1st year of Midwifery done and dusted

Wow! The first year of midwifery is over!

Well, almost. I do have half an afternoon of class to go to on Wednesday, some revision of pharmacology, and most exciting of all, an extra continuity experience with a woman who is having twins in late January!

I haven't posted up the stories of the last 5 continuity experiences I had. I got really busy with uni, writing essays and horrible things like that! My 6th woman had an elective Cesarean, she had an allergic reaction to the morphine in her spinal block, so that wasn't at all pleasant. Also the midwives were really rude and ordered me and her mother out of the postnatal room later on; I was not impressed. Neither was Jenny my course coordinator. The 7th was another elective Cesarean, that went really smoothly. The 8th was an induction as there was meconium stains in the liquor. That birth was totally amazing! She was given the lowest dose of synto to start off labour, and 75mins later she was handed her baby! I love births like that : )

Unfortunately, I missed the last two births. I had to work when the 9th women was birthing, she reported having a lovely birth! I was able to be present during the labour of the 10th woman, but then had to take Mum and Dad to the airport when they were going away up to the Gold Coast, so missed that birth as well.

I have been attending fortnightly visits with the woman who is having twins. She is really well, just feeling H.U.G.E! I am really looking forward to her labour and birth. I won't be able to do much by way of getting in there and helping because there will be a consultant, neo-reg and a couple of midwives; I am last on the pecking line! But I get to see amazing things : )

This photo was taken at our end-of-year dinner that we students planned as a thank-you for our wonderful teachers.

It was a fantastic night. We saw a slide-show of the year. Heard speeches. Gave flowers and gifts to our teachers. And presented them also with a quilt that many of the students contributed to by decorating a square. N. and I put the quilt together and in the end it looked fabulous!

It has been a fantastic year. I am a looking forward to next year in some ways, and kind of sad also that it will be different. We will be spending 24hours a week in the hospitals doing rotations of all the wards and antenatal clinics and neonatal special care nursery. That will be pretty full on. But we also do not get to do any continuity, so that's really sad.

Hopefully I will get to posting up more regularly next year. I am sure there will be lots to talk about!

Re: my fourth birth...upright position and estimated blood loss

Catherine commented on my fourth birth post, asking:
I was interested to hear about women bleeding more readily when they give birth on their knees - I have for all three and never had that problem, except for the first but that was most likely because of the length of the second stage.

I replied:
I am not entirely sure Cath, Mum said she had the same experiences as you so that's two (actually many more!) stories against one : ) It is highly likely that I misunderstood, or that the midwife was speaking only from her experience ??


Later on though I was required to do some specific reading around birth, and came across these comments on birth position and estimated blood loss:

"Blood loss appears to be higher following upright birth (Gupta et al 2004), but this may be due to the ease of measuring blood loss when upright."

• Chapman, V & Charles, C (eds) 2009, The Midwife's Labour and Birth Handbook, 2nd edn, Wiley-Blackwell, West Sussex

"Gupta and Nikodem (2000) undertook a meta-analysis of controlled studies of positions in the second stage of labour.

They noted that in all the parameters they assessed except one, a policy of upright positions led to benefits for women.

The exception was an increased risk of estimated blood loss above 500mL.

In interpreting these findings, it should be noted that 'upright' included kneeling, squatting, sitting, use of a birthing stool/chair, and use of lateral tilt, while 'recumbent' included on the back, lithotomy stirrups, lateral (without the tilt) recumbent and semi-recumbent.

It has also been observed that where maternal preference was elicited, the most frequent positive responses were from those women who had used an upright position (Sleep et al 1989)."

• Henderson, C & Macdonald, S 2009, Mayes’ midwifery: A textbook for midwives, 13th edn, Baillière Tindall, Edinburgh

Hopefully that is a lot clearer than my first reply!

My 5th Birth

Hi All,

I actually had this birth around 3 weeks ago, but as it kind of disturbed me a little I haven't written about it 'til now.

This woman and I had a very good rapport; we had had a massive chat waiting 1 1/2 hours for the doctor one time, so I got to know her birth wishes quite well. She wanted a natural, intervention-free labour and birth, then wanted to fully breastfeed afterwards. This was her first pregnancy.

