More waiting...

I'm an RM. I'm practicing. I'm still waiting! All that is left is hospital privileges. I called University Hospital today and they are only waiting on references. So I attempted to contact my references - got the OB's nurse's answering machine, but was able to talk to the administrator for the two midwives that I referred. Head midwife reference said that there should be some form that she could fill out quickly... to make a long story short, I wrote up my own references and e-mailed them to be signed by the midwives! Now I just have to get on the OB!!

I have a mom due on the 7th, and she wants to birth at U Hosp, so I hope hope hope that she doesn't deliver until they go through!

Clinic day, #2

My second clinic day. Busy, but not as crazy as last week. I had time to spend with each client, nice and relaxed.

One first time mom asked about what kinds of complications she may encounter with delivery and what our management would be, both in home and hospital. I went through each of the most common complications and our management. She wanted to know the particulars of each, and it didn't seem to bother her to talk about complications (some moms would rather not know). So I went through some common ones: prolonged labour, non-reassuring fetal heart tones, post-partum haemorrhage, shoulder dystocia, and neonatal resuscitation. I felt the need to assure her that she could call if she had questions - I had given her a lot of information to process in a short time, and I wanted to give her the freedom to call if a question came up.

I had an intake with a client who is already past the midpoint of pregnancy and is a teenager. She has been seen before in a walk in clinic but has had no care other than that, since she only told her mom 2 weeks ago. Very small girl, but has hidden the pregnancy very well. She also had never had a vaginal exam before, so I decided to postpone the usual pap and vaginal examination until next visit, as she seemed intimidated enough with me simply taking her blood pressure and simple palpation. I told her that we would do that next time, so she can be prepared for it. I am seeing her again in two weeks, since she has come into care late and we need to catch up on all there is to talk about! I find myself using language that a more educated person would use and I have to remember that she isn't out of high school yet...

Other than those, just the usual: happy, healthy moms!

Home visits

I did two home visits yesterday. Both first time moms, and both houses were immaculate. I enjoy doing home visits. There were no concerns with either prenatal, but it was so nice to take a bit of extra time - I spent about 45 minutes at each visit, and tour their homes and see what care they had put into preparing for the delivery. I am excited and can't wait to attend their births!

A Weekend of Trains

There is a saying that my dad likes to say: "good and bad run on parallel tracks and often arrive about the same time." This perfectly describes my weekend...

-I took Friday off call to go to younger cousin's wedding. Fun.
-I did not sleep well that night - too much excitment, too much food. Not fun.
-I was able to pretty much veg on Saturday. Fun.
-Sunday morning was one of those times when you cry at the drop of a hat for no reason. Not fun.
-Sunday afternoon was spent preparing for my brother and new sister-in-law's visit. Fun.
-Got called out for a birth five minutes before said visit. Fun, but not fun timing. They ended up going home without a visit, because while at said birth, I got called to another birth. Fun.
-Friendly midwife took me to General hospital to show me lab and take bloods in from home birth. Fun.
-Came home with friendly midwife and ate cream puffs and drank limeflower juice. Fun.
-Woke up to exhausted, bone-aching, slightly self-pitying feeling. Not fun.

But, when you add it all up, it was a bit better than a wash, so I can't complain.

Purse and script

My wonderful bag finally came, and I spent a wonderful 2 hours packing and organizing it. It is well organized, neat, and ready for use! Well, nearly ready... I await my oxygen and resuscitation kit, and once I get that, I'll be all set!

I wrote my first prescription today as an RM! I've modified my signature to include "RM" at the end of it, which is cool, but I can't decide whether to always sign it like that or just when it is appropriate.

Second 'real' day

Yesterday afternoon was very busy - an hour long appointment to squeeze in on top of a full afternoon. Then a woman with high BP and consult with OB (she was c-sectioned around midnight) to add to all of that. I was exhausted but satisfied at the end of the day.

