Let there be light!

Midwives often work with women who are living with disadvantage, we see the daily reality of those women who are faced with transport and access issues, who struggle to pay for a script let alone the part charge for a scan. Accessing physical and social support for these women is often down to the midwife herself, it can come out of our own pocket. Let alone the extra time required. Visits to track these clients down antenatally mean going to their own homes, taking their bloods at home and driving in from that often rural home to pathlab to drop them off. Small things sure, but when you do it three times before you catch her at home, then you are definitely out of pocket. But what’s the alternative - no care for her and her baby and lack of sleep for me? A long time ago I got some wise advice - if it’s keeping you up at night worrying, then it’s not worth it. Change it. It’s a good adage to live by.

So a while back this resulted in me taking a women’s bloods in my car - now that was tricky. She was then 37 weeks pregnant and hadn’t used the blood form I had given her when she booked at 16 weeks. In fact I hadn’t seen her since. Luckily on my second visit to her parents house she was there, she met me at the door with a big hug and an apology for not turning up to clinic so many times. Now this was our third baby together and although missed appointments used to make me tear my hair out I am getting more chill with time. Honest!

Unannounced she didn’t want me to come in the house so off to my car we went - Luckily she had good veins in that tight squeeze. She did want me to see her own house in a nearby town as she was proud of it, describing the swing set she had found and explaining the landlord was fixing the heating, which was why she was currently back at her parents.

On the phone I organised a bed for baby and chased up a car seat from a local organisation that helps mums get set up. Then we made an appointment for the following week. We both knew she wasn’t going to come, but we played the game. Then I dropped her bloods at the pathlab and went home, relieved that I finally had them in my possession. It turned out that her iron count was really low and she needed an infusion. Usually this is a referral to hospital and they get seen in a couple of weeks. But at 37 weeks we didn’t have a couple - we might not even have one. Also how was I going to get her there?

Now iron is handy, it carries oxygen - a woman loses a fair amount of blood at birth and low iron levels aren’t conducive with that good sleep I mentioned earlier. So, then it was six phone calls with the local GP, fighting my way past the receptionist, to pin them down to an appointment later that day, only to find out the best price they could do was $70. I knew she couldn’t pay that. So it’s back to the hospital referral. Now marked URGENT. Head smacking moment.

The first appointment they gave her was a week later and she didn’t have the gas for the half hour drive. Or the phone credit to ring and tell me she couldn’t make it. She couldn’t email because the screen on her phone was cracked and the keyboard didn’t work. .

The next appointment the week after she did make it to. But the hospital also did a scan and felt her baby was not growing as it should, they booked her for an induction a few days later. Whew. I can sleep well that night, the iron was in and a plan was made!

But no, that night at 39 weeks she went into labour. Of course she did. Murphy’s law. The iron wouldn’t even have had time to work.

It was about 9.30pm when she rang. I asked if there was anyone there to take her to the birthcentre, knowing by the sounds she was making that she wouldn’t make it to the hospital in the city. Apparently there was, so I hung up fast and leapt in the car as I thought living closer, she would make it there before I did.

But again no. The birthcentre rang me when I was nearly there. Apparently my clients brother had rung them (he mustn’t have found my number). She was feeling pushy and he couldn’t get her to move.

Shit. Shit. Shit. Third baby - it’s either going to be ages, or already out when I arrive. The last thing I wanted was an unplanned homebirth with low iron and a growth restricted baby. I quickly did a U-turn and phoned a colleague to attend with me. Luckily she knew the house from being a student with me - because I’m pretty sure I talked so fast in a very high pitch. I’m actually lucky she even recognised who was talking because I didn’t waste time introducing myself.

As I roared into the driveway there were people waiting to help me with my bags. Which are many for a homebirth, so that was lucky. But they took off in front of me and the door blew shut as I walked up to the porch. Now in most cases a person would calmly open a shut door. I’m sure that was my plan. You take it for granted. But what do you do if the dodgy door handle breaks off in your hand? A finely chosen word followed by jamming my pen in the now open hole and jiggling it maniacally and I had MacGyver’d myself in.

