The night sky was inky and the air was apple crisp on my checks. I was pacing. There was student midwife with me and she joined in. The room was ready, I had hastily gotten all the tasks done. So, now I was outside on the breezeway, pacing in the night. It was her second baby and I didn't know if they were gonna make it in. They had said the drive was about 10 minutes, by now it had been 20. I anxiously watched the street for car headlights turning my way. Finally, I saw them, and I took a nice long breath, they had made it.
The car door opened and I heard the Mama...the unmistakable sounds that mean a baby is just about to crown. She stepped out of the car and grabbed onto the gate, fell down to her knees and groaned. I quickly and gently felt between her legs...we had a few minutes, maybe. "Your baby is very close. We can have her here or we can go inside. Do you want to try and walk inside?" She says that she would like to walk inside, the next moment, she is sprinting across the breezeway with myself, the student midwife, and her husband trying to catch up.
Once inside, she returned to her hands and knees, groaning and full of power. We must have been quite the sight, she was crawling down the hallway, we were trying to get her clothes off, the baby was working her way down and out. I told her that she could stop crawling and have her baby where she was, however, she was determined to have her daughter in the room that she had loved during her prenatal care and classes. The instant she crawled into the bed, her sweet little girl arrived and all were well. A few minutes later, the nurse arrived and came in the room laughing. She said that the hallway looked like a movie scene...with clothes strewn about, socks, pants, underwear, etc. leading to the bedroom. We all laughed together. These moments are so special and sweet, I am honored to be a part of them.
Saturday, April 23, 2011
Wednesday, April 20, 2011
and Beyond
Well, it has most definitely been an amazing year with women! I started my blog in May, but I had started catchin' babies in April. As this anniversary has been approaching, I have been wondering what to do with this blog. I have loved keeping it, and am surprised (very happily) that a few others actually read it. It has been therapeutic, fun and in a real way has helped to foster my growth. The introspection involved is much appreciated...though not always easy to accept. After some thought, though not much because it was an easy decision, I have decided to keep the blog going. I have no idea how to change my url without loosing the content and followers, so I will keep the original name. This may be an homage to this first year and how special it has been and to the hopes of many more amazing years to come.
Monday, April 18, 2011
Stats..the first 100!
Wow, again, it seems hard to believe that I have reached this milestone! I have compiled a rough group of stats from these births, but I do have some disclaimers. First, these births are only the ones that I was able to "catch". So, these do not include Mama's that I labor sat with and then passed to my midwife sisters. Second, these do not include Mama's that I had to transfer to the hospital before the birth...which would include both vaginal births and cesarean sections. In putting these numbers together, this is an area that I realize I have unfortunately missed. In the future, I plan to also keep track of those births as well. Also, the first 40 births were done as a student and 21 of those ocurred in a hospital. Well, here goes:
There were 52 boys and 48 girls and 4 (two girls and two boys) of these babes were born en caul.
There were 11 cases of PPH (EBL > 500ml).
I had 4 Shoulder Dystocia's...however, I feel that 3 of them were more like "tight shoulders" as they were easily relieved by McRobert's position.
I performed AROM in 19 labors.
There were 4 retained placenta's.
I had 1 cord evulsion and found 1 true knot in an umbilical cord after the birth.
I cut 2 episiotomies, one of which extended to a fourth degree laceration and the other was a second degree, both were done for significant fetal heart decelerations during crowning.
38 perineums were intact, 33 had first degree lacerations (about half required suturing), 24 second degree lacerations, 3 third degree lacerations and 2 fourth degree lacerations (1 was from the epis and one ocurred spontaneously).
4 newborns were transferred to the hospital after birth; 2 for TTN, 1 with more severe resp distress and 1 with anomolies.
9 women were transferred postpartum; 4 for retained placenta's and 5 for repairs of the 3rd and 4th degree lacerations.
26 births were H2O births (for 21 of my catches, water birth was not an option at the site) Birth positions: semi-reclining = 26, hands and knees = 25, birth stool = 14, McRoberts = 14, squatting = 10, side lying = 8 and standing = 3.
Whew. Those are the big things that I can think about to tally up. I have mixed feelings on the results. I feel that the two epis's that I did were valid, though they are never "fun" to do. I am curious about the amount of PPH and want to investigate that further. I have had a tendency to practice a more active management of third stage. However, a new study was just published from Australia which puts this practice into question. It is something I will continue to monitor.
The big surprises for me were the rate of water birth and the birth position. I had thought there were more water births. The percentage works out to be 32% (when corrected for the births where not an option), which is still a good amount. I feel that almost of my Mama's have labored in the water. I think that perhaps, as a new midwife, I was more likely to have a woman get out of the pool for perceived concerns and I am becoming more comfortable with having her stay in the water now. Part of this is because the water births have increased as my numbers have gone up. The break down of birth positions was also surprising, particularly the amount of births in the McRoberts position. Again, I think this may have to do with comfort level as well and has ocurred less frequently as numbers went up.
