Losing babies

jmacmidwife

I was a bit pissed off when I first arrived here. I had been at a birth with one midwife and she decided that I would leave that birth (it was a transport for a section) and head to help with another birth.  Great, right? Well, this midwife knew that the day before, the other midwife had lost the first baby ever in her career. And now I would be heading to a birth on the heels of this tragedy, knowing full well that it could take hours, days, or weeks—who knows how long to process this and be able to properly care for women again. Sure, you can get back up and keep riding, but emotionally are you there, spiritually are you present? Thankfully this has never happened to me, and maybe this is a problem for me that I need to learn—but I tend to process and analyze and reprocess and reanalyze everything until I have mulled over and over and over again. I think about a week of births last semester that began with a birth where the baby was not breathing. Then the next day another mom transported to Madison for PTL. Then another mother was at the hospital and birthing a baby with genetic mutations. I practically caught that terminal baby, but you know what? I was still hung up on the birth 3 days earlier of the non-breathing baby and how I could have done better. It took many weeks of friend therapy to get past that birth. Did I go back and process the others, sure, in their own time, but would it have been better to be present (totally) at the time of their births, um, yes.

Plus, I know I had debriefing that I needed to do. I needed important feedback on how to do better next time. I needed to cry. I needed to mourn. I needed time. Now, maybe this midwife and her assistant did all these things quickly and in their own way. Maybe processing this was relatively speaking, easy for them? I won’t know unless I ask, but wouldn’t you at least let the new assist know what she is about to step her foot into? Sure, she is a talented and marvelous midwife and we all make mistakes and misjudge and have unfortunate events take place in our lives, but really—where is the transparency and communication with those who you are requiring to have your back and be part of your team? What is with these midwives and informed consent? Sheesh.

When did I find out about this baby death–the morning after the birth that I attended with them. Should they have said anything? No, they didn’t have to, but wouldn’t it have been quite considerate if they just mentioned—hey could handle the baby care for us? We just had a death and are a bit shaken and need a fresh, unstressed pair of eyes to be present at this birth for us. I don’t know. I tend to be idealistic and expect the best from everyone. We are just human after all. Aside from our rocky beginning, I like this midwife. She is eccentric and makes birth happen. I could clearly see myself following in her footsteps with slight modifications in place.

Follow up on the burned baby

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Follow up on Jennifer: Apparently the burns on the baby were some of the worse the trauma docs have ever seen and they are dealing with car accidents at Daytona International Speedway, mind you. So, the conclusion is that the baby was not just getting a bath, but rather boiling water must have been poured on him or the hot water was ran and not tested, but surely anyone with any sense could have seen the steam rising, etc. This baby will be in pain for a long time. He had to be catheterized because his penis was too raw to chance getting an infection from the urine. Likewise, his previous rib and clavicle injuries indicate that mom was also responsible for baby’s well being, which was clearly compromised. A warrant is out for her arrest. I don’t think she will ever see her babies again. It will most likely be many years for her to get out of prison. I thought of her while I was at the beach today. It was 80 beautiful degrees and not a cloud in the sky.  I was hoping she was enjoying her last days of freedom.

So in class, I mentioned that this aspect of midwifery—the emotional intensity– surprised me. Granted this is a rare case, after all, we are usually birthing with families who take great care of their babies and are responsible, healthy productive members of society. When all is not well with a baby or family, as it was this week, it is emotionally crippling. I put so much stock into the transformative effects of homebirth. The empowerment it provides women and the gentle beginning it affords babies. However, I have taken this for granted. All types and kinds of mommies will be home birthing. I should not generalize and assume they are all the same just as I would not want them to put me in a box with all the other midwives I know.  While yes they are all women. They don’t all bring the same baggage on the trip. There journey may be very similar, but their destination quite starkly different.

