tag:blogger.com,1999:blog-77597698956085371392024-03-12T22:02:38.291-07:00The Baby Catcher DiariesNataliehttp://www.blogger.com/profile/12859873847487399531noreply@blogger.comBlogger9125tag:blogger.com,1999:blog-7759769895608537139.post-86594181190220008212014-04-23T21:10:00.000-07:002014-04-23T21:10:01.751-07:00The joys of running....and birthing!<div align="center" class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; text-align: center;">
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<span style="line-height: 33px;">It's been a very, very long time since I've made a blog entry but I'm back! Here's a little explanation of my latest entry. I wrote this almost 2 years ago and within a few days of writing it, before I had a chance to post it, my laptop died! I meant to re-write it but it just never happened. I recently bought a new laptop and was able to recover the original document so here it is! I hope you enjoy and I hope to post more often!</span></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-size: 22.0pt; line-height: 115%;">You Run? (Have a baby without
medications?) You’re WEIRD!<o:p></o:p></span></b></div>
<div align="center" class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; text-align: center;">
OR<o:p></o:p></div>
<div align="center" class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; text-align: center;">
<i style="mso-bidi-font-style: normal;">Why would you put
yourself (your baby) in danger like that?<o:p></o:p></i></div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
I’ve often
compared childbirth to running but recently as I was struggling through a
particularly difficult run I really gained a new appreciation for the
similarities.<span style="mso-spacerun: yes;"> </span>This epiphany took place
during the “To Bone and Back Relay.” <span style="mso-spacerun: yes;"> </span>For
those of my friends that don’t live near me, a brief explanation (bear with me,
locals).<span style="mso-spacerun: yes;"> </span>Each year on the fourth
Saturday in June, hundreds of runners gather for the To Bone and Back
relay.<span style="mso-spacerun: yes;"> </span>It starts at the office of the
orthopedic surgeons that sponsor the run (get it…BONE, BACK, orthopedic
surgeons…??) it then goes 20 miles up Sunnyside Road to a little farming town
called Bone, Idaho (yes, there IS a town called Bone, Idaho) and then back
again for a total of 40 miles. Teams of one to eight runners form to split up
the five mile legs of the race. This year, I ran the seventh of eight legs.<span style="mso-spacerun: yes;"> </span>The advantage of leg seven is it is all
downhill (stay away from leg two, it’s all UP hill) the disadvantages are it is
all desert with no shade and since it’s at the end of the race it is usually
run in the afternoon when temperatures are approaching triple digits, oh, and
it’s all downhill. <o:p></o:p></div>
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<br /></div>
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All morning I anticipated my run, I prepared by packing a small
bag with sunscreen, water, PowerBars, extra socks, Band-Aids, flip flops for
after the race, sunglasses and a CPR mask complete with “how to use” instructions.<span style="mso-spacerun: yes;"> </span>I hydrated carefully so that I would be
adequately hydrated but not over hydrated.<span style="mso-spacerun: yes;">
</span>I ate light so I wouldn’t be nauseated during my five mile run.<span style="mso-spacerun: yes;"> </span>When the big moment finally arrived my dear
friends dropped me off at the starting point and the leg six runner passed the
bone to me (yes, it’s really a bone-a fake bone but a bone nonetheless) and I
was off.<span style="mso-spacerun: yes;"> </span>I was excited, relaxed and felt
great.<span style="mso-spacerun: yes;"> </span>I had my iPod on with my
preselected inspirational music and I had a firm plan for getting through the
next five miles.<span style="mso-spacerun: yes;"> </span>I had planned a
run/walk regimen because I knew I would never get through running in that heat
for that long.<span style="mso-spacerun: yes;"> </span>I was actually amazed
when I heard the voice in my ears tell me I’d reached one mile.<span style="mso-spacerun: yes;"> </span>I was not tired, I was feeling amazing and I
was every optimistic about the next four miles, this was nothing! <o:p></o:p></div>
<div class="MsoNormal">
This is often how women begin their labor experience. They
prepare ahead, packing items they will need before, during and after. They make
a plan that they are sure will work well for them.<span style="mso-spacerun: yes;"> </span>Early labor is often motivating and
exciting.<span style="mso-spacerun: yes;"> </span>Progressing a centimeter or
two feels easy and the next six or seven centimeters feel like they should be a
breeze.<span style="mso-spacerun: yes;"> </span>The plan is easy to follow to
the letter.<span style="mso-spacerun: yes;"> </span><o:p></o:p></div>
<div class="MsoNormal">
As I approached mile two I began to see that I may need to
alter my plan just a little.<span style="mso-spacerun: yes;"> </span>The heat
was getting to me, I think I may have gone out too fast in the first mile.<span style="mso-spacerun: yes;"> </span>I could feel I was struggling but I was still
determined to finish the next three miles. I began to walk a little more often
than I’d planned but still maintained an acceptable pace.<span style="mso-spacerun: yes;"> </span>I still felt motivated and excited. <o:p></o:p></div>
<div class="MsoNormal">
Often as women progress through labor they begin to realize
that although they are determined to stick to their plan, they may need to make
some minor adjustments.<span style="mso-spacerun: yes;"> </span>Maybe walking
the halls isn’t as easy as they had envisioned and sitting on a birth ball or
in a tub of warm water is more helpful.<span style="mso-spacerun: yes;"> </span><o:p></o:p></div>
<div class="MsoNormal">
As I approached mid mile three I was beginning to doubt my
ability to even finish.<span style="mso-spacerun: yes;"> </span>I was hot, I was
tired and uncomfortable.<span style="mso-spacerun: yes;"> </span>It was as I
approached mile four that our support vehicle pulled up next to me. Two friends
jumped out and began to run alongside me.<span style="mso-spacerun: yes;">
</span>They brought a bottle of water with them and handed it to me.<span style="mso-spacerun: yes;"> </span>I was so grateful for that water!<span style="mso-spacerun: yes;"> </span>I wondered how I would have completed the
five mile run if I had not been allowed to eat or drink anything.<span style="mso-spacerun: yes;"> </span>Such a physically taxing event requires food
and drink.<span style="mso-spacerun: yes;"> </span>I didn’t want a prime rib
dinner or a large pizza but water and fruit were refreshing and gave me the
energy I needed to complete the task at hand.<o:p></o:p></div>
<div class="MsoNormal">
I’ve often wondered how we expect women to go through labor
and not eat or drink.<span style="mso-spacerun: yes;"> </span>Women in labor,
also don’t want prime rib or pizza.<span style="mso-spacerun: yes;"> </span>They
usually want fluids and light snacks.<span style="mso-spacerun: yes;">
</span>Now, the reason food and drink is generally withheld from women in labor
is the risk of aspiration should she require a c-section or other emergency
surgery.<span style="mso-spacerun: yes;"> </span>As I was running, an ambulance
passed me.<span style="mso-spacerun: yes;"> </span>I later learned that there
were at least two people treated for heat exhaustion and taken to the
hospital.<span style="mso-spacerun: yes;"> </span>This could have happened to
me, I could have fallen and broken my leg and required surgery, yet the race
organizers didn’t require that no one take foods or fluids in.<span style="mso-spacerun: yes;"> </span>They also didn’t require that I run with an
IV in my arm.<span style="mso-spacerun: yes;"> </span><o:p></o:p></div>
<div class="MsoNormal">
Earlier I mentioned the friends that joined me on my
run.<span style="mso-spacerun: yes;"> </span>Oh, my dear sweet friends.<span style="mso-spacerun: yes;"> </span>They meant well, they really did…but honestly
if I would have had the energy, I may have inflicted bodily harm on them.<span style="mso-spacerun: yes;"> </span>Their cheery “come, on, only a mile and a
half to go” was not extremely helpful.<span style="mso-spacerun: yes;">
</span>At that point I couldn’t think about a mile and a half, I could only
think about the next step, then the next and the next.<span style="mso-spacerun: yes;"> </span>One of my running buddies later apologized to
me after her leg of the race. I handed off to her and by the time she was three
and a half miles into her leg she was also struggling in the heat and realized
that if someone told her “faster, only a mile and a half to go” she would have
probably ripped their tounge out!<o:p></o:p></div>
<div class="MsoNormal">
Often “supportive” family members mean well when mothers are
