The switch

So here I sit at the local market all set up to sell my pottery. Yes I’m early. I’m early because about 4.30 this morning the dog went mental waking me up. Hysterical yapping. Knowing I had guests in the Airbnb I roared out to catch her and stood smack in a pile of cat vomit… traipsed it across the carpet before I realised, then hopped to the back yard and washed it off in the freezing dew while I hissed the dogs name what felt like a thousand times before I found her. A calm awakening alright.

No more sleep for me.

Hubby was supposed to help me set up my stall after getting back from his night shift as a paramedic, but a very sick diabetic kept him late and I had to set up on my own. There was a bit of swearing at the gazebo but I managed.

I’ve left the vomit for him to find as payback.

But now I’m early so I decided I would write to you all. My midwifery life has been pretty busy this month. April babies used to be a result of the end of calving nine months before - I’m an April baby lol. Nowadays this probably isn’t the reason, maybe it’s just the lockdowns, but it’s a busy month.

In midwifery parlance: My first April client SROM’d. Then with no Ctx she became PROM, so we headed to the hospital to put the CTG on to monitor the FHR and start an IOL - and I still had to do an ARM!

Yep that’s how we talk sometimes. It all makes sense to anyone who works in obstetrics, but not to the woman it’s describing or to anyone else. I try really hard to not use acronyms when talking to my clients, or in my notes - not without at least writing it out in full first. But sometimes it’s really hard!

UTT (Up to toilet) and PU (passed urine) get written down so many times in a labour that I do admit to using those two.

In translation, for those that need me to decode, my client’s waters broke (SROM - Spontaneous Rupture of Membranes) then she didn’t get any ctx (contractions) for the next 18 hours, so became PROM (Prolonged Rupture of Membranes). So we went to the hospital to do a Ctg (cardiotocograph - which monitors the FHR (fetal heart rate) against uterine activity). Then we started an IOL (induction of labour), where even though her waters had gone earlier there were still some more to break, so I did an ARM (artificial rupture of membranes).

Whew! You can see why we use the acronyms 🤣

I’ve been on the receiving end of this when hubby goes into ambo speak telling me about his day. He just starts spouting letters at me. Usually it refers to heart stuff and he has no idea he’s doing it. It’s very annoying. For my own clients I often end up translating a doctors notes with a different colour pen so she can decipher them. They are even worse then the ambos!

This client went on to have an incredibly fast first time birth. She turned out to be one of those surprising women who have a complete personality change in labour. With what felt like a flick of a switch (and was most probably due to the fast road to transition) she completely altered her staunch personality and decided she could not continue.

At all.

Ever.

Nothing I could do or say would convince her otherwise. I felt for her, she had been coping so well up to this point. Now she was definitely not.

An induction of labour with synthetic oxytocin to cause the contractions to occur, hinders a woman’s own natural endorphins from helping her to cope with the pain. She had been a rockstar until I went for my tea break but when I returned she was sobbing and begging for me to make the pain go away. She had previously told me to refuse any requests for an epidural in labour unless I thought she couldn’t continue without it.

Now that’s a hard one. I can’t gauge her pain level. But I also know that this intense period will most likely be short lived and by the time an epidural is arranged she won’t have time to reap its benefits. But how long is a piece of string? How long is a labour? What if it’s actually hours to go. I can’t make any promises around how long she will have left, no matter what my gut tells me. A trite ‘each contraction is one step closer’ doesn’t really cut it when someone is begging.

So I went with our pre arranged plan. It’s often a winner. That if she asked me for an epidural I would get her to wait half an hour and reassess then. Sometimes the endorphins have caught up and wonder of wonders sometimes we are already pushing by then. So negotiations made, I knuckled down for 30 more minutes of acupressure, cold flannels, hip squeezes and constant reassuring words. I was sweating in my mask for sure!

And my gut was right! 28 minutes later - that actually felt like 108 - she made that wonderful guttural sound and that pre baby smell was suddenly in the room. When I handed her her baby a very short while later she immediately returned to herself. Gone was the fear and panic, replaced by this intense calmness and joy. It’s like waving a magic wand.

Absolutely bloody wonderful. When my adrenaline surge waned I felt just the same. Nothing beats seeing a mother being born!

That legendary first time mum had gone from four cm dilated to holding her baby in only three hours. No wonder she lost the plot for a little bit. I would have too! Her next baby will no doubt be an even faster home birth, but she and I will both know that the panic stage will be short lived, that her altered state is normal. Continuity of care will make her next birth easier for us both.

I can’t wait.

Right better go and switch to my other life and sell some cups…