Tag: Naive

Midwifery psycho babble

jmacmidwife

You learn something at every birth and (un)fortunately sometimes the universe gives us lessons that we need to learn—perhaps we don’t want to learn them or think we have learned them good enough, but there they are again. So, I guess it was inevitable that I go back into a hospital and face the music. I used to think doctors walked on water.  I never imagined they were these egotistical, righteous beasts.   Heck, when I was younger, I wanted to be one.

 It only took about 2 good years of doulaing for me to come to the conclusion that they had elevated themselves to God-like status and liked it, which by the way, is fine with me, until it affects me or the people who I am hired by.  The more I read, the more I believed in birthing naturally, the more I felt the hospital was unjustified in its decisions.  It was not me who could stop them. I could only inform and educate parents on the benefits and risks of doing certain procedures or interventions on the spectrum.  However, some mothers wanted an advocate in the hospital—a voice—while theirs was in labor land.  This advocacy was not unjustified or unsolicited. It was a reflection of the parents’ wishes already agreed upon weeks before when the birth plan was approved and placed in the chart. However, this voice was not to be tolerated in labor. How dare someone try to voice reason when reason was not necessary according to the physician? 

I like to give parents an example of how messed up this whole birthing process in the hospital can be. I use an example of my husband’s outpatient shoulder surgery.  A few days before the surgery, we meet with the physician who goes over the entire procedure and answers all questions.  The surgeon wants to meet your support people so he can give you information regarding care after surgery.  He is polite, unpretentious, and respectful of where you are coming from.  He gets out models and x-rays and essentially provides proof of why he is doing what he is doing. He shows us the tools he is using and how recovery will look down to the sutures he puts in. There is no stone left unturned. He does not want you to leave with an uncertainty whatsoever.  The day of the surgery, every team member who is present in the surgery comes to pre-op and explains what their role is and essentially gets your consent.  Fast forward to a hospital birth where in most hospitals a third of all women will have major abdominal surgery and all they get is one sheet of paper to read and sign stating informed consent—no other info is given.  It’s an abomination to women’s healthcare.

Recently I attended a birth, not really as a doula, although the parents introduced me as one. My midwife introduced me to the doctor as her student so it was more like—here is a person who has been supporting these parents throughout their pregnancy and since the mom is no longer a home birth candidate, now this person is supporting her in the hospital, but she is not trying to save these parents from the abominations that occur in here. We understood that we were here because we needed help from the hospital and agreed to let go of our aspirations for a natural birth. Membranes had been ruptured for many days and we needed Pitocin to get things going. Natural induction methods had already been employed.

 It was only a matter of time before I found myself wishing I had been at an erupting volcano or sinking ship rather than be in that room. My face must’ve revealed my true inner feelings and my lack of enthusiasm for the hospital policies was palpable. It’s not that I was surprised at my behavior, don’t get me wrong, I had acted like this before, but this time I expected to act less childish and more professional because I was older and wiser? However, in the face of hypocrisy and disrespect, I can only clam up and shake my head.  Nothing had changed. Not me, not my ability to play the role of facilitator in the hospital. I outwardly admitted that I could do nothing for these parents. I didn’t want to further jeopardize the midwife’s relationship with her backing physician. I was just praying it would be over soon. I should have said to the doctor that the parents may be needed more explaining of what the choices were, but honestly, I didn’t think I could have spoken nice to them at that moment. If I haven’t been in the hospital that is friendliest to homebirthers and had the backup physician working with the parents—I would have expected the behavior from the hospital staff, but this was different. I wasn’t a doula coming in guns ablazing. I was a midwife—not a colleague or anywhere near equal to him, but a collaborating member of a healthcare system. 

So, here I thought, with more experience and education and coming in with a different attitude that my experience would be different, but no.  Unfortunately this leaves a bad taste in my mouth for my return to Louisiana. I want to be the type of midwife who is able to go into the hospitals with her clients and interact professionally and civilly with the staff. I don’t want to drop them at the door and wish them luck, but I am concerned. Perhaps this is just who I am and I need to accept that I am not good at this and won’t be good at this. Can that be a choice to say I won’t work at it? I just feel that every time I interact in a negative way it does more damage to the relationship with the staff and future encounters. What a sucky place to be. It’s not that I don’t value having healthcare available when we need it. I appreciate it and am so thankful that we have a relatively clean place to go in an emergency where proper medically trained personnel are waiting to do their jobs.  Many places on Earth aren’t so lucky, but I am not going to hump the legs of the doctors just so they treat me or my clients differently. No. I won’t do it. Now, if they happen to get to a place over a few years or months of interacting and feeling comfortable with my ability to catch issues and/or consult then super, but I cannot see myself going out of my way to kiss their butts. I have already decided that I will inform my clients of my relationship or lack thereof with the medical community and if they are not happy with it, then they need to find another provider. I have to be comfortable with my abilities and that is something I just cannot provide right now. I wish I could, but I physically cannot.

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.

Almost done

jmacmidwife
  1. What did you already know that is proving helpful in navigating this course/semester? Don’t restrict your answer to things learned in this course.

Does knowing the end is near count as navigating this course? It is almost like the end of a 5K when you know you have passed the 3 mile marker and you sprint with everything you have that last tenth of a mile. Well, I feel like I am nearing that 3 mile marker and can see the finish line and am conjuring up all the strength left in me to get this stuff done. I basically have a month left. Six births to go. Six. I can’t say it out loud though because it sounds too surreal. 

I have said it before, but all that I learned in Second semester is here at this clinic. I wish I had learned it while I had been at a clinic like this or could have traveled here shortly afterwards because I am doing all these tests and screenings. I have moms coming in and we are doing urine dips to see if they have a positive pregnancy. Then we are drawing blood to get an HcG level. We are checking progesterone to see if it is low if they are spotting. We are rescheduling another HcG blood draw to determine if they levels are going up.  We are seeing the fetuses on the ultrasound. We are scheduling these moms for fetal survey, size and dates ultrasounds. We have to sign them up for Medicaid or check their insurance or figure out how they will pay. We have to get them signed up with resources like Healthy Families and encourage them to make their appointments. All those power points which seem so surreal when you are not in the middle of it—are coming back to help me get through the end. Everything from drawing up medication to vitamin K shots, to B12 shots, to pap smears, to probable or possible signs of pregnancy. It is all here staring me in the face and I am glad to see it.

My doula experience has also helped me tremendously. Really any real hands-on experience has proven to be invaluable, even seeing births in the hospital.  I have learned more shoulder dystocia maneuvers and seen more drills than I care too, but honestly, it all helps. Likewise, seeing blood loss—what is normal, what isn’t—all helps you get a great idea of when too much is too much. So, simply knowing when the blood loss is too much and coupling it with the new knowledge of what to give or do when that occurs has been exciting. I finally feel like I have a good grasp and foundation on which to finish this race up.

My Journal

jmacmidwife

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.

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!