RAMBLINGS OF A MIND UNTAMED

Not sure if I did enough of the load today but it felt like smooth sailing in MAC today.

Perhaps, I missed something. And thats why I had extra time on my hands.

I apologised to the poor med student that I was not a shit magnet.

And at dinner to help my toddler not get bored by the adult conversation I turned the story of my women today into a story about a princess who was ... I want to say stupid but the more PC way to describe them might be confused or vague.

Princess no 1.
Woman who had her first baby in Pakistan 4 years ago, had an IOL for "post dates"? and got to 4cm and was said to be failure to progress and sent for emergency c-section now came in spont labour, membranes intact, contracting on and off 1:10 or less. on the CTG, off the CTG. Not wanting pain relief. Saying her pain tolerence was high (I don't deny that may be so). She could have gone home at some points but she just wanted to hang around. Like hanging around would make her cervix open faster (it doesn't, midwives believe that early presentation and longer presentation at hospital decreases the likelihood of VBAC success-- I am absolutely not sure this is supported by evidence but the way this goes is, the more interference, the more things they find wrong with you, the lack of progress etc. they can use these against you and some how you find yourself on the slippery slope of signing a consent form for a c-section you didn't want or are not sure you need.

So she sat in the corner all day, in bed 8, taking up space. Waiting.

Princess no 2.
"Hi. I want to tell you about my underwear. It's been wet, like you know, damp. Since yesterday. But like, I'm not sure how much comes out. and I haven't been wearing a pad because I haven't got any, so I can't see the colour of the liquid, so I don't know if its like. Abnormally coloured.

Oh here I am in birth unit. Did I put a pad on? No I couldn't find it/forgot." But here am I and my .. soggy undies from like, yesterday...


Princess no3.
Hi. I'm 21. This is my second baby, the first one is 2 years old and a total screaming terror. I'm 34 weeks pregnant and also Aboriginal. My other risk factors include being 37 kg at approximately 155cm tall. This makes my fundal height inaccurate, but actually my dumb midwife forgot to measure my fundal height, which is bad. This should be a part of every basic assessment (BP, HR, CTG, FUNDAL HEIGHT, PV LOSS, BABYS movements, ?dysuria -- all this in 5 mins is your traditional midwives assessment supposed to be done in normal conversation).

Now I wonder super hard what was her FH because she looked teeny tiny despite being 34 weeks.

Anyway so. The notes said, CTG for SGA but - what it didn't say was (and now i'll go back into her voice) I had a bleed last week and on ultrasound there was a "mushroom like appearance in my uterus" and the doctors scared me about an abruption but i didn't want to stay in the hospital anymore so i DAMA'd and went home agreeing to daily CTGs. Which I came and did as I pleased over the weekend, but now I'm getting that crampy feeling I had last week again, and I've got this dark brown discharge in my pad that's pretty thick. The midwives think its old blood but I'm scared and sad that I'm about to loose my baby so I've packed my bags and I'm ready to be admitted to hospital.

Princess no. 4
I'm itchy and the clinic doctor sent me upstairs to ...
I'm not sure why but the midwife said she'd figure it out - and then started reading my notes but found other aspects of it more interesting than it should have been. I had gastric banding a few years ago but I still eat whatever I like. The dietician says i have irregular CHO amounts and eat high fat diet. So I've now gone all fish and salad to try and be healthier. I'm 45 this pregnancy so that probably also doens't help.

I'm itchy. I don't know what it means. The midwife was surprised I'm not of Indian or South East Asian (but caucasian) descent.

As I arrived the midwife said : so you haven't had a CTG yet? (no I have) and oh so you need bloods done? (and no I had that too) and I thought oh. You haven't had a review yet? But .. wait. Didn't you just SEE the doctor? who sent you here? Like .
This is where a more senior midwife would have said "look doc, so is the clinic going to do the CTG and bloods? cool so can you like. just gimme the MRN, and I can put her in the MAC book. and we can recheck the bloods when the results come and then call the lady if she needs a script? There's no need for her to come and sit in MAC to wait for results...
Instead of me who is like :yes send her up and I'll figure it out later when she gets here since you said she needs to be here, like even though she doesn't.


