Bosnian Slipper Socks...

I'm giving the old bod a holiday after the holiday overindulgences...

With moral support from my ds, am following a vegan, wheat-free, alcohol-free diet for January... and have yet to shake off this stinking headcold. Haven't particularly missed anything yet, even chocolate. Must have really over indulged at Christmas.

Now I'm off to tempt myself at the pub- parentcraft reunion!

(mind you, have been invited around to friends' for supper on Saturday, and I promised to make profiteroles for dessert - ho hum).

Back home, finally, and seven couples turned out into the cold, with their babies. Noone wanted to go home! I love seeing nervous mums with bumps metamorphose into confident mums with babes.

One particular couple I cared for antenatally had come over from Bosnia where they are involved with community voluntary work, to have their baby here. Being the avid knitter that I am (really? Yes really!) I commented on the mum to be's beautiful handknitted slipper-bootees. So I was really chuffed when they presented me with a pair of Bosnian handknitted slippers tonight, as a gift.
These are different from the booties I'd admired, but still fascinating - I've been trying to work out how they're constructed - I'm even tempted to pull one apart and reknit it! They appear to be knitted in segments with the sole going a different direction to the instep/top. The cuff is definitely knitted last, in the round. The heel appears to be a standard dutch heel, but with really long gussets. This is they:
Whatcha think? Any ideas?

Wasn't called out but had a lazy day with few visits...

At one of the postnatal visits I was astounded by the completely illogical advice given to the mum on her discharge from the hospital: she was advised to 'keep the baby indoors for 48 hours as she's small and it's cold outside". Reasonable enough, you might think, as baby Alex was only 2490grams, born at 37 weeks gestation, and it certainly is frosty cold today. But hold on there one cotton pickin' moment, just how exactly is this baby to be taken home if she shouldn't be taken outside?

And then, because the ward was busy and the mum didn't want to stay in a moment longer than she had to, she was asked to bring the baby back to the hospital the following day for the paediatric check. Let me see now, that's THREE trips outdoors into the cold. You get my gist?

AND I'm qualified to do the paediatric check...

But I had a very gratifying visit to another postnatal mother later on. I'd been to see her in the morning: 10 days postnatal and she's still expressing milk to give her baby with a bottle because she says baby Grace won't latch on, cries, refuses the breast when she tries to feed her directly. This mum burst into tears during my visit because she's so frustrated and tired - well, she would be, with twice the work of feeding the baby - all the sterilising and pumping as well as sitting down to actually give a bottle. Only once had the baby latched on since she'd brought her home, and that was when my colleague had assisted, so mum was very lacking in confidence and it's a well known fact that a baby's cry is designed to jangle every nerve in the body.

Since the baby was asleep during my visit I promised I would return this evening when Gracie woke up ready to feed. I was summonsed at 16.30hrs and hot foot round to her house: "Ok", says I, "show me what happens". So she gets her baby, positions her beautifully, and on she goes! HA! Sometimes this job is just so good. We laughed at Grace's contrariness and I congratulate mum on her breastfeeding prowess. Job well done and off I go.

JOB INTERVIEW - urk.

I'm going for a new job - if I get it, 't will be a promotion and a job-share - "Infant Feeding specialist midwife" - so just ignore me, till its all over, one way or t'other, thursday 14th. I feel sick: it's the first interview I've had in 15 years and I b****xed the last one and there's rather a lot of competition for this one.

Takes deep breaths - it'll be fine, just fine.

thanks for the award, Maylin! I'll deal with it after thursday!

Done something rash this afternoon: I've taken several steps towards signing up to train as an NCT Antenatal teacher. Do I have enough time? Probably not. But I see it as serving two purposes - 1) I can do more of one of the things I enjoy most: teaching prospective parents how to achieve the kind of birth they want and 2) keeping myself up to date - which I have to do for the day job anyway, thus killing two birds with one stone.

As a result I'm thinking of splitting the midwifery/NCT part of this blog off into a new 'baby catching' blog.