I am taking solace in the fact that for whatever reason, I did not answer my phone that night and did not call them back. I would have gone to her house and would have had to make a hard decision—well, deciding to take the baby to the hospital would not be hard. It would be facing the fact that my hands welcomed this baby into this world and they are powerless to transform his family into something better now.  Maybe I am not ready for that lesson and that is why I was shielded from it. I won’t know why and need to know that it is ok that I don’t. The universe knew best.

Just another day in Midwifery

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Today we had our audit. It went well except the caseworker asked for her chart and if we had heard. Her baby was in the critical care unit. She lost custody of both her children. The dad is in jail. The baby apparently has fractured ribs and collar bone that were healing. She may never see her babies again. The baby may not even live through this. And I didn’t answer the phone. Is it my fault? NO. Could I have prevented this? NO. Could I have made a difference in this outcome? Yes. Could I have gotten that baby medical attention sooner? Yes. Again, I am at a place of privilege and authority and I didn’t help. I am a bridge to healthcare for these people who need healthcare and may not know to go or can’t afford to go or whatever. Should I have answered my phone? YES. Now I am sitting here feeling sorry for myself when this baby is fighting for his life at a nearby hospital alone. His dad is probably never going to see his kids again. Who knows where the mom is—I can’t imagine she is doing well mentally, physical, or emotionally. And I can’t even call her nor do I deserve to talk to her. No one ever said that for as many happy happy wonderful amazing births that I will cry over, I will have as many equally as difficult, heart-wrenching, sobbing experiences. I want to say midwifery is balanced but I would rather say that it is bipolar. Going from one extreme to the next is exhausting. Holding it together for our clients is frightening. But being there for them is what makes you able to call yourself a midwife. Did I want to be a hero? No. just someone they could count on—just a midwife.

My preceptor said it’s a good thing I didn’t answer my phone and get in the middle of this mess, but what I feel like saying is how I’d rather be in the middle of it making a statement to the police than an excuse why I didn’t pick up the phone. Sigh. These lessons in midwifery are either going to make or break me. On top of all this, it is bike week here. It’s like a swarm of bees took over. Sigh. I can hardly hear myself order dunkin donuts when I roll down my window. We had two moms in the office this week who are giving their babies up for adoption. Wow. I asked my husband if he wanted to adopt one of the babies. He said he was glad I didn’t become a veterinarian.  Emotional? I feel like an absence of emotion is abnormal.  We had to take blood out of a primips ankle today. She wouldn’t let us do it anywhere else and it took 45 mins. To convince her it was all right. We went ahead and ordered the glucose screen even though she didn’t eat the standard breakfast. This was her first visit at 25 weeks.  We saw 3 moms in a rows with cuttings on their arms-some relatively fresh. The mom we saw the other day who vomited 3 times in the exam room is miscarrying. She thanked me for caring about her and offering some crackers and apples. A primip urinated on herself and she thought it was amniotic fluid. She asked me to be at her birth. I had to give 2 rhogams shots and a B12 in the deltoid. I hate giving shots. Tomorrow I get to check a mom who lost her mucous plug at 19 weeks and see if she is dilating.  I’ll swab her for cultures. I have to call in progesterone suppositories for one mom with a threatened miscarriage. She has to insert these messy beasts twice a day until 12 weeks.  Lab core will need to be called and I will have to put the box out for them. I saw a cyst in the vagina. Looked like a pearl. I wish I was drinking wine every night. Need I say more?