in labor but are often very annoying! The grandmother that chooses this time to
share the story of the eleven pound baby she delivered that “ripped me in two”
or the mother that decides while her daughter is having a contraction is the
right time to mention that her labors were much harder than what the daughter
is now experiencing-well, they are truly risking their safety.<span style="mso-spacerun: yes;"> </span>These comments do not belong in the labor
room!<o:p></o:p></div>
<div class="MsoNormal">
As I approached mile five and could finally see the hand off
area, I began to feel hopeful.<span style="mso-spacerun: yes;"> </span>I wish I
could say I had a renewed burst of energy but truly, I didn’t.<span style="mso-spacerun: yes;"> </span>I was still taking it one step at a time but
the one step at a time no longer felt like it was a never ending journey.<span style="mso-spacerun: yes;"> </span>I also wish I could say I felt great relief
when I finished the run but I didn’t.<span style="mso-spacerun: yes;"> </span>It
took some time.<span style="mso-spacerun: yes;"> </span>When I run at home and
have a particularly tough run, I usually come into the house and drop to my
hands and knees where I will breathe heavily and loudly until I can breathe
easily.<span style="mso-spacerun: yes;"> </span>Because I finished the race with
nothing but asphalt, gravel and sagebrush in sight, I was not able to drop to
my knees and feel comfortable.<span style="mso-spacerun: yes;"> </span>I had to
walk around slowly and my recovery took longer than when I am able to do what I
need to do to get through it.<o:p></o:p></div>
<div class="MsoNormal">
The end of labor is tough, pushing a baby out is hard work.<span style="mso-spacerun: yes;"> </span>It is intense and it flippin’ HURTS!<span style="mso-spacerun: yes;"> </span>Women need to be able to do what they need to
do to get through it.<span style="mso-spacerun: yes;"> </span>They need to be
allowed to move around and change positions.<span style="mso-spacerun: yes;">
</span>They shouldn’t be restricted to one position or one “way” of doing
it.<span style="mso-spacerun: yes;"> </span>They shouldn’t be yelled at and made
to hold their breath while trying to struggle through the last few minutes (or
sometimes hours) of labor.<span style="mso-spacerun: yes;"> </span>No one should
tell them they have to withdraw from the race because they aren’t running fast
enough.<span style="mso-spacerun: yes;"> </span>No one should tell them they
should withdraw from the race because someone else is tired of waiting for
them.<span style="mso-spacerun: yes;"> </span>They should only be told to
withdraw from the race when their health is truly in danger. <o:p></o:p></div>
<div class="MsoNormal">
Once the five mile run was over I was sore and I was
tired.<span style="mso-spacerun: yes;"> </span>I didn’t earn a prize, I didn’t
earn a medal, I didn’t earn fame-nor did I expect that I would when I signed up
for this race. What I did earn was the satisfaction that I finished a very
physically demanding challenge.<span style="mso-spacerun: yes;"> </span>I set a
goal and I reached it.<span style="mso-spacerun: yes;"> </span>It inspired me that
I can do other things that are difficult.<span style="mso-spacerun: yes;">
</span>It gave me confidence that I could set bigger goals.<span style="mso-spacerun: yes;"> </span>The fact that I ran five miles in the heat is
very insignificant to most people.<span style="mso-spacerun: yes;"> </span>Some
people would tell me they’ve done better.<span style="mso-spacerun: yes;">
</span>Some will tell me that it’s crazy that I run at all.<span style="mso-spacerun: yes;"> </span>Some will tell me I’m “stupid” “crazy” or
even worse-for running five miles.<span style="mso-spacerun: yes;"> </span>So,
it’s a good thing no one else’s opinion is important. <o:p></o:p></div>
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This holds true for women that choose to birth their babies
without medications.<span style="mso-spacerun: yes;"> </span>It’s not for
everyone and no one expects it to be but for those women that choose to do so,
they deserve respect and support, not criticism and hindrance. <o:p></o:p></div>
Nataliehttp://www.blogger.com/profile/12859873847487399531noreply@blogger.com2tag:blogger.com,1999:blog-7759769895608537139.post-74477382861815304442011-12-06T22:17:00.000-08:002011-12-06T22:17:01.830-08:00Being "with woman"<div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">“Tiene otro?”<span style="mso-spacerun: yes;"> </span>She nods her head, she places her hands high on the wall and leans into it.<span style="mso-spacerun: yes;"> </span>Standing behind her I place my hands on her hips and apply a firm, squeezing pressure.<span style="mso-spacerun: yes;"> </span>She sways gently and moans softly.<span style="mso-spacerun: yes;"> </span>The beautiful toddler giggles and runs back and forth between her mommy and the wall-as if playing a game of “London Bridges.”<span style="mso-spacerun: yes;"> </span>Between my little bit of Spanish and her sister-in-law’s broken English we are able to communicate effectively.<span style="mso-spacerun: yes;"> </span></span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">The contraction releases and she takes a deep cleansing breath and smiles, then begins to again pace back and forth across the floor, the little girl following her every step.<span style="mso-spacerun: yes;"> </span>Baby sister is on her way but daddy can’t be here, he’s working out of town.<span style="mso-spacerun: yes;"> </span>The mother to be has her sister-in-law and her cousin at her side helping her bring the new baby into the world.<span style="mso-spacerun: yes;"> </span></span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">“La palota?”<span style="mso-spacerun: yes;"> </span>“Si.” I help her balance on the large red ball.<span style="mso-spacerun: yes;"> </span>This makes the toddler giggle.<span style="mso-spacerun: yes;"> </span>I bring in a smaller version of the ball for her to sit on-just like Mommy.<span style="mso-spacerun: yes;"> </span>I sit behind Mommy and rub her back.<span style="mso-spacerun: yes;"> </span>This is not as comfortable as walking, she stands up and walks.<span style="mso-spacerun: yes;"> </span>She leans on the wall again.<span style="mso-spacerun: yes;"> </span>I resume the hip counter-pressures.<span style="mso-spacerun: yes;"> </span>The little girl wants to help.<span style="mso-spacerun: yes;"> </span>She places her hands on the outside of mommy’s knees and presses in-she giggles. <span style="mso-spacerun: yes;"> </span>Baby sister is getting closer.<span style="mso-spacerun: yes;"> </span>Mommy can feel her moving down.<span style="mso-spacerun: yes;"> </span>Standing is no longer comfortable, she moves to the bed.<span style="mso-spacerun: yes;"> </span>Her soft, gentle moans are becoming louder.<span style="mso-spacerun: yes;"> </span>I encourage her to work with her body-don’t fight it, let the baby come.<span style="mso-spacerun: yes;"> </span>Tears roll from her eyes.<span style="mso-spacerun: yes;"> </span>The little girl is scared.<span style="mso-spacerun: yes;"> </span>She leaves with the young cousin that has just arrived.<span style="mso-spacerun: yes;"> </span>They will go play with toys in the waiting room and return to meet baby sister.<span style="mso-spacerun: yes;"> </span>Rose comes in to help me talk to Mom in her native language.<span style="mso-spacerun: yes;"> </span></span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">She begins to bear down.<span style="mso-spacerun: yes;"> </span>“Muy bien.”<span style="mso-spacerun: yes;"> </span>“NO PUEDO, NO PUEDO, NO PUEDO!”<span style="mso-spacerun: yes;"> </span>“Si, se puede, meja, si, su puede.”<span style="mso-spacerun: yes;"> </span>We see the top of baby’s head.<span style="mso-spacerun: yes;"> </span>She will be beautiful and have a full head of dark black hair. She digs deep down and finds the last bit of strength she needs to bring her baby into the world.<span style="mso-spacerun: yes;"> </span>Rose encourages her and helps me coach her.<span style="mso-spacerun: yes;"> </span>The head slides out easily, the shoulders follow and the baby slides into my hands.<span style="mso-spacerun: yes;"> </span>I immediately place her on mom’s tummy.<span style="mso-spacerun: yes;"> </span>Rose has tears running down her face.<span style="mso-spacerun: yes;"> </span>I have tears in my eyes.<span style="mso-spacerun: yes;"> </span>Mommy has tears of relief and happiness.<span style="mso-spacerun: yes;"> </span>Aunt and cousin have broad smiles and tears. Baby is crying vigorously.<span style="mso-spacerun: yes;"> </span></span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">Happy Birthday, Baby.<span style="mso-spacerun: yes;"> </span>Your sister is here to meet you.<span style="mso-spacerun: yes;"> </span>The toddler crawls up on the bed with mommy and gently touches her sister-smiling and laughing in delight.<span style="mso-spacerun: yes;"> </span>Daddy is on the phone.