Sunday, February 15, 2015

i'm a crappy midwife (doula)

so. i'm not a very good midwife.

one of my criticisms as a student midwife was in terms of the quality of labour support i provided.

i can be hands on, provide massage, and comfort. but it's probably not my strong suite.
i'd rather women hire a doula for this.

as a midwife i'm there for clinical support. doulas don't have this responsibility.
they can make judgements without having the responsibility of clinical outcomes.

don't get me wrong, when it comes to the support i provide for women. i can be a fierce defender and protector. i will go out on a limb for the women i serve.
this might be more prenatally, postnatally. and even during labour.
i won't force women into anything.

but i'm probably not the best person if a women needs to be coddled.

i also don't have a lot of women who get epidurals. even though i attend some births in a hospital and have access easily to analgesia i'm not going to run and get women pain relief just because they've asked for it.

i'll be with them. taking every pain as they come, helping them through. encouraging them. because when they've gotten to that point, the baby is usually soon to follow.

i feel when birth is uninterrupted and working, it's best if it's left alone.

michel odent has said that it's best if men are left out of the birth space.

i say it's best if all clinical practitioners are left out of the birth space. whether that be a midwife, GP, or obstetrician. even nurses.

birth works best if it's not monitored.

if labour is not progressing, that is when clinical care comes in.

i've come to tell all my first time moms to expect labour to be 24hrs.
they must sleep when they first start to feel the pains,
they should ignore them, until they can no longer do so.
deny labour until all they can say is, "fuck. this hurts".

this weekend i had the privilege of attending a birth in which for generations were present.

i was paged at 9am that her waters had gone.
she wasn't having any pains.
she was GBS negative.
there was nothing for me to do, but wait.
i would meet her the next day to do an NST if labour hadn't begun.
baby was moving, fluid was clear. she was content.

i checked in with her at 430pm. she was having regular contractions, she had napped.
labour had started.
we made a plan to meet at the birth centre at 8pm.

when we met, her pains were stronger. more regular. she was coping
her kookum and mother came with her.
her kookum thought it was too early for her to be there. she had had 10 babies, had 34 grandchildren. 19 grand babies. the woman knew what she was talking about.

i checked the mother. 3cm, cervix was thin, baby was in the pelvis.
i was happy.

i told her to go home.

we know that it takes the longest to get to 6cm.
i can't see any point for me to be in a woman's space before 6cm.

unless she needs my support.

i told her to go home and to touch base in 4 hrs.
i said she could call me in an hour, we could meet in four. we could meet whenever.
anything she wanted.
i said she could stay if she wanted, but i told her to go home.

4.5hrs later she called.
there was a shift in her voice. she wanted to meet.

a half hour later we met. she was about 5cm.
she was feeling pains in her back and hips and baby felt posterior.
i had her lay on her left hand side.

i had to do some other work. she had so many people for support, she didn't need me.

about 45 min later she wanted to use the gas and air.
and 30 min later she was feeling nauseas and went to the bathroom.
she was sick.
she started feeling a tonne of pressure.

i checked her there and she was 8cm.

she moved from the toilet to the tub.
45 min later she held her sweet baby boy in her arms.

this was her first baby.
she trusted herself.
she trusted her body.
she moved from place to place when she wanted.

she didn't need me.

the next day everyone who came to visit asked if i was the one who delivered the baby.
my answer was the same.
no she did.
i was just there on the other side.

in most cases, this is what i see.
i tell women to go home, or if they are planning to have their babies in the city, to find somewhere there to go until they reach the point that they can't be home any longer.

i find that when women hear this, do this. they are in tune with their bodies and arrive just when they need to be.

most labours don't need clinical monitoring.
if i'm there for clinical support, then i don't need to be there.

if labours are not progressing smoothly, as we'd expect. there is definitely more for me to do throughout. i might have to work harder to help a baby turn. help a mother relax. and sometimes that means a women may need therapeutic relief. it might mean they need augmentation with medication to help their labour progress.

i'm glad that i can be the person to do this. i can monitor the effectiveness and not push medications.
not force pushing.

sometimes a women just needs to be locked in a bathroom and left alone.

this is why i say i'm a crappy midwife.
because  ultimately, i think it's best if i'm not there.

i know that some midwives pride themselves on their labour support. and don't think women need a doula.

i'd rather a women have a doula. and me be asleep on the couch until she needs me.

i'm learning that women aren't disappointed to go home after being checked. but that most often then not, they need that check in. i'm definitely there if a woman needs me. and like i said i will fiercely fight to protect that sacred space of birth and the mother-baby dyad. i won't jump to get an epidural, just because it's asked for. but i'm also not great at being 12- 36hrs of emotional and physical support. not when at the end of it i need to be present and alert.

i don't actually think i'm a crappy midwife.
but i also don't think of myself as someone who is best suited for labour support.
for better or worse.
it seems to be working.

