Still catching up with EMR

All the ultrasound data for December is now entered. I added up the number of births that I did this year and it was 190 down from my high of 334 (2004) and up from my low of 138 (2001). Now all I have to do is get all the OB visits entered into the EMR prior to 1/2/08 when the office re-opens. My partner is on call these days, but I delivered almost everyone, so her days will probably be easy. I hope so. We are facing a big new year. I will be off for quite a while (12 weeks) due to knee replacement and she will be doing it all. I hope there is a practice for me to come back to when I'm healed from my knee. I keep seeing many requests for (partner's name) for care and delivery in the charts. If I'm not there working perhaps no one will want me to do their delivery.

EMR "electronic medical records"

Ah yes, the practice I am associated with has made the big transition to EMR's. Most of the time having the chart absolutely available all the time is wonderful. I am never searching for a paper chart. I am never looking for stuff that hasn't been filed properly. I am never looking for paper that hasn't been filed yet. HOWEVER, the 1 tenth of a percent when there is a server failure, I am left with nothing. That is not even a hint of what has gone on in the past. I don't know what labs have been drawn (of course they come electronically). I don't know the estimated date of delivery. I don't know any of the psycho-social history. I don't know anything that I can't remember on my own. Now you may be getting a hint of the fact that there has been a server failure in my practice and you would be so right. When this happens you scribble notes to yourself on little pieces of paper and put those pieces of paper into folders to be addressed later (when the server has been repaired). This doesn't sound bad, except that this went on for most of December, off and on so now that I have a few days where I am not at the birthing barn, I'm tied to the computer trying to get my nose above the surface so that I will be able to function in the new year. YUCK. I do love electronic records when they work well, but when they don't work it makes life absolutely awful.

The Operating Room Conundrum

The hospital where I deliver has had a recent upgrade and we now have a dedicated operating room in our labor and delivery suite, directly across from our newborn nursery. This should be wonderful on many levels. We now meet the state requirements (we had a waiver of this requirement for 10 years); we now should not be doing surgery in an area where sick and infected people are being operated on; we now should not have to travel from the first floor front to the second floor back with a patient in heaven knows what awkward position in order to deliver her infant by cesarean section; we now have nursery and infant care/resuscitation equipment readily available without a trek through the halls and the potential of being stuck in an elevator with a sick new born (yes, this really happened)! Except for a pissing contest between two departments this would be true. OB did get a beautiful operating room in the recent remodel. It is directly across the hall from the newborn nursery. The issue is that we are not allowed to use it! There was inadequate training of the OB nurses for their roll in the OR. There was reluctance from the OR staff in opening an operating room out of the main OR area. There were kinks to iron out pertaining to personnel and patients all of which take time, communication, and problem solving. We used the new OR for about 6 months and then it was arbitrarily closed down because of politics. I am frustrated and angry because no one is being well served in this little fit of temper. The OB patients are now being processed in day surgery and operated on the in main OR in a room that is too small, and that is inadequately set up without appropriate oxygen connections. The patients are moved through the main hospital halls from the operating room to the OB unit. The babies are transported through the main hospital halls from the operating room to the OB unit. This transportation is not only cumbersome, it is unnecessary. There is a functional operating room right in the Labor and Delivery Unit. What we need is responsibility, accountability, and communication in order to safely and successfully use the OR located in labor and delivery for operative delivery of obstetric patients.

Trouble

Went for an all time record the other day. Nurtured this gal along all night and half the morning. Got her to complete with only a few grey hairs. First real push dropped the FHR to 60 where it sat until I pushed the kid back up and then FHR recovered. Tried Mom pushing again, needless to say the deceleration repeated - imagine that. I called my consulting and we delivered by cesarean section. Baby had an OP presentation with a double nuchal cord, and a true knot. Hummmm. Not planning on a vaginal delivery with that mess was he. Cute little boy. More grey hairs for the midwife.

