Tuesday, January 13, 2009

A MIDWIFE'S HOUSEKEEPING

Today I was able to spend time doing office work - the 'housekeeping' for my midwifery practice. This is a time for critical reflection, and learning. It's a real privilege to provide primary care for women who choose me as their midwife. But with privilege comes responsibility, and I am constantly reminded that these families have entrusted me with some of the most lasting and memorable times in their lives.

I have checked through my active folders; filed away those that are complete; and checked that all payments are entered properly in my QuickBooks accounting program, ready for the next BAS (Business Activity Statement) to the Tax Office next month. I have tallied my births for 2009, and looked at any challenging situations that I needed to address.

I find myself reviewing carefully the couple of births in which our plans changed.

One mother, a primip, was in very early labour when her membranes ruptured spontaneously, revealing meconium in the liquor. I listened to the baby, who did not seem distressed. We decided to go to the hospital, and in spite of the continuous fetal monitoring, the labour progressed well, and we experienced a physiologically normal birth. The hospital was very busy (there is a baby boom at present), and the midwife allocated to care for my client was happy to manage the paperwork and watch, while I knelt on the floor beside the young woman and guided with my voice and her hands as she received her baby from her body.

Another mother who transferred from home to hospital, in labour with her second child, had called me to her home. She was progressing nicely, late at night, when we heard the distinctive sound of cracking, breaking, and falling as a huge branch of a large gum tree next to the house fell. It was a frightening sound, and I was immediately concerned for the safety of my client and her baby. It was dark, and we couldn't see if anything had been damaged. I felt it best that we go to hospital, and the parents agreed. About 30 minutes after we arrived at the hospital, the mother gave birth to a bonny, healthy baby boy. Later we looked at the tree, and found that the branch which had broken off had become caught in the fork of another branch, and was suspended above a parked car, next to the house. Had it fallen all the way, the car would have been squashed, and some of the house would probably have been damaged.

Another transfer to hospital was for a mother who was not progressing well, with her second baby. This can be a very difficult call for a midwife, and the woman, to make. When is the mother needing to accept the pain, and when does she need to ask for medical help? When is pain unbearable, intolerable? When does the lack of progress indicate a problem? As time passes the baby becomes tired, and is less able to tolerate contractions.

When transferring to hospital in a situation like this, we ask the hospital staff to work with us, using all the skill and resources that are available in achieving the best birth we can for that mother and baby. In the case I am reflecting on, the birth was caesarean. Not what we had planned for, yet the best on offer in that situation, that night.

I had a few planned hospital births too. I am a plain midwife, and if a woman wants to be in hospital I go with her, despite the restrictions that hospital have placed on me and my kind. Birth can proceed well in hospital or at home. One mother had a beautiful vba2c in a private hospital. Her two previous births had been caesareans because the babies had, for some reason which she did not understand, been distressed in early labour. This labour took some time to establish, but the baby held in there beautifully. That mother's face, as she took the wet and beautiful newborn child to her breast, declared a moment of utter triumph.

Another mother gave birth to her twins, just eight minutes apart, without any medical intervention. We had arrived at the hospital in good labour. Without having planned to do so, I happened to 'catch' both babies, while the hospital midwives worked alongside me. This is unusual - most hospitals will tell an independent midwife that she is not to carry out any clinical care. I am not keen to challenge the system when I am 'with woman'. I seek to collaborate with the hospital colleagues, knowing that the woman and I have a special partnership which cannot be over-ridden by protocols or rules. But really, I don't think anyone could insist that receiving a baby who is being born spontaneously is an exclusive professional act. The mother is giving birth! As they say, it's not rocket science.

My 'housekeeping' today also helps me prepare for the births I will attend as the weeks and months of this year unfold. Each consultation, both before and after the birthings, and each birth, is a time when I must give my full focus to the individual woman. I cannot guarantee a particular outcome: what I can do is offer to accompany her through the amazing journey she has begun.

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