Reasons not to become a midwife.
Mar. 21st, 2021 05:21 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
whitewriterI was out drinking with new dragon boaters til about midnight, was in bed by 01:00 but had to get up by 5:50 to be at work by 07:00. Didn't feel it 'til I got home at 5pm.
In midwifery, much more so than in nursing do I find myself ethically compromised.
Therefore I've had a higher interest in ethics lately.
Today my woman said "I was interested in being a midwife, but I don't want to do abortions. Is that something you have to do frequently,
Interesting question.
Abortions are more formally known as "terminations of pregnancy" or TOP.
Fact: I've never had to do a termination (just haven't come across one on any of my shifts since July 2019). So that's about 2 years without having experienced a TOP
She had me reminiscing about cases I've had in the past and how I viewed them. They weren't specific TOPs but they were the kind of cases that were more commonly experienced.
To preface this, a TOP for a change of mind or change of circumstance - considered sometimes a "social reason" is mostly commonly conducted by the GP or by a clinic. The local public hospital wouldn't likely be involved unless it was a late term TOP for a medical reason (eg. significant abnormality found on the morphology scan of 18-20 weeks) or social reason (woman is a severe and current drug addict, it's her 8th baby and she's wanting a TOP).
Bleeding and SROM at 15 weeks
I remember a woman on the "women's health ward" (or what I called high risk antenatal ward) who had heavy PV bleeding and water loss from her vagina at 15 weeks. However the baby was still alive, moving (she could feel it). It's too early to do CTGs at 15 weeks so we did daily fetal hearts - and it was still alive. We gave her antibiotics since she (and the baby) was at risk of chorioamnionitis. There was a low chance that the baby would survive given the heavy bleeding and water loss at such an early gestation however she didn't want to have a TOP. So we checked her pads. Did her obs incase she became septic. Gave antibiotics to prevent chorioamnionitis or other infections, and waited for nature to declare itself. If she miscarried at that stage it would have been considered a late term miscarriage. (Before 20 weeks : its miscarriage, after 20 weeks it's called a stillbirth).
So she sat in her room, and she was teary and cried a lot and asked us a lot what was going to happen next and if the baby as okay etc. etc. - and all we could do we offer her pain relief (endone) and keep monitoring her, and say we didn't know. But if she changed her mind about a TOP to let us know.
There was a small chance the baby could have survived. Unlikely but not impossible. But at the end of the day - how she wanted to have things occur (TOP or just wait) was up to her. Until the baby died -in which there is now a time limit on how long we'd want to 'keep waiting for nature'.
Borderline Viability
We had a lady with threatened premature labour (TPL) at 23+6 who chose not to have the baby resuscitated.
She didn't speak much English, and they did get an interpreter in. However the woman looked conflicted. We asked her a second time with an interpreter. She continued to say she didn't want resuscitation- but she didn't look convinced still. However, that was what she said and that was what was documented, so we followed her wishes.
The baby was quite large when it came out -- 600g and it was quite possible that it would have survived nicely-- provided that the NICU had been involved and present at the birth and immediate intubation and resuscitation was undertaken post birth.
As the woman had chosen not to resuscitate the baby, this wasn't going to happen (resus, nor survival).
The baby was breathing, it lived for an hour. The mother said it looked like it was struggling to breathe and could we just give it some oxygen? We had to explain that we could not because that would only prolong the baby's suffering towards a certain end.
I went through both cases and I could tell she understood that cases have more to them than just being "abortions".
But.
As a midwife, - as in all healthcare -- you need to be okay with people having their own wishes and choices: no matter how against your beliefs, ideals, projections or wants.
You may be able to step aside from cases or swap it with other midwives for most occasions, but the day may arrive when you don't have a choice and have to take a case that goes against your own belief systems.
Running inductions- I find my own beliefs about childbirth heavily challenged.
But here I am, turning up regularly to run them weekly. Because I know, I need to maintain my registration, I need more experience and the only way to get it. Is to be there get it.
In the last hour of the induction I had missed for variability: these super shallow decelerations that had my trace yellow zoned for the hour. She ended up being fully (as I suspected- after all, it was a 21 year old cervix and those are amazing) - and as I was leaving she was starting to push but had a HR of 130-140 bpm so everyone was rather weary.