Pretty impressive aye! No one could hear my yelling, so needs must. I had a good giggle later when the same thing happened to my colleague. Poor thing - she yelled out ‘bloody pakaru door’ and I heard everyone having a good chuckle.

But back to the imminent birth. I stepped over a hole in the floorboards and followed the nana to my client. She was curled up in the foetal position on a mattress on the floor, surrounded by piles of stuff. Stuff everywhere! Amongst it I could tell there was a lot of blood already. But no baby. Now blood before a baby only happens on a film set, it’s not normal and it’s not a good sign. It usually means some of the placenta has detached and the blood supply to the baby can be compromised as a result. I quickly asked if they could turn the lights on so I could see better to make sense of it all.

No bulbs.

Inconvenient.

So iPhone light then. One handed catching required. Awesome. Stay calm, you got this (this was a lie!)

My second midwife turned up then with wonderful timing. No time to hug her, she could tell the only thing to do was have a baby. And fast. We needed the blood loss controlled. A quick listen said the baby’s heartbeat was normal. She was ace, her calm voice calmed me down. It was only later she said she was freaking out - so we fooled and calmed each other!

I asked for some towels for baby, but was told they were all wet on the line. “Grab what you can please!” This was starting to feel surreal.

So we knelt beside the mama and encouraged her to push. She had obviously been holding on for us to arrive. In between us trying to save the tangled bedding from the blood she easily pushed out her child, 4 minutes after I had arrived.

Then she pushed out a whole lot more blood. After drying baby with a blue inco sheet and rueing the lack of towels we passed her to her mum and dealt with the blood loss. Oxytocin and Syntometrine were needed and a whole lot of fundal massage to keep the uterus contracted. But we got there in the end. She wasn’t compromised although I’m sure some more iron would have helped!

A very intense 20 minutes you might say. We were kneeling on the floor in meconium stained waters and blood, in the dark, our gear scattered on top of all that stuff, giggling with relief. It looked like a bomb site. Worse than my sons room after a nag free week even. Which is saying something.

She agreed to go to the birthcentre to be monitored for a day. So we set about finding our gear and taking her there. Only to discover no car seat. This was at her own place - along with all the baby gear in preparation for her induction in a few days time.

Again Shit. Shit. Shit. We went to the birthcentre and borrowed a car seat. I rifled through my car and found some woollens for baby in my emergency supplies. Along with pads and a dishevelled looking nappy. Crisis averted. All baby needed otherwise was milk and mum had an abundance of that.

So not your normal days work really. But not abnormal either. Just usually you don’t get all those issues at once. This woman is doing it hard. It makes me think of the meme where they give the same sized box to three people to help them see over a fence to watch a game of sport. For the shortest person this help is still not enough to see the game. They need a bigger box than the others and probably it needs to be a different shape too.

There’s things I think from my privileged background she could do better. There’s also a system that is not making it any easier for her to change her circumstances. And you know what - maybe she doesn’t want to? Who am I to say that she should? Her kids are happy, her baby grew bloody fast, constantly latched to the breast. They are surrounded by family. I wouldn’t want broken floorboards in my house, but I know I’ve looked at another client of mine, who sits completely alone in her new $20,000 kitchen, struggling with the isolation of new motherhood and I know she doesn’t have it all sorted either.

What happened to the communal village where we all had just enough and looked out for each other?

Now I sound like a communist 🤣

So work has been a much needed bit quieter lately, no births are on my horizon, my babies are growing, my clients are cruising along nicely with no concerns at present. I’m even had some time to work in the pottery shed. The teenage daughter (amidst much eye rolling) has made me an Instagram page and much to my surprise I’ve sold some pieces already. So maybe when I retire from this midwifery lark I will still have an income!

I’ve been doing a bit of riding too, with no falls even! However, I managed to be in the wrong place at the wrong time in another way. I was waiting in catching position - with shovel in hand for the inevitable poo (shades of midwifery here I know 🤣) - after loading the horse on the float. He had some sphincter issues and farted with follow through. I got poo speckles all over my face.

Nice.

So Merry Christmas to you all. I hope you all get cuddles and joy. My love to all those midwives called away from their own families on Christmas Day to help build another’s family. 🧡💕