<span style="mso-spacerun: yes;"> </span>Daddy asks his sister to please thank the midwife for helping his baby come safely into the world…..and I know I have done my job.<span style="mso-spacerun: yes;"> </span></span></div>Nataliehttp://www.blogger.com/profile/12859873847487399531noreply@blogger.com1tag:blogger.com,1999:blog-7759769895608537139.post-10367814565606916642011-09-11T13:19:00.000-07:002011-09-11T13:19:56.091-07:00Learning to Speak Fluent Midwifery<span style="font-family: Calibri;"></span> <div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">Two days ago I had an idea for my next blog entry, this morning I had a midwifery newsletter in my inbox with an article on the same subject I was thinking about so it must be important.<span style="mso-spacerun: yes;"> </span>It’s the idea of learning to speak “midwifery.”<span style="mso-spacerun: yes;"> </span></span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">The word “midwife” means “with woman.”<span style="mso-spacerun: yes;"> </span>The very nature of the word implies a trust of birth and women’s bodies.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">Tuesday evening I had the opportunity to hear two physicians discussing a birth.<span style="mso-spacerun: yes;"> </span>Neither are physicians I work with nor are they even physicians that practice in Idaho Falls.<span style="mso-spacerun: yes;"> </span>One asked the other how things were on the labor and delivery unit where they both practiced.<span style="mso-spacerun: yes;"> </span>The female physician responded with “they just delivered the last one.”<span style="mso-spacerun: yes;"> </span>The male physician then began to relate the experience he had with a woman giving birth earlier in the day. He shared with the female physician that she was a “primigravida that was 8 cm with a posterior baby.<span style="mso-spacerun: yes;"> </span>I was about to do a Ceasarean but the nurse called and said that she might be making some progress.<span style="mso-spacerun: yes;"> </span>I checked her awhile later and she was complete so I ‘let’ her push but I didn’t think she would make it but she did start to make some progress so I couldn’t do a C-section. Then she finally delivered-I couldn’t believe it.”<span style="mso-spacerun: yes;"> </span>He appeared to be very upset about his inability to justify doing <span style="mso-spacerun: yes;"> </span>a c-section because (the nerve of this woman) she was making progress.<span style="mso-spacerun: yes;"> </span></span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">Several things about this conversation struck a nerve with me that caused me to bite my tongue.<span style="mso-spacerun: yes;"> </span>First was the female physician’s response “they just delivered the last one.”<span style="mso-spacerun: yes;"> </span>She took all credit and focus from the women giving birth and put the credit on the staff that “delivered” the babies.<span style="mso-spacerun: yes;"> </span>The women giving birth were merely “jobs” for the staff to complete-another task to check off the list.<span style="mso-spacerun: yes;"> </span></span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">The next thing that struck me was the attitude of the male physician toward the woman making “slow” progress.<span style="mso-spacerun: yes;"> </span>There was no discussion of anything that was done to help turn this baby-only eagerness to cut the baby out.<span style="mso-spacerun: yes;"> </span>He didn’t mention changing maternal position, he didn’t express any desire to have patience to let the baby come down on its own.<span style="mso-spacerun: yes;"> </span>In fact, he seemed very disappointed that she had a vaginal birth instead of a surgical birth. <span style="mso-spacerun: yes;"> </span></span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">I began to wonder how the same conversation would have gone between two practitioners that trust birth and trust women.<span style="mso-spacerun: yes;"> </span>I imagine the female provider would have responded to the male provider’s initial question with something more like “the last mother in labor just gave birth.”<span style="mso-spacerun: yes;"> </span>The discussion about the “primigravida” with “slow” progress may have been filled with excitement at the woman’s strength and power and trust in her ability to birth.<span style="mso-spacerun: yes;"> </span>C-section would probably have not even been mentioned.<span style="mso-spacerun: yes;"> </span>Instead of “I can’t believe she did it” the practitioners would have rejoiced in another successful birth with a healthy mom and a healthy baby.<span style="mso-spacerun: yes;"> </span></span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">I absolutely love my job because to me, it’s more than just a job.<span style="mso-spacerun: yes;"> </span>Pizzas are “delivered” in 30 minutes or less.<span style="mso-spacerun: yes;"> </span>Births are a process to be trusted, celebrated and not rushed.<span style="mso-spacerun: yes;"> </span></span></div>Nataliehttp://www.blogger.com/profile/12859873847487399531noreply@blogger.com0tag:blogger.com,1999:blog-7759769895608537139.post-87325101901382430802011-07-11T21:15:00.001-07:002011-07-11T21:15:08.885-07:00To Each Her Own<div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">As any reader of this blog knows, I am a huge fan of natural childbirth but even more than that, I am a fan of giving moms the birth experience they want.<span style="mso-spacerun: yes;"> </span>I think there is something to be said for the feeling a woman gets when she conquers the challenge of an unmedicated birth.<span style="mso-spacerun: yes;"> </span>It’s much like the “high” athletes get when they complete an extreme physical challenge.<span style="mso-spacerun: yes;"> </span>Sometimes, however, athletes enjoy a nice drive through the scenery instead of a bike or a run.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">Anna was pregnant with her third baby and desired an unmedicated childbirth.<span style="mso-spacerun: yes;"> </span>Her two previous children had been born without the assistance of medications and she had done very well and thoroughly enjoyed the experience.<span style="mso-spacerun: yes;"> </span>Anna came into the hospital in labor late on a summer evening.<span style="mso-spacerun: yes;"> </span>She was handling the contractions very well and breathing through them.<span style="mso-spacerun: yes;"> </span>We had discussed her plans many times in the office and had reviewed relaxation and breathing techniques.<span style="mso-spacerun: yes;"> </span>I arrived at the hospital to see her shortly after she was admitted.<span style="mso-spacerun: yes;"> </span>I walked into the room and very confidently she said “I have changed my mind, I want to have an epidural.”<span style="mso-spacerun: yes;"> </span>She acknowledged that she was doing very well but just simply did not want to feel the pain of childbirth this time.<span style="mso-spacerun: yes;"> </span>Her husband was present and he was very supportive.<span style="mso-spacerun: yes;"> </span>We, of course, honored her wishes and called anesthesia and they promptly came and placed an epidural and Anna got some much needed rest.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">While Anna rested I went and assisted with a c-section on another patient.<span style="mso-spacerun: yes;"> </span>When I was finished I came back to check on Anna.<span style="mso-spacerun: yes;"> </span>She was still very comfortable but feeling some pelvic pressure so we checked her and her baby was ready to come.<span style="mso-spacerun: yes;"> </span>Anna asked for a mirror so she could watch the baby’s birth.<span style="mso-spacerun: yes;"> </span>We positioned the mirror and she watched as the baby eased out into the world.<span style="mso-spacerun: yes;"> </span>The full head of black hair, the cute little ears, the adorable button nose-they all slipped out easily as I sat there with my hands folded in my lap.<span style="mso-spacerun: yes;"> </span>Then the shoulders began to gently slide out so I placed my hands on the baby’s head, as the shoulders slid out I encouraged Anna to reach for her baby.<span style="mso-spacerun: yes;"> </span>She reached down and lifted the baby the rest of the way out of her body and up to her chest.<span style="mso-spacerun: yes;"> </span>The baby began to cry vigorously and tears ran down mommy and daddy’s face as well.<span style="mso-spacerun: yes;"> </span>A beautiful, healthy baby girl.<span style="mso-spacerun: yes;"> </span></span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">Many times mothers that originally planned an unmedicated birth and then change their mind feel guilty and they often apologize to me.<span style="mso-spacerun: yes;"> </span>I try to reassure them that they do not need to apologize to me at all-it is their body, their birth experience, not mine.<span style="mso-spacerun: yes;"> </span>Anna had no guilt.<span style="mso-spacerun: yes;"> </span>When the birth was over she told me that she was very happy with her decision.<span style="mso-spacerun: yes;"> </span>She enjoyed watching the birth and participating and based on her past experience she didn’t believe she could have done that with the pain she would have been feeling.<span style="mso-spacerun: yes;"> </span></span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">This was truly a successful birth in terms of giving the mother the experience she wanted-even though there was a change of plans…and giving moms the experience they want is what it is all about!</span></div>Nataliehttp://www.blogger.com/profile/12859873847487399531noreply@blogger.com3tag:blogger.com,1999:blog-7759769895608537139.post-5628017591236192302011-05-19T20:56:00.001-07:002011-05-19T20:56:31.562-07:00The Little Midwife<span style="font-family: Calibri;">Every time I think my job can’t get better, it does!<span style="mso-spacerun: yes;"> </span></span><br />
