Time stood still...

Yesterday was one of those days that you look back on and question whether you did everything you possibly could given the situation. So much so, that you go to bed thinking about it, dreaming about it and the next day it begins to crash down like a ton of bricks.

The morning went smoothly as I attended a Caesarean Section. I was nervous going into it because the woman had had a previous emergency and had ended up with a cerebral aneurysm and impaired sight due to the effects of the anaesthesia and a postpatrtum haemorrhage which unfortunately I am getting used to. Thankfully all went well both for mother and baby. I spent a lot of time with her postoperatively and I lost count of how many times that she asked 'why do people opt for this?' or 'why would anyone want to put themselves through this if they didn't have to?' I am not entirely sure myself.

After this I was given the opportunity to care for another woman in labour, all was going well throughout the morning. Another induction but progress was being made. As always, there was the generalised attitude that multip=quick labour and despite a dilation of only 4cm in about 6 hours, amazingly everyone was pretty happy to let things go (Hallelujah!)

Things progressed well and next thing second stage had begun and we had baby's head on view. Again it wasn't as normal for a multip as the head took a long time to manoevure the Curve of Caris and crown but it happened just the same. It was beautiful to watch the woman instinctively work through it.

Time stood still and I awaited restitution... nothing. Contraction and nothing. The head slid back after I caught a glimpse of a cord and it was freakishly tight. Midwife made the call to cut and I made the call that we had a shoulder dystocia.

It took two to at the receiving end, two on either side trying McRoberts and me climbing onto the bed to begin with suprapubic pressure. All hope seemed lost until I felt the shoulder and manage to flick it around the symphysis pubis.

I don't think it really hit me what had happened until the midwife I was working with burst into tears. I am just glad I knew what to do at the time. Even more, of those midwives I have spoken to, many of them have gone years or decades without ever experiencing this or the extreme of PPH's and here is me, not even a registered midwife and I have been a part of both. I am taking it as a positive in the sense that experience equals knowledge and knowledge of what to do in situations like yesterday could mean everything.

Questioning the obvious and proposing the unlikely...

Despite getting used to the occurrence of getting to work and being made aware of the amount of inductions and caesarean sections, it still gets to me. I do understand that there is a time and place in which they are needed but shockingly, the facts that Michel Odent spoke of are becoming more real and evident. I have been reflecting and addressing my frustration over this and trying to formulate some plan to change this trend particularly as I am due to take the leap next year and finally drop that infamous word 'student' from my title.

I am aware of the mass opinion that I will be up against when I finally do become registered but I am hoping that I continue on the path I have laid and stand strong and make a difference. Obviously it will be a challenge given the politics and legalities of the system but given my incessant need and want to bring birth back to what it is or in todays culture, what it should be, I will fight until the bitter end.

I have grown complete and utter despise for induction and looking back on my own experience, think myself lucky that it went reasonably smoothly. Almost every induction that I seem to witness fails or causes complications that inevitably result in a section. I am close to summing it up in my head - induction = delayed c-section. I choose my words carefully because in the delay between induction and section comes intervention. I am trying to find the words to express what I am feeling in relation to the future of this rather bold and forthright equation because I am sure that amongst the mist and the clouds, there are many that are pushing for something along the lines of - induction = c-section or worse birth = c-section.

The worrying thing for me has been the encroaching nature of the beast on length of gestation. Once upon a time it seemed safe to leave a woman to bloom until 42 weeks. Four years ago, knowing very little and being as naive as I was, I had to beg the doctors to induce me at term + 12 days. They wrote on my notes - IOL for social reasons. Now compare this to what I am seeing today

• IOL from the EXPECTED due date
• Social induction from around 38 weeks
• Failed induction due to unripe cervix (GO FIGURE!!)
• Vernix covered babies at T+ gestation (hmmm)

And thats only the start of it. Although I do not like to generalise, it seems that by majority we have lost touch with our bodies and hence when pregnancy miraculously occurs, we have no idea when we conceived, when our last menstrual period was or even care. I can understand this because sometimes the last thing I want to think about is my period and how annoying it is but what I am trying to highlight is the fact that, our bodies, our cycles, our ability to produce life, sustain it and give birth to it have become second, third, fouth, etc, to higher priorities.

