IM BACK!

It hasn't been because of complete and utter slackness... I just haven't had much of a chance to get on here to write the way I wish I could. The last half a year has been completely draining and pretty surreal all at once.

I am elated to say that I have finally completed something in my life that has set me on the path to making a difference the way I had hoped. I am now a registered midwife and therefore have created a new blog. One that I hope I will add to on a more frequent basis. I feel like there are things that need to be said and debriefing that needs to be done.

http://bringing-back-birth.blogspot.com/

I have not deviated from the title of this blog for obvious reasons but wanted to start afresh!

Leaving tomorrow!

Can't believe how fast it has gone since I first contemplated going to Malaysia... Time flys when you are having fun, so the saying goes!!

I'm nervous for a number of reasons, not just the fact that I have never left Australia's shores; more so because its the first time that I will have been away from my kids for more than a day and because it brings back memories of the days my husband would go away for months on end with the Navy. There is that ugly, awkward feeling inside of me that I used to get whenever he would leave, but this time the shoe is on the other foot.

I have kissed the kids a million times and put them both to bed for the last time in 3 weeks... the thought of it alone is bringing tears to my eyes. But I know in the long run I am doing all of this to benefit them... I just hope the both of them and their Daddy know how much I love them and how hard it is going to be for me to say goodbye tomorrow.

Time to go, tears are starting to well... will write again soon. Hopefully once I get to Singapore.

Oh what a day!

I am lost for words after Friday... I received a letter that congratulated me on being nominated for the 'Midwife of the Year' Award by one of the women I worked with whilst on placement. Still in shock, I had to giggle because I didn't know what else to do... it was strange being nominated for such an award particulary as I am not quite a midwife!

In the scheme of things, I would never strive to do what I do only to receive something such as this. I do what I do only because I feel it is every womans right to have a midwife that listens and assists in the ways that are most important to her. It just made me realise that I am fulfilling my purpose in this role which has always been my ultimate goal. I am just completely taken aback that this woman has taken the time to appreciate me in this way even though it is everything that she deserved. I should be thanking her for providing me with the opportunity to do what I love doing.

Thank you so very much N. xoxo

Time and Numbers...

I am not entirely sure why I called this post what I did... I guess that both of these things have become pressing in my life in recent weeks and I cannot seem to separate myself from them as much as I try to.

After stepping into this course in 2006 and thinking that 3 years would take forever to pass, I have been rudely awakened to the fact that time goes faster the further that you proceed into life. I have decisions to make, and fairly big ones at that, as to what I am going to do next year. Ideally I would love to become independent and not constrained by the system and politics but there are obviously the realities of finances and social aspects of my life that I have to consider.

I have options and I am going to keep them open because I know all too well that planning months, weeks or even days ahead is pointless as time has it that things can change and do change in an instant.

The most positive thing is that I am well on my way to completing the requirements of the course and will not be impeded in anyway by the 'numbers'. As much as I hate saying that word, it is a reality that at the end of it all, it has become about a number on a piece of paper. Nevermind that these numbers are women and families who have needs and wants and a wish to be respected. It is one of the most awkward of things to be asked - 'what number am I?' by a woman in labour and even harder to try and take away the focus of it being as such. Unfortunately, it is a result of the way this course is structured and the high demands they place on us. At the same time I whinge about it, I am glad that the numbers are higher than they have been in previous years because I am feeling better prepared and more able to step out with at least some confidence in my judgement and abilities.

And then there is the race against time... If something unforeseeable happens and I don't get my numbers its going to impact on what decision I make in the short term. Seems fitting in that the entire concept of that race is a constant element of birth and the length of time that a woman is allowed to birth. It is becoming less and less.

I cannot wait to finally be qualified, to make an impact on midwifery and more importantly on the women and families that I work with. I love what I do and I love the reality of the challenges that I am going to face however sucky the politics are going to be.

To cut or not to cut... that is the question!

Further to my recent post titled 'Time stood still...' I have been thinking about the lifeline they call the umbilical cord. Initiated by the fact that the shoulder dystocia that I experienced was combined with a nuchal cord and the recent 60 minutes documentary on birth choices that had women making reference to cord around the neck as a significant complication, I am prompted to discuss my thoughts and my recent research into what should be done, if anything.

For 259-294 days (more or less!) two arteries and one vein encased in whartons jelly transport everything that a fetus needs (and doesn't need) to ensure its survival. This supply line is the umbilical cord and it is what literally bonds mother and fetus. Damage, compression or compromise of the cord is associated with fetal compromise.

So what do we do when it comes to actually severing it? Controversial issue for many but for me it seems pretty simple. LEAVE IT!!

Unfortunately in practice this very rarely happens. It is not provided as an option similarly to physiological third stage. It is just done. Research that I have undertaken is not convincing as to reasons for active third stage and the use of syntocinon or syntometrine yet its the most common birth drug used and amazingly, never formally consented to by majority.

So what is the deal with cutting the cord or even checking for cord? Seems odd to me that it would be a problem because logic would have it that if the baby is born with nuchal cord than for a reality decent amount of time previous to labour and birth, the cord was around the neck. Even more logical is the possibility of it is happening. A baby freely moving within the amniotic fluid with something resembling a jump rope, seems highly likely that it is bound to wrap around something. So as normal as it is, what is the panic?