<br />
<div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">This afternoon I had the opportunity to catch a darling baby boy, but this time, I had help!<span style="mso-spacerun: yes;"> </span>This mama had lots and lots of family support.<span style="mso-spacerun: yes;"> </span>Daddy was there, the grandmas were there and the big sister was there.<span style="mso-spacerun: yes;"> </span>We’ll call big sister “Sarah.”<span style="mso-spacerun: yes;"> </span>Sarah is six years old and she was SO excited to finally meet her new baby brother. Every time I would walk into the room she would ask me if it was time yet.<span style="mso-spacerun: yes;"> </span>At one point she saw a little bit of blood on my glove after an exam and was a little worried.<span style="mso-spacerun: yes;"> </span>The grandmas were amazing and promptly reassured her that it was OK and perfectly normal. It quickly became obvious to me that the mom and the grandmas had already done a great job of preparing Sarah for what she might see during a birth.<span style="mso-spacerun: yes;"> </span>Her mom asked me if it was OK with me if she stayed in the room for the birth.<span style="mso-spacerun: yes;"> </span>I always feel like I’ve failed a little if they have to ask me something like that-it’s THEIR experience, not mine.<span style="mso-spacerun: yes;"> </span>I told mom that I was supportive of whatever they wanted.<span style="mso-spacerun: yes;"> </span></span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">Finally the time was here to meet the new baby brother!<span style="mso-spacerun: yes;"> </span>As mom pushed, Sarah became very interested in the process.<span style="mso-spacerun: yes;"> </span>She was fascinated with seeing the top of her baby brother’s head as he was about to be born. Sarah started out standing next to her dad, daddy was more nervous than Sarah.<span style="mso-spacerun: yes;"> </span>At one point, Sarah said to her dad “daddy, you’re shivering!<span style="mso-spacerun: yes;"> </span>Stop shivering, it’s going to be OK.”<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>She progressively moved from the head of mom’s bed to my side.<span style="mso-spacerun: yes;"> </span>I asked mom if it was OK if Sarah helped me catch the baby-she said it was so we asked Sarah if she wanted to help. She eagerly said “YES!”<span style="mso-spacerun: yes;"> </span>In no time at all we had her outfitted with gloves and a gown so she wouldn’t get her “I’m a BIG Sister” t-shirt messy.<span style="mso-spacerun: yes;"> </span>I gave Sarah instructions that I would help guide the head out and once the shoulders were out it was her job to “catch” the rest of the body with me.<span style="mso-spacerun: yes;"> </span>As the head began to emerge Sarah was very “hands on” I gently supported the perineum and Sarah’s hands were right next to mine the whole time.<span style="mso-spacerun: yes;"> </span>Then, two contractions later the baby boy was born.<span style="mso-spacerun: yes;"> </span>Sarah did exactly as we’d discussed and she caught the baby’s lower body and together we put baby on mom’s tummy.<span style="mso-spacerun: yes;"> </span>She was SO excited and asked so many very good questions.<span style="mso-spacerun: yes;"> </span>She wanted to know everything there was to know about babies!<span style="mso-spacerun: yes;"> </span>Once the baby was on mommy’s tummy Sarah wanted to take her gloves off and climb up next to them-which she did!<span style="mso-spacerun: yes;"> </span>She touched the baby and talked to him-she took ownership of him!!<span style="mso-spacerun: yes;"> </span></span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">Sarah’s midwifery skills didn’t stop with the birth.<span style="mso-spacerun: yes;"> </span>The nurse rubbed mom’s tummy and checked her bleeding.<span style="mso-spacerun: yes;"> </span>Five minutes later I looked over to see Sarah sitting on the bed next to mommy, pulling up her gown and rubbing on her belly!<span style="mso-spacerun: yes;"> </span>Once mommy and baby were all stable, Sarah and I both signed the birth certificate.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">I’m sure some people think I’m weird or crazy but that’s OK, Sarah will never forget this experience-and I’m sure her kindergarten teacher will get a kick out of “Show and Tell” this week!</span></div>Nataliehttp://www.blogger.com/profile/12859873847487399531noreply@blogger.com3tag:blogger.com,1999:blog-7759769895608537139.post-77046970094623204742011-05-04T14:21:00.000-07:002011-05-04T14:21:42.404-07:00The Amazing Melding of Midwivery and Medicine<div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">Several weeks ago I caught six babies in a row in which mom used no medications, no interventions-they “went natural.”<span style="mso-spacerun: yes;"> </span>I was amazed at each and every one of these amazing, strong women.<span style="mso-spacerun: yes;"> </span>Over the past 24 hours I have been amazed by three more amazing women.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">“Jenny” was one of the first moms that I saw for every one of her prenatal visits-from first to last!<span style="mso-spacerun: yes;"> </span>Jenny was pregnant with her second baby. With Jenny’s first baby she labored for some time before having a c-section.<span style="mso-spacerun: yes;"> </span>Many times during her pregnancy we discussed her options to attempt a vaginal delivery or schedule a repeat c-section, this was a difficult decision for her.<span style="mso-spacerun: yes;"> </span>In the end, Jenny decided to wait and see if she went into labor on her own.<span style="mso-spacerun: yes;"> </span>As her due date approached without contractions the thought of a scheduled c-section was becoming more desirable.<span style="mso-spacerun: yes;"> </span>The experience of laboring for such a long time only to end up with a c-section was quite traumatic for Jenny-and an experience she didn’t want to repeat.<span style="mso-spacerun: yes;"> </span>The day before her due date her cervix was still closed, long and firm so after much discussion, <span style="mso-spacerun: yes;"> </span>we scheduled a c-section for the next day.<span style="mso-spacerun: yes;"> </span>I assisted the doctor with the c-section and Jenny had one of the most beautiful baby girls I have ever seen!<span style="mso-spacerun: yes;"> </span>I was again amazed at a strong woman who educated herself on her birth options and made a decision that worked best for her!<span style="mso-spacerun: yes;"> </span></span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">“Maria” is a woman I had only met one time early in her pregnancy.<span style="mso-spacerun: yes;"> </span>She had met my “partner in crime,” Susan, several times during her pregnancy but when complications developed her care was transferred to the physicians so she could get the level of care that she and her baby needed.<span style="mso-spacerun: yes;"> </span>Maria’s complications worsened and it became necessary to induce her labor.<span style="mso-spacerun: yes;"> </span>After many hours of labor and quite some time of pushing as well as an attempted vacuum assisted delivery it was determined by her physician that the safest route of delivery would be a c-section.<span style="mso-spacerun: yes;"> </span>I was lucky enough to be in the right place at the right time and had the honor of assisting with the birth of Maria’s baby girl.<span style="mso-spacerun: yes;"> </span>As soon as I saw her I was convinced the reason she wouldn’t come out was a very scientific diagnosis that I refer to as “cheek dystocia.” This sweet little girl had the chubbiest cheeks I have EVER seen.<span style="mso-spacerun: yes;"> </span>What a cute, sweet little (big!) thing!!<span style="mso-spacerun: yes;"> </span>What a strong woman to endure the treatments that were necessary to treat the complications of her pregnancy, to try so hard to push her baby out and then to be so brave in undergoing surgery to bring her baby into the world in the safest way possible.