Hmm. Babies. My better half reckons they ALL look like Winston Churchill.

I saw this today, on the Net, from the "Musings of Harry":

Dear “medical practitioners”
You are not doctors. You exist because the government can’t afford more doctors. You are the NHS equivalent of Police Community Support Officers.
The fact that your job exists is probably a bad thing. It’s certainly a bad thing when “negligence isn’t really an issue for us” midwives kill their patients with epidurals.
Would this woman have survived if a doctor had administered the injection? Perhaps. Perhaps not. But if you had to choose between a doctor and a midwife to give you your epidural, who would you choose? I wonder who administered Sarah Brown’s medication when she was in labour?
Doctors are trained to diagnose. Doctors are trained to understand how drugs work. Doctors study these things for longer and in much greater depth than any other “medical practitioners”. Doctors should be diagnosing and prescribing, not ancilliary staff — especially not those who are currently unable to obtain insurance because the insurance companies refuse to insure them."

Dear Harry

This would be a one off occurrence you're talking about? A midwife killing a patient by administering bupivicaine down the IV line instead of the epidural catheter? I feel so sorry for Marie To and the family of the victim of this dreadful event. It was certainly a terrible, tragic happening and the sort of thing that has to be every midwives' nightmare, but might I remind you of the activities of another doctor: wasn't Harold Shipman a one off occurrence? Though the one was an accident and the other was far more malign as I recall.

As a midwife I do epidural top ups frequently - as do thousands of my colleagues - without mishap. (I must correct your terminology - no midwife 'gives' anyone an epidural - the anaesthetist sites it, we just administer the drugs after the initial 'loading dose' has been given, and look after it - AND I suspect a midwife administered Sarah Brown's medication!). I also do all the antenatal/intrapartum/postnatal care for my clients (who fall within the 'normal' pregnancy remit) without mishap at home and in hospital and have done so for the last 15 years. I don't hesitate to transfer women in from home if I'm at all concerned, or call for a doctor if the pregnancy or labour deviates from the norm.

LET me give you an example of the training I undergo: I can now undertake the 'Examination of the Newborn' - a simple all over check looking for abnormality that takes place 6-48 hours after the birth which includes checking for heart murmurs and congenital hip dislocation. To do this check I had to undertake over 6 months of lectures and tutorials, including the writing of two essays, and the completion of a portfolio with 40 exams documented (8 of which were overseen by a paediatric Consultant or Registrar). This work was marked and verified by the University of Plymouth and was separate and on top of my basic training. My Paediatric Senior House Officer colleagues (who, to be fair, have undergone extensive basic medical training) get shown how to do the examination once then told to get on with it.

I am insured because I work for the NHS. My independent colleagues could also be insured but that the insurance companies want the same rates for that coverage that they ask of obstetricians, and they just can't afford to pay that kind of sum. Which is not quite the same thing as you're saying, Harry. Also, independent midwives work exclusively in the home in the UK - so wouldn't even be administering epidural top ups.

I doubt if many doctors would want to do my job - care for women through the long hours of labour - though they might do what they do in many countries (including USA) where they get 'Obstetric Nurses' to do the hard slog then gallop in at the last moment on their handsome white charger to 'catch the baby', which any old fool could do. Ah, why am I bothering to respond to this garbage?

When Knitting and Midwifery collide: A Birth Story.

Apologies for the length - but I just got to share this one!