Breastfeeding frustrations

Alas, one of the services I offer in my practice is help with lactation. If a Mom plans to breastfeed I do a nipple assessment prior to delivery (actually early in the pregnancy) and we talk about what it takes to get nipples that stand up so the newborn can latch. After the delivery, I don't leave the room until the baby is well latched and suckling like a champ. This sometimes takes a while, especially if Mom has had medication and the baby is sleepy. My frustration arises when I see these Moms back in the office from 3-5 days after delivery and I am told: "I got a pump from WIC and I'm just pumping and giving my baby breast milk in a bottle, the baby really likes it." or "It is really hard to breastfeed at night so I have my boyfriend give the baby a bottle of formula so I can sleep." or "I don't have the time to breastfeed my baby, all the baby wants is to be held and suck on my boobies." I explain that pumping will not keep the supply of milk up and that every bottle of formula given works to decrease the supply of breast milk because breastfeeding is supply and demand - the more demand (nursing/suckling) there is, the more supply (milk) there will be. My clients all reply "Oh, I have plenty of milk, that is not a problem for me. The when I see them back at 4-6 weeks and sometimes sooner, they are whining and crying that they don't have enough milk and they don't know what to do, or they don't have enough milk and the baby really likes bottles better then breastfeeding and so they are going to stop pumping/nursing and just use formula. I am so very frustrated by this. My population is poor, young, ignorant and for the most part selfish. They find having to spend time with their babies a pain in the ass and are happy to pass the baby and the bottle off to someone else so they can go about their lives unencumbered by baby feeding. They all espouse the breastfeeding is best ideal, but when it comes to making it happen, they are not motivated, or unselfish enough to offer their baby their time or their breast milk from the source. Bah!

Lifes little trials

So, my body is wearing out faster than my spirit. This is causing my spirit to wear out faster. A long time ago, in a world far far away, I hurt my knee. Now, some thirty years later, it needs replaced. This is all well and good, and we have the technology except. . . . .I work in the medical profession and knowing what goes on "in the business" contributes a tremendous amount of terror to my decision making. Do I have the work done locally where I can pick my anesthesiologist; do I go to a bigger hospital where they do more procedures but I don't know anyone but the surgeon. Do I choose the type of joint I want put in and then find a physician that does that type of joint; or do I choose the physician and go with whatever type of joint he/she uses? Do I go to a local hospital where I know the infection rate, and lots of the nurses and staff; do I go to an out of area hospital where I don't know anyone and they don't know me. Is the number of times a surgeon has performed an operation more important or does that matter once competence in the procedure is obtained? For that matter, how does the consumer determine competence in a surgeon? How does one find out the MRSA infection rate for a hospital? They sure don't broadcast that information at the hospital where I work. Who do you ask for the answers to these questions. How does one decide where to go for something as important as a knee replacement. I want to be able to walk again, hike again, run again, bike again. I want to actually reclaim my life and get back to doing more physical things again. How do I choose? All inputs welcome

Time flies like an arrow - Fruit flies like a banana

WOW! My daughter and her 4 babies (ages 5, 3, 2, and 12 weeks) were here for 4 weeks. It was wild and wonderful. We had the opportunity to go to the ocean, go to the swimming hole, go GeoCaching, eat great food and just be together! It was crazy. I had work as I have taken too much time off this year already, but I was able to spend some wonderful time with them. My husband was able to go and play and do everyday with them. We so wish that we could live closer together. Virginia to Oregon is just too far.
I did some nice births while they were here and didn't have anything too hairy come up so it is good. I did however get really far behind in my administrivia. It was difficult to stay and do paperwork when I knew that they were all having fun without me. So I tended to leave the paperwork for later and now am paying the price tremendously. Oh well - it will all get done eventually.

Wedding wisdom and Off Call

We had our anniversary last weekend. I was on call and at the hospital for part of the weekend. While there I shared with the nurses that it was my 34th wedding anniversary. I was asked how I made it last. Further thoughts on that question brought up the following key points:
1) NEVER go to bed mad.
2) Be best friends before you become lovers.
3) Most importantly - Don't attribute to malice what can be accounted for by pure stupidity.


This weekend I'm not on call!!!! I am so happy to be off. Today I had a nice day with my husband and we just worked around the house and did a bit of shopping. It was productive and peaceful. What a pleasure. I've had some really nice births recently and have been rewarded with some less hectic times in the office as well. The biggest stress in my life is the fact that my professional licenses are up for renewal soon and I need continuing education. Thank goodness for the Internet - I can do classes there and keep up with the world at large. Our grandchildren are coming tomorrow and will be staying with us for 1 month. I'm so excited. The down side is that I have to continue to work during the day. Too bad for me, but I'll be home in the evenings.

Politics

Yes, it is hard to believe that there are politics, even in birth. Mostly it is the interpersonal stuff between the nurses and the practitioners (physicians and midwives). Sometimes it is between the family and the practitioner or the different members of the family and the patient. It is all about manipulation and spin on the situation or the information. I get really sick of it. I just want to catch babies and have nice births - not get into a pissing contest with someone over doing a job, entering a room, viewing the birth or not, holding the baby or any of a number of other inane trivialities. We need to talk nice to one another, go the next step, treat others as we want to be treated and above all remember that no one is more important than anyone else. Everyone has a purpose in life, even if it is hard to see what that might be in the moment.

