whitewriter (![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png)
whitewriter) wrote2021-06-13 08:51 am
whitewriter) wrote2021-06-13 08:51 am
Entry tags:
Catchup post 1: double at SSH - 8/6
I've been rather slack on blog posts as of late due to prioritisation of sleep and rest which whilst it improves my work day, reduces the quality of categorisation and reflection of my experiences.
My perceptions and thoughts have evolved in 7 days, and feelings are never as strong as they are ATOR.
These now serve as memories rather than daily updates I suppose but I am determined to keep up the momentum that was raised during the painful (and thankfully short) period that was "new graduate midwife" or was it just the pain of being in a new hospital and not knowing who you can trust and who you can't trust to help you through the transition.
I had been burned more than a few times as a new graduate nurse and again in my transitions program so it wasn't like the first time when I had no fear.
Plus the stress of being paid as an RM 8 without the RM 8 level of experience.
This is how they reward you for jumping off the cliff into a new field, I suppose.
How this shift came to be
On the Saturday before, I was enjoying an extremely privileged trip to South Australia to visit a mate using dirty cheap flights (in which I had to wear a mask and do a survey to say I hadn't had any covid risks. No one asked me directly nor did they temperature check me at the airport) -- the senior clinical MUM at SSH messaged me to ask if I could do any extra work next week.
You know how, when you take a holiday you always need a day or two (at the least) to get over said holiday. A day of nothing. To catch up on life admin piling on your desk while you were away or to do the laundry that you didn't do because you were on holiday.
So that meant no to Monday.
And the weekend after was the long weekend - and Pete's birthday - and considering I was a real tool of a partner last year at the end of my midi studies that I completely completely forgot his birthday - and I'm barely around most days - I decided part of my gift would be to just stick around for the long weekend and not work. (catch-up on my diary etc.) - once again, a gift for him is also, a gift to myself. Two birds with one stone?
So looking deep in my diary the only extra hours I could offer SSH was to turn my Tuesday morning shift into a double, 16 hour shift.
I'd just had a 2 week holiday, surely working 16 hours straight should be fine, right?
Besides they were *4 down* that morning. Their staffed for 10. But only had 6 people to work.
The First Lady of the day: The little Malteser
2nd baby.
planned C-SECTION (LSCS- lower segment cesarian section) for previous LSCS due to failure to progress (not an IOL) after 8 hours "labour". (Do I even want to unpack this?).
Maltese couple - who recognised I had a Maltese last name.
She'd had her first baby at the private hospital about 3 years ago and now realising she could easily save 10k going to the public system for what was essentially a free LSCS, she was here for baby number two.
I've been meaning to write a post on the risks associated with LSCS and LSCS for previous and VBAC (vaginal birth after cesarian) which in some places is called trial of scar
and the advantages and disadvantages of the public v private systems for obstetrics---- but -- back to the topic!
The little malteser lady sat in the bed nervous, a little uptight (due to the nervousness I think) and my role there was to prepare her for LSCS.
I got her into a gown, undies off.
I offered to put in the IDC (and said it was up to her: she could have it in OT if she liked) and she agreed it was (nicer) doing it in the room with just me and her husband rather than the anesthetics doc and nurse and scrub and scout and assistant surgeon there too.
Boy was that one hard IDC To place. I honestly, couldn't see the hole. Usually in young women, if you swipe down with the gauze, you literally see it wink at you but she just wasn't relaxed- so with some luck, I got it in. Saw a tiny amount of urine and prayed (literally) it was in the right spot.
Came back an hour later to check : yup. urine in the bag. bingo. Lucky. Cause that wasn't easy.
It was getting past the point where I could just hope aesthetics would turn up and put an IVC in for me and give her some fluids and start the case -- so I tried to put one in her wrist and failed.
I didn't bother a second attempt.
Not knowing who was going to theatre when and in which order was literally the biggest bane of my morning.
We were informed there would be 3 ladies, 1 was an emergency and already being wheeled in. It was myself and another covering for the usual LSCS midwife who was going to do something else until 13:30.
So. The other new grad Gina and I bounced questions and answers off each other all morning, reassuring ourselves with our plans (almost the blind leading the blind) but we made it work.
I was informed I had to go find woman number 3 and do a fetal heart and check her pre-LSCS.