"A midwife should have a good pair of hands and know how to sit on them" says Michel Odent? Or maybe knit with them says I.
I was at O and R's birth the other day - O is a midwife herself and knew exactly what she wanted - a home birth, with a quiet and dimmed atmosphere, with lots of love around. She wanted as few interventions as possible, and wanted to use TENs and for R to use Shiatsu for pain relief. They both had an array of homeopathic and bach flower remedies to hand... O had a long prelabour - she'd been up for two nights before I got there and R hadn't had much sleep either. We'd only met once before, but it's always so much easier for me when a couple know what they want...
I arrived at 11am and she was pleased to be told her cervix was 5cm dilated and the baby was in a good position and his heart was always really reassuring and steady. R has the most amazing smile that lights up the place and great big hands just great for massaging - mine didn't compare and O only wanted R's hands doing their magic on her shoulders and lower back.
I went off to collect the resus equipment and entonox (and grab some lunch). When I got back at about 1pm, O's contractions were still plodding along at about 2-3:10, strong but slightly irregular. Using acupressure would bring them up to speed slightly but they would always drop back to 2-3:10.
Still, O's cervix was 8 cm dilated at 17.15hrs (I'd left it a bit longer to check as I knew that we weren't going to get 1cm an hour!). I'm getting a bit of pressure from Labour Ward by this time - the coordinator would phone and want to know if I was happy and why didn't I do an ARM?!

Again, I can stave off unhelpful advice if I'm backed up by a birthplan!

ho hum, 3 hours later, t'was still the same. But far from getting discouraged O became even more determined. I've called the second midwife who was also really supportive and all the time I'm knitting socks and listening in to baby and checking O and R were OK but they were getting on so well without me doing anything but knit and keep a watchful eye on the slooooow but steady progress. We debate the usefulness of ARM and R gives O caulophyllum (sp?) and SRM happens - wahey! I think the baby heard us. Light meconium staining but we can live with that as junior's heart is still steady as a rock... Contractions are now strong 4:10. so I'm disappointed when O's cervix is STILL the same 2hrs later.
But even as we're arranging transfer for delay, O starts to make that wonderful grunting noise that signifies second stage and there's a show and so, we cancel the ambulance and we say welcome to baby boy just half an hour later. And wait for the cord to stop pulsing and admire the true knot. The placenta only takes 11 minutes to arrive.
Beautiful baby boy is so alert and goes straight on the breast. O has achieved everything on her birth plan - a wonderful normal birth with just a whiff of entonox to get through transition, and R would make a wonderful midwife... His smile lights up the room after its all over. I have such admiration for their love and strength and courage and determination and teamwork.
HA! - I frogged the sock I'd knitted because I'd made it too narrow, but the next day I knitted up a teeny tiny pair of socks in the same yarn for O and R's baby boy, to remind them of that incredible journey - just as O had soaked a silk square in liquor (mec and all) to remind their son of his time in the womb.

I called them I ching socks because the lines remind me of those little pictograms.

If any of my blogland friends have been wondering where I've been - I've been over on Ravelry! What a wonderful place to get lost in. I've also been celebrating my half century - and made my birthday last an entire week - wonderful.

A Good Day was had...

which is just as well as I had a shit day and night yesterday - had to pay a parking fine (from January - I'd written a nice note explaining that I'd paid the car park ticket for what I expected to be a short visit at work and an emergency had arisen so please could they let me off the excess charge - but no, the b*****ds not only wouldn't but took three months to tell me so), AND I'd been with a client attempting a vaginal birth after section all the long night which culminated in a touch and go emergency section because she suffered a (thankfully rare) uterine rupture. I've never seen one before. Mec happens. Baby and mum both fine. Thanks whatever godesses were watching over us all.

As well as getting my camera back, the postie brought lots of knitting goodies. The first thing was Interweave Knits - I've just subscribed and the first (Spring) issue arrived. It's taken ages to get here but I immediately got immersed in an article about an artist that PAINTS KNITTING which is wierd because I'm thinking about doing just that for the decorations at a 'knit in' to celebrate Knitting Week this Autumn. Not much in it I'll probably knit but I'm excited that Eunny Jang is the new editor and I liked the layout and content very much.

Then, as I was leaving for work, my neighbours brought this out to me - they have a porch and the postie often leaves parcels there if we're not home. Yes - a parcel from my secret pal! Another Terri! who spent a FORTUNE on air mail! S'cuse all these exclamation marks!

I was tempted to rip it open there and then but I decided to excercise some self restraint and wait till I got home to savour the opening thereof.

Later that same day: First thing we see is masses and masses of sparkly green packing - like a lucky dip!

