Tuesday, November 21, 2006

Midwifery diaries, part 4

This is part 4, the final part, of the midwifery diaries. It's the original email that Mama's midwife friend sent out that inspired me to ask her if I could share her birth stories here. Unlike the previous posts, which were homebirth stories, it's a clear window into the world of a midwife working in a busy urban hospital, and I think that it's a good reminder that being a midwife doesn't only involve delivery of healthy babies to happy parents. There's a lot more to it than that.

I've gotten some comments and messages about various readers' experiences with midwives. Some of us have had good experiences, some of us have had bad experiences, and some of us have had both kinds in the same day. Each of us has gotten something different from these moments; from our experience, I was reminded that just because someone is a midwife doesn't mean that she'll automatically have a great bedside manner or a personality that's compatible to mine or Mama's.

These glimpses into the life of a midwife also remind me just how much a midwife is dealing with and prepared for when she steps into the room--be it a bedroom in a mother's house or a labor and delivery room in a hospital. Being a midwife takes compassion, perserverance, and tremendous strength, and these entries from Mama's friend has demonstrated that she has all of these characteristics as well as great courage.

In this week of thanks (here in the U.S.), I'm thankful to her for sharing this view from the other end of the bed with us, and I'm thankful that she's working as a midwife, because she's exactly the kind of person who I would want to catch our baby as he or she came into this life with us.

[Note: All of the names and initials have been changed, and any identifying characteristics have been omitted or modified, to protect everyone's privacy.]

I'm back from my first call at the hospital--which is where I do triage, labor, delivery, and post-partum care. It's totally different than working the health clinics doing prenatal visits--so it felt like a whole new world today--with an entirely different set of rules, parameters, clinical skills, and people to meet. Gah, I'm exhausted.

Just a little update, though--to share a little of my life as a midwife.

I did a 12-hour shift--to ease me in, as I'll normally do 24 hour shifts. I worked with another midwife (Michelle) as I will during my 2+ months of orientation. We moved nonstop from 8-3pm--not a break or moment to decompress, breathe, or eat--then got a little space, then kept moving again until I left at 8pm.

Amazingly, it was considered slow there, as we were doing lots of paperwork stuff, consults, management, pager calls. Still--for me it was intense and not slow at all.

My first woman was 21 weeks pregnant, diagnosed with a closed myelomeningocele, a neural tube defect--NTD (which can cause paralysis and lots of other problems--can be genetic or due to low folic acid consumption at conception), and was terminating the pregnancy. The fetus had already received a potassium chloride injection, which stopped its heart--and then she was receiving medication to dilate her cervix. When I got there, I checked her cervix and she was almost completely ready to push. Immediately after her water broke, Michelle and I came into the room to do the delivery; the woman pushed while we were setting up the cart, out came the fetus, which was wrapped up and taken away.

The client seemed okay--not very emotional, but I think that's more cultural expression than anything (at least from my own experience with West African culture--she's from West Africa)--and she was given some IV pain meds right before delivery--so she was also pretty out of it when things were happening. As for me, I've delivered an intrauterine fetal demise (IUFD) before--but never so early in pregnancy--so I was learning as I went along. It felt super overwhelming--but Michelle and the nurse got me through the skills and helped me when I needed help. We later examined the fetus, and it was intense to see the NTD, already obvious in its pathology at such early fetal development.

After this experience, we did rounds in post-partum and discharged a woman. We then spent a lot of time consulting on another woman I saw yesterday in the clinic--who has high blood pressure and could possibly develop preeclampsia. After much back and forth, we transferred her to our high risk docs for care.

Another woman came in at 16 weeks pregnant, bleeding profusely from her vagina--passing clots, as well. She still had a viable fetus with heart tones, and no obvious etiology for the bleeding--as she wasn't cramping or contracting, making us think she might be having a miscarriage. I did a speculum exam, saw tons of blood in the vaginal vault, and blood coming from the cervical os (the opening of the cervix). I then did a digital vaginal exam, but found her cervix to only be open a fingertip. When we ran her blood work, she was shown to be severely anemic. we consulted again with the high risk docs and transferred her to their care for a blood transfusion and to continue managing the bleeding. Still not sure what was happening--but at that point, if she were to miscarry, there was nothing we could do to stop it, so it was a lot of expectant management regarding the pregnancy.

Another woman came in with abdominal pain at 34 weeks--turns out she's an uncontrolled gestational diabetic who had been missing appointments and came late to prenatal care. Another doc consult . . . as well as my doing an exam to see if she was in pain from labor. No contractions, no bleeding, cervix was open a little, which--while not great--can be normal if she's had a baby before (which she had). She was transferred out of our care as well. I did a lot of discharge teaching her her and her husband before she left--trying to strike a fine balance between trying to create more compliance regarding her care, and not being patronizing, of the "I know what's good for you and you don't" variety.

Finally--a 23 year old came in for induction of labor due to being past her due date. she was all alone--no longer involved with the father of the baby, and didn't want any other family/friend support. Her cervix was super ripe and ready for induction--so we got that started and she responded with great contractions. All seemed well with her when I left--her last cervical exam showing good progress. Just sad to see her all alone, comforted by an epidural and the television. That's an enormous part of my job--working with people who have so little support in their lives. It's hard to not want to work miracles . . .

So, anyway--that was the day in a nutshell. Not to mention a bunch of pages to return, so many new details--where to get billing forms, how to use the computer, where the charts are kept, room codes, where the cafeteria is located, new names and faces, new politics. There were moments when I felt like melting down and just asking if I could go home--that I was done learning for the day. Other moments, when I was singing my midwife song--just so amazed that I was there, and no longer a student.

Anyway--so here i am, a midwife.

The incredible thing is how unique each day will be. Today was heavy on the abnormal--lots of high risk, and my only "birth" an IUFD. Friday (my next call) may be 5 births in a row--all lower risk, all within the realm of "normal" that I believe pregnancy and birth to be. Or maybe something i've never seen before. Who knows.

Much love.

I'm a midwife!

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1 comment:

  1. For some reason, the one story this time that really got me was the last woman, laboring all alone while watching the TV. I sure hope she got some family support after the baby came.