Tag: idealistic

Birth takes forever sometimes

jmacmidwife

No one truly understands what it entails. Everyone just watched the Business of Being Born and voila is calling a midwife. Sure they understand that the interventions are different, but the biggest lesson I received from this birth was knowing that the expectation to manage the birth is still there, no matter where they are laboring. These women still don’t want to own their births, they just want to be handled, told what to do, in a way that makes it appear that they are empowered and given choices. Ok, I have to repeal that empowerment comment because I don’t even know if that piece is there.

For many moms, I believe birth isn’t defining them, their character, their future, their image of themselves as mothers and that is ok with them—however mind blowing that is for me! So, huge step in understanding what women want. This mom had been in off and on labor for three days. Yes, I said days.  For my idealistic brain, this mom was savoring her labor, going through the process of birth and unfolding it as it should be for her. Did she want this 3-day labor-no? Did she give a shit who unfolded it-no? She just wanted to tell her FB friends at the end of the day that she had a homebirth.

So, it was like day 2 or something that this mom said to me—I feel pain in my back. Well, hunny. News flash—labor is painful. It was like she was surprised that it was hurting and kept wanted to have her mom, also a chiropractor, adjust her. Fine, you know, I am sure relaxing her made it much more tolerable, but we have to work with the pain not make it go away. Huge lesson. Make sure moms understand and accept this. She was like shocked. It was weird. Next, this baby wasn’t descending. UGH. She was spending lots of time resting and not enough time walking. I wish I would have hired her a doula. I was wasting so much of my time and energy doulaing for her when her DH and mother wanted to sleep. That is not my job—ok—not all the time, especially when you are in what I consider prodromal labor. The good thing to come out of all this was that I had the opportunity to do plenty of vaginal exams. YAY for internal exams. I think I am finally getting the hang of finding these elusive cervixes. I can’t really tell how effaced moms are, but I am sure that will come in time.

My fearless leader finally got bossy with Ada and started stretching her cervix. We made her get out of the tub and walk around, do squats, etc. Nothing seemed to help. During one vaginal exam, I felt a huge caput, which was cool to feel and we later found out it was a combo caput/hematoma. This baby was about 0 station the entire first stage. It would not descend for anything. So, pushing this cervix out of the way was incredibly hard. I think I broke a sweat and made my fingers sore in about three minutes of attempting to hold it back. The midwife said I have to get over this fear of holding these back. It isn’t a fear, it is just a dislike, a huge disservice to my inner hippie, but she will forgive me. Next time for a lip, I think I might pancake flip mom on all sides–through like 8 contractions. Or else I would knee chest her to get that cervix better positioned on the head because reducing the cervix is no fun, but that is the thing I needed to get— mom didn’t care and I don’t have to like it—I am here to serve her in the best way possible within my SOP and rules and regs and within her ideal of a good birth. She truly didn’t care and I wasn’t hurting her like I could make myself imagine I was hurting her if I said hold back the cervix. Like I said, at the end of the day if she had every trick thrown at her in the book, that was fine, she just didn’t want a section. We trusted the process but she only wanted to trust it for so long.

However, I always have to over process right? So, I am thinking of this other couple I doulaed for in the hospital about 5 years ago. I wanted to help the mama and give her all my gadgets and comfort tools and she had to jolt the over-zealousness out of me literally. She said—look—I didn’t hire you to do stuff to me—I hired you to be here and believe in me and trust this process. So, it’s that approach I took, but —that was in your doula lifetime—you are a midwife—completely different. Different approach, totally—I HAVE to manage these births—duh—that is what these are—manages. Dare I say that I hate it? Not midwifery, but the idea of having to manage this outcome when I want these mamas to be slow dancing across a field of daisies and own this process yet surrender at the same time and out slides a baby. Clearly my vision is flawed. My spirit is shaken. Has midwifery really gotten to this point or has it always been here and I just didn’t realize it? Will I still be able to have these doula-type clients or will I be forced to control this process that I pretend is as normal as sneezing? WOW. The midwife did ask me what I wanted to do with this mom—and I had to face my inner love child and tell her—no this mom is not going to sit in the birth pool and have the water birth she envisioned. You are not going to tuck her in bed and hope to God that after she wakes on the 4th night of contractions she will finally get somewhere cervical change-wise.  No, I couldn’t do what I wanted to do; I had to do what needed to be done– AND THAT WAS OK!!! So, this pity party for the midwife-self that I thought I was becoming needs to wrap up and move on. My idealist world will be better played out in someone else’s head. 