Common responses to this have been - short cord, very very tight around the neck, impeding on the ability of the baby to be born, etc... Hmmm...

So the head has been birthed and we have nuchal cord... at which point, the only oxygen supply is still the umbilical cord as baby still has not taken its first breath. So in making the decision to cut the cord at this point for whatever reason is dicey. Not only are we cutting the lifeline and oxygen supply, in doing so there is there is poor placental transfusion of blood that is vital to facilitating the blood flow through the lungs to initiate fetal ventilation. Further to this, there is the risk of hypovolaemia, pallor, anaemia, hypotension, hypothermia, hypoxia and respiratory distress etc... in comparison to possible bruising due to a tight cord.

Any baby that has a nuchal cord is in greater need of oxygen and yet it seems that the first thing that most do is deprive them of the most effective and efficient source. I have witnessed this decision being made and in almost every case it was a decision based on panic and uncertainty and more so the preempting of resuscitation being required.

Even more frustrating for me is the realisation that the process of resuscitation that seems to be in place completely contradicts the normal and physiological resuscitation that occurs. Not only is the cord cut, the cold-crying and cold-pressor reflexes are interrupted by the warmth from the resus trolley - the process that normally constrict the blood vessels of the cord and result in the placental transfusion that initiate ventilation and assist in closing of the foramen ovale and the beginning of fetal circulation. To add to the this, the entire process is done AWAY from the mother.

Something that I also read explained a lot about the normal and natural process of birth being interrupted rudely. Why is it that women refuse to cut the cord? Morley (2002) simply states that it has everything to do with with the mothers strong inhibition to 'damaging the cord'.

Like much of what I observe, its practice based on fear rather than fact. I found this quote - More proof that science, intervention and understanding have actually caused more harm than good. In 1842 it seemed so simple and yet somehow we have made it so difficult and contoversial.

“Let the loop be loosened to enable it to be cast off over the head. … [or] by slipping it down over the shoulders. … If this seems impossible, it should be left alone; and in the great majority of cases, it will not prevent the birth from taking place, after which the cord may be cast off. … Should the child be detained by the tightness of the cord, as does rarely happen, … the funis may be cut … Under such a necessity as this, a due respect for one’s own reputation should induce him to explain, to the bystanders, the reasons which rendered so considerable a departure from the ordinary practice so indispensable. I have known an accoucheur’s capability called harshly into question upon this very point of practice. I have never felt it necessary to do it but once. … The cord should not be cut until the pulsations have ceased.”
Charles D Meigs, M.D. Professor of Midwifery Philadelphia, 1842

Update - Malaysia Placement

I have now paid my deposit and all has been confirmed for me to jetset to Malaysia late September. Although still 3 months away, I am getting excited about the thought of doing something that is completely unlike me in the sense that I am homebody, a bit of loner and hate being away from my family.

I still haven't yet received my itinerary but we have been advised to organise our passports, immunisations and learn some of the native language. All a bit exciting!

I am hoping to get more info in weeks to come so stay tuned!

Jampa lagi!!

Time stood still...

Yesterday was one of those days that you look back on and question whether you did everything you possibly could given the situation. So much so, that you go to bed thinking about it, dreaming about it and the next day it begins to crash down like a ton of bricks.

The morning went smoothly as I attended a Caesarean Section. I was nervous going into it because the woman had had a previous emergency and had ended up with a cerebral aneurysm and impaired sight due to the effects of the anaesthesia and a postpatrtum haemorrhage which unfortunately I am getting used to. Thankfully all went well both for mother and baby. I spent a lot of time with her postoperatively and I lost count of how many times that she asked 'why do people opt for this?' or 'why would anyone want to put themselves through this if they didn't have to?' I am not entirely sure myself.

After this I was given the opportunity to care for another woman in labour, all was going well throughout the morning. Another induction but progress was being made. As always, there was the generalised attitude that multip=quick labour and despite a dilation of only 4cm in about 6 hours, amazingly everyone was pretty happy to let things go (Hallelujah!)

Things progressed well and next thing second stage had begun and we had baby's head on view. Again it wasn't as normal for a multip as the head took a long time to manoevure the Curve of Caris and crown but it happened just the same. It was beautiful to watch the woman instinctively work through it.

Time stood still and I awaited restitution... nothing. Contraction and nothing. The head slid back after I caught a glimpse of a cord and it was freakishly tight. Midwife made the call to cut and I made the call that we had a shoulder dystocia.

It took two to at the receiving end, two on either side trying McRoberts and me climbing onto the bed to begin with suprapubic pressure. All hope seemed lost until I felt the shoulder and manage to flick it around the symphysis pubis.

I don't think it really hit me what had happened until the midwife I was working with burst into tears. I am just glad I knew what to do at the time. Even more, of those midwives I have spoken to, many of them have gone years or decades without ever experiencing this or the extreme of PPH's and here is me, not even a registered midwife and I have been a part of both. I am taking it as a positive in the sense that experience equals knowledge and knowledge of what to do in situations like yesterday could mean everything.