Well at 10 days over her due date, she was induced. They tried prostoglandin gel; then broke her waters; and finally hooked her up to syntocinon. She dilated to 3cms, then for 3hrs was "not progressing". I was working a full 8hr shift so couldn't come in until 3:30pm. When I got in, they were just about to do another VE. I walked into her room, she was sitting in the chair (as she said it hurt so much more on the bed) and we had a little chat in between contractions. Another VE was done, still "no progress", and the doctors were talking about a c-section, which I thought was a little weird as her waters were broken only at 7am.

Well the midwife pushed for an epidural instead, as this can make the muscles relax and so dilatation continues. The doctors reluctantly agreed to offer it; the woman reluctantly agreed to have one, and it was put in. Only the anaesthetist drove in 4cms too much of the tube (catheter?) into her back, so after 4hrs of excruciating pain another anaesthetist diagnosed the problem and took some of it out. After that the pain relief was immediate and she could sleep. She was ordered nil by mouth as she might have to go in for a c-section, 2-3 hourly VE's, and given until 1am to fully dilate (the epidural went in at 5pm).

Whenever a VE was done it showed that things were progressing really well, and by 1am she was fully. All this time the fetal heart rate was perfect; but her HR was a little high, and she was febrile but as she had a cold/slight flu this was to be expected, however the doctors were not too happy about it. Her HR rose to 130bpm, and she wasn't seen to be "pushing productively". At around 2:30am the decision was made to use vacuum (without really asking for consent...it was just, this really needs to happen, though they never really said why). Well, we went down to theatre, and trialled vacuum. I was nominated scribe, so had to write down times that the individual doctors came into theatre (neonatologist?, consultant, registrar) and when vacuum was started, stopped, etc. The registrar pulled as hard as she could on the vacuum, then the consultant took over. He pulled as hard as he could, until the cap came flying off; then he tried forceps. He pulled until he was red in the face, and with an episiotomy, the baby eventually came out, at 3:20am.

Baby didn't make much of a sound; and was taken to the neonatologist. Baby was really limp, blue, not crying. The neonatologist picked his arm up and let it drop (just from a small height) and it did just that, drop. He had a 0 for muscle tone, overall a 5 at 1 min. They put O2 on him, and after allowing the parents to kiss him, took him up to special care nursery.
I went up with him and the midwife, saw that he pinked up with O2 (and that I liked the look of the midwives in there...feeling very protective of MY baby...they were fantastic). I went back to the midwive's station, and promptly fell asleep in the chair. I had to get my Mum to pick me up and slept for 12hrs straight!

Went back the next day and baby was doing okay. Over the next few days he got better little by little; my woman was expressing and feeding him, and he went from having mainly formula, to having a little bit of formula to comp the breastmilk. The hospital was fantastic in allowing my woman to stay until baby was discharged on day 5. The last night both parents and baby slept in the rooming-in nursery which was lovely; dad got a little shock from having to get up to baby in the middle of the night though : )

All that week both parents kept saying how wonderful it was to have the continuity of a student midwife, and how wonderful it was to look up in the foreign and scary theatre and see a familiar face (that was trying very hard not to show the fear that was inside!).

In the end, a lovely baby handed over to lovely parents : )

My fourth birth

Hi All,

I had my fourth birth this morning!!! I received a call at around 6:30 this morning to say that I had better get in there quick as she was in 2nd stage already.

When I got there she was already pushing, but her husband was encouraging her to "breathe through" a lot of the contractions, so she didn't have a fast 2nd stage, but it was good. Her "big" sister and auntie were also there; big sister was such a brave girl! She was calmly eating away while everything was going on, talking about her baby sister coming soon, and eagerly watching for the head with the rest of us! Apparently she was also having a baby, but as soon as she saw the final parts of the birth she changed her mind (probably looked like to much hard work!). When the midwife suggested to the woman to just push, immediately the baby's head was out! Really amazing little thing, trying to breathe even before the rest of her could be born Such a cutey!

The shoulders were a little more tricky to birth, but the midwife pulled gently up. Baby also had the cord wrapped around her neck twice, but it was loose and easily taken off. She was born around 8:30 with a gush of blood, but apparently that is fairly normal when women birth on their knees (the midwife did immediately give her sytocinon though).

