Saturday, February 19, 2011

but on the OTHER hand...

Today is another day. A new day, a brighter day. If you read yesterday's post, I'll update you to say that both (a) and (b) have been resolved, which might have a lot to do with the brightness of the day... or maybe, it just has to do with the support of some great friends, a good night's sleep (even though, to be honest, there were a handful of moments where
I woke up thinking, "oh, @*$#, now what?!"...), and a belief in something out there that will just let things be as they will be).

The conclusions I've come to -

I am not brand-spankin' new to this - I am not a new nurse, not a new OB/L&D nurse, and not a new student nurse-midwife. I know how to check a cervix, I know how to deal with and support women in the throes of labor, and I know how to assess their well-being.

There are parts of this game that I need help with - that's the point of learning. That doesn't mean, though, that I have to let myself and my confidence in my own abilities be funneled down... whether I'm doing that to myself, or letting the nurses, the Midwife, or the families I work with to do this (and please understand, this is not to say that they are or are not doing it intentionally - so many of these issues I am certain are happening in my own mind).

This is the point where, like the mamas meeting the burning at crowning, I have a choice to make... I need to push through, and birth the midwife within, rather than fighting the same pressures and pains I have had for so long.

At work recently, one of my patients delivered precipitously... the weather was worse than it seemed, and the doctor's drive in took just long enough that she walked in as the head was delivering. Thinking that her drive would be the "normal" length, I had my mama start pushing and worked with her as I have become accustomed to more as a SNM than an RN; everything was going perfectly and - had the doctor arrived as expected - the babe's head would have been merely a few pushes from delivering. Instead, I caught --- as it was my patient and the ER doctor was unable to make it --- and everything went smoothly, to the patient and doctor's happiness. The entire process was calm, and reinforces my belief that I can do this --- it is in me. In this experience, when I should have been anxious/nervous/antsy/fill-in-the-blank... it was blissful. Even though this wasn't my patient... wasn't supposed to be "my" delivery... and I didn't have my preceptor's watchful eye... (not to mention the niggling thought of getting in trouble, though I certainly hadn't planned to deliver)... it was beautiful, perfect, and right. My hands did exactly what they needed, my mind didn't falter, and any coaching that needed to be done was there.


  1. "This is the point where, like the mamas meeting the burning at crowning, I have a choice to make... I need to push through, and birth the midwife within, rather than fighting the same pressures and pains I have had for so long."

    LOVE, LOVE, LOVE this!!!!!!!!!!!!
    It is so true! And I'm glad you are feeling a bit better about things today.

    As for the difference in opinion on the cervical exams, I think that can be very subjective. Once one of my preceptors was considering inducing a patient, depending on her "readiness", based on my VE. I checked her and thought she was very high, ballotable, thick. She checked her and felt like she was favorable and even suitable for AROM (!) which she offered to let me perform... I told her I didn't feel comfortable breaking the bag due to my difficulty reaching the cervix/presenting part. I let her have the honors. ;) I'm not sure what she thought of my declining, but I disagreed with her assessment so I did what I felt was right. She tends to be a bit more aggressive than I am, and maybe that will change for me after I've had some experience, but for now, I have to do what feels right for me based on the experience and knowledge that I have.

  2. This is why I don't think we should rely solely on the docs. Our bodies know what they're doing. There is no way to plan for or anticipate how long or short a labor is going to be. With Seth, my pushing phase was long (mag sulfate will do that to ya). With Joy, pushing took 4 minutes, and the midwife barely made it (she was napping on the other end of the hossi). With Skye, I told the midwife DO NOT LEAVE the maternity ward, and fortunately, she didn't. Despite the nurse telling me not to push because I was only at 9 1/2 cm, on the next contraction, Skye crowned on her own! (I really COULD NOT fight my own body!) The nurse yelled for the midwife, she came running in and caught from the side! I really only had to push Skye's lower body out.

    I guess my point is, there are many people who are more than equipped, trained, and capable of delivering a baby. The medical profession and the general public need to be more open to and trusting of that. I mean, mom's doing all the work. Anyone can catch. Let's let them, if they're there. Let's not hinder births, try and make moms wait for the doctor, and interfere, when its not really warranted. Who needs the extra stress and panic?! Yes, I know there are protocols, and that they're there for a reason, but maybe they need to be lightened a bit to include capable, well-trained L&D nurses. Getting back to my own case, what if the midwife had been in another wing or at her clinic across the street?! SOMEBODY would have had to catch! I have no doubts that my nurse could have and would have, but would she have been as calm under pressure, knowing that there could potentially be consequences for catching my baby, as someone "more qualified" (meaning a doctor, I don't really think this way)? Probably not.

    I think you bring up an excellent point, and I am glad you brought it to light. :)