Lesson One: Answer the Phone

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I’m really disappointed with myself today. I’ve had to hold myself together all day in front of clients. Tough is not a strong enough word to describe it. Let’s begin. Luckily, I have already told you about Jennifer in an earlier entry. I’ll elaborate on that story. Having been with that family, I feel like I had a good feeling about them. The dad never gave me that creepy feeling. I never felt threatened or uncomfortable around him. He was always cordial and polite. He just kept to himself. Not unlike any other man who would come home from work (a minimal wage job probably doing some menial job in a hot kitchen across town to which he took a bus to get to). So, when he came home, I felt it was normal and healthy for him to have a snack or meal and go have a smoke. It’s what we would all do, right? While Jennifer did yearn for his involvement, I have seen many dads from all socioeconomic status that have had the same reaction. Nothing different, nothing to be concerned with. After all, your wife is 9 months pregnant and what do you know about that besides her midwife (student) is here, so I can clock out or at least no one needs my full attention immediately. I never saw him do anything that would indicate he would harm me or his family. Sure, I saw them argue, but he would walk away. He wouldn’t even engage in arguments more than he had to. Again, normal human behavior and honestly, I was glad he was walking away rather than engage in a battle. Now did he do that every time—I don’t know, but I do know that I was not seeing any signs of it and I was in his house at odd times in odd circumstances.

Why didn’t I answer the phone? WHY!!!! Why is this a lesson I am having to learn? Really. OMG. This mother, this family trusted me. I failed them. She trusted me enough to call me at 12:30 at night and leave a message asking me to call her back. And I didn’t.  I got into midwifery for the connection. The connection to families. To emotion. To life. The raw. The uneasy. The real. The hard and the good and the awesome amazing wonderful gift that is birth. I had a connection with this family. I let them down. Feel like crawling under a rock or a tire right now. Just amazed at my selfishness and choice. This isn’t a profession— this is the becoming of a thread in the lives of families. It isn’t a nine to five job!!! It isn’t something you can shelf until tomorrow. I’m not beating myself up. It is the essence of what I want. What I chose. What this family chose—they allowed me into their lives. Trusted me enough to call me in the middle of the night and I wasn’t there for them. I am in the business of building relationships, foundations, families. I have been given the ability, the chance, the opportunity to be here in this place of privilege and honor and trust and grace. What was I thinking? Midwives always answer their phones.  Holy crap. They called me at 12:30 at night and I didn’t answer.

Now I know I am idealistic. Sometimes overly idealistic. But seeing this ex-con covered with prison tats, exuding identity crises and insecurity, witness the birth of his son, whom he names after himself, really got my attention. He was a great dad to Jennifer’s first baby (from another daddy of another race) and he instantly became enamored with this baby. He was in there trying to help her with breastfeeding. He took over feedings. He paid attention to instructions. He was in all my accounts a great dad. Now, did he know what he was doing? Was his dad a good role model? Did prison teach him any parenting skills, coping skills? Life skills? Who knows? Maybe I should have asked. Someone should have asked. Jennifer was by all accounts, bipolar, depressed, add, but she tried to be a responsible adult considering she had one foot out the door and into the street. She made all her appointments. Maybe 14 prenatals, which in my book is fabulous. She was always early to her appointment which she had to take a bus too and she followed most of the instructions. She was on food stamps. She even had a job at 7-eleven for a few years. She could be a functioning part of society. I cared about her. And I didn’t answer the phone. OMG.

We saw Jennifer for her 7 week visit. While she was getting her pap smear, I held the baby who was sleeping the entire time. He looked good, healthy. She was formula feeding him, but that was ok. She needed to get back on some of her medications. He needed to grow. All worked well.  I had mentioned to her that I had seen the dad several times around town pushing the double stroller. So, if he was some loser deadbeat—would he have even hung around? NO. She was excited that she was finally on the list for the transitional home in town with potential for a brighter outlook on life. We said good bye only to see her moments later when I chased her down the street because she left the tea set on the counter that she wanted to bring to her daughter. It was a beautiful day.

