Time and Numbers...

I am not entirely sure why I called this post what I did... I guess that both of these things have become pressing in my life in recent weeks and I cannot seem to separate myself from them as much as I try to.

After stepping into this course in 2006 and thinking that 3 years would take forever to pass, I have been rudely awakened to the fact that time goes faster the further that you proceed into life. I have decisions to make, and fairly big ones at that, as to what I am going to do next year. Ideally I would love to become independent and not constrained by the system and politics but there are obviously the realities of finances and social aspects of my life that I have to consider.

I have options and I am going to keep them open because I know all too well that planning months, weeks or even days ahead is pointless as time has it that things can change and do change in an instant.

The most positive thing is that I am well on my way to completing the requirements of the course and will not be impeded in anyway by the 'numbers'. As much as I hate saying that word, it is a reality that at the end of it all, it has become about a number on a piece of paper. Nevermind that these numbers are women and families who have needs and wants and a wish to be respected. It is one of the most awkward of things to be asked - 'what number am I?' by a woman in labour and even harder to try and take away the focus of it being as such. Unfortunately, it is a result of the way this course is structured and the high demands they place on us. At the same time I whinge about it, I am glad that the numbers are higher than they have been in previous years because I am feeling better prepared and more able to step out with at least some confidence in my judgement and abilities.

And then there is the race against time... If something unforeseeable happens and I don't get my numbers its going to impact on what decision I make in the short term. Seems fitting in that the entire concept of that race is a constant element of birth and the length of time that a woman is allowed to birth. It is becoming less and less.

I cannot wait to finally be qualified, to make an impact on midwifery and more importantly on the women and families that I work with. I love what I do and I love the reality of the challenges that I am going to face however sucky the politics are going to be.

The 'Let Down' and the Beauty of Birth!

My intentions were good... I really wanted to debrief here everyday after work but it seems that baby bundles had other plans for me!! I had made the decision before I started this placement to throw myself into every possible opportunity and that I have. Monday and Tuesday were back-to-back days of 14 hours followed by an awesome encounter with Michel Odent on Wednesday at the BBB Conference backed up with two more days of 'my' midwifery! Below is a little of what happened...

Monday unfolded in a way that had me believing in myself as a midwife. Without really being aware of it at the time, I reflected on the day as awakening me to how much I knew and how far I have come. I had initially started on the ward and had completed my first round and then sat to await the influx of antenatal assessments from clinic. Fortunately for me, with this influx came the opportunity share one woman's experience of nature of birth to creep up at the most unlikely of times.

Whilst she leaned over the desk holding her belly and pointing to her appointment on her handheld record, the adrenaline started pumping. I wasn't quite sure whether to trust what I was suspecting and yet I seemed to go with it sub-consciously. Palpation further confirmed suspicions - LOA, head engaged, uterine tone, concentrated breathing. Baby??

As a formality I continued with the CTG and even with the understanding that their story of the situation isn't always a true indication, I soon had a trace in front of me that flashed 'labour', 'LABOUR', 'LABOUR'!!

Of the many opportunities I have had, it was the first I had been able to step up and take the reins in the sense that I did what I had to do as far as the politics were concerned but also in bring the elements of birth how I know it to assist and optimise this woman's experience. Despite our medicalised surroundings, I kept it simple. We utilised the floor for massage, optimised the calm with minimal light and between contractions, engaged in chit chat. As contractions intensified and second stage neared I followed to the shower that soothed the pain and empowered her with a sense of owning the moment and listening to her body. Close by but far enough away so as not to intrude in 'her' space, I directed the stream of water. When her legs became tired we moved back to the the birthing stool and she found comfort in sitting leaning against her partner whilst I took the weight of her legs on mine to assist in the squat. Position changes flowed to the beginning of second stage and the calm remained.

This mood remained for so long as second stage continued to the point where progress seem to stall despite the numerous position changes and reassurance and a completely happy baby. Given the 'time' restraints and the lingering registrar, it was found we had a case of Deep Transverse Arrest and ventouse birth soon followed.

Tuesday began with another birth and entering the room was so different to the day before. Light, people, urgency. The stage was set and a baby was had. It was beautiful in its own right.

The urgency soon dissipated and I was soon blessed with the opportunity to be with another woman. Although it was an induction, the mood was similar to the day before and I observed as she went about labour as just another part of the day. Ignoring the the syntocinon infusion and the continuous CTG monitoring (which is sometimes hard to do!) she birthed her baby like a goddess. I was fortunate to work with a midwife that was happy to hold the active third stage (query as to whether I can call it a physiological third stage or not due to the synt infusion) and I was supported in my choice to allow the cord to pulsate and the baby's need for the blood more than the blood bottles. Skin-to-skin and left to indulge in each other. Beautiful.