First to emerge from all that stuff was what his label proudly announced to be a PADDY O'LLAMA! He is oh so soft and fluffy and has a very solemn quizzical expression (bit like the real ones). He is apparently suitable for anyone over 18 months so that's alright then. He has made himself right at home next to the PC (climbed all over the screen inititally but I've taught him the ground rules and he seems to have settled down nicely). He no longer has the spotty ribbon. He was a bit of a naughty llama and ate it.

Then there was YARN from Cascade (which I've never seen in LYS here) - sassy stripy sock in oil on water blue green purple colours and the new (according to the Vogue Knitting that came too) DiVE Italian soft scrummy merino, tucked cosily into an organza bag which looks green in one light and red dwon in the bottom right of the photo. A Vogue Knitting magazine which I sat down and read with a cuppa - No - I haven't got this issue, Terri - in fact I haven't bought any knitting mags for a long time (Interweave Knits must be the first I've bought in years) so it was a real treat. There are loads of sock patterns - and I'm contemplating knitting Nancy Bush's traveller's socks. And a book by one of my favourite authors: John Irving's "A Prayer for Owen Meany" not bookcrossed but I'll register it this afternoon. There was also Burt's complete hand care kit. I'm not sure who this Burt is but he's provided some neat little white gloves to wear to bed. What DH is going to say about that little caper remains to be heard. Since my hands are suffering from the gardening I've been doing lately, and are so rough they are snagging on my ISE4 scarf this is a timely and thoughtful gift. And last, but not least, there was a lovely labrador bookmark with a non edible bone attached. Hear that, my faithful hounds? NON edible. No choccies. This is because both me and you are on a diet and my secret pal is thinking of my well being. I haven't had any chocolate since JANUARY! This is an all time record. I might be forced to have just a little this weekend. Or maybe not.

A fab parcel from my Secret Pal - but if you want to send any more parcels by surface mail, honest, that's OK by me, even if it does take years to get here. I feel well and truly spoiled.

Thank you so much Terri!

Preparation for life after the birth...
(This one is for Dirk and Felicia because I'm thinking about them a lot these days)
I've just finished my last 'preparation for birth' antenatal class for a while. I'm not quite at my best, having been hauled out of my bed at 4am this morning to care for another Team's client in labour. (Despite being designated as 'high risk' because she is an insulin dependent diabetic, with all the prerequisite drips and continuous monitoring that entails, she had a lovely normal birth sat on a birthing stool - the first birth my student has witnessed in her training).
So, we're chatting about 'life after birth' - is there any? I always invite a couple of new parents to this session as the resident experts to be quizzed. We've just got on to the topic of crying babies and how to cope - and I'm saying that there are no parents in the world, ever, who have not felt like chucking the baby out the window in despair at some time or another, even if momentarily. And that, under these circumstances, it is OK to leave the baby in one room at one end of the house then take yourself to the other end of the house to calm down with a nice cup of tea (english way) or even nicer glass of wine (international) before venturing back to be with the baby again. Or taking a shower is a good way of relaxing and drowning out the sound of crying. There was a pause after I'd said this. Then one Dad says "so let me get this straight - you're saying a shower is a good place to put the crying baby to drown out the sound?!".


The entire class degenerates into helpless laughter.

This illustration taken from here

A lovely little story from work (made my day, anyway).

I don't always work on Delivery Suite but this particular evening I was helping out as another Team was short. I had applied a cardiotocograph (or CTG as it's better known) to a woman's belly to monitor the baby's heartbeat and contractions on a strip of paper -not routine, but this woman had had complications. The baby's heartbeat was looking fairly flat, which is not desirable but sometimes occurs when the baby is less active. "Hmm",says I, "I think this baby needs to wake up..."
So the father-to-be then puts his face really close to Mum's belly and says "WAKEY WAKEY BABY!". Lo and behold the recording of the fetal heart immediately starts to jump and accelerate and look far more normal!

KNITTED KNOCKERS!