I didn’t know but Jennifer had left the kids with the dad that evening as she was spending the night away. He apparently was getting the kids ready for bed and began bathing his 2 month old in the sink, but didn’t realize he turned the hot water on more than the cold. The 3 year old child needed his attention, so by the time he saw what happened the baby was scalded on 50% of his body with 2 and 3rd degree burns. He wasn’t able to judge the amount of burns to the baby and thought he was alright. Trying to rectify the situation, as any good parent would do, he cooled his son off, put cool compresses and thought all was well. Who knows, maybe he was scared—he had been to jail before—what would people think if they saw this? Jennifer returned home the next day in the afternoon. She called me that night at midnight and I didn’t answer. She left a message stating that she needed my opinion and that she needed me to call her right away. Did I mention that she trusted me enough to call me at midnight? I rolled over. I rolled over. So, what I am thinking right now, is how the hell can I justify taking care of anyone or anything? I feel so unworthy. Jennifer called me the next morning and woke me up. She actually trusted me enough to call me BACK!!! The next day!!! Now I truly didn’t see the emergent situation unfolding before me—WHY NOT???? What kind of midwife does not see how a mother who is technically no longer in your care—calls twice within 8 hours??? It must be important!!! UGH. If I could kick myself right now. She asked if I felt like the baby was sick when I saw him the other day. I replied no. She said he has a fever and how she could remedy this. I asked what she tried. She explained that his breathing was not right either. I said he may have a virus or something else, but if he isn’t breathing right, to trust herself and go to the ER. I text her Friday night and ask if he is ok. Someone replies that he is in hospital with no details given. Coincidentally, we are being audited by the state at this time, and her chart was one we were auditing. I couldn’t find a form of hers we needed, so I was going to stop by and have her fill out another one, but I couldn’t reach her.

Duffle bag baby

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Nothing ceases to amaze me in midwifery. Maybe other professions are this crazy and I just don’t know it because I am not pursuing them? I don’t know. This birth story is about Marie. Yes, all names have been changed to protect the innocent and the guilty. Marie had been late to care and noncompliant the entire time. Her dates were off and she had no idea when this baby was coming. Her other children had come postdates so it was not surprising when her belly kept growing and she didn’t call. It was in these last few weeks of her care that we had been trying to get her to come to her appointments and she was avoiding us because she wanted a homebirth and was afraid that drawing any attention to her growing belly would get her induced. All we wanted was to chart a NST and BPP. These weren’t gonna happen. Plus, she was in the middle of a heated custody battle with court dates set all around her questionable EDD–hardly the climate to make a mother want to go into labor.

Luckily her children were with their father the night she did call us. The baby daddy had rented a motel room across from her apartment as he was not allowed on the premises due to his criminal record.  This motel was not the kind with room service or even a coffee maker. It had a shower and barely enough toilet paper to think about going to the bathroom. The heavy stench of cigarettes permeated the walls, floor, bed spread. An old television, not the flat screen kind, was on a table next to the window unit air conditioner. I think you could rent these rooms by the hour. Anyway, the dad was a sketchy character, shifty eyed and uncertain of what this whole birth entailed. He wasn’t overly supported and spent most of the evening outside smoking, thankfully.

We set the birth pool up; luckily it is a horse trough so it doesn’t require much. The mom was four cms when she got in the water. I stepped outside to eat my multigrain bagel with cream cheese and was flossing the sesame seeds out of my teeth when the midwife whipped open the door and shouted that she was pushing. Dad and I comically both ran toward the door at the same time, almost pushing the other one out of the way to get inside. We didn’t even get gloves on to catch this almost 11 pound baby. She was in the water for less than 20 minutes. The baby was gunky sounding, so we quickly cut the cord and I did what I call the c-sec pat on the baby. I turned baby on its side on the heating pad, with its face slightly lower than the rest of its body. I gave it firm pats to get that gunk out of the way. Mom got out of the tub quickly to deliver the placenta. We caught our breaths just in time for the other birth assistant to arrive and gain the attention of the motel management. We had apparently surpassed our allotted parking spaces. Luckily smoker dad intercepted the manager who was demanding that at least one car leave. The dad replied that the midwives will leave after the baby is born. Um. Wrong answer. Management gets angry and says she will call police if we don’t leave. Babies cannot be born on the property. It is about 15 minutes postpartum. Thankfully the universe had made me purchase a pump for the birth tub just days earlier. Otherwise we would have had to bucket brigade the water out of that birth pool. We quickly, faster than I think we have ever cleaned up a room, got everything out and into the cars before the manager came back.