Today I spent the morning sterilising instruments and packing my home birth kit - what fun! I got those hard pencil cases that are about 8 x 6 x 2.5 inches and made up a newborn exam kit, suture kit, sterile water injection kit, and kit for drugs, each with a different colour. Then I got an extra long one, probably 15 inches long, for a birth kit (with gloves, amnihook, instruments, etc). I also made an IV kit in a larger plastic bag-type thingy that the heating pad came in, but once my "real" bag comes, there are two pull out kits that I can put the IV kit and birth kit in. I am thrilled with it, especially the colour coding aspect. I can just reach for the blue kit and have all my newborn exam supplies! I can't wait until my really good bag comes - it will be so much better!

I took my hospital privileges application over to the General Hospital (I had already sent my application to University Hospital), and then headed off to a home visit this afternoon. I just met her today, and she is already nearly 38 weeks! I hope I have another week or so just to get to know her a bit more. Unfortunately she is going to birth (at U Hosp) before I have my privileges, so we'll have to admit under my backup. I wish everything was faster - I feel like half a midwife without privileges!

Getting back in the swing

Today is my first clinic day. I was terribly nervous this morning, so much so that I forgot to put on deodorant. Oops. The office has been cool, so no evidence of this fact as yet.

It turns out that my nerves were unwarranted. After a few minutes in the first prenatal, I realized that I do remember how to do this!

My afternoon will be much busier, as there was some mis-communication and I am double booked for an hour. We're just going to go with the flow, though!

Like a kid on Christmas

I got most of my supplies today! I was very excited, and look forward to getting my EMT bag so I can put together my kit. The bag that I wanted is actually on back order for another month or so, but it is such a good bag that I'm willing to wait for it (it has incredibly sturdy zippers and lots of pockets/straps, as well as kits within the bag, which is great for IV setup or a quick birth to have everything at hand).

I still have a few miscellaneous things to order: birth stool, neonatal resus kit and O2 tanks, heating pad, and possibly a TENS unit, and of course gather up all the reusable supplies from the clinic. So tomorrow's job is to finish up ordering supplies and finish the paperwork for hospital privileges.

My first clinic is scheduled for Wednesday, and I am looking forward to it! It will be great to start to get to know my clients!

RM

Bells are ringing, birds are singing, people are happier, I'm happier!

Yes, my four readers, funding is IN, I'm a REAL Registered Midwife, and I couldn't be more thrilled!!

I walked in to the office this morning and just as I walked in, the College called with my registration number, and after a quick phone call to my mother (she, along with the rest of my family kept me sane during these many years of training and testing), it was off and running: rescheduling clients to see me instead of their backup midwife, on the phone ordering supplies, ordering requisitions, ordering the administrator around (ha! just kidding).

I'm on cloud nine. And just a wee bit nervous.

Distant whisperings

Funding is rumoured to be coming soon...

I can barely wait!

Reader beware.

I just realised that I hadn't made a warning that my family and friends will undoubtedly be aware of, but visitors will perhaps not.

Read the next phrases by lowering your voice about an octave. THIS WEBSITE CONTAINS DESCRIPTIONS OF A GRAPHIC NATURE. VIEWER DISCRETION IS ADVISED.

Practice meeting

In all the excitement yesterday of running out of practice meeting for the birth, I did not take the time to mention how much I love being in a group of midwives. It was awesome to sit and eat lunch and discuss the obstetrical community, past cases, and be with women that are chowing down on pad thai while discussing birth.

I am marvelously contented.

Big girl

Just returned from a birth (I attended as the second attendant to assist because funding STILL isn't in...). We were in the middle of practice meeting at a lovely Thai restaurant, and I had JUST finished my meal when the primary midwife called and said that her multip was fully, and their home was about 15 minutes drive away. Of course I drove like a mad-woman and made it in 11 minutes (I would have made it in 10 but some idiot was driving 60 in an 80 zone in a very hilly section so I couldn't pass). I got there, rang the doorbell, and barged in, up the stairs, and the head was near full crown - 7cm showing!! It stayed that way through another contraction, and when it was born, shoulders were a bit snug (no dystocia, just snug), but McRoberts came in quite handily, and she was 'safely delivered' of a 9lb 8 oz girl! So it was very fast (unlike her first one, 6 hr 2nd stage in hosp w/OB, ended up with forceps). They were very happy.

And so am I.

Long e-mail re: postpartum visits.

I'm still awaiting funding from the Ministry of Health. I can't wait to start practicing!!!

For now I'll just wait out the heat in the library or my friend's house.

