Tag: goals

Sick babies and reflection

jmacmidwife

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.

Goals

jmacmidwife
  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.

Expectations and goals

jmacmidwife

            I usually have high expectations and end up being disappointed.  So, I am trying hard to be more realistic than idealistic.  Being involved in the Louisiana midwifery community for several years has allowed me to slowly become more comfortable with harnessing my passion of birth and redirecting it to serve women as they see fit instead of some glorified unrealistic birth dream that I have.  Maintaining this train of thought is now the goal.   I expect this course to stretch my mind in ways it hasn’t been stretched by engaging what I know, with what I learn and encouraging me to apply all of it to a variety of scenarios.   I expect to learn

  • the reason behind many of the seemingly routine practices in midwifery, particularly—what are midwives looking for—or more importantly—what are they thinking (since I want to be the kind of midwife who isn’t spending a whole lot of time looking or doing, but rather just being).
  • all the medical jargon that my obstetric counterparts are learning so that I can understand their perspective and be able to converse quickly, competently and respectfully.  
  • how to chart smartly in a legal context 😉
  • how to take a client from start to finish i.e. not necessary what to do next, but how to approach issues, what to say, how to frame it.  By being a LLL leader, I have grown to learn what is appropriate to say and what is not, as this is one area of mine with plenty of growth potential 😉
  •  the anatomy of the reproductive organs and all that mundane stuff, which I do appreciate.  It is training me in the areas I need to know, which is what I am here for.  If I was to pursue the PEP process without this program, I know myself good enough (finally!) to know that I wouldn’t learn the information as well as if I just studied for NARM myself.  So, this class has the potential to be a great launching pad for my ‘formal’ studies in midwifery and I don’t know if I have said this enough—I am so grateful the program is here and I have the opportunity to be part of it!

My goals are expansive this semester.  They range from merely surviving to enhancing my repertoire of skills.  Since arriving I have caught myself several times crying, not because I am sad, but because I am so fortunate to have had this opportunity to pursue this path—my path– into midwifery.  Yes, at times it is a bit overwhelming, I cannot deny that, but only overwhelming in the sense of how far out of my comfort zone will I go to fulfill this dream?  And it isn’t knowing the answer to that question which is important, because there isn’t one.  It is in the excitement of being so surprised (in a good way) at myself and the feeling that this is where I am supposed to be—those are the overwhelming parts.  It is talking to my friends in Louisiana on the phone and remembering their births and being inspired to return to Louisiana or wherever I land and be in a position to offer more families and that community more choices.  Being here feels normal—like the next step in the journey.  So, as I meet new friends (usually mothers of my daughter’s friends) and they say to me ‘wow, you are so brave to come here for that!’ I have to remember that not everyone understands my journey, just like I wouldn’t necessarily understand theirs.   It is my story and by allowing it to unfold however– is the most comforting thing in the world right now.

Knowing myself, I need to stay focused on attaining my goals. My goal is to piece what information and experience I have thus far into something resembling a sponge-of-a-midwifery student.   I feel blessed in the fact that I have been given a new lease on my midwifery life, so I want to soak up all that is before me.  I have committed myself, my family, my friends, and everything in between to a life in Wisconsin and I have no desire to let any of us down.  In the past, I have been more of a procrastinator than I would like to be and time management has never been my strongpoint, but last semester gave me the opportunity to decide if I really want this—so I had to make some personal choices and change some old habits.  Now that I have decluttered a bit and opened myself up to the potentiality of this opportunity, I am to stay focused on learning as much as I can while I have all these valuable resources available to me, while maintaining my marriage from afar and mothering my children.  It will be challenging, but I am strong and ready—bring it.