Clinic day #13: paid in full

Wow, was this clinic day ever a doozy. Nothing too much to report, just appointment after appointment after appointment. Two even cancelled, and it was still a long day.

Things went well though. My gestational diabetic is keeping her blood sugars so well controlled that the high risk clinic doesn't even want to see her again (unless that changes). My other slightly complicated lady seems to be doing well, with a follow up appointment with the high risk clinic - the word is still out on whether I'll be delivering her or not. I did an intake for an intelligent woman that will be a VBAC (though she has already had one vag birth), perhaps at home. The going thing seems to be that EVERYBODY is measuring small for dates. So I'm ordering gobs of ultrasounds.

I did a nice deep stretch and sweep for my lady that was due yesterday (this is basically a vaginal exam where I stretch the cervix with my fingers and separate the amniotic sac from the uterus. It often causes cramping, and throws some women into labour). I hope I hear from her tonight or tomorrow.

Another lovely birth

Christmas Evening, around 5:00, I sat at the end of a bed, and caught a bouncing boy. It was a lovely birth. No complications, just a simple stitch job at the end. They were so very happy and they had reason to be. What a beautiful Christmas Eve.

Happy Christmas!

Well, actually, Happy Boxing Day!

I didn't have Christmas off this year, so parts of my family were coming to visit me (until the 30th when I have 24 hours off and will go for the 'official' Christmas with the family). Overdue women were starting to pile up for the other midwives, and my neighbour midwife was taking Christmas weekend as her weekend off. On the 23rd around noon, I got a page from a teen client who was not due until the 1st. She was contracting q 5-6, lasting 45-60 sec. I told her to wait until they were 4-5 x 60 sec for an hour. So I ran to do a home visit for one of neighbour midwife's clients before anything could get going. Later on I called to check on her, and they had spaced to q 10-20 minutes.

After that I spoke with the other midwife on call (Kmidwife), who informed me that she was going to have to do an induction with her overdue woman in the morning, so if my teen client did go that she would have to go to University hospital as opposed to the General because we were the only two midwives on. I didn't think she'd go into labour, but I was wrong. At 0415 on Christmas Eve morn she paged saying her water had broken, and she had had one contraction five minutes later, but that it REALLY hurt. I talked with her for a bit, and then she got another contraction. I decided to wait on the phone with her and see how the contractions were, and each one was closer: 3.5 minutes, 3 minutes, 2 minutes... So I told her that we would go to University hospital and I'd meet her there. Normally I go and assess at home (especially a first-time-mom), but I just knew we'd be going in. When she arrived at 0525 she was vomiting and wide-eyed. Upon checking her she was 5 cm, 100% effaced, and the baby at 0 station. Nice. Got her vitals done, blood drawn, and she settled in nicely. Then she got an urge to push. Check her: 6cm (at 0550). She wants an epidural. So, I let her know that we have to get half a bag of fluid in her, get the IV started, and paged K-midwife because I am not yet epidural certified. Half of the bag gets in, and she has the strongest urge to push. Check her at 0640 and she is a rim (9cm). Midwife arrives just then and we page anaesthesia. And we wait... 0700, and I see some parting of the labia. Check, and she is complete, +2station, and this babe is coming. Anaesthesia arrives literally 30 seconds later and we turn them away. Beautiful birth at 0717 over an intact perineum. Lots of tears from the grandma, sisters, and boyfriend. Beautiful, beautiful birth.

I wonder if young Mary, the mother of our Lord had such a lovely birth.

Clinic day #12 or "Pay me now, or pay me later"

This week's clinic was SO empty. I did three visits in the morning including one intake, then ate my lunch, slept for an hour, did a couple more visits including another intake, saw my chiropractor, then popped back to the clinic for one last visit, and was still done by five.

I'll pay for it. Next week will be crazy.

You just never know..

I was backup for a delightful woman who was due between Christmas and New Years. Her first baby was large: 9 pounds, 14 ounces, but she had no trouble with delivery.

Second babies are often larger.