Though they only seem to come in one size. We actually use a stripy knitted womb for our preparation for birth classes.

I've just found a pattern here OK?!

That was the week from hell, that was!

Work? who needs it.


Let me tell you about how our Midwifery Group Practice is supposed to work (most of the following is taken from an article we did for 'Practising Midwife' lat year, on how we try to keep things normal):

I work in the National Health Service. There are 6 of us in the MGP (4.8 whole time equivalent) and I am the only full time (37 1/2 hour week) midwife. We cover a predominantly rural area in Devon. Our home birth rate for last year was 18%, our normal birth rate is around 60% (And by 'normal' I mean unassisted vaginal birth - 'abnormal' would include Caesarean Sections and Instrumental Deliveries).

Our Trust has a model of care which embraces “Changing Childbirth” in its totality. We have the ability to provide midwife led care throughout pregnancy and birth, from first booking contact and referral to a midwife led antenatal clinic, through to 28 days post partum, leaving our obstetric teams to concentrate on higher risk women.

We have excellent support from our managers, supervisors, and obstetric teams, where two-way communication is facilitated. We may refer women to an obstetric team for second opinion and they are referred back when assessed as ‘low risk’. General Practitioner support has taken time, but we now have their confidence, and it has been agreed that they do not have intrapartum care involvement unless they wish to.

Policies and Guidelines are evidence based and have midwifery input. From the outset of pregnancy we emphasise the MGP philosophy and aim to build the confidence of the woman and her family in the normality (or otherwise) of her pregnancy. Risk assessment is ongoing and discussed openly and honestly with women enabling them to make informed choices. Any request which falls outside hospital guidelines (e.g. home VBAC) is not dismissed out of hand, but involves the whole team: woman and family, managers, supervisors and obstetric team agreeing and documenting an action plan.

Although the group have very different personalities we share the same philosophy of care. We are confident, autonomous practitioners with a sound belief in women’s ability to give birth and put the safety and welfare of their baby first. We are confident at homebirth, water birth and suturing. Most of us have taken the 'Neonatal Life Support' course. We do not take the hospital mentality into the home but vice versa. This is helped by labour rooms at the Maternity Unit having the bed pushed aside, shower rooms ensuite and mats, beanbags, stools and balls available. We aim to combine the Art and Science of Midwifery by watching and listening during labour, being patient and not interfering unless action is required.

Home intrapartum visits are offered to all women to encourage them to keep their options open. They can change their minds regarding place of birth depending on risk assessment at time of labour. If intrapartum transfer is warranted, we follow by car or accompany in the ambulance, as appropriate, then continue care in hospital.

We carry pagers and mobile phones to facilitate contact with women and each other. The Delivery Suite Coordinator will provide professional support and coordinates the provision of a second midwife once requested for home birth. Equipment for home birth is serviced regularly and we know how to use it. Paramedic support is readily available. We do not feel alone.

We support the use of simple ways of enabling women to cope in labour – distraction, massage, water, heat, cold – rather than opting straight for pharmaceutical or epidurals. Caring and touch go a long way. However, we also care for women who want ‘high tech’, epidural hospital birth and still aim for vaginal birth.

All this sounds ideal. Meeting the needs of women means we have to be flexible and have supportive families and friends. We write our own rota and support one another to be able to attend a school play or similar. Long-term sickness and staff shortages in the unit or other teams may often require us to cover other areas, hence our women may receive care from other teams too. Pay back time can often be difficult to achieve, therefore the system then relies on good will to keep going.

MGP does seem to work most of the time and thereby facilitates normal birth. Despite covering a large area, we have raised the home birth rate, and maintained good mortality and morbidity statistics.

This is us on at our post Christmas dinner... Don't we look happy? (I'd come straight from work so I hadn't dressed up).

HOWEVER the unit is sooo short at the moment, we're being called in to help willynilly, which means our work in the community is being neglected and piling up.