Thoughts and meanderings

I love my job. I love what I do. I have decided I don't like being tired. I have done a delivery in the night every night for the last week. I have worked in the office Monday thru Thursday seeing patients and Friday doing administrivia. I am on call 24/7 as my midwife partner is out of town. I'm tired and I'm tired of calls in the middle of the night. Hum, it is hard to do midwifery care without being available. I'm also tired of not being able to get out of dodge at the drop of a hat. When I'm on call, I need to be able to get to the hospital within 15 minutes. Rarely do I get to do a delivery as soon as I get there - mostly I need to be there to labor sit. My patients are reassured having me there with them insuring that they get to do the things that they want. I'm good with this until I get really tired and then sometimes I get cranky. Mostly, I keep the cranky to myself. Occasionally it creeps out as jaded sarcasm to the answering service or the nurses with whom I work. Alas, I will probably be tired for a while. I'm on call next weekend too.

More birthing

I've had a couple of really nice births - fast, pleasant, and easy and a couple of strange things - an undiagnosed breech picked up by ultrasound for amniotic fluid volume and a cord around the neck 3 times. Go figure. Part of the excitement of this job is that it is never boring.

Punished for being good.

My partner and I are considered easy to work with. We do a nice calm birth. We labor sit with our patients, and help out the nurses as we can. Because of this we are often working with new/less experienced nurses. I love teaching. I love birthing. However, It seems unreasonable that we (the midwives) should continuously be labor training nurses. That means we have to be extra alert to see that everything we need in case of an emergency is in the room for the birth. That means we have to be planning ahead for extra help if the new nurse doesn't know what is expected. That means we check all the standard equipment and set ups to be sure that they are correct. That means we are doing our own job and our own charting plus the new nurses thinking. It is being punished for being good at what we do. This is a very frustrating experience.

Revelations

It has been a while, and I'm not sure where this is all going. I have seen two or three law suits in the newspaper which included blog sites. I've given it lots of thought and am concerned that I too might be included in that category. I initially thought that blogging would be a great way to put some of my thoughts and frustration in order and perhaps get feedback if anyone in the world read them. Now I know that although it might be therapeutic for me, it also could be harmful. I feel that I have to limit my commentary. I'm still delivering babies, and for the most part still loving it.

Best Birth

I had the opportunity to be present for a wonderful home birth. This was the birth of my 4th grandchild. My daughter had asked me to "catch" . I was prepared to do whatever needed to be done and am well aware that "catching" is not the only thing that needs to happen as a baby is being born. I had no need to run the show. As it turned out I was able to hold my daughter in my arms as she birthed baby number 4 in a standing squat into the waiting hands of Alice my daughter's midwife. This was another girl. Now the count is 3 girls, 1 boy. It was a beautiful birth and everyone was present. The family experience was wonderful and there was truly a feeling of joy and thankfulness all around. Baby Leila Naomi is breastfeeding well and everyone is healthy and happy and doing great. How lucky I am to have such a beautiful, healthy family.

Worthwhile work

I did a post partum visit with a woman who had a very nice birth recently and it was number 4 baby. She had 3 previous deliveries with a physician. At our visit after the work was done we were just talking about life the universe and everything and the BirthMom said that she was so inspired by my obvious love of what I am doing that she was going to go back to school and take lots of different classes until she found something to do that she loves as much as I love doing midwifery. I was really honored and surprised. I do love doing true midwifery care. I love having good births. I was thrilled to be able to help her birth. I certainly hope she follows through. I find that when you love what you do, you never really "go to work".

Partnership: Relief and Challenges

I was a solo midwife for a long time. Then I got a partner (another midwife in my practice). I already had a lifemate in the form of a husband of 30+ years. Now, I'm sometimes not sure what to do about this partner thing. I'm thinking that I am not someone who plays well with others. I love the fact that I'm having every other weekend off and that I can actually take a vacation. That is wonderful. What sucks is that now my partner schedules inductions and does deliveries and runs the show her own way. She does do nice deliveries, and we really do have similar practice styles. Sometimes people that I have delivered before end up being in when she is on call and so she gets to make the decisions and help with their births. I don't like that sharing thing. I don't think that I could continue to be on call all the time, but I haven't adjusted to someone else making decisions about plan of care for people that I have taken care of during previous pregnancies or even thru most of the current pregnancy. I really like the time off. I really like the ability to have a drink (a beer, or a glass of wine) knowing that someone else is responsible Before she came, I just didn't drink because I couldn't take the chance on getting called in after having had alcohol. It is wonderful to have the increased freedom and time of my own. I just don't like sharing that much. Hmmm, I can't have it both ways... imagine that.