Saturday, December 6, 2014

breech birth. and coercion.

i have a family in care with a stubbornly persistent breech.
they are almost 38 weeks.

they've tried everything. inversions. acupuncture. homeopathics. moxabustion. an external version attempt by an OB. nothing. baby is frank and that's the way she wants to be.

this week we decided to let her have her way.

the parents are committed to a vaginal birth (first baby).

they've weighed the risks and benefits. they are doing their research. they know if they need a section, they will accept one. but they are not electively choosing one.

i've been doing my research as well. watching videos. studying. refreshing.

it's the directive of the doctors at our hospital to call in a more experienced person who can assist in breech births.

we've discussed the potential for fear mongering and the use of coercion to dissuade them from their decision to attempt a vaginal birth.

i'm actually fairly encouraged by our hospital. they really are trying to practice evidence based, and are progressive. example, they are trying to redefine active labour as 6 cm and that you can't diagnose labour dystocia before then.

think about the profoundness of that ideological shift.... that is a lot of potentially avoidable c/s.

we've talked about the potential for the midwife to remain primary, under supervision of an OB. i've talked about my (lack of) experience. my comfort level. this couple, even addressed this, they understand that the success of breech birth has as much to do with the skill and confidence of the care provider.

i'm sure there are those that would disagree, but i'm 100% behind this couple.

they feel this support. this positive energy. regardless of the outcome, it's good to know that they are going into this with that energy. that support. they are not having to fight. they are not having to scramble. they are not looking at a booked section. they are awaiting spontaneous labour. they are also seeking out breech friendly OB's. this couple is smart. they want to know the OB's so that when they go into labour, whoever is called, knows them, knows their belief, know's that they have educated themselves, that they are prepared.

as a midwife, i never want a family to feel coerced into any decisions or actions.

i had a client (GBS neg), who's water broke on a friday morning and she had prodromal labour until sunday morning. contractions were finally starting to get regular. i was fine letting her labour until she was active. i was in no rush. i gave her a few options. go home until more active, go walk and reassess in 4 hours, or get an epidural and start a drip (she probably would have got an epidural friday, if i had "let" her). i left her and her sister to discuss. i came back and she wanted the epidural and pit. ----> as soon as that plan was made, she started contracting every 2-3 min. she got her epidural and baby was born 5hours later. no pit needed.

when it came down to it, she and her sister thanked me. the mother was able to make every decision, no pressure, no negativity, no judgement. she did what was right for her. not what i wanted her to do.

birth can look like so many things, but ultimately it's how families feel after the experience.

for me the whole process is preparing them to be parents. i want them to enter parenthood confident, knowing from the beginning that the choices they are making are for them and their families. that they are the right decisions for themselves. because no one can really share the same lived experience, i want to support families to trust themselves to know what is best.

if parents are coerced into actions throughout their pregnancy and birth, how are they going to be prepared to be parents?

Sunday, November 30, 2014

waterbirth. communication. and reflection.

i went to a waterbirth workshop with barbara harper a few weeks ago, with one of the women i work with.

she was a fantastic road trip companion.
brought new inspiration to me about my practice and waterbirth.

we have a lovely tub at our birth centre
(which is 3 minutes from my door. this is also quite lovely).
(this also helped last thursday when we had two babies born overnight, 12hours apart)

11 births so far.
3 in the water.

this weekend, i had a mom come in and 13 minutes later birth her baby in the tub.
she arrived. got into the tub i had waiting for her, pushed, and when i helped her forward into a squat, pushed out her 4.53kg (10 lbs.) baby girl.

i felt as her head emerged. she sat there between contractions. coming back from the conference i brought with me something from cranial sacral therapy.
a way to communicate with the baby.
i gently touch her temporal bone, above the ear.
helping her decide which route to take into the world.
she restituted to the left. and spun out into this realm.

this weekend was spent saying goodbye to my sister and her family as they move back to calgary. i've been lucky to have them living at my parents house this last 9 months. i've got to watch as my niece developed into this little person, who when see's me come into the house, reaches to be in my arms.

it was spent watching as a new life transitioned into it's own autonomous self.

it was spent fulfilling the simple chore of shovelling my driveway and sidewalk. a simple task that grounds me.

it was spent continuing to flush all the toxins from my body from eating grains when i shouldn't have been.

it was spent in sweat. and in meditation. and practicing yoga.

it was spent in quiet reflection.

i'm inspired. 

making plans. 

i feel this year. 

Tuesday, November 4, 2014

on being 34. nesting. and moving forward.


it was my birthday on saturday.

one year ago i was in toronto. i turned 33. i had graduated midwifery school and was embarking on registration in canada.

it was last november that i first interviewed for the position that i now hold.

it's amazing what can happen in a year.
it's amazing what can stay the same.

but i'm here.
i'm moving forward.

in my 33rd year, i registered as a midwife in saskatchewan. i returned home. witnessed the birth of my niece and the growth of my sister and her husband as parents.

i returned home.

for the first time in more years i care to count i have a home. i pulled it off some how, but i bought a small house.

this road warrior is settling down.

man, it's been a struggle. but i have not doubted this course for one minute. i know to the core of my soul that i was meant to be exactly where i am right now.

i'm mourning the loss of a relationship. not quite accepting that it's over and still trying to overcome the impossible.

but i'm moving forward.

so what will this next year look like?

growth.
as a midwife.
as a woman.
focus on building community.
birth community.
arts community.
friendship and support community.
healing my body.
healing my heart.
creating art.
moving my body.
moving my soul.
writing.

my goal is to write more.
i've fallen off. lost focus.
not knowing how to approach this new space.

this year, my focus it break myself wide open...

this is 34.