Straight onto mum's breast, and feeding away like a starving child almost immediately. She could be heard suckling from across the other side of the room, just amazing! Mum is doing really well, a little knocked around with the afterbirth pains though (she also needed a few stitches). Baby is fantastic! And the midwife and I decided we both really wanted to bundle up both the little girls and take them home with us, so cute!

A C-section !!

Hi All!

I was called yesterday from my woman to say that she was in labour!

All the time I have been with this woman antenatally she was having some bleeding; which just before I met her was assessed by an Obstetrician. I met the woman at her 32 week ultrasound, which was to confirm the position of the placenta. She was diagnosed with placenta praevia, where the placenta is right down near the cervix. It was unsure at this point whether the placenta would move further away from the cervix, so we were kind of just waiting to see what would happen as things got closer.

At 39+4 the GP advised to go back and have another ultrasound as she had experienced continued bleeding bi-weekly since her last ultrasound (filling up two pads each time), including some clots. I was REALLY worried about this, but every time she rang the birth suite she was told it should be okay. The GP didn't seem all that worried either, so I was concerned that they weren't looking hard enough, or being responsible. At the ultrasound it was confirmed again that the placenta was near the cervix, only 2.5 cms away.

As I was still worried about this, I rang Jenny and had a chat to her about it. She said that actually if the placenta is near the cervix, it can be normal to have bleeding, as the cervix is getting ready to birth it moves a little and can cause the placenta to move a little too...so that should be fine. Next day Michelle rang and re-confirmed what Jenny had said, so I felt better about everything.

On Monday my woman's waters had broken, and everything was fine, until Friday morning when she noticed some green fluid on her pad. So she went into hospital and they said she had a meconium stain in her liquor so they would have to induce her. She rang me around 3pm to say that she was 1cm, so I went in. She was really out of it when I got there as she had just had some morphine...she was hanging out big time for 4cm dilatation when she could get her epidural! I went for dinner with the postgrad students around 6:30. After 3 hours or so the epidural went in, I placed myself in a prime position to watch...that is the grossest thing I have ever seen!! It looked so terribly painful. She had the local so didn't actually feel a thing. The anesthetist was having just a little trouble pushing the massive needle through the ligament (which is apparently what has to happen with every epidural, ewwww!!), but it was all fine, she felt the effect immediately, and we could turn up her sintocinon (induction drip) to speed things up a little.

Around 10:30 she was 5cm, I went for a 1/2 rest. The Midwives were just lovely and so was my woman, they kept asking if I was alright, and did I want to go for a rest. I was amazed at how often my woman asked me that, she was the one who was exhausted!! They are such a lovely couple!

At around 3:30 she was 8 cm, but had a swollen lip of cervix, they gave her a few hours, and even though she came to 9 and a bit cms she never got any further. I and the primary Midwife had an hours lay down, then was called by the other Midwife as they had decided to go to the operating theatre and do a c-section. I didn't have to scrub, just put on the ridiculous clothes, shoe socks and hat, but we all looked ridiculous together so it didn't matter. I put myself in a great position again, and got to see everything as it happened. The woman's epidural didn't work like it should have, so she had heaps of top ups, gas and a few breaks from being opened, but in the end a beautiful baby boy was born!!!! He is such a cutey : )

Poor dad cried so much, it was really emotional for him. He said it was really scary going into theatre, and the poor woman was frightened too. I was nominated photographer, so since the woman was being stitched while baby was weighed and everything I took a million photos! It was just lovely. And the woman got to touch her little one while his dad held him, so I got heaps of photos of that too. It was such a lovely outcome in the end, even though it was a shame that they had to go through a c-section.

So there you go! I am can't wait to go see them, I have developed such a lovely rapport with both the parents, so I just really want to see that poor mum holding and breastfeeding her baby!

The Middle-Wife

The 'Middle Wife' by an Anonymous 2nd grade teacher

I've been teaching now for about fifteen years. I have two kids myself, but the best birth story I know is the one I saw in my own second grade classroom a few years back.

When I was a kid, I loved show-and-tell. So I always have a few sessions with my students. It helps them get over shyness andusually, show-and-tell is pretty tame. Kids bring in pet turtles, model airplanes, pictures of fish they catch, stuff like that. And I never, ever place any boundaries or limitations on them. If they want to lug it in to school and talk about it, they're welcome.

