Jordan & the girls came out to Alberta, and we spent 2 weeks with our fabulous friends in Edmonton and went on a road-trip to the Dinosaur Museum at Drumheller in the Alberta Badlands and, on a whim –our first major travel-bug whim since Eva was born 4 1/2 years ago–to Banff in the Canadian Rockies.
And that was fantastic.
Here are some pictures, courtesy of the internet:
Then they left me to join Jordan’s parents out in Nova Scotia, leaving me one bereft mama.
Luckily there have been some busy clinic days & births to distract me. But sometimes you get what you want, and sometimes….well…
Had two women yesterday, both term with ruptured membranes and no labour. Both were Group B Strep negative, which translates roughly into no-risk-factor-for-infection, but, still, we want that labour to get going. I was worried about one –just a kind of gut-feeling–but in the end she had an absolutely lovely water birth, the baby just slipping out slowly into my hands.
Look at that, I thought. I really, really needed that kind of birth.
And just in time to catch a yummy Greek dinner with my preceptor.
Leaving the restaurant we were paged by the nurse–our other client was now in excellent active labour. We hightailed it to the hospital and I put on my sterile gloves almost as soon as I saw her: a 3rd time mom with two previous lovely deliveries under her belt, she was pushing hard in the tub, readying to catch her own baby.
She was a client I’d gotten to know more than most of the others, and I crouched down beside her, looking forward to witnessing the birth.
And then: she was pushing, and pushing, and pushing, and 20 minutes passed, and that baby wasn’t coming. 20 minutes isn’t much for a 1st time mom, but for a 3rd timer it just shouldn’t take that long. We checked and confirmed full dilation. And then the thought was crystal clear in my mind and, I knew, in the minds of the other student, my preceptor, and the nurse:
Slow baby = big baby = possible shoulder dystocia.
In a shoulder dystocia, the head is born but the shoulders get stuck. With the head out and the body in, the newborn’s oxygen supply is severely diminished if not completely cut-off.
In other words: a true obstetrical emergency.
Out of the tub & into a squat & that baby did come, but not before my preceptor worked a few tough manuevers. “Call for help,” she said almost immediately, since calling for extra hands is always the first step of an emergency protocal, and so that baby got born in a room with one midwife, two student midwives, one ER physician, five nurses, and, I was later told, an army of nurses waiting in the hallway.
Not to mention dad & grandma.
Baby did very well, pinking up and crying before the cord was even clamped & cut, which might have had something to do with how slow I was at clamping and cutting the cord, never having done one under duress before. Though, I might add, the evidence is clear for delayed cord clamping.
Three weeks ago I had my first post-partum hemmorhage (PPH). Now I’ve witnessed my first shoulder dystocia. Both are obstetrical emergencies that I knew well — in theory. We study and we simulate and we study and we simulate but the real thing — the real thing is terrifying.
I have a long way to go, still. During the PPH I knew what to do, but there was some disconnect between my mind and my body. I got everything together for the IV, and fast, but I blew the actual IV.
Next time: breathe.
But we learn from experience. After last night’s birth I looked at the mom and said, “this is a clinical indication for giving you an oxytocin injection” –to help firm-up the uterus and prevent a hemmorhage. Like last night’s mom, our PPH client gave birth to a large baby. Like last night’s mom, she had declined prophylactic oxytocin in prenatal discussions.
This time, I acted on the risk factor. Maybe our PPH mom would have bled regardless, and maybe last night’s client wouldn’t have. I’ll never know. Still, ordering the oxy last night felt, in the end, like one thing I anticipated and did right.
Everything else felt like more than I could handle.
After everything settled down I cornered Gillian, my student-midwife compatriot. “I need you for a moment,” I said, all professional in front of my preceptor and the nurse.
I lured her into an empty labour room, shut the door, and sobbed.
I explained the situation clearly to her: I was absolutely incompetent, far, far more incompetent than any other student has ever been. A danger to women everywhere. As a responsible citizen I should quit immediately, but I’d dragged my family into debt for this degree and so was now chained to it.
Incredibly, Gillian told me that she often felt the same way. Like, all the time often. Then she shared a story of her own incompetence. “Oh,” I said, “that probably happened during your 1st placement.”
“Ilana,” she told me, “that happened this May.”
Not one to refrain from blatently begging for pity, I emailed another student midwife friend this morning with my tale of woe. She wrote back write away. “I suck, suck, suck,” she wrote.
I know she’s actually a fantastic caregiver, absolutely meant for the job. And I know Gillian rocks, because she and I have now done a whole bunch of births together. So I am hoping that this means that I’m all right, too.
Birth can be beautiful. And birth can be dark. Sometimes I wonder if I’m insane to want to do this job.
Right now, I’m still waiting on an answer.