Reflecting

It’s been a contemplative week. With lots of links to previous blogs happening. it made me think I should share with you all.

So I’ve been waiting for this one baby for a while. I wrote in two earlier posts ‘the case of the missing underwear’ and ‘shits and giggles’ about a client who was pregnant with her fourth baby with me and that two of those babies had died as infants.

After her return from staying up at starship she was - unusually for her - now 41 weeks pregnant. Her other three babies had all been born at exactly 39 weeks. It had me wondering about the power of the mind, was she holding on to her baby? Did she think it was a safer on the inside? When would she let go? At what stage does the body outweigh the mind? I was expecting the birth would bring joy, reflection, healing, and a whole bag of mixed emotions.

But the day finally came. Although I knew it would be bittersweet again, we always also have a few laughs during her labours. She is inspiring to watch birth too. I was looking forward to seeing her wide smile when she met her rainbow baby.

After a message saying her contractions were 10 minutes apart at 5.30pm, by 9.30pm there was no further word and when I caved in and rang her it went straight to the answer service. Phone probably flat I assumed. Try her partners phone you say - but they share one for cost purposes. Shit do I go to bed or not? Story of my life lol.

Eventually they emailed me back with a new number to ring them on as they had no credit. Contractions were still 10 minutes apart and had been for most of the day. I got her man to do some pressure points on her hand that encourage more contractions and got her to adopt the position that the contractions felt most uncomfortable in. Mean I know! But sometimes it’s effective, going by the theory if it is a stronger feeling the cervix is opening more. The plan was to do this for 30 minutes and if that didn’t bring on established labour to then try having a sleep. I would check back in an hour.

An hour later they were now 7 mins apart but only lasting a short time. Some of them made her feel pushy at the peak. My guess was that the baby was in a posterior position and she was probably around 4cm dilated. But without being psychic you are never going to know for sure over the phone. And if I know one thing, it’s that with birth there is always an exception to the rule. She wanted a nap - so we went for that option.

A kip was a wise move for me too I thought, as it was now 11pm. Of course I was almost nodding off when the phone rang. Contractions three minutes apart. Bingo! I should have just tried going to bed two hours ago and saved all the confusion 🙄. Me getting into bed is a very effective induction of labour technique.

Within a couple of hours - while she was enjoying the pain relief of the pool - she started to show signs of being transitional, baby should be here soon.

This woman that never complains, not about her grief, not about her emotional or physical pain, just let the tears run quietly down her cheeks. That was hard. I‘ve spent a lot of time trying to get her some counselling from different services in her rural community but as she is not suicidal I can’t get her bumped up the wait list. If two lost children don’t qualify you for immediate grief counselling then I hate to think what does.

Then she said “My legs are shaking!”. I responded with “It’s alright you don’t need your legs” and was met with that hearty giggle of hers that I so love to hear. It’s heartwarming y’know?

A few minutes later I lifted up her biggest baby yet. Her parents greeted her with another flower name like the other kids. Then we were all crying and laughing. Except the baby, she was just crying LOUDLY. Clearing her lungs and making her presence known. A beautiful sound.

Mum and baby are both doing well, feeding non stop and all set to gain weight - instead of lose it as is most common - in the first week.

This week I also had my annual Emergency Skills day to attend. Something I always begrudge beforehand and appreciate afterward. I begrudge that I have to pay a decent wad to attend it, that I have to pay for a locum to cover me for the day and that it’s usually covering the exact same stuff. Although the food is always good.

This year we received an email the week before telling us to bring our own lunch! That didn’t help my enthusiasm at all. I left home at 7.15am to get there for the 8am start and on a Saturday too! No one else was there but my friend and I, she had got the time wrong and I had not bothered checking myself and believed her. So off to a coffee shop we go to return again at 9am. More people now, but some had been told a 9.30 start so that was 90 more minutes I could have spent in my bed!

