Goals

1. Describe your goals for this semester.                                           

One of my goals is to learn the newborn exam and gestational age assessment.  My friends, who are midwives, discuss these scores and exams and I am excited to be able to finally know what they are talking about.  Right now, I look at a baby and see a baby, but look forward to the day when I am looking at a baby and notice those creases, breast buds and ears immediately and can tell how old baby is. I know that sounds silly, but I like when I know something and can be proficient in it.  I look forward to feeling like I always knew the baby exams and have been doing them forever.

Another goal would have to really understand fetal position.  I enrolled in one engineering course in college and withdrew from it because it was a 3-dimesional course.  I had such a hard time wrapping my brain around how to see objects and incorporate them on a blueprint or in a computer program.  So, working backward and seeing my books with the 2-dimensional babies moving through the pelvises, then having to imagine the outcome will be challenging, but one that I have been looking forward to and working on.

I really want to learn how to cut the cord and put on the tape (not the clamp).  It looks simple and easy, but I have never done it.  I would also like to help a mom birth a placenta and what that feels like.  I don’t like touching the uterus after birth, but need to learn what a boggy versus firm one feels like.  Also, I hope to get some shots and blood draws under my belt.  I hope I can put all my new learned skills to use if necessary.  I can’t wait!

We didn’t have a hemoglobinometer with us today, but needed to check or at least get a ball park estimate of the iron level of one client.  So, if no field test is available, we can look into her eyes, by pulling down the bottom eyelid and checking the conjunctiva.  If it is white or light pink, then iron level is less than 10.  Also, you can look at the creases of the hands.  These should also be pink.  I am also learning how important it is to keep your equipment in working order. It gets tough in those bags sometimes and by calibrating periodically, the BP cuff and other items is crucial to obtaining accurate results, especially when gathering baseline information. 

I also learned that when checking a fundus after birth and the bladder is full, then the uterus could be off to the right side and/or boggy.  Additionally, when doing a fundal height or palpating the baby during a prenatal, and the mom has super strong ab muscles, you need to push delicately, but firmly.  This will enable you to get an accurate measurement.  I am really curious to witness this mother give birth (it is her first) because I think she will have great strength to align her baby and uterus.

I also had the opportunity to give a Rhogam shot today.  There is much more to that procedure than I thought. First of all, I had to fill out all this paperwork in the box so that the mom had a record of the lot number and shot info.  Makes sense we would do this, but I just hadn’t thought of it before. I guess when you have it done in the hospital, you never see this info as it should be in the chart, I assume.  After properly injecting the shot, it was nice that the mother had a good outlook on the whole Rh factor issue. She said that the good that comes out of her receiving the shot is that there are more women in the community that are positive, so her son will not cause his wife to have to get the shot.  It is so nice that some people have such positive attitudes.  Plus, if the mother has Rh negative blood, we need to determine the father’s blood type so that the mom can be informed on whether she would like the Rhogam at 28 weeks.  If dad is negative, we do not have to worry about the baby being positive. It is a nice feeling being able to draw blood to determine if we can be conservative in our treatment.