Wednesday - BBB Conference! I need a separate post for this. See here!

Thursday - Continuity! Postnatal care of two of these women to discharge! And showered with thankyous and gifts... I swear they are trying to make me fat - I have enough roses chocolates to feed an army!!

Friday... An absolutely fulfilling end to an amazing week! Again blessed with another birth, not just ANOTHER birth but a very special, unique and empowering experience for all involved. This woman was amazing, her husband was amazing and I was priviledged to be given the joy of being there with them. Circumstances for this woman warranted an epidural but the atmosphere was beautiful.

It was this finish to an unforgettable week that awoke me to my evergrowing intuition and my obvious distrust in it! Silly me... All signs pointed to second stage - palpation, fetal heart heard OA and early decelerations with contractions = head compression. Registrar appears. Outcome of palpation - head felt high! Response - huh? and a quick check. A show and head on view! Two pushes, no gloves, baby born, to chest, finds boob, sucks... no fuss, no rush.

SO I have explained the latter part of the title of this post and have in the best way expressed how I brought my understanding of birth and midwifery to the forefront and advocated and empowered the woman despite what was outside the bubble...

Definitely no 'let down', but plenty of 'let downs'!!! (what birth does to a breastfeeding midwife!) HOW I LOVE OXYTOCIN!!

Thought provoking reading...

I ventured onto a few other midwifery related blogs tonight, one Lisa's - definitely 'the' words that highlight, empower, rejoice and celebrate the power of a woman and her ability to birth. There is not one word, phase or story that could come from Lisa's heart that could demoralise or steal from what is a woman's right. Something that inspires me to be that midwife... the one who is in every sense, 'with women'. I can say this with confidence having not only been lucky enough to have her as my midwife, but also work alongside of her and witness and be influenced by her completeness and commitment to 'true midwifery'.

After a long week of pouring my best efforts into an assignment addressing the care of women with postpartum depression and other mental health illnesses and reading tiring journal articles and reviews that seem to overlook and totally dismiss midwives and midwifery, I needed to indulge in something midwifery.

In doing so, I came across some varied opinions of what midwifery is. Despite these coming from midwives, I was quite shocked to be confronted with almost opposing opinions... that word again... After nearly 2 and a half years you would think that I would be used to the fact that some midwives have this rather strange and deranged idea of what midwifery is (my opinion... for good measure) and yet somehow it still depresses and distresses to say it nicely.

I am lost as to how you could unjustifiably denigrate midwifery to just 'a job' or a means to an end, so to speak. Anyone who has had to opportunity to witness birth, regardless of gender, role, personality or input, would be lying if they said it wasn't one of the most emotional, amazing and fulfilling experiences they have ever been a part of. Admittedly, not all can openly confess to it whilst clouded by memories of pain, choice words, vagina and blood... take these clouds away and the beauty of the birth of a child is something that can only ever be justified by witnessing it.

Maybe its a case of 'seen one, seen them all'... however birth isn't just birth in the literal sense. Birth is what makes birth. It is not just a fragment of time, there is history and future in the making, not just for one but for many. Birth is unique; not one is the same.

And whilst I am laying out my two cents for all to see, why is it that a word such as midwifery- a neutral, empowering holistic one has managed to take on such power, indifference and control, in many instances? Maybe 'with woman' would be better changed to 'with midwife' for the majority because the most of what I have experienced has not been entirely about what the woman wants. Despite the obvious time constraints, protocols and policies in the system, there is not even enough emphasis about informing and empowering women to question and discuss their options.

Two words that kept reiterating themselves during my thought process... reciprocity and autonomy. I have experienced too much 'take' and not enough 'give'. Even the most normal and simple choices such as what a woman wears and what and when they are able to eat and drink are stripped from them. And that is not to mention the lack of consideration for privacy, dignity and respect... you would think that closing a door, pulling a curtain, covering a woman, knocking before entering and ensuring the bitching done behind the nurses station doesn't echo through the corridor to be heard by all, would be common sense. If only...

Childish behaviour has some how has grown legs and left the school yard. Time and energy that could be better spent fighting for birth, for women and for their rights.

As a student, I walk on a fine line. In many situations I have found myself pressured to do exactly the opposite of what the woman wants by midwives, registrars and consultants; to me pressure that was based on little or no indication. One such instance, the words 'infiltrate' and 'episiotomy' seem to ring in the background whilst my conscience beat them down with 'consent' and 'crowning' and 'contraction'... I stood my ground until literally removed to make way for intervention. I was fortunate enough to have a supportive midwife who up until that point placed confidence and trust in me to listen to the woman.

So I end with this, a thought provoking and real statement about who or what a midwife should be... I couldn't put it better myself so will use Lisa's words

Compromising your clients wish for a great birth isn't
our role. Keeping the space is.