Well, one day this little girl, Erica, a very bright, very outgoing kid, takes her turn and waddles up to the front of the class with a pillow stuffed under her sweater. She holds up a snapshot of an infant. 'This is Luke, my baby brother, and I'm going to tell you about his birthday.

''First, Mom and Dad made him as a symbol of their love, and then Dadput a seed in my Mom's stomach, and Luke grew in there. He ate for nine months through an umbrella cord. 'She's standing there with her hands on the pillow, and I'm trying not to laugh and wishing I had my camcorder with me. The kids are watching her in amazement.'Then, about two Saturdays ago, my Mom starts saying and going, 'Oh,Oh, Oh, Oh!' Erica puts a hand behind her back and groans. 'She walked around the house for, like an hour, 'Oh, oh, oh!' (Now this kid is doing a hysterical duck walk and groaning.)

'My Dad called the middle wife. She delivers babies, but she doesn't have a sign on the car like the Domino's man. They got my Mom to lie down in bed like this.' (Then Erica lies down with her back against the wall.)'And then, pop! My Mom had this bag of water she kept in there in case he got thirsty, and it just blew up and spilled all over the bed, like 'psshhheew!' (This kid has her legs spread with her little hands miming water flowing away. It was too much!)

'Then the middle wife starts saying 'push, push,' and 'breathe, breathe. They started counting, but never even got past ten. Then, all of a sudden, out comes my brother. He was covered in yucky stuff that they all said it was from Mom's play-center, (placenta) so there must be alot of toys inside there. When he got out, the middle wife spanked him for crawling up in there.

'Then Erica stood up, took a big theatrical bow and returned to her seat. I'm sure I applauded the loudest. Ever since then, when it's show-and-tell day, I bring my camcorder, just in case another ' MiddleWife' comes along.

Births, Fainting, and Episiotomies

Hi All,

My second woman went into labour late last night (around 11:45). I was called at 12:15 this morning by the Midwife, who said that if I wanted to make it I would have to really hurry! Was totally exhausted, but jumped out of bed and threw on my cool new polo and drove off.

When I got to Calvary, she was in transition and went into 2nd stage very soon after. She was lying semi-recumbent (that was the word the midwife said to use--I was calling it "on her back" at first--but semi-recumbent sounds much more sophisticated!). The midwife asked her if she wanted to change positions, but she very decidedly said "NO!!!!", so the midwife looked for ways to make it more comfortable in the bed for her. But the midwife didn't need to do much, as the woman was instinctively doing most of the right things anyway. She was pelvic tilting, rolling her pelvis around, rolling slightly from side to side (hardly ever was actually on her side, but was moving all the time). But she was flaying her arms around, and grabbing our arms or shirts in the midst of contractions or pushing. So the midwife got her to hold underneath her thighs and push into her thighs, and that helped a lot. (Both us and her) : )

I was so carried away with the fact that it was going to happen so soon (and that I could actually see EVERYTHING that was going on this time) that I didn't think to sit down or move from the one spot. All of a sudden I felt really hot, light headed and nauseous. I fought it off for as long as I could, but then I just couldn't stand up anymore, I HAD to sit down! I sat on the nearest chair, and the midwife looked highly amused and suggested I go out and get a drink of water. I went out, passed the other midwives at the desk (who stared at my total lack of colour), slumped down against a wall and drank as fast as I could. So the heading is kind of deceiving because I never actually fainted, but I felt SO close to it, and it was not nice!
I didn't want to look like a scared chicken or really green, so I went back into the room as soon as I could and started helping again, but found that I had to sit down every couple of minutes; pretty much in between every push.

The woman did not progress normally, and the midwife was worried that perhaps the baby was posterior, so conducted a vaginal examination. The baby was not exactly posterior but lateral and kind of leaning a little on the posterior side (I think), but definitely coming down a little. So we waited, and the woman pushed, and we waited, and she pushed. Eventually we could see some small part of the head, but then it didn't keep progressing. Then about 15-30 mins baby's head definitely coming, but still only a little, the woman began to tear rather badly, so the midwife made the executive decision to do an episiotomy. Baby's face came through and the head had been transverse which is why she was tearing so badly. The midwife allowed me to put my hands over hers, so that I could experience what she was doing, then she had to really wiggle the baby out and I picked baby up and put baby on the woman's chest. That was lovely !!! I also was able to rub baby down a little, and had to keep baby from sliding off its mother as she was a little out of it all.