Sunday, September 21, 2014

sunday morning in bed. with an on call phone.

sunday morning lie in. coffee in bed.

on my way to a postpartum visit
the sun is shining.
it's the equinox.
time for change.

the leaves turn colours and fall.
we shed our skin. releasing all that no longer serves us.

the on call phone sits beside me.
quiet.
two mothers-to-be past their dates.

a new baby arrived a few days ago.
welcomed in our little birth centre.
bringing birthing back into the community is such a lovely thing.

so many first time mothers are choosing this option. knowing we can travel the hour into the nearest hospital if more pain relief is needed. they are trusting in their ability to safely have their babies close to home.

we may not be able to offer home birth right now. but the option we are able to provide is something that local families want.

i'm looking forward to this fall. every month we are full, with the majority of families intending to birth in the community. some are still reticent about being so far from an operating room and anesthesia. for some making that drive feels like the better option. being able to offer choice of birth place, is important.

i found where i'm supposed to be at this time.
plans for the future. but living in the present.
i bought a house. i'm building a home. i'm staying for awhile.

following this journey.

Thursday, July 3, 2014

4 months

I’ve been working at the women’s health centre for four months now.

Totally new perspective on things.

So much to learn.
not because things are unknown, but because experiencing a women’s story never ends.

Forever changing.
Many perspectives.
Always learning.

Stories.

A major difference between my training to be a midwife in the states and now, is that where I would identify abnormalities, run tests, and diagnose, and then refer as necessary. I now am the one to also treat and follow up with care.

For the most part.

Obviously cardiac and what not conditions need referrals, but we are able to care holistically for so many women. And by holistically we mean we can care for women in all aspects, working with specialists when needed.

Working with a nurse practitioner for prenatal clients, enables our moms to be seen and get treated for any ailments outside the midwives scope of practice quickly. 

For the first time I work in a place where the physicians refer women’s health needs and prenatal care to the midwives and nurse practitioners.

We have the time to spend with women, however much time they may need. 

We have a womens’ helper, who guides women spiritual, culturally and in times of need. She will transport women that need rides and works with our health navigator to aid women with whatever complex systemic needs they may have. We have a psychologist. Ultrasound. and amazing admin staff.

We’ve had 3 births so far in our birthing room. Two water babies, and one that came quickly on the land. come the fall, most of our births are planned to be in the community. 

Everyday is different.

On Monday I got the results of my Canadian national exam. The last barrier to my unrestricted license. 
I passed. 
My license application has gone back to council to remove the restriction, and grant a full license. The registrar said I would know by next Wednesday.

My safety net of the last four months is being removed.

Time to fly solo.

…..

of course I have the collaborative knowledge of the women’s health centre behind me.

#luckymidwife

Sunday, May 25, 2014

after the exam

it's a drizzly sunday morning. perfect for writing.

i've been m.i.a. for the last bit.

why?

living life. settling in. working hard. and planting my garden!

that last bit, some will know is true happiness for this vegabond. when you move around as much as i have, a garden isn't possible.

roots. i've planted roots!
****
work.

i'm loving the "job".

i get paid, so i guess we will call it that. but when it's your weekend and you can't wait to get back to work, you know you've done something right.

i wanted to do a big post on the career fair i went to, but i never took photos of my booth, so...
but yes, i went to a career fair at one of the local schools. there were lots of other, definitely more career related booths, but i was the lady handing out condoms and information on sexual health and STI's.

births.

one of the most exciting happenings is that we have had our first birth in our new little birthing unit!

finally women who chose, can give birth without having to drive the additional hour to the city. we are already getting calls from women an hour + away about wanting to birth with us. i hope the hospital is saving their pennies to hire another midwife!

overall births have come in spurts, with a lull in between. a much slower pace then what i'm used to, and something that i'm not minding. i've been granted privileges at the hospital in the city and am getting all of those small details slowly worked out.

this fall is shaping up to be busy. and exciting. i can't wait until we transition into attending most of our births in our community hospital. it's wonderful that the family doctors are so supportive. we have a few that worked in rural scotland, so they are used to midwife-led birthing units. and the younger doctors, well they are eager to learn.

the exam.

this is the big one.
on thursday i wrote the national midwifery exam.
now to wait for the results. 5-6 weeks. bleurg.

failure is not an option.

the future is wide open, but the present moment is filled with clarity and all the rewards i could have ever imagined after this long journey to becoming a midwife. the fact that i returned to where i grew up, after all the travelling i've done, all the places i've been, the fact that i have returned, and feel at peace. i'm not sure there is anything better than that.

until next time...