At each appointment, we measure the uterus with a measuring tape by starting at the pubic bone and going to the fundus (the top of the uterus). The number of centimeters should roughly correspond to the number of weeks of pregnancy, or at least a steady growth. During mid-pregnancy she was measuring large, and neighbour midwife and I could envision this massive baby... But what to do about it? Well, besides doing testing for gestational diabetes, neighbour midwife had to do an OB consult (a College of Midwives guideline which I personally think is quite ridiculous, because what are you going to do about it? It is not good medical practice to induce labour for macrosomia [literal translation: large body], so basically they say, "Yes you are having a large baby, good luck!").

She went into labour on Monday evening, and I was paged to assist at quarter to two. She had a beautiful birth - no concerns with the delivery at all... an 8 pound 14 ounce boy! It was one of those " what a beautiful birth" births.

So you just never know.

I know you from somewhere

You know that sensation that you get when you meet someone and you know them from somewhere? I had that feeling when I did a prenatal appointment before I went on holidays. As I was on holidays, I figured it out. This woman looked for the world like one of my grandfather's sisters' granddaughters. I guess that would make me.... a second cousin. Anyway, she delivered yesterday evening. The primary midwife (my neighbour) called me to let me know that things were happening, and that she would probably need an epidural, and as I wanted one more epidural for experience before I went to do my epidural certification, I decided to go in for the whole kit and kaboodle. I'm glad I did. It was a nice birth, and she did get an epidural, and it was a nice reintroduction to the hospital/paperwork, etc. I feel ready to do my epidural certification now.

Turns out that this woman isn't related to me in any way. I'm glad she had a good birth though, because she still felt a bit like family.

Hospital Privileges, clinic #10 &11, births, etc....

Well, I'm back from a great month off. Many people have been amazed that I have gotten a whole month off so soon in my career. The reason is that we take 4 clients per month (and back up for four as well) for ten months for a total of 40 (80) births per year. That leaves two months without births. The month of November in the practice was very slow, so I was offered the month off and took it. It actually turned out very well - turns out that I needed a holiday. Getting oriented to a new job is very stressful, and having the month off after three months on was a perfect break for me. So I decorated my apartment (with my sister and mother's help), travelled to Texas and visited the birth centre where I had trained (and had a GREAT time seeing everybody), and had a graduation/congratulations-on-starting-to-practice party put on by my parents, which was fun.

Shortly after getting back from Texas I visited the general hospital in our area where in my absence I had (finally!) been granted privileges. I got my badge, did a computer orientation, got the speech about keeping up on chart deficiencies, and was generally welcomed. A very good feeling. (When a patient is discharged, the chart goes down to medical records. They look it over and invariably find places that you forgot to sign or a box that you forgot to check. They then stick a note in your box to inform you of the 'deficiency'. If that goes longer than 2 weeks, you get notice in the mail and if it goes longer than a month your privileges are suspended. The University hospital at any given time has around 10,000 chart deficiencies because it is such a huge hospital!)

It felt sort of strange to see my clients again - they have all grown (of course) and having missed one or two appointments, I took a bit extra time to 'get to know' them again.

I had one pregnant client that I thought would deliver while I was gone. She was booked for me as due on the 8th, but with 3 weeks cycles she was actually due on the first. Well, she went on the 8th, so I was back for her care. I thought she would be quite an interesting case, but she turned out to do quite well. The Children's Aid Society was involved (they wanted a drug test for the babe), and that is always a bit of a wild card. Turns out that during the month I was gone, she passed a drug test and got her 10 year old daughter back. The birth went well, she did well and her partner was very supportive. She didn't progress well at the end and wanted an epidural, so care was transferred to the OB (at General hospital that's the way it works, we don't have epidural privileges). Once she got the epidural, it was no time at all that she was delivered. The next day I talked to her CAS worker, who said that she had no concerns, so I went to see her and she was doing really well, so I discharged her home. Over the past few days she has done well and baby is gaining really well, and I have no concerns.

My next delivery isn't due until the 27th, but I am backing up for a few, and I need to get my epidural certification at University hospital, and my oxytocin certification at General hospital. I also need to finish writing our home birth handout. It should be a busy month.