I think she'd do well but I'll have to look her up when I get back.
I may have yet to experience a termination but I'm sure the day will come.
In midwifery, much more so than in nursing do I find myself ethically compromised.
Therefore I've had a higher interest in ethics lately.
Today my woman said "I was interested in being a midwife, but I don't want to do abortions. Is that something you have to do frequently,
Interesting question.
Abortions are more formally known as "terminations of pregnancy" or TOP.
Fact: I've never had to do a termination (just haven't come across one on any of my shifts since July 2019). So that's about 2 years without having experienced a TOP
She had me reminiscing about cases I've had in the past and how I viewed them. They weren't specific TOPs but they were the kind of cases that were more commonly experienced.
To preface this, a TOP for a change of mind or change of circumstance - considered sometimes a "social reason" is mostly commonly conducted by the GP or by a clinic. The local public hospital wouldn't likely be involved unless it was a late term TOP for a medical reason (eg. significant abnormality found on the morphology scan of 18-20 weeks) or social reason (woman is a severe and current drug addict, it's her 8th baby and she's wanting a TOP).
Bleeding and SROM at 15 weeks
I remember a woman on the "women's health ward" (or what I called high risk antenatal ward) who had heavy PV bleeding and water loss from her vagina at 15 weeks. However the baby was still alive, moving (she could feel it). It's too early to do CTGs at 15 weeks so we did daily fetal hearts - and it was still alive. We gave her antibiotics since she (and the baby) was at risk of chorioamnionitis. There was a low chance that the baby would survive given the heavy bleeding and water loss at such an early gestation however she didn't want to have a TOP. So we checked her pads. Did her obs incase she became septic. Gave antibiotics to prevent chorioamnionitis or other infections, and waited for nature to declare itself. If she miscarried at that stage it would have been considered a late term miscarriage. (Before 20 weeks : its miscarriage, after 20 weeks it's called a stillbirth).
So she sat in her room, and she was teary and cried a lot and asked us a lot what was going to happen next and if the baby as okay etc. etc. - and all we could do we offer her pain relief (endone) and keep monitoring her, and say we didn't know. But if she changed her mind about a TOP to let us know.
There was a small chance the baby could have survived. Unlikely but not impossible. But at the end of the day - how she wanted to have things occur (TOP or just wait) was up to her. Until the baby died -in which there is now a time limit on how long we'd want to 'keep waiting for nature'.
Borderline Viability
We had a lady with threatened premature labour (TPL) at 23+6 who chose not to have the baby resuscitated.
She didn't speak much English, and they did get an interpreter in. However the woman looked conflicted. We asked her a second time with an interpreter. She continued to say she didn't want resuscitation- but she didn't look convinced still. However, that was what she said and that was what was documented, so we followed her wishes.
The baby was quite large when it came out -- 600g and it was quite possible that it would have survived nicely-- provided that the NICU had been involved and present at the birth and immediate intubation and resuscitation was undertaken post birth.
As the woman had chosen not to resuscitate the baby, this wasn't going to happen (resus, nor survival).
The baby was breathing, it lived for an hour. The mother said it looked like it was struggling to breathe and could we just give it some oxygen? We had to explain that we could not because that would only prolong the baby's suffering towards a certain end.
I went through both cases and I could tell she understood that cases have more to them than just being "abortions".
But.
As a midwife, - as in all healthcare -- you need to be okay with people having their own wishes and choices: no matter how against your beliefs, ideals, projections or wants.
You may be able to step aside from cases or swap it with other midwives for most occasions, but the day may arrive when you don't have a choice and have to take a case that goes against your own belief systems.
Running inductions- I find my own beliefs about childbirth heavily challenged.
But here I am, turning up regularly to run them weekly. Because I know, I need to maintain my registration, I need more experience and the only way to get it. Is to be there get it.
In the last hour of the induction I had missed for variability: these super shallow decelerations that had my trace yellow zoned for the hour. She ended up being fully (as I suspected- after all, it was a 21 year old cervix and those are amazing) - and as I was leaving she was starting to push but had a HR of 130-140 bpm so everyone was rather weary.
I think she'd do well but I'll have to look her up when I get back.
I may have yet to experience a termination but I'm sure the day will come.