I was hopping around OT downstairs trying to find her. I had a sticker and an MRN and I showed the receptionist who said "she's already had her baby and is in recovery" -- and I'm like whut. The only lady that was done so far is the emergency (32 weeker with HTN and preeclampsia).
People just assumed midwife, current case.
Our birth unit receptionist assured me, that woman 3 was admitted. Somewhere. Couldn't say where her physical location was and the theatre receptionist said the LSCS was done.
What a nightmare waste of 1 hour trying to sort that out and gigantic potential mistake for wrong person.
In the end I ended up deciding (with Gina) that theatres would eventually find this woman and wonder where the f the midwife was and phone BU looking for me. Because you cannot start a case without the midwife present.
I made sure malteser had fluids going since she said she had had nothing to eat or drink since 18:30 the previous day - and went and had morning tea --
To then, as I had suspected would happen - be called to OT To do woman 3 as she was going to be the 2nd case.
This is when the big near miss happened (near miss number 2). So they start the op. And as I hadn't had time to assess the woman more than do a FHR, I assumed the surgeon would put an IDC In her before starting or at least, confirm there was one in. But somehow this got entirely missed by anesthetics and the surgeon until he had cut her open, and exposed the bladder, and wondered why it was protruding so much.
Well. That would be because there is no IDC.
Mid op. Woman open. They had to put a sponge on the abdo, lift the drape, unscrub, put in an IDC, rescrub, pull down the drape, and then continue.
The woman none the wiser.
ANd thank GOd for that because her husband turned out to be a nightmare in a basket that I only had to experience for 20 mins.
He wanted to know how to get the operation report (they're still sowing up his wife behind me). He wanted to trim the cord and have a photo of that (that was relatively normal and reasonable) he wanted to know if I'd done the injections yet (dude. the kid was just out - and I'll do them in front of you so there will be no need to wonder about if they're done or not.
And all sorts of things.
Then the regular LSCS nurse came just as we were in recovery to release me for lunch. I'd gone MIA for 5 min as I went to pick up the rego papers for the dad and baby (and got mildly told off for leaving the baby alone with it's father in OT) -- fastest handover ever -- and I left.
Poor LSCS nurse later detailed the barage of questions she got from Dad whilst I had food.
After lunch I was asked to please go do LSCS number 2 (the malteser).
If I was on only a morning shift, I would have done only one LSCS That day due to the length of time LSCS 2 took. But as I was on a double, things were different.
Malteser baby (LSCS number 3) came out fine - I think it was nice that I was able to build a rapport with them earlier in the day, and then come back in the afternoon to receive the baby during the LSCS.
From the getgo, she didn't want to breastfeed. She said the 1st baby had been too stressful, and so this time, she wanted to go straight to formula. She asked if she needed to take a pill or something. I explained that dostinex came with a lot of side effects and therefore wasn't usually reccomended. Instead, (from MISH experience) I explained if you didn't touch or stimulate, it should work out without using tablets. So instead of skin to skin we did... wrapped cuddle bonding. A thing I made up on the spot so she wouldn't feel left out just because she chose formula based on her experience with her first baby.
Now. As a baby friendly hospital I'm sure I'm supposed to try and have that discussion with her - that discussion being real, counselling session about breastfeeding.
But firstly, it's her 2nd baby so it's not like she doesn't know.
Secondly, I've just met her and if you think I can develop a therapeutic relationship that quickly your dreaming.
Thirdly I have such little experience in having these discussions, or seeing them being conducted, I just didn't bother. Would it have done something? Maybe. Some people are just so uptight no amount of counselling or talking through a problem is going to change the perceived solution (formula).
This conversation is in my to-do list of things to work on for future women.
But frankly these are the facts I already know :
Mums who are younger tend to breastfeed less and for shorter periods of time.
Mums who have more children are less likely to breastfeed subsequent children (say, she might breastfeed child 1 for 2 yrs, child 2 for 1 year and then say no to breastfeeding baby 3 or 4). It's not a pleasant discussion (do you realise you are disadvantaging your younger children) nor is it taking into consideration her whole life as a woman to go at a concern with that level of intensity without proper build up. It would be like accusing a person on the street who walks past a beggar without donating -- of being a bad person without knowing their financial situation, home life, belief systems and etc.
The after afternoon tea induction
In Australia not everyone drinks tea but its called "tea room" where you go to have your "morning tea" and your "afternoon tea" (designated names for breaks that aren't lunch or dinner). A nod to our colonial past.