The midwife, the fearless leader she is, decided that we would not let the manager know that we had the baby. She didn’t want the police called because this mother didn’t need that to complicate her custody battle. So, mom put on her best acting face and waddled out of the motel room huffing and puffing as if she was in heavy labor as the manager and housekeeper stood by watching. They asked if we needed an ambulance and we said no thanks we would drive quickly straight to the hospital right now. Really, we were heading right across the street to the mom’s apartment to do a newborn exam, well, really, do everything. I don’t even think we had time to do a round of vitals after the placenta and before we “transported.” Mom hopped into the front seat and her duffle bag was placed on her lap and didn’t make a peep.

Cervical Star

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I have said this before, but I really, really, really need to learn Spanish.  It is not even an option anymore. Five years ago I would have said—ah, I probably won’t serve anyone who speaks Spanish. Well, nope that is not true. If it isn’t to learn it for the mother, it is so important to be able to speak to her support people.

This birth was interesting because the dad could not speak English very well and the mom had to translate, but as one might imagine, the mom was in labor and fairly preoccupied with laboring. Duh.  It was during this birth that I saw an incredible amount of blood lost before second stage-actually before transition.  Interesting enough, I didn’t see the blood loss for a while as the mom was in this dark tub and the room was dark convincing me that a light tub or frequently looking in the tub is essential for good care.  The cervix was tearing and she was not having super hard contractions and it had been a slow labor up until that point. She did have a yeast infection, but otherwise was healthy.  She got onto the bed and she was able to push her baby out with the help of moving a cervix out of the way, but it was torn in several places. It felt like a star. Thankfully, she did not bleed after birth.

Seeing this blood loss before second stage had me nervous, very nervous.  I probably would have transported had I not seen this managed.  While yes we were concerned with her blood loss, as long as her vitals were fine, we were not going to let it affect the labor. We just prepared for PPH and prayed. Lots and lots of prayers.

Cervical Checking?

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You truly don’t appreciate the Amish, until you are not with them.  Their modesty, faith in their bodies, and physical stamina are so underappreciated.  While yes, they are still women, they are amazing women who can birth babies usually without many complications aside from horrendous varicose veins and anemia that is lifelong. 

Meet Jennifer.  Bless her.  I haven’t had a needy mama in a long time And I mean needy in the best way possible.  Her first baby was a hospital birth with an epidural.  Wanting a different birth the second time around, she found a midwife, but actually didn’t have a home to have the baby in, which was Jennifer’s first hurdle.  The second, was convincing her ex-con boyfriend to have a home birth. So, after these hurdles were met, she needed someone to be with her and reassure her. I visited Jennifer no less than 5 times that weekend, reassuring her that she was fine. That she was not in labor and checking her. Sigh. I have to get over this internal exam piece.  It isn’t that big of a deal, but yet it is. I just don’t know about it.  I have to convince my women that they don’t need it unless we are going to do something about the course of their labor, but this mama wasn’t even in labor, which was my problem. So, day after day, visit after visit, I was there checking her! Sigh. It is ok. I have to learn how to do it eventually. Well I know how to do it, but having to stick my entire hand, literally up and back behind their cervix to feel it, is just too invasive for me. If it isn’t near enough for me to reach, then why am I going after it? I can see how checking is semi-important if they are having preterm labor because you want to stop it, but really after 37 weeks—unless contractions are patterned and there are other signs and symptoms then really—what are we doing? If God or Goddess or Mother Nature or whomever wanted us fishing around up there, then she would have given us the ability to reach it easier right? And you know what? It isn’t even reaching it that is the problem; it is the fact that it hurts mothers. That is right, I said it—it hurts mothers. I can’t stand hurting mothers for NO reason.