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">“Tina” is a woman that began her care with a physician but I was so lucky to “inherit” her when her physician retired from OB practice.<span style="mso-spacerun: yes;"> </span>Tina is such a sweetheart.<span style="mso-spacerun: yes;"> </span>She is always smiling and I always look forward to seeing her. <span style="mso-spacerun: yes;"> </span>When it came time for Tina to have her baby, the little princess had plans of her own.<span style="mso-spacerun: yes;"> </span>Apparently, when it was time for her to make her grand entrance, she wasn’t quite ready. Her mama worked so hard to urge her out into the world.<span style="mso-spacerun: yes;"> </span>She worked at it and worked at it and worked at it.<span style="mso-spacerun: yes;"> </span>I was amazed at the strength this woman had after hours and hours of pushing she still kept at it.<span style="mso-spacerun: yes;"> </span>Finally, there came a time when her drive and determination began to outlast her physical strength. This little princess was SO close but just needed a little extra help coming out.<span style="mso-spacerun: yes;"> </span>I called one of my physician colleagues (at 4 am no less!) who, without complaint, came in to help us out!<span style="mso-spacerun: yes;"> </span>With just a little assistance from a modern medical device, this woman was able to dig deep inside herself and find that last little bit of strength that she didn’t even know she had to push the guest of honor out to the party!<span style="mso-spacerun: yes;"> </span>Tina said over and over that she felt like a “wimp.”<span style="mso-spacerun: yes;"> </span>Wow! She was the farthest thing from a “wimp!” She pushed for over three hours-her strength and endurance is amazing!!!!<span style="mso-spacerun: yes;"> </span></span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">So, women of the world, whether you “go natural” or utilize modern medicine in some form or another-you are amazing!!!<span style="mso-spacerun: yes;"> </span>I am so grateful everyday to have the great honor to work with such amazing women!!!!!<span style="mso-spacerun: yes;"> </span></span></div>Nataliehttp://www.blogger.com/profile/12859873847487399531noreply@blogger.com1tag:blogger.com,1999:blog-7759769895608537139.post-23014677833234238762011-04-13T12:20:00.000-07:002011-04-13T12:20:44.081-07:00Tim McGraw, My Pedicure and the Demise of a Long Sleeve T-ShirtThe sun was bright and warm. The sand cushioned my freshly pedicured, bare feet. The breeze gently lifted my hair away from my face. I was enjoying a long walk along the beach accompanied only by the rolling waves and a man with a goatee and a sweet southern twang that introduced himself only as "Tim." He was about to sing to me. I could her the strum of his guitar. It became louder and louder, it was as if I could feel the vibration on my cheek. Then, just as quickly as it all started, it all ended and I realized the vibration was not the musical work of a very hot southern man but, yet the ringing of my phone under my pillow. I tried hard to simultaneously hold my eyes open and focus on the screen (as if I didn't know who was calling). Just as I thought "L&D 208-557-2729." I fumbled with the phone as I struggled in my state of semi-consciousness to recall which button on the screen to touch to connect with the person on the other end of the line. Ah, yes, I remember now, "Answer" that's the right one. "Hello?" "Hi" the all too chipper voice on the other end of the phone greets, "you have a patient here she is 39 weeks 4 days, contracting, she is 4 centimeters and she's worried that maybe she came in a little too early." Four centimeters? How many is that again? How many weeks does she need to be? When does she need to come to the hospital? So many questions that my mind can't really sort out right now. I take a deep breath, turn on the lamp next to the bed and open my eyes, hoping it will help me think. "Ok have her walk for an hour and see if she changes if she doesn't and wants to go home for awhile she can, if she wants to stay, let me know." <br />
<br />
I turn the light out and wrap myself in the warm comforter. I hope Tim waited for me. I drift back to sleep but I can't seem to find Tim, he must not understand the life of a midwife-remind me to discuss this with him next time I see him. An hour and a half later the phone rings again, this time I don't have as much trouble answering it. "She's six centimeters now with bulging membranes." I get out of bed and briefly consider just wearing my pajamas in to the hospital but then reconsider. I put clothes on (a black short sleeve tshirt that says "I'm not a Gynecologist but I'll take a look" over a long sleeve white tshirt and jeans) and slip sandals on my feet so I can show off my cute pink nails with the white flowers on the big toes. I walk out into the dark and get into the car. As I back out of the driveway Tim McGraw comes on the radio "ah, there you are" I say right out loud. I drive to the hospital singing like a karaoke queen the whole way there..."and it felt good on my lips!" <br />
<br />
Once I arrive at the hospital I change into scrubs (but make the mistake of leaving the long sleeve white tshirt on) and take a few minutes to read through the patient's chart-considering I have never met her-she's always seen the other midwife for prenatal care. I finish reviewing her prenatal record and I'm headed into the room when I see the call light pop on above the door. I go in just in time to hear the nurse say "can you send Natalie in?" I announce my arrival and I see the patient standing next to the bed and a large puddle of fluid on the bed-her water had just broke. Just then she said, in broken English "I need to go to da bathroom." Then with speed impressive for any human being, let alone a woman at 39 plus week pregnant, she ran into the bathroom. Now, this ain't my first rodeo so I know better than just to assume she's going to empty her bladder in there so I follow her in. She sits there for approximately 60 seconds with no results. She then gets up and walks back to the bed, just as she sits down she jumps back up and runs to the bathroom again. This time she makes soft grunting noises as she sits in the bathroom. Between my little bit of Spanish and her little bit of English I am able to convey to her that the sensation she is feeling is the baby's head, but if she's more comfortable pushing on the toilet, I'm OK with that. We realize that we need to make her more comfortable so we pad the pipes behind the toilet with pillows so she can lean back on them while she pushes.<br />
<br />
OK, so we are going to have a baby in the bathroom. We get the nursery nurse, Anna (who thankfully speaks Spanish) and we pull the cart with our equipment into the bathroom. Anna looks at me like I'm crazy because I'm on my knees in front of the toilet wearing sterile gloves with my hands in the toilet (OK, not in the water) supporting the crowning head. Now, in her defense, I probably am crazy. I ask Anna to please tell her that once the head is out she'll need to stand up because there is simply not room for the rest of the baby to come out while on the toilet. The mama says she understands this. One contraction later the mama gently pushes the head out. For anyone that's ever had a baby without medication-you know how intense this part is. Once the head was out she had a bit of a hard time maintaining control. Although she did stand up, she was having a hard time remaining standing and kept trying to sit-a few times right on the baby's head! I could see this wasn't working so we helped mama to her hands and knees on a sheet on the bathroom floor. By this time we had noticed that there was meconium stained fluid (we hadn't noticed this before because her water broke on a green sheet!) so we had called for the respiratory therapist. Soon after moving her to hands and knees she pushed the baby into my hands. The sweet, seven pound, six ounce baby girl cried right away! The respiratory therapist arrived about this time-all I can say is the look on his face was priceless when he saw us all in the bathroom! The baby was a little bit pale so she was handed over to the nursery nurse and the respiratory therapist, they took her to the warmer to check her out. <br />
<br />
We helped mama get up so we could get her into bed to deliver the placenta and make any needed repairs. As we walked from the bathroom out into the room she looked over to the warmer and I realized this was the first time she'd seen her baby so I said "do you want to go see her?" She did. So, with the umbillical cord in my hand I walked her over to the warmer to see, touch and kiss her baby. I wish I would have had a picture of the RT's face when he saw me holding the umbillical cord that was still attached to the placenta that was still inside the mama! <br />
<br />