Princess on the phone
Hi, when i walk I have pain. But when I rest i don't and it's better. The baby moves well, or it did this morning. Not sure now. I haven't taken paracetamol - because (no reason why) but I'm worried about this pain. I know you said it sounds like round ligament pain but it hurts bad. And my PAPP-A was high which I know is a risk factor for miscarriage /non continuing pregnancy so I'm extra worried. I can't come in until 4pm is that ok?

Sure. Whenever you'd like since you really want an assessment - so whats your medical record number and name. Cause I can't find you in the system. You know what. So We've had the discussion, and we've talked about causes and normal things to experience in pregnancy. You said you want an assessment - and that's your right - to come in, as we are open 24/7 how about, you go on your merry way, and come in when you can and i'll go talk personally to the reciptionist to figure out what your file is so I can write a note and hand you over to the PM staff because I'm outta here by 15:30.

The Dari lady

This is my ignorance, on handover, the buzzer goes to call for a 2nd midwife to attend a birth and the in-charge sends me (oh man my heart is in my boots I'm so nervous) so I go anyways because face your fears - and I'm introduced to a p0 non english speaking lady who speaks Dari.

and I look at her and think, you don't look Indian.

but that's beside the point.

The main point is suspected macrosomic LGA baby on scan, for IOL in a few days but she started spont labouring earlier so here we are.

Pushing for 30 mins, head coming down slowlyish.

Macrosomia, macrosomia, macrosomia, my head says.

There was a 3a tear last week. The previous midwife says "theres an epis scissors and I've loaded the syringe for infiltration." I look at it on the birth trolley.

I didn't see her draw it. up but there's no time to get another set of everything. I'm just glad its all prepared.

she leaves to like, talk to the drs and finish up the notes so it's me and the Dari lady (who I think is from india, but she doesn't look Indian. but thats not important) and I think we're gonna need an epis.

Then a student pops up.

This day could not get any better. but actually this was a very independent student so that was nice. But I was the one who needed to cut the epis.

I decide to infiltrate in the chance we might be cutting an epis.

I've seen this done like, less than 10 times and the last time would have been more than a year ago, so I dig deep into my brain and I think I did it right.

How am I still a midwife, I wonder. I feel like the wild west.

It looks correct when i've done it. I had to do it a few times because it didn't seem like i put very much. I probably did about 15 mls all up.

And them after 4 pushes of not getting very far, I think I'll cut one.

And So I did. Right during the contraction, and no she did not have an epidural.

The baby did not bust out, and still had a ways to go -- such getting me worried that I called for a 2nd senior (ha like I'm a senior... 8th year wages and title and all) and I say I think I've cut it too short. And she's like too short or too early? and that got me thinking. Was it a bit too early to cut it?

She did a very controled set of pushes too then eventually the kiddo appears and all is well and good despite the large gush of thick mec after the kid.

I changed the chart from SAGO to postnatal -- the observations would have been wrongly classified otherwise. The student forgot to do that and I didn't spend the time to correct her.

Or was it the RM before forgot to do it. I don't know.

She wasn't Indian, she was Afghanistan. which makes sense although if I looked at her and was to guess I'd say she was from south America, or Chille or something.

But Afghanistan is way more common around SSH area. Anyway.

Because I also had :

Lady no2.

Termination of pregnancy, medical. for --- and kill me now i didn't find the time to write it down:

Anencephaly

and something else.

This was her 3rd Top.
She was a G4P1. No one could figure out from the notes what the other TOPs were for, and it wasn't really a time to ask.

she was only 24 and her one live birth was a 2 year old.

I made a massive mistake today -- so I was delivering the placenta and the cord snapped. Great. We ended up waiting an hour (first I did a VE and I had no idea wtf I was feeling for) so I call the educator who does a VE and explains: She's 5 cm dialted and the cervix is holding the placenta in. And she can't get past it.

She thought there was a low chance that she would birth the placenta naturally. We tried her squatting on a pan and giving it a good go -- but that seemed to not get anywhere. So I sat on the doctor to come and do a VE and the doctor had a go - but then was like nup.

theaters it is.

I forgot to somehow weedle into the conversation with the admission pre op nurse that it was for a TOP. Not like, the baby was born and then the placenta cord snapped (Cause that happens too and yes that means theater too).