I heard from a woman who interned after I did at a birth centre in the south USA. She trained after I did, but is already practicing, thanks to the more relaxed 'red tape' in her state. She was inquiring about including a day 4 or 5 postpartum visit and was wondering my opinion (the birth centre protocol is a 2 day then 2 week, which I don't think is quite enough). Because I am lazy, I have pasted her e-mail and my response below.


>>> "____" <____> 08/02/06 12:11 PM >>>
Hey, [Storkforbabies],

Are you going good and strong yet? It sounds like when you do, you'll be going steady, as far as how many clients you already have...blessings on all that.

I have a question for you. What pp visits do you do? And what exactly do you do on those visits? I'm considering adding a 5 day pp visit, but I really don't know what I'd do on that day. I really think that clients need a little more support than just 2-day and then 2-week. What do you think?

Love you,

____


>>>
Hi ___!!
So good to hear from you!

I am not yet practicing... still awaiting funding from the Ministry of Health. It has come as late as mid-august before, so it looks like it might be that this year too...

Regarding postpartum visits, I find that the 4 or 5 day is VERY valuable. Right now the [provincial] schedule is day 1(within 24 hr), 3, 5, 7 (7th day is usually at the clinic), then 2,4, and 6 weeks (all at clinic). For an experienced mom with no problems on day 1 and 3, sometimes the 5 day is a telephone call instead. The reason I think that the day 4 or 5 is very valuable is that if postpartum depression is going to set in, it is usually around this time. I usually warn moms that sometime on day 3 or 4 they will have a blue day, but if on day five they are still down, and struggling, it is a good time to have a chat with them, perhaps pull out the Edinburgh depression scale and go through it with them, either to rule out PPD (and give them some reasurrance that although they are going through a rough time, there is nothing wrong) or to diagnose it and get them to see their family doc. I actually had a PPD this winter (this mom had a bit of a rough time: breastfeeding difficulties, her husband didn't make it to the birth, etc), although when I asked her how she was doing, she said "better". I could tell by the way she said it, that that was a stretch! After the visit, I called her family doc, and discussed it with her, and they made the decision not to medicate but to do some counseling. After an hour long visit with me and talking out a lot of issues such as re-negotiating roles within the family now that there is a new member, as well as allowing each other to handle the baby the way they are going to do it (being supportive of each other), as well as talking about how they are feeling, she felt much better, and felt like she wouldn't need to see her family doc unless I thought it was necessary. I felt like it would be a good idea considering that on the Edinburgh scale she was considered depressive, and she went ahead and did that. I think also the fact that I took the time to sit down and talk about it in a caring manner made a big difference to her (in fact, her husband said he felt like he was at the therapist's!!!).... Of course, we don't get a lot of moms with PPD due to the kind of care we give.... but I digress...

Back to the topic - day 5 is also a good day to confirm that things are going well with breastfeeding. Sometimes on day 2 they are still struggling a bit, haven't got things quite perfected, etc. and it is good to be sure that babe isn't starving... ! and to give mom encouragement.

Also, if you are going to get endometritis, it usually shows up day 4 or 5. I had one of those too this winter, and I'm sure it was hospital-acquired, but you never know... anyway, with no activity (just laying on the bed or sitting on the couch) this mom was having about 15 quarter-sized clots per day with her flow, and because she was a first-timer had no idea that that was abnormal (even though we go through the whole speel about how much bleeding is too much). After a round of antibiotics she was fine. No temp BTW. Pulse was borderline high.

Another reason I do it is because often about day 4 or 5, some moms feel like they have been in bed for a long time and they can now get up, vacuum the house, do the laundry, and lug around their 2 and 4 year old. It is a good thing to step in and say "just a bit more rest, please".

So to sum up, yes, I think another visit is very appropriate, and my clients sure appreciated it. There are many reasons to do it and I am all for it. I believe that the clients are well served with it.

..... [personal stuff]


Love you,
Stork

The Second Post

I have decided that I am going to use this blog after all.

Caveat emptor: it will not be smart, funny or clever (see Kinnor's blog for this).
It will be simply a diary of my life as a midwife, with random birth stories for anyone to enjoy - sans names (mine or anybody else's!)

To Life!