<div style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none;">We had such a FUN time with this delivery. I had to throw my shirt away because it was covered with blood, I got blood on my cute toes and my sandals while I walked mama to the warmer to see the baby, and as a special treat, my dear friend Roz-who was also the labor nurse, was kind enough to model the position in which the mama gave birth! </div><br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhRwjELkwUgLg4sV46BWdFdSLiL8LLTaBUtKrLW78NEFyduRQYy3ZI_OwEw6E9UQ5mDebasmJhH3lVH-cxlORSYhcR_IR7Ay4Yx59m5nqMDAGLGBVn9M6ix17UxchLwAvRf-vwla7EO0egR/s1600/ROZ.bmp" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" r6="true" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhRwjELkwUgLg4sV46BWdFdSLiL8LLTaBUtKrLW78NEFyduRQYy3ZI_OwEw6E9UQ5mDebasmJhH3lVH-cxlORSYhcR_IR7Ay4Yx59m5nqMDAGLGBVn9M6ix17UxchLwAvRf-vwla7EO0egR/s320/ROZ.bmp" width="320" /></a></div><br />
Even the mama had a great time! When I saw her the next day she laughed about her baby being born on the bathroom floor-I told her whatever works for her works for me! That's the beauty of being a midwife-I let the mama make the rules!<br />
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</div>Nataliehttp://www.blogger.com/profile/12859873847487399531noreply@blogger.com4tag:blogger.com,1999:blog-7759769895608537139.post-42148225604907515782011-03-26T21:36:00.000-07:002011-03-26T21:36:25.289-07:00Losing My HatFirst, I want to apologize for taking such a long time to make this post. I forgot my log in information and it took me awhile to recover it! <br />
<br />
Before I started my clinical experience as a student last year, I traveled to Frontier School of Midwifery in Hyden, Kentucky for an orientation. At the end of the orientation each midwifery student is given a baby hat to give to the first baby they catch-or to a memorable patient. As it turns out my first was also very memorable. This is the story of how I lost my hat! <br />
<br />
I have changed the names and many details to protect privacy. Enjoy!<br />
<br />
<div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">I had the great pleasure of meeting Emma on <span style="color: black;">February 10<sup>th</sup> when she came to the office for her routine prenatal visit.</span><span style="color: red;"> </span>Emma is the type of person that is always smiling and always has a positive attitude.<span style="mso-spacerun: yes;"> </span>I was able to meet her husband at her next prenatal visit on February 17<sup>th.</sup> He was equally pleasant and very funny.<span style="mso-spacerun: yes;"> </span>They were a perfect couple!<span style="mso-spacerun: yes;"> </span>Emma and Matt were expecting their first baby, a boy to be named Jacob; he was due on February 25<sup>th</sup>, 2010. They had a strong desire to have a natural and unmedicated birth. My preceptor, Susan, <span style="mso-spacerun: yes;"> </span>and I encouraged Emma and Matt at their prenatal visits, we gave suggestions for comfort measures at home while in early labor and told her when she should come to the hospital.<span style="mso-spacerun: yes;"> </span>We assisted her in writing her birth plan and discussed it at length at her visits. She was very excited and very motivated to have this baby naturally.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">On <span style="color: red;"><span style="mso-spacerun: yes;"> </span></span>February 12<sup>th</sup>, <span style="color: red;"><span style="mso-spacerun: yes;"> </span></span>I met Ashley and Brett.<span style="mso-spacerun: yes;"> </span>Ashley was 36 weeks and 1 day pregnant with their first child, a girl whose name was yet to be decided. Ashley’s blood pressure was 144/90, she had 3+ pitting edema and mild headaches. We ordered a CBC and a hepatic panel as well as a 24 hour urine. We also did a non-stress test and an ultrasound to check AFI. All labs were normal that day, but she did have a significant amount of proteinuria<span style="mso-spacerun: yes;"> </span>in the 24 hour urine test the next day. We discussed the diagnosis of PIH with Ashley and Brett and sent Ashley home to bed rest, discussed PIH precautions and gave her the cell phone number to call to reach us. We also began to let her know that if the disease progressed we would probably have to induce labor early. Ashley began to cry but her husband was at her side comforting her. She also had a strong desire for a natural birth with minimal intervention. We reassured her that we would do everything we could to make that happen but we all agreed that a healthy baby and a healthy mom was everyone’s goal. <span style="mso-spacerun: yes;"> </span>I was able to see them again about 4 days later and Ashley’s blood pressures were about the same and she was feeling much better.<span style="mso-spacerun: yes;"> </span>She was able to get her company to allow her to work from home thus easing some stress on her from being on bed rest. They had also chosen a name for their baby girl but wanted to keep it a surprise.<span style="mso-spacerun: yes;"> </span>Ashley and Brett went home that day to come back in three days for another NST and blood pressure check.<span style="mso-spacerun: yes;"> </span>On Friday February 19<sup>th</sup> she returned to the office for her appointment.<span style="mso-spacerun: yes;"> </span>Ashley’s blood pressure had increased to 158/108 and she was beginning to have more headaches. She was now 37 weeks pregnant and her cervix was a fingertip, 50% effaced and baby was at a -2 station.<span style="mso-spacerun: yes;"> </span>After discussing her situation with our consulting physician we all decided that it would be best to induce her labor after cervical ripening with cervidil. Ashley and Brett were comfortable with that and also felt it was best. We had them go home to get their bags and come back to Labor and Delivery. </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">Shortly after Ashley and Brett arrived at the hospital, Susan and I visited them and I placed a cervidil then we returned to the office to see patients. That afternoon Wendy came in for a labor check. She was 38 weeks pregnant with her third baby-the first girl for her and her husband, John.<span style="mso-spacerun: yes;"> </span>She had been contracting every 5 minutes off and on all day. Her cervix was 4cm/50/-2. We told her she would probably continue to contract and we’d probably see her in the hospital this weekend. </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">After office hours, Susan and I decided to go check on Ashley before going home so we went upstairs to labor and delivery. We found a picture perfect Ashley and Brett sitting in the bed together eating dinner.<span style="mso-spacerun: yes;"> </span>We saw their camera sitting on the table so of course we took pictures of them-it was a very precious picture! We again discussed the plan and assured them that the nurses would call us if she started to get uncomfortable and we would be right in. After spending a few minutes with the happy couple we went to the nurses station to write a progress note.<span style="mso-spacerun: yes;"> </span>Susan co-signed my note, I closed the chart and replaced it and we stood up to go home…..just as Emma came around the corner-her smiling face was red, she was bent over and holding her abdomen with one hand and her husband’s hand with the other. The unit secretary asked “can I help you” Emma smiled and excitedly replied (mid contraction!) “yes, I think we are having a baby!” Susan and I walked up to her and began to help get her to a room.<span style="mso-spacerun: yes;"> </span>She noticed it was us helping her and her eyes lit up. “I am so glad you are here, that is just crazy that you were right here when I came in!”<span style="mso-spacerun: yes;"> </span>The labor and delivery unit was buzzing with activity and unfortunately, there were no rooms open at the time. We took Emma to the c-section recovery room and helped her get onto the gurney. I checked her cervix and she was 5cm/100%/0 station. The baby’s heart rate pattern was perfect. Susan, Matt and I stayed at her side and did counter-pressures during contractions. Before long the nursing staff had a room ready so we moved her to the room, filled up the tub and helped her into the water. Emma labored in the tub for quite some time. She changed positions frequently-we got creative about keeping her comfortable and as a result we ended up with Emma and five bath towels in the tub. Between contractions we talked, she ate and drank and Matt encouraged her. Soon Emma began to feel intense back pressure, almost unbearable. We offered her sterile water papules which she accepted-Susan and I and two other nurses injected the papules-which instantly took away the pressure. She tolerated her labor very well.<span style="mso-spacerun: yes;"> </span>She compared labor to her experience as a cross country runner-her husband also being a runner was able to understand what she was saying and used that to encourage her. As the contractions became more intense Emma would remind herself of her chosen mantra which was “pain with purpose.”