It's now 18:00 and I'm going to start an induction for post dates.
2nd baby so P1.
Previous NVB after an 8 hour IOL (holy shit that's fast) so I'm assuming a similarly fast labour. So quick I get slightly concerned I'll deliver this one on my shift too (3 in one day is... a lot for anyone).
I ask if she's Indian - and actually, they are - but they are from Kenya (they migrated there and then Australia) and so, culturally their a little mixed. After a breif apology for assuming (based on appearance) they told me about how it was amazing you could have a lion across the street from your house! And that that was normal. Pretty cool.
I do the IVC and this time, after a mild amount of fumbling around I get it into her hand!
Afterwards she tells me she has a needle phobia and I am astounded as she stayed so still and was so trusting as I literally, stabbed an 18 gauge needle into the delicate veins of her hand and withdraw 2 vials of blood before attaching a bung and a dressing on top.
I get her going. She didn't have a foleys, and I'm unable to break her waters with her posterior, multi-os cervix which is very stretchy but ... yeah.
So PM T/L Ags comes to do it.
We start.
I get a student RM who was an RN who has had 8 children herself accompanying me for the shift - so I can have a dinner break. She details how she lost a woman once to the RM because at the end of it all the woman wanted the RM to deliver the baby instead of her. Boy was I lucky that didn't happen to me during my student days. IT made me wonder if the midwives I worked with stepped back more when I was around to give the impression to the woman that they trusted me to do it. And if the midwife trusted me, then the women should too.
I handover to a junior midwife who came from QLD to complete new gad in NSW due to the paucity of new graduate spots in her state.
The T/L did a bitch thing, at first saying she couldn't sign my 21:00-2200 sticker because it wasn't 22:00 yet (handover is 21:30) and then at 22:00 I asked her to sign it she said she had "already handed over-- so I had to get the night T/L to do it.
The majority of that sticker happened on your shift and you and I are still here and yes I handed over too but it's my sticker and it's not signed... I think she just didn't want to deal with the mild rise in baseline despite all other good features that that sticker was sporting.
-- and then I went home (on time!) thinking that I was nuts for doing a 16 hour shift right before 3x 12s at MICH.
It's surprising the amount of detail I remember when I bother to sit down and go through it properly. Offloads the brain.
My perceptions and thoughts have evolved in 7 days, and feelings are never as strong as they are ATOR.
These now serve as memories rather than daily updates I suppose but I am determined to keep up the momentum that was raised during the painful (and thankfully short) period that was "new graduate midwife" or was it just the pain of being in a new hospital and not knowing who you can trust and who you can't trust to help you through the transition.
I had been burned more than a few times as a new graduate nurse and again in my transitions program so it wasn't like the first time when I had no fear.
Plus the stress of being paid as an RM 8 without the RM 8 level of experience.
This is how they reward you for jumping off the cliff into a new field, I suppose.
How this shift came to be
On the Saturday before, I was enjoying an extremely privileged trip to South Australia to visit a mate using dirty cheap flights (in which I had to wear a mask and do a survey to say I hadn't had any covid risks. No one asked me directly nor did they temperature check me at the airport) -- the senior clinical MUM at SSH messaged me to ask if I could do any extra work next week.
You know how, when you take a holiday you always need a day or two (at the least) to get over said holiday. A day of nothing. To catch up on life admin piling on your desk while you were away or to do the laundry that you didn't do because you were on holiday.
So that meant no to Monday.
And the weekend after was the long weekend - and Pete's birthday - and considering I was a real tool of a partner last year at the end of my midi studies that I completely completely forgot his birthday - and I'm barely around most days - I decided part of my gift would be to just stick around for the long weekend and not work. (catch-up on my diary etc.) - once again, a gift for him is also, a gift to myself. Two birds with one stone?
So looking deep in my diary the only extra hours I could offer SSH was to turn my Tuesday morning shift into a double, 16 hour shift.
I'd just had a 2 week holiday, surely working 16 hours straight should be fine, right?
Besides they were *4 down* that morning. Their staffed for 10. But only had 6 people to work.
The First Lady of the day: The little Malteser
2nd baby.
planned C-SECTION (LSCS- lower segment cesarian section) for previous LSCS due to failure to progress (not an IOL) after 8 hours "labour". (Do I even want to unpack this?).