Last Saturday I worked all day 'till 4pm doing postnatal visits, prebirth antenatal checks etc. Then I get asked to come in to the unit to transfer a client to a hospital 35 miles away. I get in to the Unit and while I'm waiting for the ambulance crew to arrive I acquaint myself with the woman I'm escorting. She was being transferred for very sad reasons which I won't go into on this public forum but was not likely to give birth enroute so I didn't take any of my equipment apart from my doppler.

On the way, the paramedic in the front of the ambulance sticks his head through the hatch and says "There's a woman in advanced labour not 5 minutes away and we're the closest crew - do you mind assisting?". What could I say? So we divert to a farm in the middle of nowhere - and I leave the woman I'm travelling with in the ambulance reading a mag., and venture into the house with the crew. There is labouring woman, obviously pushing, head in dogbasket, kneeling on cold quarry tiles in the kitchen. I check: yes, this baby is most certainly on its way! We try and make woman slightly more comfortable (yoga mat to kneel on) and fetch warm towels. The ambulance crew have a very basic maternity delivery pack - no syntometrine. The baby arrives not 5 minutes later - a healthy boy! This lovely baby, no worse for the experience, is placed skin to skin on mum and draped in towels while we wait for the umbilical cord to stop pulsing. Mum is rhesus negative and the ambulance crew don't carry blood bottles (thinks to self, next time I bring ALL my gear regardless of wether woman is likely to deliver or not) - I take a syringe of blood from the cord and hope it'll do. Mother delivers placenta and membranes easily and we help her to sofa in front of roaring fire, looking much more comfortable and very very happy and the baby latched on to her breast and suckling well.

I write down times and history of this labour in notes as best I can (a woman can have her baby in 5 minutes but it still takes over an hour and a half to do all the paperwork) while the ambulance crew check mum's routine observations of BP and pulse etc - and then hang around long enough to hand over care to the midwife coming from the Unit (about 20 minutes later).

We all then carry on our way - and what the woman in the ambulance thought I don't know but I gave her a big hug. By the time I get a taxi back to the Maternity Unit in it's now 11pm and I'm starving and eager to get home. But NO - there are no more midwives available (everybody and the world is having their baby tonight) and a woman who has previously had quick births is contracting and wanting a home birth. Plan, I go out to review her and the Delivery Suite coordinator will ask another midwife to relieve me as soon as possible. What can I say? So off I goes (in the opposite direction to home) to see this woman. She is certainly in labour so I set up all my equipment just in case (no more surprises, thankyou!) and wait to be relieved. The Dad to be takes pity on me and gets me a cheese and pickle roll (mmm). I can see the mother is progressing well, and, after a couple of hours I phone unit and ask where my relief midwife is - she has been delayed. I tell them that this baby will have arrived in half an hour so they'd better get someone out to me quick! Sure enough, baby arrives - lovely normal birth of another boy, all is well. Relief midwife arrives just in time to see the placenta into the world. By the time we finish notes and I get home it is 4am. Sunday I recuperate.

I have Mondays off to do my art class - the midwife on our patch is called in to Unit to help as they are still incredibly busy and staff are going off sick (surprise). Midwife doesn't get home until 8pm and people who should have had visits are missed and the answerphone in the office is ignored. We spend rest of week catching up and I don't finish earlier than 7pm on any day. I have MUG tattooed across my forehead.

On Thursday I get a parking ticket. The job isn't always like this, otherwise I'd resign tomorrow. Thank goodness I'm off for a couple of days now. This is why I haven't updated my blog.

Sorry!

I've been doodling cartoons for the ARM mag. Dear Hubby didn't 'get' this.

Probably because it's not exactly funny - it's SAD!

Woo hooooo! I've finished all the examination of the newborn checks I needed to complete the practice portfolio - all FIFTY of them. Including the last five which had to be supervised by a consultant Paediatrician no less (very offputting, having someone looking over your shoulder even if they are very nice) - and I've passed - that bit anyway. The Paed said I was 'competent, confident and thorough' and I hadn't even offered the bribe...