</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">As we supported Emma in the tub a nurse came in and requested that we come review Ashley’s fetal tracing. Susan asked me to go look at the strip (she told me she trusts my judgement since I am a fetal heart monitor instructor)I saw minimal variability, some late and some variable decelerations. I discussed my plan with Susan and I ordered an IV fluid bolus and oxygen as well as a position change . I also rechecked Ashley’s cervix and removed the cervidil; unfortunately she had not changed. Her blood pressures were beginning to rise to the 165/110 range. We decided to re-evaluate after the bolus. </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">By this time, Emma was feeling more pressure and was having a hard time getting comfortable in the tub, she decided to get out and try the birth ball. She sat on the ball, Matt sat on a chair in front of her with pillows on his lap and she leaned on them. After a few contractions she decided that was not comfortable and requested to lie down. Shortly after lying down she began to feel an urge to push. She pushed a few times and soon the membranes were bulging out of the vagina, after a joke or two about being in “the splash zone” we decided to rupture her membranes (since Matt didn’t want to be “splashed"). Emma pushed spontaneously with only encouragement to listen to her body. Thirty –five minutes after the urge to push began, she was now crowning. Two pushes later, she pushed “Little Man Jacob” gently into my hands-I instantly placed him on her tummy so she could enjoy the sound of the healthy cry. She greeted her 5 pound 13 ounce son with a smile and tears-as did his daddy.<span style="mso-spacerun: yes;"> </span>A family was born.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">We tucked Emma, Matt and Jacob in for a rest and we went to check on Ashley again. I reviewed Ashley’s fetal monitor strip and I was concerned. The baby now had persistent late decelerations and minimal variability and no accelerations. Her cervix had still not changed and she was only having mild contractions and they were irregular. I discussed my concerns with Ashley and Brett and told them I would consult with the physician but there was a fairly strong chance that we would need to do a c-section, they were disappointed but understanding. Our consulting physician was on the L&D unit so I asked him to consult-he agreed that a c-section was the safest way to deliver the baby. The decision was made and the staff began preparations. </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">Just as we were about to take Ashley to the OR, Wendy came in reporting ruptured membranes two hours ago with irregular contractions. My preceptor went to the OR with Ashley and I stayed out on L&D to care for Wendy. I checked her cervix and it had not changed from my earlier exam in the office. We discussed options-Wendy also had a birth plan that included little or no intervention. We decided to watch and wait through the night. </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">Shortly before midnight, Ashley and Brett’s baby was born. They finally revealed her name after her birth. Sarah weighed in at 4 pounds, 11 ounces. Sarah had a bit of difficulty transitioning to extrauterine life but after a few minutes of oxygen therapy and time, she came around and did well. She was able to join her parents in the surgical recovery room within an hour for a midnight snack.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">Susan and I said goodbye to Ashley, Emma and Wendy and told them we would see them in the morning unless they needed us sooner. We asked the nurses to please call if Wendy became more uncomfortable with contractions.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">I came home to find my two little girls had taken over my bed but I was able to slide in next to them. I slept lightly and restlessly for a few hours. At 6:30 am Susan called to say that Wendy had not started to contract yet and her cervix had not changed so she ordered pitocin augmentation. We both decided we would shower and then meet at the hospital. When we arrived, Wendy was still not having many contractions but was very comfortable with the idea of pitocin augmentation. The plan was to use a low dose and turn it off when she began to have regular contractions and cervical change. We visited our other patients then Susan went to the office to take care of some paperwork and I met my husband and children at McDonald’s for a quick breakfast, then we both returned.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">Several hours later, Wendy became more uncomfortable so we turned off the pitocin and encouraged her to change positions.<span style="mso-spacerun: yes;"> </span>Wendy began to become more vocal and the contractions were more intense. Just as we could tell transition was near, a nurse came into the room and frantically said “I need you in room one, you have a patient here that is 35 weeks and she is 9 cm!” The new patient only spoke Spanish so Susan (who speaks fluent Spanish) left to go check on the new patient. I rechecked Wendy and she was 7 cm. Susan sent a nurse to get me so I could catch Maria’s baby.<span style="mso-spacerun: yes;"> </span>John took over the counter-pressures and a nurse stayed with Wendy.<span style="mso-spacerun: yes;"> </span></span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">Maria’s baby was in a right, occiput posterior position and despite pushing well, the baby was not moving down. Maria was in total control and smiled and laughed with her family between contractions. I told them I would do my best to speak only in Spanish and they were more than welcome to laugh at me if I said something wrong.<span style="mso-spacerun: yes;"> </span>I kept my promise and spoke almost exclusively in Spanish. We rolled Maria to her left side and within two pushes she was crowning. She asked if the baby had hair-I reassured her that he did have a lot and with a wink, I told her it was blonde.<span style="mso-spacerun: yes;"> </span>She laughed and said “oops!”<span style="mso-spacerun: yes;"> </span>her husband also laughed and they joked about the “blonde” hair. The next contraction she eased her baby boy out over an intact perineum. I placed baby right where he should be-on mom’s belly. Because he was a little early, the pediatrician was being conservative and prior to birth ordered direct admit to the NICU for at least 24 hours. <span style="mso-spacerun: yes;"> </span>We let mom keep baby for several minutes-he was very vigorous and appeared to be very healthy. The nursery nurses then took the baby for evaluation. Gabriel weighed 4 pounds 15 ounces. Just after the placenta delivered, a nurse came in to tell us that Wendy said “the baby is coming.” </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">Susan and I rushed to Wendy’s room and checked her-she was still 7cm but feeling the urge to push so she pushed. After a few pushes she wanted to change position so she moved to her hands and knees and the urge to push went away. After several contractions it returned. She soon became uncomfortable on her hands and knees and said she was more comfortable on her back. She pushed a few more times before we discovered her baby was also in a posterior position so we turned her onto her left side, she pushed twice and delivered “Miss Mariah” very controlled and gently, over an intact perineum. I handed baby right to her and she was thrilled, mom and dad touched the baby, noticed her features and compared them to the other children. After the cord stopped pulsating I clamped the cord and dad cut it. Mariah stayed with mom and all newborn procedures were performed while Wendy held Mariah. Wendy began to bleed a little heavier than I would like so we gave her some pitocin and she asked that the nurses weigh Mariah while we got her bleeding under control. Miss Mariah weighed in at 6 pounds 9 ounces. After some pitocin and Mariah nursing, the bleeding slowed.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">By this time it was Saturday afternoon.<span style="mso-spacerun: yes;"> </span>Susan and I finished our documentation, made one last visit to each of our patients and went home for the day.<span style="mso-spacerun: yes;"> </span>Sunday morning we returned for rounds, we visited each of the patients-all were doing well, all babies were nursing well and all mommies were feeling good.<span style="mso-spacerun: yes;"> </span>After visiting everyone, I returned to Emma and Matt’s room and presented them with their hat for Jacob and told them the story of Frontier. They loved the story and asked me many questions about midwifery.<span style="mso-spacerun: yes;"> </span>They had no idea how much care midwives provide but were thrilled to learn that most of Emma’s healthcare could be provided by a midwife. I thanked them profusely for allowing me to be a part of their birth experience.<span style="mso-spacerun: yes;"> </span>I truly could not have asked for a better two days to start out my clinical experience!!!