Maltese couple - who recognised I had a Maltese last name.
She'd had her first baby at the private hospital about 3 years ago and now realising she could easily save 10k going to the public system for what was essentially a free LSCS, she was here for baby number two.
I've been meaning to write a post on the risks associated with LSCS and LSCS for previous and VBAC (vaginal birth after cesarian) which in some places is called trial of scar
and the advantages and disadvantages of the public v private systems for obstetrics---- but -- back to the topic!
The little malteser lady sat in the bed nervous, a little uptight (due to the nervousness I think) and my role there was to prepare her for LSCS.
I got her into a gown, undies off.
I offered to put in the IDC (and said it was up to her: she could have it in OT if she liked) and she agreed it was (nicer) doing it in the room with just me and her husband rather than the anesthetics doc and nurse and scrub and scout and assistant surgeon there too.
Boy was that one hard IDC To place. I honestly, couldn't see the hole. Usually in young women, if you swipe down with the gauze, you literally see it wink at you but she just wasn't relaxed- so with some luck, I got it in. Saw a tiny amount of urine and prayed (literally) it was in the right spot.
Came back an hour later to check : yup. urine in the bag. bingo. Lucky. Cause that wasn't easy.
It was getting past the point where I could just hope aesthetics would turn up and put an IVC in for me and give her some fluids and start the case -- so I tried to put one in her wrist and failed.
I didn't bother a second attempt.
Not knowing who was going to theatre when and in which order was literally the biggest bane of my morning.
We were informed there would be 3 ladies, 1 was an emergency and already being wheeled in. It was myself and another covering for the usual LSCS midwife who was going to do something else until 13:30.
So. The other new grad Gina and I bounced questions and answers off each other all morning, reassuring ourselves with our plans (almost the blind leading the blind) but we made it work.
I was informed I had to go find woman number 3 and do a fetal heart and check her pre-LSCS.
I was hopping around OT downstairs trying to find her. I had a sticker and an MRN and I showed the receptionist who said "she's already had her baby and is in recovery" -- and I'm like whut. The only lady that was done so far is the emergency (32 weeker with HTN and preeclampsia).
People just assumed midwife, current case.
Our birth unit receptionist assured me, that woman 3 was admitted. Somewhere. Couldn't say where her physical location was and the theatre receptionist said the LSCS was done.
What a nightmare waste of 1 hour trying to sort that out and gigantic potential mistake for wrong person.
In the end I ended up deciding (with Gina) that theatres would eventually find this woman and wonder where the f the midwife was and phone BU looking for me. Because you cannot start a case without the midwife present.
I made sure malteser had fluids going since she said she had had nothing to eat or drink since 18:30 the previous day - and went and had morning tea --
To then, as I had suspected would happen - be called to OT To do woman 3 as she was going to be the 2nd case.
This is when the big near miss happened (near miss number 2). So they start the op. And as I hadn't had time to assess the woman more than do a FHR, I assumed the surgeon would put an IDC In her before starting or at least, confirm there was one in. But somehow this got entirely missed by anesthetics and the surgeon until he had cut her open, and exposed the bladder, and wondered why it was protruding so much.
Well. That would be because there is no IDC.
Mid op. Woman open. They had to put a sponge on the abdo, lift the drape, unscrub, put in an IDC, rescrub, pull down the drape, and then continue.
The woman none the wiser.
ANd thank GOd for that because her husband turned out to be a nightmare in a basket that I only had to experience for 20 mins.
He wanted to know how to get the operation report (they're still sowing up his wife behind me). He wanted to trim the cord and have a photo of that (that was relatively normal and reasonable) he wanted to know if I'd done the injections yet (dude. the kid was just out - and I'll do them in front of you so there will be no need to wonder about if they're done or not.
And all sorts of things.
Then the regular LSCS nurse came just as we were in recovery to release me for lunch. I'd gone MIA for 5 min as I went to pick up the rego papers for the dad and baby (and got mildly told off for leaving the baby alone with it's father in OT) -- fastest handover ever -- and I left.
Poor LSCS nurse later detailed the barage of questions she got from Dad whilst I had food.
After lunch I was asked to please go do LSCS number 2 (the malteser).
If I was on only a morning shift, I would have done only one LSCS That day due to the length of time LSCS 2 took. But as I was on a double, things were different.