PREGNANT PAUSE!
I haven't posted for a while - I'm at work and shouldn't be posting NOW but while the anecdote is fresh in my mind:

A couple I am looking after are getting soooo excited as the due date looms nearer - Every braxton hix contraction, they think is labour... Well, t'other night, she wakes up and the bed is SOAKED! Both instantly wide awake, this must be it! Waters must have broken! NO! Our pregnant mother-to-be only fell asleep clutching a glass of water - and that's what soaked the bed. Partner not best pleased at having to change bedlinen in wee hours :-)

Same mother-to-be few days later is drying her hairin the bedroom, enjoying being in the nude as it's so HOT. (Admits was even contemplating a spot of perineal massage - ask me if you don't know!) -Glances up and sees the WINDOWCLEANER at the window - Hides behind wardrobe door, blushing furiously - window cleaner (neighbour's nephew) - quite blase and carries on until he's finished. HA - by the time this baby arrives, I think it'll be kittens!

All these pregnant ladies sitting around in the waiting room, waiting for their appointment with me and NOT ONE OF THEM KNITS! I'm doing my best to convert them.

Back to work, ho hum.

Two snippets...

I've started the Examination of the Newborn Course - lots of work, more than I'd thought. At the back of the classroom, I was nibbling at some 'hemp seeds' as recommended by Dr Gillian Keith as a 'healthy snack' and offered some to my fellow students. Back came the retort from Wendy: "no thanks, I'm driving"! Damn, why am I never as sharp as that?

One of my clients has PUPPs (Try googling it!). This is horribly itchy and a real pain if you're pregnant. Smearing juice from the Aloe plant is reckoned to be a good cure - so I passed on this tip. Aforementioned client duly trots off to plant shop where some geezer fobbed her off with a cactus instead of an aloe plant. Can you imagine? She has been smearing essence of cactus all over her belly, not to mention dealing with the spikes!? Of course it didn't work. When she finally realised her mistake and got the right plant it worked a treat

Birth Story

This picture is not of the baby in the story - but was another one of my catches from last year. I drew baby Jozef in charcoal... this needed an illustration and he'll do just fine.

The first birth of 2006 was lovely - even though I did give me enough rope to hang myself~

I got paged at a very civilised time - about 2pm - I hadn't seen Kate* at all during this pregnancy and I didn't realise I knew her until I stepped through the door. She'd got married since her first baby and changed her name. It was lovely to see her and her husband Chris again - they've moved into a much bigger place at the top of town and their relationship is flourishing. Her first baby had been a big surprise - he has Down's syndrome and this had been missed despite all the screening, probably because she was only 21yrs at the time. Anyway, he is a lovely chap now at 3 and a half years of age though I didn't meet him on this birthday because he was at Grandma's. Kate had had a very quick birth first time round and I remember suggesting then that she ought to consider staying at home the next time. All this came flooding back as I stepped into the sitting room.

Kate looked very calm: she was contracting about once in every 10 minutes and still very chatty. I did a complete check of all her observations and was very alarmed to find the baby's heartbeat was bradycardic (much slower than normal) - thinking this might be connected to her position at the time (she was lying very flat on the sofa so I could feel her tummy and check the position of her baby) she sat up. I was muttering about cancelling the planned home birth and transferring in when the heartbeat returned to normal - and we all breathed a sigh of relief. Kate agree to have a vaginal examination just to check what was going on - good news! Her cervix was 4-5 cm dilated (though posterior) and the baby's head was very low in her pelvis (at spines or even +1, though, like many NHS midwives, I have a dreadful tendency to underestimate everything so as not to get tangled up in arbitrary time limits and policies). The baby was moving around well and I decided the umbilical cord must have been compressed and that it was OK now. But just in case we all agreed I could do a CTG (cardiotocograph monitoring) just to make sure there wasn't anything awful going on. I wouldn't hang about, but it was also agreed I would nip out and get the homebirth emergency equipment from the Community hospital (Oxygen, suction and entonox - I have everything else in my car) - drop off Syd my dog at home, bless him, so he wouldn't have to spend the next 8 hours or whatever cooped up in the car, and pick up some lunch (late lunch - it was already 3pm, but I had left over chicken and rice in the fridge). Managed to accomplish all that and get back to Kate and Chris inside half an hour - I'm tending to caution this year as I had 3 'born before arrivals' in 2005 and I don't want to get caught out again.

