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!
My Journey as a Licensed Midwife in Louisiana 