But the course once it got started was really good. We covered the usual maternal collapse and neonatal resuscitation. As well as sepsis which is on the rise as a cause of maternal morbidity in NZ, and is the highest cause of maternal death in the UK. But don’t think the nz system is rocking it here - our highest cause of maternal death is suicide 😔. Anyway I digress. We then moved on to post partum haemorrhage. They wanted examples of situations in our practice where this had occurred.

Shit.

I could feel my heart thumping. I was going to have to talk about it. I know the benefit of talking - don’t get me wrong - but I don’t actually like doing it!

But I knew if my heart was thumping I probably needed to not ignore it. So I explained about the time I had to do bimanual compression. I told you all about this in ‘the calm before the storm’ post. Where my paramedic hubby was with me at a beautiful birth of a first time mum. But after the placenta she was in grave danger with the amount of blood she lost.

It’s something that pops into my head at random times and I know I am very lucky to have my man to talk about it with. I know he still thinks about it too. I have touched base with this woman a few times in the year since her baby was born.

Talking with midwifery colleagues in our own lingo and knowing they understood and could completely empathise with what I had to do and how that felt was healing. I should have done more of it earlier.

We always have to do the dreaded role plays, acting out an emergency situation. For the haemorrhage one I got to be the woman bleeding. So with a big belly strapped on - fully equipped with fake vagina even - I was lying on a bed holding on to my fake baby and informing my midwives that I felt a bit dizzy and there was something between my legs. While they buzzed around and treated me with drugs, a urinary catheter and an IV line into my fake arm (with actual red dye flowing through it - very cool!) I tried to keep up with what they were doing over my huge puku.

It was confronting from the woman’s perspective. Women often tell you it’s all a blur for them. I think I thought I understood this, they’re in pain, they’ve had a massive shock, they don’t understand the medical mumbo jumbo. I’m reassuring them - but I’m also pretty bloody busy! I never thought about the actual position the woman was in having an impact. The Midwives’s faces were all upside down, I couldn’t see what they were doing between my legs, they were talking over me and I couldn’t keep up with all the conversations. I could only hear the loudest person.

This supine position is not something we can change, flat on the back is the only one to save a life. I don’t think I can talk to a woman and reassure her in an emergency any more than I do already. But it made me think about our NZ continuity of care midwifery model. Imagine if you didn’t know any of those upturned faces. Where would you go in your head?

So at the end of the study day I messaged my client to check in a year on. I told her my man and I think of her and that day often. That I hope she knows to get in touch with me if she needs to.

You may have heard the hospital - or core - midwives are striking this upcoming week. Like us community midwives they do it hard. Working conditions for employed midwives and nurses are horrific. I’ve never seen it this bad. They are exhausted. Which means when we community midwives turn up for their help exhausted too - after already being with a client all night - they don’t have much left to give us. They are so stretched and overworked.

So now imagine if you didn’t know any of those upside down faces AND those unknown faces were burnt out and exhausted.

Ironically, the minimum staffing requirement for maintaining ‘Life Preserving Services’ (which the midwives union is required to ensure during the strike) is more than the amount of midwives normally rostered on in most of our DHB’s. Certainly in mine. And that folks, is why they are striking. That’s NOT ok. Showing your support for their strike draws attention to the needs of women and their babies who are so affected by our current midwifery staffing issues.

Now on a more entertaining note. The little boy with the earmuffs from the homebirth I wrote about in ‘Cutie and the Gina’ (that calls me Cutie) seems to have had a rethink. His mum has been waiting for the staff at daycare to tell her his version of events the day his little brother arrived.

It took him seven weeks! The other day she was greeted at daycare by the teacher saying “I had an interesting chat with your boy today about babies. He told me how you had a baby and it popped out of your ‘gina and there was blood EVERYwhere - but the dinosaurs came and helped you.”

So I’ve gone from Cutie to a dinosaur!

Nice. Thanks mate.