I was able to watch closely the registrar suturing the (I think 3rd degree incision), which was pretty cool, but a little gross, especially since the woman kept experiencing pain (not from the needle but from the cleaning out of the vagina of blood, so the registrar could see properly).
Baby didn't want to breathe at one stage as he was a little clogged with fluid, but after the midwife rubbed his back vigorously and tilted him forwards, he spewed it all up and became pink again.

I got to measure, weigh, and do all the vital signs on him, so that was cool. I also dressed, wrapped and rocked him to sleep, while his mother was showering. I feel very blessed : )

And tired...

Facebook scams

Source: Canberra Times
Title: Stolen online identity
Author: Conrad Walters

A study found 84 per cent of people divulged their full date of birth on Facebook, 87 per cent divulged details about their education or job and 78 per cent listed their current address or location.

Facebook safety tips
1 Review your online profile to reveal only what you need to.
2 Don't assume default privacy settings are appropriate or sufficient.
3 Don't post contact info or share any details that could help someone guess your password.
4 Use a unique password for your Facebook account to isolate it from any problems elsewhere.
5 Keep anti-virus software current to detect programs that could monitor your online activities.
6 Ignore emails that ask you to confirm details for your account.
7 Don't share your logon details with other people.
8 Block messages from other people who solicit information from you.
9 If you get an emergency appeal from a friend, confirm it independently.
10 If you suspect there is a problem, contact abuse@facebook.com.

In Facebook the controls that govern what information other people can see rests three levels down. (Look for "settings", choose "privacy", then "profile".)

Time for God's Will

Author: Elisabeth Elliot
Source: A Lamp For My Feet

Time for God's Will

One reason we are so harried and hurried is that we make yesterday and tomorrow our business, when all that legitimately concerns us is today. If we really have too much to do, there are some items on the agenda which God did not put there. Let us submit the list to Him and ask Him to indicate which items we must delete. There is always time to do the will of God. If we are too busy to do that, we are too busy.

Lord, help me to take your yoke on my shoulder, not a yoke of my own making. May I learn from You to be gentle and humblehearted. May I find that your load is light.

My first birth story...

Hi Everyone,

Just to let you all know that "my" woman gave birth last night!!!! I have had four hours sleep this afternoon, so I am now able to articulate what happened : )

She is with the Birth Centre, and I had had two antenatal visits with her already, one at 39weeks and the other on her due date (which was last Friday) ... but no call that day which I was very disappointed about!

I waited all day, and all day Saturday and then on Sunday I couldn't handle it anymore and I packed a "birth bag" for myself in the (possible) case scenario of having to stay 12 hours or so (considering past labour of 21hours).....but still no call : (

I finally decided to go to bed, just lay there looking up at the ceiling, when I was called!!WOoohOoo!!! It was this morning at 12:48 am, by the midwife's stand-in, as the midwife was having a weekend off (apparently a rare incidence). I immediately got together my "birth bag" ... and jumped in the car to head off to the Birth Centre.

I sat in on a few contractions, but both the midwife and I decided that the couple should have some time to themselves, so I sat in the midwife's station and copied out notes about check-in and the initial palpation and vaginal examination....then I went and sat in for a few more contractions, and again went back with the midwife. She periodically checked the baby's heart rate so we went in for that, and popped our heads in just to see that she was okay. Otherwise, we chatted midwifery, this birth, what I knew and didn't know (took longer to tell that bit!), and listened to her moans and (increasing) grunts.

When the grunts became a little more guttural we "moved" into her room and gave her some extra encouragement. I was uncomfortable doing much but observe, but it was a lovely and rich experience. She got into the bath when the pain became too great and I got to see how a water birth looks like. The urge to push became really strong around 5.00am, but after a VE the midwife recommended not pushing as the cervix was not fully dilated. (If you do push when the cervix is not fully dilated it causes swelling of the cervical muscles, the midwife said, which makes it increasingly harder to birth.)