The exercise of putting these numbers together has been very informative, it is something that I would recommend to all midwives. We can easily remember things differently...like, I would have estimated my water birth rate to be much higher and my PPH rate to be lower. Some information may not be what is expected, for good or bad, but we must always strive for the facts in order to improve our practice.
There were 52 boys and 48 girls and 4 (two girls and two boys) of these babes were born en caul.
There were 11 cases of PPH (EBL > 500ml).
I had 4 Shoulder Dystocia's...however, I feel that 3 of them were more like "tight shoulders" as they were easily relieved by McRobert's position.
I performed AROM in 19 labors.
There were 4 retained placenta's.
I had 1 cord evulsion and found 1 true knot in an umbilical cord after the birth.
I cut 2 episiotomies, one of which extended to a fourth degree laceration and the other was a second degree, both were done for significant fetal heart decelerations during crowning.
38 perineums were intact, 33 had first degree lacerations (about half required suturing), 24 second degree lacerations, 3 third degree lacerations and 2 fourth degree lacerations (1 was from the epis and one ocurred spontaneously).
4 newborns were transferred to the hospital after birth; 2 for TTN, 1 with more severe resp distress and 1 with anomolies.
9 women were transferred postpartum; 4 for retained placenta's and 5 for repairs of the 3rd and 4th degree lacerations.
26 births were H2O births (for 21 of my catches, water birth was not an option at the site) Birth positions: semi-reclining = 26, hands and knees = 25, birth stool = 14, McRoberts = 14, squatting = 10, side lying = 8 and standing = 3.
Whew. Those are the big things that I can think about to tally up. I have mixed feelings on the results. I feel that the two epis's that I did were valid, though they are never "fun" to do. I am curious about the amount of PPH and want to investigate that further. I have had a tendency to practice a more active management of third stage. However, a new study was just published from Australia which puts this practice into question. It is something I will continue to monitor.
The big surprises for me were the rate of water birth and the birth position. I had thought there were more water births. The percentage works out to be 32% (when corrected for the births where not an option), which is still a good amount. I feel that almost of my Mama's have labored in the water. I think that perhaps, as a new midwife, I was more likely to have a woman get out of the pool for perceived concerns and I am becoming more comfortable with having her stay in the water now. Part of this is because the water births have increased as my numbers have gone up. The break down of birth positions was also surprising, particularly the amount of births in the McRoberts position. Again, I think this may have to do with comfort level as well and has ocurred less frequently as numbers went up.
The exercise of putting these numbers together has been very informative, it is something that I would recommend to all midwives. We can easily remember things differently...like, I would have estimated my water birth rate to be much higher and my PPH rate to be lower. Some information may not be what is expected, for good or bad, but we must always strive for the facts in order to improve our practice.
Saturday, April 16, 2011
A Milestone
All I can say is, WOW! I have reached a big milestone recently. I was blessed to catch baby #100! It seems somewhat surreal, but wonderful. I can realize how much I have learned and grown...I can also realize how much more I have to learn. Currently, I am in the process of putting together some stats about these births...boys v girls, birth positions, water v land births, etc and will be sharing them. But, I couldn't wait to share the news of my Big 100.
Thursday, April 14, 2011
AWOL...
Wow, how time does fly!! I must apologize for my long absence...and offer an explanation. While I was on the long path to midwifery, my dear husband was amazingly supportive...and actually my biggest cheerleader on those inevitable road bumps. He truly made it possible for me to complete the journey, without too much guilt about the time taken from my family. It was a long road, several years in fact. I feel that it many ways loving, supportive midwife-husbands are the unsung heroes of our service to women, as they are often left to pick up the slack at our own homes. So, several months ago, when my husband started talking about running for a local elected office in city government....I, of course, wanted to be supportive. This is something that he has considered doing for years, but was always busy being my cheerleader. Now that I have finished the formal education part of my path, it only seems fair to "pay it forward" and give him the same support in return. So, long story short, I have become a committed member of the campaign...and the official treasurer (which is actually quite hilarious if you know anything about me and numbers). We have been canvassing in our community, attending forums, taping TV spots, and stuffing envelopes! It is a process that we are all learning together and it has been an adventure. The whole family is involved and it has been a great way to spend time together. The election is coming up and I feel that we have a good shot and if he doesn't win, it will not be from lack of heart or effort. Clearly, this has kept me very busy indeed! I have continued to work with women and their families, catching babies and all that entails....I just haven't had any time to sit and share my experiences...which I have truly missed doing! Don't worry, I have been keeping my birth journal and have some great storied to share..... Stay tuned for some good, juicy midwife tales.....
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