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Saturday
Oct092004

Nobody Ill Can Scream Like That

(one of my favorite lines ever in a book/movie)

Secret Garden

2am on Saturday morning.

It feels like forever since I have last written! I miss it. I dream about blogging, but so haven't had the time. My clients are having a harder time than we would have expected at this time.

* I missed a doula client's birth because Baby 3 took my phone and pager and put them in the office (here at home) and closed the door. I was sick and went to bed and forgot them on my purse. He told his mom he moved them because they "kept going off." I wanted to explode. Everyone else finds it amusing. I was infuriated and feel he should pay me back for some of the money the client is sure to ask for back.

* That same client had a velamentous insertion of an umbilical cord, an anterior placenta, a breech baby with a nuchal cord x2. They went from wanting a homebirth to "let's see how a scheduled cesarean can be made better." I spent loads of hours on the phone and in the office with them (they were also in our childbirth class) and then about an hour before she went to bed the night before scheduling her cesarean with her doctor. Her water broke and that is when they called and called me and went to the hospital and had surgery 20 minutes later. A beautiful boy! I have no idea about the cord yet, though. I'll need to see the Op Report. Dad got to cut the cord, though, which was great! And her sister was also in the OR with dad; very unusual. I am SO disturbed I missed it. I offered to do the PKU for them free-of-charge, but they didn't take me up on that. No mention from them of wanting money back yet.

* Another client is just barely 36 weeks and is 3cm dilated with head engaged and ready to GO. She had a 30 min labor last time with hemorrhage (the only IV I have ever gotten; got it when it was important!) and there are 4 midwives on alert for her... we hope at least one gets to her. She is about 12 min from my house, but about an hour from the office. The other closest midwife (my Licensed Midwife with this birth) lives about 25 min away, but is leaving on vacation on the 14th for 2 weeks. The CNM is backing me up (overseeing), but it would be better if it were the LM, simply for familiarity's sake. The CNM, however, delights in IVs and we want to have a Hep Lock in this mama the second she feels contractions going... and a pit and meth in a 250 ml bag of fluid just in case something goes on.

An aside about pitocin: It takes 3-5 minutes for intra-muscular (IM) pitocin to kick in/take effect in a body. It takes effect immediately when done intra-venously (IV); hence, the IV being ready.

We hope that if we have everything ready, we won't have to use a thing.

* Another mama, due mid-November hadn't felt her baby move for far too long. I had her drink a couple of cups of coffee and some ice water (when babes won't/don't move and makes mom nervous, we have them drink their favorite caffeine... either soda, juice, or coffee... works very well), but the baby still didn't perk up. She lives an hour away (at 85mph with no traffic... I know for a fact), so I sent her to the local hospital (if she'd have been closer, I would have gone there to check; next time, I will drive there anyway... probably best to find out if there is a fetal demise at home than have the experience you are about to read). I called her midwife at the local teaching hospital and she said it was the right thing to do, that if she were closer, she could have come down here, but if the baby was dying, sooner than later was good.

She got to the hospital about the time I was in 25 minutes away and dad called to tell me the baby sounded good and I wept with relief after hanging up.

I got there and mom tells me she told them she was having an HBAC and they were having cows over it. She also told them her midwife was coming up. (!) She was nervous, for sure, but I attempted a save later... dunno if it worked.

The baby's heart rate was a perky 150-170 (120-160 is normal), which was not unusual considering the coffee intake. She was reactive and doing well, but also having some mild contractions. When I was still driving, they said they might want to keep her overnight, but when I talked to the CNM down at the other hospital, she said we could come down there if overnight was necessary (and to deliver the baby if it was gone). When I got there, the dad said they talked about the AMA (against medical advice) thing and how insurance wouldn't pay for the visit if that were they did that. I didn't have time to explain it would have been a transfer of care, not AMA, but it became irrelevant.

The nurse made comments every time she came in the room about the risks of a homebirth and a homebirth after cesarean... acting as if my client chose to HBAC on a gambling bet or something. She is a nurse, for crying out loud! And well-read. And she and her husband have discussed all the pros and cons for years before this pregnancy. The discharge papers said it all: Patient educated (EDUCATED?!?) on risks of home birth and vaginal birth after cesarean. Gee, if y'all hadn't said anything, we never would have known!

Besides the odd comments in general (why wouldn't you want to deliver in the hospital naturally?), two stand out:

Nurse - You know, we had one of our nurses try for a homebirth after her cesarean and, well, it just was a disaster. *tsk tsk-ing* And her baby... *trailing off for effect* (None of us three picked up the trail, either... we let it lie.)

Doctor - Now, you know the risks, right? I mean, the baby could die. You're okay with your baby dying? *looking right at dad* You're perfectly fine with your baby dying at home?

Dad - Uh, no, I am not okay with the baby dying, but I do know the risks. (YESSSSSSSSSS!!! Can't get much more graceful than that, can ya?)

sigh

When the nurse was in the room, I mentioned calling the other hospital and asking the midwife for her records, but they were still at the office since she was so early. The nurse looked at me oddly and then the client and said something about delivering with midwives in the hospital... we didn't pursue that either. But, at one point, I did say I was her doula. That sucked. I don't even remember the context.

I didn't feel especially scared, but it was a taste of what I will feel/get in a transport situation and needed to feel/experience that to remind myself I am not within the law and to make sure my fear doesn't push me to the ground.

* I know, in many ways, my pregnant/birthing women are keeping me alive and mostly well.

* The 2 new midwives do not want to work with one of the older midwives. Originally, it was going to be a job sharing situation, but neither is comfortable with her style. That midwife is doing major power crap at the office as she feels more and more threatened. A midwifery chart takes about an hour to put together and she needed 2 papers in one and didn't want to wait for the receptionist to get them from the file, so she tore apart a chart for them and threw the rest of the out-of-order chart into the re-file box. I was sooooo mad. I will email and speak about it when I see her next. She also keeps telling the new midwives that they will get all the clients now and she won't have any. I told the one midwife who felt badly about that that the issue was the midwife's ego and to not let that affect her at all! The midwife has clients jump ship with subsequent pregnancies because of her "style" and attitude. Her skills are fine, if not great; her attitude sucks.

* The 2 new midwives and I went through my birth kit and talked about why things went where and how I'd labeled everything and why. We played with gauze to show how each of us packs (or doesn't pack) for suturing. I shared my strengths and weaknesses so they would know and not be surprised at a birth.

Strengths: shoulder dystocias, calmness in emergencies, neonatal resuscitation (I practice all the time), labor support

Weaknesses: IVs, suturing (2 things I have rarely, thank god, had the opportunity to experience)

They shared their strengths which included IVs and suturing. smile

I let go of the worry about suturing, however, when I heard an older midwife say: if you put two pieces of a vaginal cells together in a room, they will find each other. I figure suturing them together will help that process even more.

* Besides the fevers and stuff, my heart is lighter. I love birth and this life. I am tired, but happy. I want more... time, money, and leisure... but, who doesn't?

"Nobody ill can scream like that."

That's how I feel with my writing.

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