Clinic day #6; off-call blues

Clinic day #6 was great. No issues. A pictoral collage gift from homebirth client two weeks ago....swell

I am due to go off call this weekend. I am having my brother and sister-in-law over for supper then going to visit my parents way out of the catchment area. I really do not want to go off call. I want to be there for my clients! On the other hand, I really would like some time off call. Maybe over the Thanksgiving weekend I will stay on call (even though I'm scheduled to be off). I'm so torn. Is this a sign of becoming too attached to clients? Being co-dependent?

Clinic day #5

Yes, readers, I missed posting about last week's clinic.
It was uneventful.

This week's clinic, on the other hand, was lovely. The prenatals were uneventful (the way I like 'em!), but 'my' two babies came in back to back, and they are both growing wonderfully and their parents are doing great!

I'm feeling rested after last week, and ready for more births...

It pours

A lot has happened since I last posted!
I got my privileges at University hospital. Yay!
I attended as the primary midwife for my first delivery as a Registered Midwife in Ontario! It was a good 'butter birth' (nice 'n' smooth!). First baby. She woke at 1:30am with sporadic contractions, which continued all day. She was still contracting every 5-10 minutes when she came to the clinic about 4:00 where I was finishing up my clinic for the day. On exam, she was 1 cm with the head very low at +2 to spines. I finished up my clinic, ran and did a home visit for the mom that delivered without me, then ran back to midwife neighbor's house to eat fabulous chicken soup and homemade bread and watch House. 8:40 paged to come, and at 9:00 I checked her and she was 4 cm, +1, thin and stretchy with a nice bulgy bag of waters. She was coping fair, but we got her in the tub, and she settled in very nicely. At midnight she was booking right along: 7cm, 1am her membranes ruptured, and shortly thereafter was feeling pushy. VE revealed a cervical lip (very stretchy), so just put her on hands and knees and soon the urge was unavoidable, and then her labia started to part! A beautiful girl at 2:01am. She tore a small second degree, so we moved her to the end of the bed so I could stitch her up. Well, her bed was very low to the ground - 20-24 inches or so. so a chair was going to be too high for me, so I thought I'd just sit on the floor with her legs on chairs on either side of me. It worked very well - I knelt, set up the sterile field, and enjoyed a lovely stitch job. Call me morbid, butI quite enjoy suturing. It is very relaxing. Anyway, I finished up and went to get up...and couldn't - my feet wouldn't hold me and I went crashing on my butt! Everyone though I was passing out, but my feet were asleep from kneeling for 20 minutes, and I couldn't feel them! So it took a good 10 minutes of rubbing before I was okay enough to stand on them! I felt like a MORON!!!

I attended another birth at University hospital with neighbour midwife on Thursday (actually, the birth happened Friday morning). It was a good birth for orientation: non-progressive labour, AROM, moderate meconium, no progress so oxytocin augmentation and epidural. So I was able to observe consults with Neo, Obs, and Anaesthesia. A good chance to learn paperwork and consult protocols while still having a lovely outcome - a nice vaginal birth with no complications.

This morning a section after failure to progress: polyhydramnios, 41 and 2 weeks, non-progressive labour (after prostaglandin gel x2 and oxytocin augmentation), macrosomic baby, which turned out to be direct OP - no wonder he wasn't coming down! That one felt weird to be at because we were just supportive care: care had been transferred to the OB due to the issues involved, and we just basically did labour support, then received the baby after neo had done the initial assessment and were comfortable leaving.

I need sleep.

privileges

So this weekend the first mom had her baby. The dad called at 3am, with contractions going for 15-20 minutes. I was halfway there when he paged again at 3:15, saying she had some rectal pressure. I told them to GO TO THE HOSPITAL NOW!!! (They were adamantly against a home birth, which I tried to encourage them to consider because she went so fast with her first, but they weren't comfortable with that option). I slowed down from 150km/hr and pulled over to assemble the cavalry. Called the backup midwife on her home phone: no answer. Cell phone: no answer. Paged. Five minutes later she called back saying she was in a city 1.5 hours away. Hung up. Called second backup, then third midwife as I cannot even second for the birth without privileges. Made it to hospital, walked in as baby's head is showing, and the room is going crazy with nurses, resident, then a midwife from another practice... then finally third midwife made it as head is crowning, and things calmed down a bit. Beautiful birth... I was a bit disappointed but not at all surprised that she delivered.

The push

So yesterday I was on top of my references and managed to have everybody get them in to University hospital in the hope that maybe, just maybe my priviliges would go through before the weekend. The gal in the credentials office managed to get them off to the chief of Obstetrics for a signature last night. So I called his office this morning, and his nurse/secretary said that he won't be in until Monday morning. Bummer. So if the mom due on the tenth delivers, I'll be out of luck.
I'll say it again: Bummer.

Clinic day #3

Totally uneventful clinic day this week.

A mom due late this month came in with the late pregnancy miseries: tired of waiting, tired of being heavy, just plain tired. I think we were able to cheer her up a little... with talk of lots of sex.

Borrowed time....

So despite my prayers that no one would go into labour before my hospital privileges came through, at 0034 on Wednesday a mom due on the 10th paged. I went screaming down the highway (not literally) because they live a good 45 minutes away, and her first went very quickly. Checked her, 2cm. An hour later, ctx (contractions) had really picked up, so checked again to see if we needed to head in to U hospital, still 2 cm. Delight of all delight, she is in false labour! Put her in the tub, ctx gradually petered out. Slept on their toddler's bed from 4 to 7 (checked on her a couple times in that time), then headed back home, with ctx every 20 minutes or so. She was disappointed and amazed that 'false' labour really feels like real labour - pain and all!

If she delivers before my privileges go through, I'll have to go as her friend/labour coach, and get one of the other midwives to deliver her.