</span></div>Nataliehttp://www.blogger.com/profile/12859873847487399531noreply@blogger.com2tag:blogger.com,1999:blog-7759769895608537139.post-85849625595203996972011-01-27T02:09:00.000-08:002011-01-27T02:09:11.989-08:00My Journey to being “With Woman”<div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">My quest to become a midwife; which directly translated means “with woman,” began in the early evening hours of June 10, 1973.<span style="mso-spacerun: yes;"> </span>This journey began when I simultaneously took my first breath and picked up the scissors that had been placed on my mother’s abdomen.<span style="mso-spacerun: yes;"> </span>The next several years were spent growing up and my road to midwifery was soon forgotten. </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">Shortly after the birth of my second child I finally decided to fulfill my adolescent dream of becoming a nurse.<span style="mso-spacerun: yes;"> </span>My dream was to become an emergency room nurse.<span style="mso-spacerun: yes;"> </span>I had no interest in any other kind of nursing.<span style="mso-spacerun: yes;"> </span>Three years later I was approaching graduation and enrolled in my last course, Maternal Child Nursing.<span style="mso-spacerun: yes;"> </span>Within days of beginning the course I realized that my dream of traumas in the emergency room had rapidly been replaced by dreams of crying babies in delivery rooms.<span style="mso-spacerun: yes;"> </span>Shortly before graduation, the almost unheard of happened and I was offered a job in the labor and delivery unit.<span style="mso-spacerun: yes;"> </span>New graduate nurses simply do not get jobs in labor and delivery, they usually must serve their time on a medical or surgical unit.<span style="mso-spacerun: yes;"> </span></span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">I quickly confirmed what I had suspected all along-I am an adrenaline junkie.<span style="mso-spacerun: yes;"> </span>I would never wish a major trauma on a mother, I would never wish an emergency c-section on anyone (especially those very special c-sections we refer to as “dash and slash” c-sections) but if it had to happen I wanted to be there.<span style="mso-spacerun: yes;"> </span>The busier the better.<span style="mso-spacerun: yes;"> </span>The more patients I could care for at one time, the happier I was.<span style="mso-spacerun: yes;"> </span>The more complicated the patient, the better.<span style="mso-spacerun: yes;"> </span>What better way to make a situation complicated than to add a bunch of stuff that isn’t really necessary?<span style="mso-spacerun: yes;"> </span>I loved pitocin, I loved epidurals, I loved continuous monitoring, I loved scrubbing in on “dash and slashes.”<span style="mso-spacerun: yes;"> </span>I hated seeing mothers in pain when it was so easy to give them drugs, I didn’t understand it, I didn’t understand what they had to prove.<span style="mso-spacerun: yes;"> </span>I’m not sure exactly when it happened, but it happened-that all changed.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">Several years into my new career I began to become frustrated with what I would later learn is called the Medical Model of care in labor and birth. Epidurals were not only the norm but patients who declined them were considered “weird” “freaks” “granola crunchers” and often received less care and attention from the nurses when what they really needed was more support. Nurses who barely knew the mother-to-be provided nearly all of her care and the doctor would come in at the last minute to catch.<span style="mso-spacerun: yes;"> </span>As any labor and delivery nurse knows this is always a fine balance; don’t call too early and don’t call too late.<span style="mso-spacerun: yes;"> </span>It’s debatable which is a worse offense.<span style="mso-spacerun: yes;"> </span>Be sure to call if there are complications but don’t, under any circumstance, bother the doctor unless there is a true complication that cannot be resolved by a good labor and delivery nurse. Be sure to give the doctor appropriate updates and at appropriate intervals-don’t wait too long and don’t call too often.<span style="mso-spacerun: yes;"> </span>Most mothers were unpleasantly surprised by the lack of physician presence during their labor experience. There are many reasons for this-physicians are simply too busy to provide one on one care in labor so, although not ideal, it’s understandable why this is the way it is.<span style="mso-spacerun: yes;"> </span>I also began to wonder if the things we do to mothers while following this Medical Model were in fact the very cause of the complications that were so thrilling to adrenaline junkies, like myself.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">I knew I was frustrated with the process but everything I’d ever heard about midwives was highly unfavorable.<span style="mso-spacerun: yes;"> </span>Midwives didn’t shave their legs, they wore tie-dyed broomstick skirts and no bra.<span style="mso-spacerun: yes;"> </span>Midwives delivered babies at home and denied mothers and babies life saving treatments if they needed them.<span style="mso-spacerun: yes;"> </span>Midwives made their patients give birth without medications. Midwives gnawed through the umbilical cord with their teeth and fed the placenta to the new mom.<span style="mso-spacerun: yes;"> </span>No way was I going to be one of them.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">Then, something strange happened.<span style="mso-spacerun: yes;"> </span>I found my vocabulary changing, “deliveries” became “births”<span style="mso-spacerun: yes;"> </span>“natural birth” became “unmedicated birth.”<span style="mso-spacerun: yes;"> </span>Suddenly, things like letting the cord stop pulsating before clamping it didn’t seem so strange.<span style="mso-spacerun: yes;"> </span>The idea of intermittent fetal monitoring and changing mom’s position to help labor progress and, heaven forbid, water birth, started to sound like favorable options for women.<span style="mso-spacerun: yes;"> </span>The idea of women being empowered by understanding their bodies started to make sense.<span style="mso-spacerun: yes;"> </span>I began to see the disempowerment of women in the suggestion that they were unable to give birth to a healthy baby by encouraging induction of labor one, two and sometimes more weeks before the baby was due.<span style="mso-spacerun: yes;"> </span>It may seem insignificant to some but the message is a powerful one-“I am here to save you from yourself.<span style="mso-spacerun: yes;"> </span>I will give you medicine to make your body do what it’s supposed to do because it’s obvious your body can’t figure it out on its own, then I will deliver your baby. Your baby will be healthy and beautiful because I saved you from harm.”<span style="mso-spacerun: yes;"> </span>I began to see that the medical establishment, physicians and nurses alike, is narcissitic and often has a super-hero complex.<span style="mso-spacerun: yes;"> </span>I began to accept the idea that going five days over a baby’s “due date” was not a medical emergency but rather still within the normal gestation range of thirty eight to forty two weeks.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">So, 35 years after my journey began on that late spring, Sunday evening, I began midwifery school.<span style="mso-spacerun: yes;"> </span>For the next three years I had my nose in a book nearly every waking moment. I began to appreciate how the medical model and the midwifery models of care can co-exist. My appreciation of birth as a natural process became deeper.<span style="mso-spacerun: yes;"> </span>My knowledge base grew.<span style="mso-spacerun: yes;"> </span>At times my previous experience was a life saver, at other times I had difficulty reconciling what the evidence tells me I should do and what I’ve done for years in caring for women. My passion for birth was fueled and I discovered a new passion for women’s health.<span style="mso-spacerun: yes;"> Throughout this journey, I shaved my legs and armpits on a regular basis and I must admit, I do own a broomstick skirt or two.</span></span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">In August 2010 I graduated with my Master’s Degree in Midwifery. In October 2010 I passed the American Midwifery Certification Board exam and shortly after I began my new career as a midwife.<span style="mso-spacerun: yes;"> </span>This blog is a journal of my experiences.<span style="mso-spacerun: yes;"> </span>While reading my stories please keep in mind that these are my stories, told from my perspective.<span style="mso-spacerun: yes;"> </span>I will never use a patient’s real name nor will I discuss the events near the time they happened<span style="mso-spacerun: yes;"> </span>and I will not discuss situations in great detail. All stories are subject to some creative liberties. I look forward to having my friends and family join me on this journey!</span></div>Nataliehttp://www.blogger.com/profile/12859873847487399531noreply@blogger.com4