Everything comes out OK

Well the induction was a complete success and we got a 9 pound baby boy with a 14-1/2 inch head. All is well.

Induction and a rant

Have a mom coming in tomorrow morning at 5a.m. for induction. She has had an unstable lie for weeks. Sometimes vertex, sometimes breech. I saw her today and scanned her. Baby is vertex but definitely not engaged!!!! She is 40 weeks 4 days. So tomorrow we will start pitocin and see if we can drive that little head down into the pelvis so that we can get this baby birthed. I'll let you know how it all comes out.

On a completely different note. What follows is a rant: I continue to be amazed at what people think they deserve. I have a BirthMom who is a 2 pack a day smoker, who missed half of her appointments was on bed rest and of course didn't stay down and she is now all worried that there is something wrong with her baby. Go figure. She honestly believes that she didn't do anything during this pregnancy that could possibly hurt her baby. I am so frustrated with the I have no personal responsibilities and everyone else is to blame for whatever happens mentality. Rant completed.

Nice births but not without challenges

Last night I did a birth with a long time client. She came in at 3 cm and spent a good hour to hour and a half in the jacuzzi and got out of the tub at 7 cm dilated, 100% and zero station. She had an incredible urge to push. I encouraged her to push only as much as felt good for her body. She did this, but we didn't get much change. Her cervix had a fat anterior lip and the baby was occiput posterior (looking at BirthMom's abdomen instead of her back). I had BirthMom squat, kneel, lay on her side, finally I had her kneel with a ball supporting her upper body. The baby rotated and descended beautifully. I hardly had time to get on my gloves before the baby delivered. BirthMom was on her knees leaning over the ball. Dad helped deliver the baby and cut the cord. It was beautiful and it was a girl. The first one for several generations in that family. Everyone was thrilled. Got home well after midnight, grabbed a bite, read the paper and went to bed. Got called in this morning early for a labor. My birth today was almost exactly the same as the one last night except that BirthMom wouldn't push on her hands and knees so we rolled over and she delivered in a more traditional birth position. Instead of the father helping deliver, her sister helped deliver the baby and cut the cord. This one was a little girl as well. I also had a c-section today. It was a repeat. Last baby was breech. This one was vertex but had a 14-1/2 inch head. Sent 3 people home today. Spent most all of the day at the hospital. Got home about 6:30p.m. Nice dinner with my honey, and now some rest. Hopefully, I get to stay home tonight.

Birthin babies

I've had another beautiful vaginal delivery of a little baby at 41 weeks. A challenging vaginal delivery with a nuchal (around the neck) cord while mom was standing in the bathroom and a cesarean delivery over the past few days. Frankly, I'm tired.
My 41 week delivery was really nice except for the baby poop that was in the amniotic fluid (this often happens). That was easily taken care of and all was well. My bathroom delivery was a total comedy. BirthMom was 7 centimeters and wanted to go to the bathroom - I assisted her there. While on the toilet she whispers that she needs to push. I ask her if she plans to deliver there or go back to the bed. She says that she'll go back after the next contraction. The next contraction comes and she whispers to me "I think the head is right there" I have no gloves on but reach in to check and sure enough she is right - the baby's head is on the perineium. I ask if she is going to deliver on the toilet or stand and head back to bed. BirthMom says she will go back to bed. I help her stand up and we take 2 steps and she begins to push and promptly delivers the baby's head. I still have no gloves on. I support the head and feel around the neck where there is a very tight cord. The baby cannot birth the rest of the way until the cord is cut and unwrapped. So I have my nurse push the delivery cart into the bathroom and open it up. I grab the clamps and clamp the cord twice and cut between the clamps, unwrap the cord and deliver the baby. I ask for help, but the help gets sent to the wrong room number so I don't get any help. I put BirthMom in a rolling chair and go help with the resuscitation of the baby. I then wheel BirthMom to the bed and deliver the placenta. Evaluation of her bottom reveals a perineal laceration which I numb and suture. We get baby to breast and all is well. BirthMom says that this birth was much nicer than last time because it hardly hurt at all. I think this birth was much more stressful than the last one, but am pleased that she is happy. I think the bathroom and the birth room looked like a murder scene once I was done and it will take housekeeping hours to clean up all the places that I got blood. For this I'm really sorry, as I try to be neat and tidy. Sometimes it just doesn't work out. We'll see what happens next. I'll tell you things are never boring.

