How is this experience affecting me as an individual?
I definitely value my husband more. While yes, I may have sacrificed a lot to help raise our children, this has been by far the bigger commitment and the most trying time is yet to come. When my children are home without me and he has to juggle his job and them, well, is going to be difficult to say the least. I hope my mother can go and help frequently and that I can finish up with the NARM next February or August.
I think this experience is helping me to see the other side of midwifery a bit more clearly. For instance, I thought I knew it all or was close to it in Louisiana, especially surrounding what preceptors think of students or what politics they have to deal with. There is certainly more than meets the eye. I am being exposed to how that looks, how hard that is to negotiate, and navigate. And that sometimes students don’t know poop.
Unfortunately, as a student midwife, I feel like I am getting fed up with the lack of communication with this process. For instance, in our sheets we have to fill out with our preceptors, the one which describes breastfeeding experiences does not indicate whether we need those experiences to be primary or not. However, my preceptor has said primary, which is fine, but when we hold our breath and try and count everything, it would be a lot easier if it was precisely delineated what we need to do. I am all for NOT stressing the numbers of X, Y, and catches we need, but for heaven’s sake do us the consideration and communicate exactly what is required of us and when, especially considering the NARM guidelines are changing in the next year. I love my preceptor, but if my family is not with me, I don’t want to be here for more time than necessary.
We discussed laughing gas at NRP the other day, except I really didn’t know how to respond, despite having read numerous articles about Nitrous Oxide. A midwife mentioned the ease of getting birthing pools approved in hospitals, so I suggested laughing gas. She asked me why I as a homebirth midwife felt comfortable pushing a drug and what the difference was between it and a narcotic. Well, at first I was like, ummm, seriously, one is a gas and one is IV, but then I realized she was looking for a more philosophical answer, since they are both interventions. Well, since I didn’t have my spiel down I couldn’t really answer her in a way that I felt could explain my stance on laughing gas, so I went home and thought about it and came up with something like this…
Opioids like morphine have numerous side effects or the mother and can cause significant respiratory depression because it rapidly crosses the placental barrier and has a prolonged half-life persisting for 2-4 days. N2O is not an opioid but a unique method of analgesia and is used in nearly half of women giving birth in many western countries including the UK. The pharmacologic pathway by which N2O achieves its euphoria is not well understood, but is thought to release endorphins. Primigravids are less impressed with N2O. Part of its effectiveness is the women’s ability to control the administration of the drug and in part control the pain. Less effective than an epidural, but more potent than opioids. A 50% mixture of N2O with oxygen is safe for both mother and baby because N2O is eliminated through lungs and not liver. Potential adverse effects include nausea and vomiting and rarely loss of consciousness if too much gas is inhaled, but this can be easily remedied with a few breaths of room air. Mom’s control their intake of the gas and usually prevent this. Toxicological mechanisms surround the inactivation of B12 leading to an impairment of folate and DNA synthesis, which may be the underlying cause of the higher rates of miscarriage reported in workers exposed to nitrous oxide. Fertility issues can affect workers as well as a degeneration of the spinal cord. However, the lipid solubility of the gas, the trace accumulations over time and the relatively short term repeated exposure greater than for a single exposure. The benefits include not requiring IV fluids or EFM. Moms can shower and walk between dosings as it can be started and stopped at any time. This does not require an anesthesiologist! It is particularly helpful for women having fast labors, during transition, second-stage, and suturing. However, because N2O inhibits B12 metabolism, fatigue was experienced in pp women. Some claim that this delivery system is contributing to increased greenhouse gases and occupational health risks for those around administrating gases have been suggested. N2O is heavier than air, does not disperse uniformly but collects in clouds or ‘hot spots’ usually at floor level, especially in still air. There has been a possible correlation between mothers who use N2O for prolonged periods of time and amphetamines.
Hopefully, someday we will all have access to more choices for laboring women, which are safe, easy to use, and inexpensive. In the meantime, we need to unite ourselves with the dentists and figure out an approachable plan of action to present this to Congress or ACOG. If European women have this choice, we should seriously consider it or encourage our mothers to birth there.
My Journey as a Licensed Midwife in Louisiana 