Malteser baby (LSCS number 3) came out fine - I think it was nice that I was able to build a rapport with them earlier in the day, and then come back in the afternoon to receive the baby during the LSCS.
From the getgo, she didn't want to breastfeed. She said the 1st baby had been too stressful, and so this time, she wanted to go straight to formula. She asked if she needed to take a pill or something. I explained that dostinex came with a lot of side effects and therefore wasn't usually reccomended. Instead, (from MISH experience) I explained if you didn't touch or stimulate, it should work out without using tablets. So instead of skin to skin we did... wrapped cuddle bonding. A thing I made up on the spot so she wouldn't feel left out just because she chose formula based on her experience with her first baby.
Now. As a baby friendly hospital I'm sure I'm supposed to try and have that discussion with her - that discussion being real, counselling session about breastfeeding.
But firstly, it's her 2nd baby so it's not like she doesn't know.
Secondly, I've just met her and if you think I can develop a therapeutic relationship that quickly your dreaming.
Thirdly I have such little experience in having these discussions, or seeing them being conducted, I just didn't bother. Would it have done something? Maybe. Some people are just so uptight no amount of counselling or talking through a problem is going to change the perceived solution (formula).
This conversation is in my to-do list of things to work on for future women.
But frankly these are the facts I already know :
Mums who are younger tend to breastfeed less and for shorter periods of time.
Mums who have more children are less likely to breastfeed subsequent children (say, she might breastfeed child 1 for 2 yrs, child 2 for 1 year and then say no to breastfeeding baby 3 or 4). It's not a pleasant discussion (do you realise you are disadvantaging your younger children) nor is it taking into consideration her whole life as a woman to go at a concern with that level of intensity without proper build up. It would be like accusing a person on the street who walks past a beggar without donating -- of being a bad person without knowing their financial situation, home life, belief systems and etc.
The after afternoon tea induction
In Australia not everyone drinks tea but its called "tea room" where you go to have your "morning tea" and your "afternoon tea" (designated names for breaks that aren't lunch or dinner). A nod to our colonial past.
It's now 18:00 and I'm going to start an induction for post dates.
2nd baby so P1.
Previous NVB after an 8 hour IOL (holy shit that's fast) so I'm assuming a similarly fast labour. So quick I get slightly concerned I'll deliver this one on my shift too (3 in one day is... a lot for anyone).
I ask if she's Indian - and actually, they are - but they are from Kenya (they migrated there and then Australia) and so, culturally their a little mixed. After a breif apology for assuming (based on appearance) they told me about how it was amazing you could have a lion across the street from your house! And that that was normal. Pretty cool.
I do the IVC and this time, after a mild amount of fumbling around I get it into her hand!
Afterwards she tells me she has a needle phobia and I am astounded as she stayed so still and was so trusting as I literally, stabbed an 18 gauge needle into the delicate veins of her hand and withdraw 2 vials of blood before attaching a bung and a dressing on top.
I get her going. She didn't have a foleys, and I'm unable to break her waters with her posterior, multi-os cervix which is very stretchy but ... yeah.
So PM T/L Ags comes to do it.
We start.
I get a student RM who was an RN who has had 8 children herself accompanying me for the shift - so I can have a dinner break. She details how she lost a woman once to the RM because at the end of it all the woman wanted the RM to deliver the baby instead of her. Boy was I lucky that didn't happen to me during my student days. IT made me wonder if the midwives I worked with stepped back more when I was around to give the impression to the woman that they trusted me to do it. And if the midwife trusted me, then the women should too.
I handover to a junior midwife who came from QLD to complete new gad in NSW due to the paucity of new graduate spots in her state.
The T/L did a bitch thing, at first saying she couldn't sign my 21:00-2200 sticker because it wasn't 22:00 yet (handover is 21:30) and then at 22:00 I asked her to sign it she said she had "already handed over-- so I had to get the night T/L to do it.
The majority of that sticker happened on your shift and you and I are still here and yes I handed over too but it's my sticker and it's not signed... I think she just didn't want to deal with the mild rise in baseline despite all other good features that that sticker was sporting.
-- and then I went home (on time!) thinking that I was nuts for doing a 16 hour shift right before 3x 12s at MICH.
It's surprising the amount of detail I remember when I bother to sit down and go through it properly. Offloads the brain.