Birth in the night

I had a Mom who was 41 weeks gestation come for a visit in the office. We put her on the monitor because she was post dates and we had good dating. The baby's heartbeat was flat as flat could be. No variability. I got her scheduled that day at the hospital for induction. She (unbeknownst to me) went to lunch prior to showing up at the hospital for her induction. When she finally got into the hospital the nurse did all of the admit stuff prior to starting the IV and the antibiotics for the positive GBS status. When the IV finally got started it was more than 3 hours after I had sent the patient in to be induced. I wanted 2 doses of antibiotics prior to delivery, to protect the baby from the GBS, so this meant that we had a further delay. After the second dose of antibiotics had infused, I ruptured membranes and we anticipated a very rapid delivery. Didn't happen. Of course, now it is into darky night. I have worked at the office all day and I'm tired. It is my Friday and I want to be done and go home. The BirthMom wanted to turn off the pitocin and get into the jacuzzi. I had told her that we could do this, even before we started the pitocin. So we turned off the pitocin and let her get into the tub. She was very comfortable there for about half an hour. She informed me that the contractions were getting easier and further apart, so she got out of the tub and we restarted the pitocin. She did the labor dance, the labor moan, the labor on hands and knees and was really working well with her contractions to get the baby out. Then she wanted to get back into the tub or the shower. So - off goes the pitocin again and we assisted her up to the shower. She spent maybe 5 minutes in the shower and she stated that she needed to push. We helped her to the bed. She pushed and I could feel the head move down. With the next push, I could see the top of the head. She pushed beautifully and delivered a really cute little girl over an intact perineium. She did such a great job and they were so happy. Baby went to breast right away and nursed well. Of course by this time it was 3a.m. so I charted, dictated, and when home to my bed. It was a nice birth and a good time was had by all. When I left the big sisters, who had been present for the birth, were holding their new baby sister who really still wanted to be at the breast.

A crazy day at the office

Everyone I saw today was in crisis. Nothing really bad, just needy. There were complaints of tiredness, exhaustion, bleeding, tired of pregnancy, and whatever other whiney things one could imagine. Everyone was fussy. I finally finished all the add ins that had to be seen today at 6:30p.m. and then it was clean off the desk and answer messages as well as review labs and take action on these things. Imagine that, there is still stuff to do even after all the patients have been seen.

Ho Hum, just another day in the office. . .

So my talk to the nursing students went great and I got to the office on time. I saw patients in the office all morning and then ran to the hospital to discharge my gal who had (this is the operative word) kidney stones. She has no pain and was ready to go home. She is out the door and scheduled back in the office at her regular appointment time. Checked on my Mom who had breastfeeding issues, she is doing well. Then out for some lunch with my honey. We got done quick and had a few minutes for some Text Twist on line. Then patients in the afternoon. Not too much going on birth wise. After all, I tried to deliver everyone on the same day. Darn that full moon anyway. Hoping for a quiet night tonight - we'll see.

And so it goes.

My term Mom from yesterday slept the night and we started some medication to augment her labor this morning at 4a.m. My 7:30a.m. repeat cesarean delivery went great and we got a beautiful baby boy who is a pound larger than her last one and all is very very good. My lady from last night got into an active pattern about 8a.m. this morning and we labor danced and walked and rocked and sat on the toilet and laid in the bed and sat on the ball and switched positions and ultimately ended up with a beautiful unmedicated birth at about noon. This one a girl 8 pounds and change. It was a happy day so far. There was an induction going on which was set up by the MD that I am in practice with. She wanted pain medication. We got her an intrathecal and in hind sight I think an epidural might have been a better choice because it would not have worn off, but I didn't really believe that she was going to be in labor that much longer. After the intrathecal, I ruptured membranes. She got to complete and pushed for an hour after which she said she wasn't going to do this any more. I tried encouraging her, but was unable to change her mind. Her family was upset, but I explained to them that I can't get the baby out vaginally without the BirthMom's help. She didn't want to help, I can not make her do the work. I contacted my MD and we took her for cesarean delivery in the OR. I was sad, because I really believe that if she would have worked with us, she would have delivered vaginally. However, I cannot make her do something that she has decided that she is not going to do. Ultimately, we got a good baby 8 pounds and change. Then I went to the office (mind you it is after 6p.m.) and did an ultrasound scan on a Mom for whom the nurse couldn't find fetal heart tones. I found the baby easy and made some cute pictures for her. While I was scanning her, the nurses left the office and went home. I found this a bit frustrating. I still have charting at the hospital to do and so cleaned my exam room, shut off the ultrasound machine and headed back to the hospital to do my paperwork. My back is tired. My feet hurt. I'm tired and hungry (no breakfast, no lunch, no dinner - yet). I still love what I do.
Tomorrow I talk to students from the nursing program at the local college and then I have office hours. I'm hoping for sleep tonight.