I am deliberately making this point to try and justify in my minds how there always appear to question marks near or around the estimated due date. Deliberately because I want to make the point that its only an ESTIMATE!!!! Normal pregnancy gestation is 37-42 weeks, look in any text or reference and this will be clearly written, yet somewhere and somehow someone decided that that wasn't good enough. We need routine, structure, a timetable!

As far as I can gather the EDC or EDD was only created to give them woman some insight as to when labour may start. I dont think it was ever meant to be THE be all and end all OR the determinant of what will or wont happen. So unfortunately this date has been manipulated in such a way that it warrants the rights of OTHERS to make a decision as to when a baby is born.

I sat up thinking about this last night with the knowledge that primips or first time mums in general will go into labour post their due date and wondered with the understanding that we have, that being that between 41-42 weeks gestation is still safe, what would happen if we shifted the EDD to equal a gestation of 41 weeks rather than 40? Come into play politics and legalities but all that aside, what would be the outcome particularly as I am aware that 40 weeks gestation is an average gestation.

Nothing much changes. There is still an EDD, there is still that date to linger on, there is still room for manipulation. The truth of the matter is, nothing in this world is set in stone, nothing is stagnant, things change. Given that as humans we manipulate and influence so much, how can we be sure that we haven't done the same on the normal gestation of pregnancy? Its obvious we have had an enormous influence on it in a surgical, medical way but I am talking more of the physiological, psychological and environmental way. If the human race has the ability to F*#$ the planet as it has and influence global warming, seasonal shift, pump hormones into the food we consume, control life as far as messing with genes and cellular bits and pieces and possibly initiate many of the natural disasters that have occured in recent years (or months!), whats to say that we haven't done the same to pregnancy, the initiation of labour, a babies' birth??

Food for thought and my need to question...

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!!

Placement - Day 1

It was easy to walk back in there having been there for a good four weeks over Christmas and New Year. Being a small place, most of the staff remembered me and seemed to be confident that I was right to take on responsibility of patients from the get go.

The first question I was asked was 'how long are you here for?' and when I replied with 4 weeks the response was 'Oh great! That means we dont have to do any work for the next 4 weeks!' I wasn't quite sure whether to take that as a compliment or not but throughout the day it became quite obvious that I was going to be given a great deal of opportunity not always with the greatest of assistance. On most occasions, this isn't an issue as I generally know my stuff and am confident in what I am doing but at times, I had to stop and think about what would happen if things went bad and there was no one around because so many times when I wanted to just run things past someone, there was no one around. Particularly as the lack of urgency about an emergency situation became striking clear last time I was there.

Despite that, it was a good day and I had plenty to do. We didn't have anyone in labour so I mostly faocused on postnatal and also attended to a couple of antenatal assessments which were good learning experiences.

I was a little deflated when I first got there and looked at the board... every single one of the postnatal women had had a c-section for one reason or another. Some repeats and one, supposedly a result of a deceleration which to me, really didn't look like decel at all but rather maternal pulse... hmmm...

Tomorrow I am down to work with the midwife going to theatre for yet another section and should hopefully attend to the paperwork and following through her care on Friday. As for today, I am not entirely sure where I will be and what I will be doing.

But for now I must get going!

Placement!

Tomorrow I start placement again, one week of antenatal followed by 3 weeks of intrapartum. I am nervous, as always, about what I am going to encounter - experiences and people particularly as a couple of experiences I had whilst I was at this hospital last time were ones that left me questioning whether I was right for midwifery, or whether midwifery was right for me. One was a distressing and disgusting forceps birth by a consultant and the other, a postpartum haemorrhage that could have ended in disaster... for both woman and baby.

I did a lot of soul-searching, questioning and crying trying to decipher where and why things ended as they did and going back there means reliving those events mostly because the PPH was the last birth I witnessed before I finished.

Expect me back tomorrow for a debrief :)