Ada, it turned out, had broken her tailbone as a child—why the F this is not one of our questions when taking histories is beside me?! We needed to get her off her bottom and heart tones were worse on the birth stool, so we flipped her.  Mom was working so hard that we gave her blow by, but I wish I had put the adult mask on the end because the mom and FOB were doing a shitty job at holding. She was purple pushing. She looked like she had been beat up. The midwife was arguing with me that I had never pushed a 10 pound kid out so I didn’t understand how to push. WTF? ok.

Which brings me to a good point. Midwives are stubborn, strong women, but if you cannot take criticism please do not become a midwife.

New revelations?

jmacmidwife

I have to preface this entry with– it seems I learn something after almost every contraction. It is amazing. I am so thankful to be here with a midwife who wants to teach and wants me to get it. I appreciate her time and patience greatly.

OK, new birth, New revelation. I am coming to terms with the fact that I am being faced with whatever I need to learn or at least that is how I am coping with it. It isn’t really that bad. It is just these primips!!! A few things. I don’t think we are educating them enough. While yes, this one –I’ll name her Ada—knew about induction methods and wanted a waterbirth. Plus she wants to be a doula and is a massage therapist and chiropractor– a great base for knowing her body and understanding natural practices.

A cornerstone to midwifery care is knowing your clients. While yes, I knew all this cool stuff about Ada and a little about her birth plan—I don’t know until later that she really doesn’t care THAT much about the homebirth that I have in mind for ALL my clients. I have to stop projecting my vision of a quick, beautiful, elegant birth goddess under moonlight in a babbling brook birth onto them. I don’t know where I get this random vision or ideal, but it isn’t for everyone, heck, I have no idea if any mom I meet will ever really want what I want for them. That is lesson one: move on from your ideals. It isn’t about me. Learn who your clients are and know them. While yes, they are in love with the idea of a homebirth, they are not in love with the idea of a 4-day painful, hands-off, non-interventive, midwife sleeping on couch, ineffective contractions, blah, blah, blah. GET WITH THE PROGRAM—these people just want to avoid a section!!! Ok, that might be a little simplistic, but I have to make it that simple sometimes for my brain to wrap itself around this monumental discovery. I hate to say it—but Kombaya is so yesterday.  It’s becoming trendy just to say you had a homebirth.

I should rename this blog– the death of a midwife

jmacmidwife
  1. In what ways do you think this experience might affect you as an individual? In what ways do you think this experience is affecting you as a student midwife?

This experience has made me much more confident in myself. I have never been so outgoing on purpose. Being able to interact with a variety of clients has enabled me to appreciate all of them and really look forward to hopefully working with many different types of people.

I found that I feel comfortable in a clinic setting, but get the benefit of being part of homebirth families.  It is almost the best of both worlds, but I can see how working with affluent families has its perks. Rarely would you have to concern yourself with STIs or hepatitis. You don’t have to be concerned with drug withdrawal or worrying about the wellbeing of the baby when you leave. Plus you get paid pretty well usually.

I never thought I could be this happy doing something I consider work. This has also taught me that I want to pursue more education, maybe not right away, but eventually. I think I will get my MPH or CNM. I don’t know what will happen with healthcare, but it seems like as less OBs are born, more NP, PA, CNM and other supportive nursing personnel will take over the role of prenatals, postpartum and maybe even normal low-risk births. I think if I want to get a piece of the pie, I need to get more letters behind my name.