Sleep - Who needs it.

So, I sent off my post, talked to my daughter, talked to my Mom and got ready for dinner and guess what happened? Hospital calls and I have a term patient in with no labor and ruptured membranes and a preterm patient who is contracting. It is not looking good for sleep tonight. Got to find my happy place and get some energy. I think it might be a long night. Of course my term Mom with ruptured membranes doesn't go, I may get some sleep. In any event, I have a 7:30 cesarean section on Monday. Yes, I also first assist on the cesarean sections in my practice. Some midwives don't do this. I have been in practice long enough that I have repeat business with Mom's who had Midwifery care for an earlier pregnancy and then ended up with a cesarean delivery. They want midwifery care for the next and the next pregnancies so they come back to me. I do their prenatal care and then I first assist on their surgeries and round on them just as I do my vaginal deliveries. They also see me after delivery for post partum care and contraceptive counseling. It works. I get to do pre and post natal care and also help with the births. They get Midwifery care all the way around.

On Call and NO sleep

Last night was a very, very long night. I got to stay home, but the hospital was on the phone to me every few minutes. I got at least one call per hour and sometimes more. This makes for poor sleeping. I also had a Mom call me thru the answering service with complaints of "pelvic pressure" at 3a.m. Now, at 3a.m. I'm in my bed if I'm not labor sitting or catching so I have a hard time with someone who calls to wake me up to complain of pelvic pressure. What is she doing out of bed a that time? What is it she expects me to do about pelvic pressure at 3a.m. She assures me that she is not in labor, she has no cramping, no bleeding, yes, the baby is moving but she has so much pressure and is there anything she can do about this? EEEEEK In my most supportive and empathetic tone I reassure her that pelvic pressure is normal and that there is really very little she can do to decrease it. I encourage her to try being on her hands and knees to allow the baby to fall a little forward and out. She tells me she already tried it and it didn't work. Imagine that. Finally, I ask her when her next appointment at the office is and she tells me next week. I ask her to be sure and keep that appointment and we can talk about that pelvic pressure more at that visit. We say good bye and I again try and settle down to sleep, but no luck. The hospital calls again. I'm hoping for no labors tonight so I can sleep.

The Baby Business

I'm a certified nurse midwife. I birth babies. So now I'm birthing a spot to comment on my world and the people who will inherit when I'm gone. My hours are long. My work emotionally intense and physically challenging. I offer my clients an opportunity to have their ideal birth in a hospital environment. I do 15 to 20 births per month and love it. I have done as many as 6 births in 18 hours and alternately gone a week or more with no births at all. I see patients in a private office during the week and am on call all the time. It can be grueling but it is also a blast and I love what I do!
When I'm not birthing, I'm resting. I have a wonderfully supportive, fantastic husband who encouraged me to follow my dream to become a midwife and who is always willing to bring me food when I can't get away from the hospital because of labor sitting. He willingly shares me with my moms and babies and is (almost) always willing to let me run away to work at the birthing barn (hospital).
And so it begins:
I did a birth yesterday/last night that was probably the most awful birth that I have ever done. When all was said and done there was no adrenaline in the room, no excitement, no joy, no love. The BirthMom was laying in the bed with her eyes closed crying, "I hurt, I hurt" she wouldn't open her eyes, or hold her baby, or interact with her husband at all. Both Grandmothers were in the room for the birth and they were there, that is it, just there. The husband verbalized "I never want you to have to go thru this again". Now the clincher: This is a young woman who had an epidural and slept thru the entire labor. She pushed for right at 2 hours and I only turned the epidural off after 1 hour of ineffective pushing. So the only thing she felt during the entire labor was the end bit. I was amazed at how the family infantalized the BirthMom and how they were so into the reward at the end (the baby) that there was no recognition for a job well done, or support for the BirthMom for the work that she did birthing this baby.