Saturday, January 15, 2011

Yes, Yes, Yes!! (You got this...)

One thought has been surprising me more than any other as I've been crossing the line between OB nurse and midwife... I don't remember thinking, "I don't see this woman being able to birth vaginally" much as a nurse, and yet, as a student midwife, this negative thought process seems like it always pops into my head at some point during labor.

For example, take "Susie". She was a primip, working on her first baby, and things were going fine... she was (sadly, like most of my labors during at least the first half of my clinical rotation) being induced, but doing well with it. Baby looked good, she was tolerating things well, and she was just starting to get more uncomfortable. At her last cervical exam, she had been 2-3, with the head just starting to really work its way down into the pelvic; my preceptor had ruptured her membranes, and we were expecting things to really start kicking in. At the next check, she was 4, and hopped in the shower for some pain relief. An hour and a half later, things were even more intense... and she was still four centimeters. Labor progressed this way, slowly, slowly, slloooowwwwly.... as well as Susie and her husband worked with the contractions, breathing, moving, massaging, her cervix was taking its sweet time. Finally, she decided that a little bit of IM narcotic may be what she needed, and this was given. She progressed, and her baby descended, and her cervix opened, until she was found to be 8 centimeters. From there, we waited. And waited, and waited. She felt an intense amount of pressure, was feeling nauseous, and really just ready to be done - but her cervix stubbornly held out at 8. 8... 8... 8. Baby continued to look good, Susie was doing all right (albeit tired)... honestly, it was just the novice student-midwife who was having a hard time being patient, and starting to wonder what was wrong. Suddenly, in her own good time, with no help from anyone else and no worries, baby rotated just enough, slipped to the perineum, and was born lickety-split. Voila!

(And who was worried?!)

It amazes me that these women don't need my trust, my confidence in their bodies to do this... or at least not yet. Maybe it's just their own trust or ability, or that of my preceptor, or just plain luck. But something must be going right - I've attended at least 25 births (that doesn't seem like a ton, in the grand scheme of things, but considering the circumstances in this short span of time - I'll take it) over the past couple of months with my precepting CNM, and only one of those births has ended in a cesarean birth (failure to descend). Considering that all except maybe two or three of those have been induced labors - not a fact I am proud of by any means, just a matter of practice for this particular practice - that seems like a fairly good rate. No vacuum deliveries, and I believe only one or two "small" (if there is such a thing) episiotomies made. I think that equates to about a 4% c/s rate, for that very small portion of the year's deliveries. (Stastically, that's not all very sound - just anecdotally interesting to me.) Personally, I think I'm wondering to myself, more than anything, if part of the reason I have the nagging worries with each "slow" labor is due to the much higher 20-odd percentage c/s rate that I'm used to at any other facility... anywhere else that I've practiced, really, many of these women probably wouldn't be delivering vaginally. They may be coined "failures" (such a terrible, terrible tag - for "failure to progress", "failure to descend", etc) or otherwise might require further interventions on the part of a provider who is impatient and decides s/he needs to try to 'speed' things up, and therein ends up stressing out the babe.

Yesterday, I had the honor of playing OB nurse and labor coach; I didn't get to catch a baby, but I was paid for my time (so there was a silver lining!), and during my shift, we had a mom who was in that exhausting end-of-first-stage labor. She was slowly working her way past a stubborn anterior lip and - without the aid of any pain medication - began to push her baby into the world, when she met the unbearable burning of he** that so many of us can identify with. She was terrified, hurting, and tired - but standing at her shoulder with gentle encouragement and strong support (including steady affirmations of "you are doing this"), i was able to watch as she moved through the fear of being ripped in two and gave birth to a beautiful baby daughter.

I can only hope that yesterday's birth leaves that little OB nurse on my shoulder, whispering in my ear, reminding me that it is in every mother - all I need to do is be there, at her side, 'with woman'.

Tuesday, January 11, 2011

Paradise... or Alaska?


Everybody needs one, but a lotta people don't have them. I've been breezing (breezing?!) through this midwifery school thing, telling myself the whole time, "It doesn't really matter if I don't find a job right away, I'll keep working as an OB nurse until the right CNM job comes along..."...

(I don't know how to make a SCREECHING HALT noise appear on my blog, but if I could --- that would be the spot for it.)

Suddenly, almost two years into this thing - it hit me. I want to work as a midwife. Like, literally, the very second I can. I love being an OB nurse - but I hunger on such a much deeper level to be a nurse-midwife. The few shifts I've worked as a nurse since starting clinicals have been agggggoooonnnizzing. To stay in the background, trying to be encouraging while the (gasp) doctor gets to (gets to??) wheel in and yank the baby out?! Ridiculous! That's supposed to be me, sitting next to that mama, coaxing her babe out with her... not on that fun little wheely chair, with the bed broken down. Nope, I get on the bed, with her, and together, the four of us (mama, dad, baby, and me as an afterthought) we breathe, we push, we scream, we swear, we laugh, we grunt, we poop (well, maybe we don't all do that one...), and - eventually - mama delivers.

So, anyway, that's where I'm at today. And was yesterday, and the day before. Looking for - you guessed it! - a midwife job. (There are, of course, no midwife jobs in my near vicinity) New York? I'm too small-town. Florida? Ugh, too --- pan-handle. Paradise, CA? Bingo! I checked out the posting, and it sounds wonderful... looked at the attached link and website, and it's gorgeous. The more I snoop around on the site, the more I love it - especially when I learn one of the midwives is an alum of my school (not always a good thing, I suppose, but I love my school, so it seems like a good omen). But, my hi-how-are-you-hey-can-I-come-visit-and-maybe-do-some-clinical-hours-with-you-and-by-the-way-please-PLEASE-PLEASE-hire-me message is first rejected by their "contact us" form, and then by the email address listed.

Boo. Fail. Hiss.

I'm starting to think if Paradise won't work, maybe I should give up the whole darn thing, when I stumble across a listing for a tribal site in Alaska. (Now, I know what you're thinking... Alaska?! A girl who can't even handle the only-moderately cold, snowy, gloomy winters of the Northern Midwest would consider... Alaska?! And, you would be --- right. But, hey, Paradise is shooting me down, what do I have to lose?)

So, I started filling out the application. I've worked for tribal communities before. I've been a tribal games employee (I tried my damndest to know basic strategy for blackjack, but just never got it... even so, I seemed to make good tips), and a maternal child health nurse, so that seemed promising. I started having visions of pristine white snowfalls, Alaskan Natives and pure culture surrounding me... and then thought of having my closest family and friends being what google maps told me would be, officially, a 2 day, 15 hour car ride away.

Now, I won't say if that would be a good thing or bad thing - but it was enough to make me stop and think. And then, I realized, it was two o'clock, and time to get ready for work. And then I looked outside, at the pure, fat white snowflakes falling, and thought, "f*ck, it's going to be a cold walk to work."

I'm gonna hold out for Paradise.