Hodgepodge of thoughts

jmacmidwife

I had the unique opportunity of attending a peer review with some pretty awesome midwives and students today.  I enjoyed the nonthreatening environment of eating at a restaurant while discussing cases and having some really helpful, nonjudgmental feedback.  There was a question of boggy uteruses and what to do with them.  The lower segment can be held and the fundus milked to get the clots out. You place your hand on the lower segment and squeeze your hands so that they open change-purse style and clots can come out.  Also, instead of rubbing or massaging a fundus, you can hold and clamp down on it so that the uterine wound heals.  The rubbing may cause the wound not to be able to stop bleeding.  

I had the opportunity to assist with a pap today.  It was my first time being an assist with that.  It went kind of like this—mom on bed, legs apart, relaxed as much as possible, can put pillows under bottom or place bottom on end of bed so that when you turn speculum, it won’t hit the bed.  Tell mom she will feel your touch, place two fingers at introitus, lube up the speculum, warm lube in hand if necessary prior to putting it on spec., or warm spec in hand.  Insert spec at an angle and then make horizontal. You should be entering at an angle down to the tail bone so you don’t have to pull spec out and look for cervix after opening spec. A light source should be available—a flashlight will do.  Find cervix and using brush turn 5 times to the right and 5 times to the left. Take out brush, pull spec out a bit before closing it. Again, remove at an angle. Brush head goes in liquid container, and everything else can be thrown away. Make sure to put mom’s name, birthday, and date and time on vial. Diagnosis is postpartum on lab sheet. 2 requisitions are needed for the lab with paps. 

I admire the Amish’s respect for herbal medicine, but have heard so many good things about homeopathics that I want to be able to deliver a good description of these to them, when and if the time comes.  Plus, if the need arises in labor for a homeopathic, I would have already explained it prenatally or would have the speech down pat so I could just let it roll. I have decided my homeopathy spiel should go something like this…

Homeopathy and allopathic medicine complement one another.  Homeopathy (homeo meaning same and pathy meaning illness) is a holistic system of medicine which has been described as long ago as Hippocrates.  It follows a rule of like cures like using highly diluted forms of animal, plant, or mineral.  In other words anything that can make you sick, in safe doses, can make you well.  Homeopathy is a safe, convenient, easy treatment system which avoids the undesired effects of conventional medicine.  Homeopathic remedies come in tiny pellets, either with a milk or sugar base, which dissolves under the tongue.  One to two pellets is considered a dose. They are low cost and over the counter. Remedies are specific for each woman, yet there is no harm in changing remedies if it does not appear to be specific for that woman.  Once the medicine has been evaluated and evaluated to match the person’s vital energy, health will be achieved. 

Luckily, I was already a doula; so much of the labor support information has been a review. It has been helpful to review these positions and when exactly first stage and latent stage exist.  I have always enjoyed reading Penny Simkin’s books. Attending births as a doula, apprentice, and birth assistant has really aided my perspective. I really trust birth and the processes behind it, so much that I feel much more comfortable with managing this part of pregnancy, more so than prenatal visits. I guess it is just because I have more experience in attending births than prenatals. It surprises me that I am not more comfortable at prenatals, but I guess I’ll get there someday.

Likewise, I have always been interested in expectant management, so looking at third stage again, more in depth is nice. My prior knowledge has mostly come from hospital observation and Internet research, so actually reading the midwifery texts and gaining that perspective should add to my understanding that much more.  I always thought active management was the work of the devil, but actually there is some sound reasoning behind it.

Having already gone through the BS associated with other midwives in other states, I can honestly say I try and steer clear of everyone.  I am not here to make friends.  I don’t care what everyone else is doing. I just want us to make more midwives.  While yes, I would love to love every new midwife that is born into this profession, the fact is, I don’t have to like them all nor do I need to be friends with them.  So, already seeing how unsisterhoodish this profession is, has helped me hold on for the ride and keep my eyes on the prize—just gotta get done!