When I got back, Chris had prepared the room for the birth - plastic and blankets draped over the sofa, which was pushed back against a wall to make plenty of room, baby clothes and towels warming by the gas fire. The Fetal heart was still fine but we did the CTG anyway - Kate was contracting about 1:8 now, and the heart beat showed a slight deceleration with some of the contractions, but this was the only suspicious feature I could see - it was otherwise very normal and I scored it 6 out of 8 on our '5-alert' scale.

After this, Kate decided to have a bath while I discussed everything with the Labour Ward co-ordinator. I downloaded the trace to LabourWard which was a MISTAKE! A Registrar looked at it and thought a section of the recording looked sinusoidal. He thought Kate ought to transfer in for closer observation and should not have her home birth. 'Sinusoidal' my ass, I thought, but didn't say - I actually said I disagreed with his findings but I would inform the parents of the doctor's advice. I'd put myself in an invidious position if anything went wrong at the birth now! I went upstairs to tell Kate and Chris - Kate announced the contractions had really picked up and this was it - she couldn't contemplate going anywhere. Isn't it wonderful when the mum knows what's happening with her body and tells you what's going on instead of vise versa. She climbed out of the bath and I could see great crashing contractions every couple of minutes (4-5:10).

I said I was happy to look after her - I was monitoring that baby's heartbeat very regularly as you can imagine - and everything looked very normal from where I stood. I documented it all.

Kate paced up and down the room like a tiger, pausing only to hang on to Chris every time another surge rolled over her. I didn't need to any more vaginal checks to know it was time to call for a second midwife - oh bliss, it was our old student, Liz, who would be coming out, and I knew she would be supportive. Kate was holding on to a towel draped over her hips like a sarong - she looked magnificent and I told her so. I got all the equipment ready and sat and waited like a midwife does. (There's always so much bl**dy paperwork).

Kate wanted a pee, so I suggested she go up to the bathroom and sit on the loo, facing the wall - it's a bit more private and the lighting was very bright downstairs. Chris took some oil to massage her back. Meanwhile Liz had made great progress coming from the general hospital and arrived within the hour - so I updated her.

There was a shout from upstairs - Kate's waters had burst - this was it! Typical - we'd prepared a lovely nest downstairs, so the baby decides to arrive on the bare boards of the bathroom floor! The Fetal heart had been absolutely fine through all this, so I felt justified in putting my neck out.

We helped Kate off the loo onto her knees (we hauled the blankets and resus stuff upstairs very quickly) leaning over the side of the bath - it was fairly cosy in there - Chris had to climb into the bath. Kate was a bit reluctant to push - but I praised her and encouraged her to move the noise she was making in her chest downwards. She didn't have to push much - her body was pushing the baby out for her, and just three contractions later the head was born. The baby made faces at me on the perineum before punching his way out into the world like superman (he had a nuchal fist).

He also had the cord very loosely wrapped around his neck which unravelled as he slithered out.

Having caught him I posted him through his mum's legs so she could sit back and check him out (Yes, it was a boy!). Kate and Chris were quite overcome and the baby looked deliciously normal and yelled to let us know he was definitely here. The cord stopped pulsing relatively quickly, and Chris clamped and cut it as he'd asked to do. Their son was on his own! Kate pushed the placenta out only 12 minutes after he was born - they didn't want to keep it. Kate was helped downstairs to the sofa so she could get more comfortable - fortunately she only had superficial labial grazes despite her boy's fist. The baby took a while to settle down (he yelled a LOT) and go to the breast but when he did he fed for ages. I left them some hours later all snuggled up together.

It was a beautiful birth and a great one to start the year with.

*all names changed in this account.