Clinic day #30: I'm here for you

It occurred to me yesterday that in our society we don't very often make statements aloud of support to one another.

Yesterday I was doing two prenatals in a row for first time mothers that are 28-30 weeks along. Around this time I usually discuss the birth process with them, letting them know what to expect, going through right from when labour starts to the home visits afterwards. In both visits I made a statement akin to: 'Please feel free to speak up and let me know if you need anything or if I am doing something that doesn't feel good in your labour, for instance "rub my back harder/lower" or "somebody talk me through contractions" or "you're too close" etc. Feel free to be open and honest; I'm not going to take offense. I am here to support you in your journey, and whatever I can do for you, please let me know.'

Both women started crying after I made this statement. Of course one could chalk it up to pregnancy hormones, but perhaps these women's souls needed a bit of tending.... what a privilege for me to be able to perhaps calm their nerves and meet that need. I love my job!

My Achilles Heel

The province I am located in has a newborn screening program that tests newborns for metabolic, endocrine, and genetic diseases. These disorders are serious, and by the time you are seeing signs and symptoms of one of these disorders, the damage is already done, and your wee babe is either very ill or dying. Early treatment is vital. As midwives, it is our responsibility to poke the little heel of every baby we deliver and collect five 1cm circles of blood to send off to test for these diseases.

I really, really do not like doing it. Not because I hate poking the baby's heel (though it isn't my favourite part of my job) - I poke people regularly, and to be honest, it is somewhat routine. I also know that it is in the best interest of the child to be tested for these diseases. In all sensitivity, I encourage the mom to put the baby to breast so that they can be distracted and also receive the calming effect of breast milk while being poked and having their foot bled, but if they cry, I can even tolerate that without too much conflict. No, what I hate is poking the parent's child. Especially because the parents are there watching. To be the one inflicting pain on their precious babe is torture to me, for the parents' sake. I truly feel more for the parents than for the poor babe.

When I'm done collecting the sample, I usually kiss the poor baby's foot and apologize: "There, there, all done. I'm so sorry, little one" but inside I'm thinking "I'm so sorry mum, I won't hurt your babe any more." Maybe I should say that aloud too. I don't know that it would help the mum, but perhaps it would help me.

Social inductions

Labour can be pushed. We can prod it on if it is slow, we can try to start it if it hasn't started. It isn't the ideal scenario. Labours will generally go better if allowed to progress on their own. A labour that is pushed has more chance of ending in major surgery, not to mention other interventions like epidural, instrumental delivery (forceps, vacuum), and being confined to bed (or at least, confined to the fetal monitor).

So we make a practice of not offering induction unless there is a medical indication for it. We don't offer inductions for being overdue until they are overdue at least 10 days (2 weeks is the maximum our College will allow us to allow a woman overdue), or if there is a fetal indication such as IntraUterine Growth Restriction, or Oligohydramnios, etc.

Before neighbour midwife went off call, she was giving me report on all the cases she had that I was backup for. One of them was a mom having her fourth baby, who also had 5 foster children. She was due Wednesday, but was requesting to be induced for a couple reasons - childcare was difficult to arrange at the last minute, her last baby was born in 45 minutes as an unplanned home birth, and she was wanting a hospital birth, but above all she was ready to be done (as every mom is close to their due date!). These are all not medical reasons for induction: they are social reasons. Good ones perhaps (you be the judge), but social nonetheless. She also thought (despite what ultrasounds early in the pregnancy stated) that she was at least a week overdue based on conception date. So neighbour midwife had arranged an OB consult for that evening to get an induction arranged for Monday when she would be back on call.

That evening about 8:00 I get a page: Going to General Hospital to be induced. Pls call. Great. She had seen the OB, he had checked her and said why not tonight? She said sure. (note the childcare arranged at the last minute!). The OB wanted to maintain care but allowed me the courtesy catch. If it would have been my client, I would have taken greater measures to resume care (we can induce, the OB just has to order it), but since this woman a)wasn't my client, b)was requesting an on-demand labour and c) WAS STARTING THIS AT NIGHT (!), I admit to feeling a little bit like I couldn't care less. I had all these women due and she was demanding labour and at the same time putting us out for it! So if her result was going to be to have a stranger manage care, I wasn't going to quibble. (Am I a bad person?!)

The induction went very well. I hung out with the nursing staff, having a great time, and now an then hung out with her (she had good support, and when the nurse was in there coaching her, I didn't want to step on toes), and when it came time to deliver, I delivered, and the OB stayed at the door! That baby came out COVERED in vernix [definition: cheesy white substance that coats baby before they are due] - She wasn't overdue at all! (also her foot creases only went part-way down her foot, another sign of being early). So I got home at 6am, praying fervently that no one else would go into labour. Thankfully no one did, and I got rest.

Next time I'm not cutting my fingernails. Sheesh.

New Wives Tales

I have this strange superstitious belief that when I cut my fingernails that that makes it more likely for a mom to go into labour. As if my being ready will make it so. So entrenched is this superstition that I will not trim my nails if I'm wanting to not get called out! Crazy, yes. I don't tell this to too many people I know - it sounds too much like the midwives of yore that put a knife under the bed to 'cut the pain'. Despite all my intellectual eye-rolling at my neurosis, the superstition remains and every time I get out the nail clippers, I wonder who will go into labour.

Right now I'm waiting on a bunch of births. Neighbour midwife went off call for her June weekend off. She'll be off until Sunday evening. She has three multips due that I am covering for, and I have two primips past due as well as two multips due in a bit over a week. I'm anxious to have one of them deliver!

So I trimmed my nails.

The General

Relations between midwifery staff and the University Hospital are excellent. Relations at the General are good, but I don't have the comfort level at the General that I do at University hospital.

My first birth back was planned for the General Hospital. With a bit of nervousness, I headed in. I needed a consult for GBS prophylaxis and the mom had chosen to be induced after her waters broke - she didn't want to wait for labour to progress naturally. I consulted with the OB on call, and after a misunderstanding (which was sorted out with the utmost of politeness), relations throughout the day with the staff were excellent - I found myself wishing to do more births there!

Return from holidays; clinic day #29

I'm back from a month of holidays, and happy to be back in the saddle, as it were.

Nothing much to report from clinic - just the usual!