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.