

the doctor and nurse treated me with respect. me just a student was consulted with and informed of the status of our client as though i were their peers.

through this birth i was introduced to a new perspective on midwifery care. in this area ~20% of births are attended by midwives at home. some midwives (LM's) have hospital access.

there are open (somewhat) lines of communication.

it's not perfect, but it's a hell of a lot different than arizona.

i'm so excited what the next year will bring.

oh and it can't hurt being back on the farm and being able to watch the sun rise over puget sound from our couch.

x

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. 

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?

anyways...it's things like these that keep me awake.