It has taken me a long time, but with more and more experience and confidence and knowledge, I can honestly begin to calm myself down once I start to get ahead of myself and freak out. This isn’t rocket science. Believe me, I have taken a prereq to that and it is nothing like this. I got this, I do. Just a bit more practice and I’ll be ready to fly on my own. I am actually getting excited about the day I finish without trying to downplay all the learning left I have to do. But I feel like I will get through this and come out the other side relatively unscathed.
During class, my preceptor called me and asked me if I wanted to see a client who was not feeling her baby move. She is 37 weeks and has been having blood in her urine and pelvic pressure her whole pregnancy. I am really interested in seeing how this birth goes and if any anomalies are present. So, after class, we met at the client’s house. We got to do an AAT!! How exciting! I have read about these in class and in power points, but to actually get the opportunity to do one and have a good outcome—excellent! Another great experience—so happy I am being included in this adventure! After confirming that baby was in a good place, we finished our prenatal with this mom. We discussed how she may not go into labor over Easter weekend as I will be in Louisiana dropping off the kids for spring break. I have to send some pretty serious labor vibes her way so that she has the baby before I go and on a day that I am available.
So, we had our second uterine infection this semester—perhaps the universe is trying to teach me something? Hopefully, because I wouldn’t want to think that we are seeing them for a cleanliness issue. That would be unfortunate, but I could work on washing my hands more often and being meticulous with what I touch when wearing gloves. I used to laugh at the concept of sterile field in a hospital, but it is not so funny after seeing a new mommy lying helpless with a 100 degree fever and a uterus which has almost reached her umbilicus and tender. As per Mayes, a rising pulse of above 90, which this mom had a pulse of 100 where it has normally been 80 her entire pregnancy, is a sign of deterioration. The skin is hot and dry, which hers was also, and she looked acutely ill. Her lochia was scanty as well. So immediately after assessing and consulting with the physician, who ordered Amoxicillin and Augmentin, we went to the pharmacy and purchased these antibiotics and returned with instructions on how and when to take these.
Ok, I guess I need to back up and give a history on this mom. It was her first baby, although I wasn’t at her birth, apparently it went fairly fast for a first birth. Except, the baby’s cord had to be cut fairly quickly after birth as mom was gushing blood. Pitocin was given. Mom also suffered from a second degree tear, which wasn’t sutured per mom’s request. Just to spice it up a bit, dad didn’t want mom given any medication for her bleeding, instead offering cinnamon or cayenne.
So, as I imagine everyone does after an infection, one considers how they may have contributed to the problem and what they could have done differently and moves on from there. Well, I imagine that there were at least a few times that the midwife was down there having the potential for introduction of bacteria. I see it like this—a small possibility of infection from dilation check in labor, and a huge infection risk when the perineum was assessed after all the previous visits to that area had been made. Since the laceration was not examined at the postpartum visit, I am only speculating that an infection from that area could have further developed into a uterine infection. Having the mother take impeccable care of her bottom and wiping postpartum is essential too. So how did the infection ultimately resolve? Well, at the 8th day visit, we discussed how her husband did not want her to take the antibiotics, so she opted to take an infection powder tea made from goldenseal, elderberry, yarrow, dandelion, black cohosh, gum myrrh, blue violet, red clover, and hyssop. Take .5-1 Tsps. to a cup of hot water or take 2-3 capsules several times a day. She said that her mother or mother in law came and applied some Swedish bitters on her belly and (I don’t know if the bitters caused the clots to leave her body or if there was some massage of her uterus involved), but she said some clots had been wasted. She looked much better and the baby had gained several ounces almost back to birth weight despite her having this infection and baby having a circumcision in between all of this. I have decided that my take home message would be that I need to respect the family’s decision to medicate how they see fit, while yes, a uterine infection is a serious life-threatening problem and I do need to have a strong informed consent about the dangers of this, I also need to respect their culture and way of life. Most people choosing homebirths are not the antibiotic types and do seek alternate means of healing. Perhaps I need to be open to this as well.
My Journey as a Licensed Midwife in Louisiana 