When the midwife had "breathed" the woman through several more really tough contractions, she did another VE and said that it was now okay to push. Very shortly there was a crowning; then baby's head out; then the shoulders were a little stuck and the midwife had to ask the woman to get out of the bath, lift one leg a little, and with the help of another contraction and the midwife easing the baby out, out came a gorgeous baby girl! SO LOVELY!!

I had to really hold back the tears, it was just so lovely! And even though I was "only" observing I did get to document all the "births" (baby, placenta, etc) timings while the midwife was in the thick of it all...so that was exciting : ) And I found out that my name is put on the birth register as a witness to the birth, how cool is that??!!! : )

25 things I hate about facebook

This is absolutely hilarious!

25 things I hate about facebook

Photos of Grandad

True Christianity

William Wilberforce wrote in Real Christianity:

Measure your progress by your experience of the love of God and its exercise before men....

In contrast, servile, base, and mercenary is the notion of Christian practice among the bulk of nominal Christians. They give no more than they dare not withhold. They abstain from nothing but what they dare not practice. When you state to them the doubtful quality of any action, and the consequent obligation to refrain from it, they reply to you in the very spirit of Shylock, "they cannot find it it the bond."

In short, they know Christianity only as a system of restraints. It is robbed of every liberal and generous principle. It is rendered almost unfit for the social relationships of life,and only suited to the gloomy walls of a cloister, in which they would confine it.

But true Christians consider themselves as not satisfying some rigorous creditor, but as discharging a debt of gratitude. Accordingly, theirs is not the stinted return of a constrained obedience, but the large and liberal measure of voluntary service.

From: Passion and Purity by Elizabeth Elliot

Love God more

As I was reading "Passion and Purity" by Elizabeth Elliot, I came across this Christina Rossetti poem:

Trust me, I have not earned your dear rebuke,
I love, as you would have me, God the most;
Would lose not Him, but you, must one be lost,
Nor with Lot's wife cast back a faithless look,
Unready to forego what I forsook;
This say I, having counted up the cost,
This, though I be the feeblest of God's host,
The sorriest sheep Christ shepherds with His crook.

Yet while I love my God the most, I deem
That I can never love you over-much;
I love Him more, so let me love you too;
Yea, as I apprehend it, love is such
I cannot love you if I love not Him,
I cannot love Him, if I love not you.

It reminded me of what Elizabeth Prentiss says in "Stepping Heavenward" when someone accuses her of loving her children too much:

You cannot love your children too much. You simply love God more.

Book Giveaway---Prayer by C. H. Spurgeon

I am giving away this wonderful book! It is open to all readers who want to enter. Just leave a comment ON MY BOOK BLOG POST and share about a spiritual/devotional book that has led you to come closer to God.

Here are some sentences from the back of Prayer:

"You feel like you don't know how to pray--you can't find the right words, or just can't seem to get God's attention. You will be encouraged by this treasury of devotional expressions for Charles Spurgeon."

His elegant prayers, beautiful in their simplicity, will invite you to be vulnerable before your Creator.

His profound trust in God will set an example for your own pursuit of peaceful spirit.

His persistence in intercession will motivate you to pursue God in prayer.

Also, part of one of the prayers from within Prayer:

You who are King of Kings and Lord of Lords, we worship You. "Before Jehovah's awful throne, we bow with sacred joy." We can truly that we delight in God. There was a time when we feared You with the fear of bondage. Now we reverence You, but we love as much as we reverence. The thought of Your omnipresence was once horrible to us. We said, "Whither shall [we] flee from thy presence?" (Psalm 139:7). It seemed to make hell itself more dreadful, because we heard, "If I make my bed in hell, behold, thou art there" (v. 8).

But now, O Lord, we desire to find You. Our longing is to feel Your presence, and it is heavenly that You are there. The sick bed is soft when You are there. The furnace of affliction grows cool when You are there. The house of prayer when You are present is none other than the house of God, the very gate of heaven.

I'm in !! Midwifery program 2009!!!!

After completing a year of nursing at university, I have been accepted into Canberra's first Bachelor of Midwifery program.

I love nursing, but my passion is in caring for women and babies. I knew that it was going to be hard to get into this as there were many applicants, and few places; but after much prayer, and a lot of work on my curriculum vitae (read Resumé), I was accepted!!