So, did Jennifer have a great second birth—yes, yes she did. She did amazing, but unlike most mothers I see that are transformed after the birthing process, I don’t think Jennifer changed that much. I believe (and I don’t think I have seen this quite so pronounced before), that she was transformed by the entire process of being empowered by the choices and ability to make those choices by midwifery care. Although it was pretty amazing to watch, I am sure it was even more amazing to be her—what an awesome profession this is!

My Journal

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Every semester as part of our assignment at SWTC, we had to journal. Let me tell you, I am not a journaler. I am more of a seek-out a good friend and call them or go to coffee. Don’t get me wrong, I enjoy writing, but I do not enjoy being forced to do it. I think it takes on a more reverent place in my life. Like, if I am gonna write, I want it to come from an authentic place, if that makes sense. Nevertheless, this was one of my more authentic, heart-felt, albeit naive entries….

Ahhh, the ever-present journal is back for its last semester, thank the heavens.  Let’s see, this semester, I look forward to learning in some of that stuff that shows you really what you are made of— like hemorrhage and shoulder dystocia.  You can’t really show your cards until its sudden death, literally, and you have to make a move, hopefully the correct ones at that. 

I look forward to (ok I am a bit anxious) but also excited to be called on the carpet—so you have seen this before, you have read about it, you have had a quiz on it, and a few power points—what are you going to do about it in a scenario and real life? Will I be able to draw upon my knowledge with swift voracity and deftness or will I fold?  Karen expects a lot, which has both its good and bad points. She is an amazing woman—so kind and generous and offers the moon in terms of teaching new skills and finding ways to get you the opportunities you need to succeed, but oh my, what pressure. Trying to concentrate and remember so many new protocols and procedures is mind-numbing some days.  My pillow calls my name while my brain yearns for autopilot.  Spoiled by the crystal blue water and snow white sand, I never liked the Atlantic Ocean, but believe me, it’s like a couch at the shrink’s office for me now.  I go there to renew my low vitamin D levels and spirit.  Here my tears can reunite with other molecules of salt water from beneath my superstar sunglasses and my sobs drowned in the sound of laboring waves. Thankfully, I haven’t had too much time for this kind of therapy and instead enjoy the healing sunlight, but am glad it is available.

 It is time to test our skills or perhaps learn it for the first time in the field. I entertain the idea of these new challenges ahead and look forward to being able to forge into my being with direct confidence and renewed abilities. This is the time to blossom, I plan to take every chance and opportunity I can and go after these skills and competencies.  It isn’t time to be a late bloomer or in my case even wear bloomers.

I think my goals for this semester expand beyond the classroom further than they ever have before into managing not just my birth environment, my business, and my clients, but also my personal life.  Keeping my family together, even though we are apart, will be difficult at best.  I will be working and hopefully trying to focus on finishing up all that is before me in a relatively short amount of time, so I need to be balanced now more than ever. Thankfully I am a Libra, so it should all work out as it should if I listen to the universe and myself—together I will go where I am needed and accomplish what I should.

Sick babies and reflection

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It is really bad when a mother is sick, but when it is a baby, it is so sad.  It is a helpless feeling.  Recently, we went to a call for a baby who was not reaching her milestones. She had a dazed look and her eyes would sometimes not focus on the same object.  She didn’t have much of an expression and her tongue would hang out of her mouth a bit.  She was very floppy and lacked what seemed any muscle tone.  She was almost 10 months and still ate from a bottle and didn’t sit up.  We called to get her into the primary care doctor who would then refer her to a specialist.

Another baby has had really bad GERD.  She is only 5 months old and barely sitting up. So, she will most likely grow out of it, but I hope with the help of the prescription we got her, she will be feeling better soon. While we were at the pharmacy waiting for her medicine, the pharmacist asked who we were. Not really wanting to go into much detail, since we didn’t remember this baby’s name or her birthday since she was a UC, we just said we were community nurses and did some midwifery.  He said wow; you are like angels for the community. What a nice thing to hear after a long 10-hour day!

