Friday, January 15, 2010

Being a Midwife, two very different cases:



Its days like today you remember why you are a midwife. I had the pleasure and privilege to support a couple at birth with a great team of midwives who all in their own way added to the wonderful experience for the couple during the day. As I walked in the room the woman had an epidural in and was kneeling on all fours there was an air of serenity, peacefulness and expectation. This was the couples fourth child, they were so in love you would think this was their first baby. The woman was tall very attractive quiet and confident. The husband was short, ordinary in appearance quietly spoken, at first glance you might wonder what attracted the pair to each other they seemed so different. Yet it would only take a few moments to see why this was such a dynamic couple, they were so in tune to each other, a mutual respect, he was devoted to his wife and she was listening intently to her body.... it was beautiful to observe, it wasn’t so much what they were saying it was how they were with each other, the unspoken word..... The touch, the silence, the unity, the support from just being there from the husband without saying a word.... and the inward journey the woman took to be able to gently push her baby out and without tearing. It was a superb birth of a gorgeous 10.11 lb (4855gm) baby girl, who cried as soon as she was born. The parents were delighted with their prize baby and mum was very pleased with how her labour and birth went, she was beaming from ear to ear.... she looked beautiful as she cuddled her baby against her skin. It was no surprise when the family came to visit that the children were delightful, they came in with flowers excited they could hardly contain themselves, yet they did, they were so caring towards their mother, smiling constantly and in total ore of their new baby sister, they all sat around their mum and talked about the birth and dad hovered around busy taking photos as mum breast fed the baby...... I was truly touched by their closeness, unity and obvious love for each other.



My second case was a 16 year old at 38 weeks feeling unwell with symptoms of pre-eclampsia. Some 16 year olds are just too young to have babies, they are babies themselves, they can be challenging and this one was. I wonder if not enough education about what is actually happening to them in pregnancy is part of the problem or if when they do get the education they are not listening and don’t take it all in. However in my experience this age group can be difficult in any health setting. The girl was also needle phobic and was promised numbing cream....She was supported by some friends and her mum was en route...... and she wanted her mum understandably however I did ask the question did she want her mum there at conception... this did raise a smile and said no...her admission CTG was reactive (meaning normal) and she was maybe having some tightening, her blood pressure was boarder line.... and she was sent to walk around to see if that would encourage some contractions whilst awaiting blood results. The decision based on the blood results was to have an induction of labour, so after explaining the process to her...... the course of action was set...... a vaginal examination, prostin gel 2mg and CTG for 30mins, then wait for labour to commence, reassess in 6 hours, more prostin or Artificial Rupture Membranes. There were times I felt that this young woman did not understand some of the issues discussed, and this was confirmed when I helped her to the toilet and she asked me to explain again what the doctor had said.....which I did and hoped she had a better understanding of the issues. Seems straight forward, however nothing goes according to plan...... 5 mins after putting on the CTG post insertion of the prostin, she started to have decelerations, one after the other....I called for help....there were no obvious contractions.... the doctors were in attendance....we attempted to wash the prostin out using a saline wash, which did improve the trace, however we ended up going to theatre for an emergency Cesarean section approximately 15 mins later. It took some convincing to put the IV cannula in... due to the needle phobia.... but there was success...This is the first time in my years of midwifery that I have seen such a reaction to prostin gel.......yes it can happen sometimes the baby just does not take well to these things. The end result was a beautiful baby girl weighting 2710gm, mother and baby well, and her mother made it to support her in theatre and help with the baby..... This young girl has a lot of growing up to do, I am sure she is still in shock and the reality will hit in a few days. it is a shame to have very little understanding of the process of birth.....I am pleased that she will have time to adjust and will have help with mother crafting before she goes home, it is fortunate she has a very supportive mother and I suspect that the mother will be doing a lot of the caring of the baby......it was nice to see the family together.... mother, baby and grandmother.....
All’s well that ends well...... thank God.....

ref pictures:bawandinesh.name/whats-love/
www.thewomens.org.au/CardiotocographCTGinterp

4 comments:

Laura Jane said...

Yep, from chocolates to boiled lollies, sometimes in one shift. That first birth sounds lovely. I had a nice one on Thursday night, a vaginal breech after 2 CS (sadly at 21 weeks, but technically..... it was my 60th birth)

I had a trying night last night, with a lovely baby girl by CS at 7.15am. You can't win em all.

Pam said...

My experience with young teenage mums to be and antenatal education is that they are a specialist group in the way in which they are approached.
I've been developing a blended method of delivery.
My blog about it is at http://pamdh.wordpress.com

InfoMidwife said...

Hi Laura Jane,,,, nice analogy "chocolates to boiled lollies".. sorry to hear you had a trying night... hope it gets better.

InfoMidwife said...

great blog Pam, thanks for the headsup will apply some of your tips....cheers

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