Finally, a few Amish babies have been struck with pneumonia and RSV this year.  It is sad to see these little babies struggle to breathe.  This one little baby has been struggling since he was born. He was the brow presentation, then super-jaundiced, then losing weight, now this. His oxygen sats were 80 and he was life-flighted to the hospital.  This is another reason I may need to invest in a pulse oximeter.

This semester has flown by, which is a good thing.  I wish I had more time to read my texts and really soak in all the information. It seems like I will need to read and reread these texts and then I may fully understand more.  My goal is to do that his summer—really read each book again, especially Varney and Frye.  I want to know them inside and out. 

I feel like I touched on most of my goals for this semester, but definitely could improve.  I have had a few opportunities to conduct the newborn exam, but really don’t feel confident that I am getting everything yet.  I am getting better at gestational age, but again, not totally correct.  Likewise, APGAR scoring seems so subjective, but I am working on remembering to look at my watch and get those uber important times down.  The more practice I get, the better I feel prepared. I think I finally mastered handling those baby shots.  I don’t like to do it, but I can. The Rhogam ones intimidate me. Haha. I do need to still work on those boggy uteruses.  Ultimately, if I can get more hands on time, and make more births, I could have achieved my goals. 

The NARM changes have really got me fired up to finish my numbers, if at all possible.  I don’t want to leave early and definitely don’t feel like I will be prepared to go out on my own after reaching the NARM quota, but I don’t want to do more numbers that I need to record.  I would love the opportunity to continue to work with whomever after I turn in my paperwork, but don’t think I can commit to staying longer than a year, if I need to finish the new NARM requirements.  I may have to rethink staying in this program if it doesn’t allow some flexibility in completing the numbers. Although I value a brick and mortar education, I can’t continue to attend SWTC if it is holding me back form achieving the very numbers it required me to get.

First pap

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  What new skill or information have you learned over the last weeks?           

It was much less intimidating than I thought it was going to be on that side of the speculum, but I tend to make things harder than they really are and well, this was one of them.  So, I have received my fair share of Pap smears and it is so surprising how little I actually pay attention to the words that have been used. I guess it is such an odd procedure and one that so many people block out so they don’t hang on every word? 

First of all, I like to say I won’t proceed until the woman feels in control, and if at any time she does not feel in control, respected, comfortable to let the provider know either verbally or dropping the sheet which is across her lap.  It is important that she not push the speculum or hand away, so she doesn’t hurt herself, but it is important she feels safe and trusts you will do what you need to do in regards to her well-being, mind and body.  On the whole, I need to work on the technique of getting faster and figuring out how to open it without fumbling, otherwise, it was much easier than I thought.  Really, there was not much to it. It was easy to see the walls of the vagina, but the cervix was hiding.  I didn’t have to redo the speculum insertion, but just aim downwards and to the right to find the opening. It looked just like it is supposed to J The brush did its job and I got that taken care of in no time.  I did get lube all over my gloves, so I may need to figure out how not to do that.  I ended up regloving before the bimanual exam, which was annoying.  In hindsight I could have just not gloved my hand that was palpating the abdomen.  Actually, I was thinking that it could have been easier for me to feel the ovaries if I didn’t have that hand gloved as I think it took away some of the sensation. 

Needlesstosay, I didn’t feel ovaries, I felt the cervix and moved it around.  No pain was felt and we were good to go. She was not pregnant, so I did not need to feel the uterus.  It was nice to have this internal exam practice so that I could see how to position my body. I was too far away from her and the exam table was too high.  Next time, I would need it to be lower and I would need to be by her side so I could get more vertical and in a better place to determine what was what. All in all—what a great experience! YAY!