And after i left the staff started asking the lady about her baby.

oops.

I forgot to deliver the placenta container with the lady so I went back down later and bumped into the pre op nurse who said "can you tell us somehow next time" and I was like. Oh. Yeah. Damn.

Then I spent the rest of my time doing clinical photos and trying to do momento photos, and the educator said "let me do them" lol and she re-did mine because in her very kind words "those (that I had taken) are a little confronting.

I left thinking "does she need dostinex ?" at 14+5 I think its a grey zone. It's definatly needed for 2nd trimester but 14+5... is just the beginning.

Lets hope she doesn't lactate at home.

Por por is finding her feet still
I come to my mums house to pick up the kids and I find Wendy's eyes glued to the TV.

My mum claims she can't control her and Wendy keeps hitting May2 in the head, so she turned the tV on for "a long time" (I asked how long and she couldn't say) I turn it off and there are immediate tears. So I did my usual trick - lets go outside for a walk! (more wails) Lets see if we can find a bunny! and instantly Wendy was so excited for this bunny.

We went for a short walk to peruse the street because I was considering a site for OC trailer parking (long story). We figured it wasn't suitable but wouldn't have known until we went down for a look. On the way we met a nice lady in a house with a bunch of kids who offered to show Wendy their baby cat but wendy was scared so we didn't get to see the kitty.

I was walking with my work uniform on so I wonder if that made members of the public more friendly or aware of me.

Cause I clearly am either a nurse or a midwife.

Anyhow. Por por wanted to take them for a walk also but I hadn't prepared the pram with toddler board and my mum was worried that since Wendy woke up complaining of ?knee pain (she's two) and she had a tonne of scratches on her face and bruises everywhere (lol she was a bit wild yesterday at my mum's during my annual UNSW friends Christmas party) that if they went to the park and wendy declared she couldn't walk home that there's no way my 75 yr old mum could carry heavy Wendy and May2 back home on her own.

I might not have minded so much if wendy was watching something good on the TV but it was some weird mime thing. Like what the heck.

LOLs.


Elizabeth didn't sleep well at my mums, She did ok but then would wake up for a drink but then get distracted by the new environment and start getting playful....

at 3am.

Yeah not fun,

And then at 5am. I think I was also dehydrated and so maybe my milk supply was downish. So she probably wasn't as satisfied as usual.

It's late and there's a giant day planned for tomorrow.

Oh and the cleaners came and the house actually, for once since Wendy was born and Pete and my mum had the capacity to help me, smelled clean.

For now anyway.

( Lebanese girls do well in labour )

See you in September - if you'll have me back SSH.

Lately I've been on the swing shift.

What this means is that I just end up hanging around and helping various people. Which really means, get sent to MAC to cover breaks, which means - help out with 1 or 2 women - while other staff members declare they are too busy to go for a break.


Nothing too interesting has occured and my brain hurts with the amount of things they want done for each lady.

Obs, proper palp, CTG, link the eletronic CTG, sign off the CTG sticker, document it all in powerchart and in ASSA, the yellow card, talk to the woman, council them properly.

A few memories that stuck with me.

Some women you just wonder how they got pregnant in the first place
28 yr old Indian? lady.
Had trouble conceiving for no reason.
34 yrs old.
Ended up having IVF
Now pregnant, 38 weeks, complicated by Cholestasis and rising bile acids
Therefore they've decided she needs to have the baby now.
That means induction
So they reccomended usual route - fokeys first (mechanical ripening of the cervix) followed by usual oxytocin drip. They tried to put the foleys in 3x and failed.
so then they're going to do chemical ripening (what I experienced).

The Doctor is like, okay so we are going to put this hormonal gel into your cervix and it will open your cervix. You will need to be admitted to the hospital.
The negative effect of this gel is that if it over stimulates your uterus, and your baby cannot cope with this over stimulation (which we will see on the CTG aka. baby ECG or EKG) then we will take you for a c-section, okay?

I remember back to when I had the chemical ripening of my cervix and I can tell you now. No one said the C word to me (c-section). So I was a little shocked with how blunt the Doc was about it.

But at SSH they have a lot of bad experiences with families and the doctors down that way are ultra scarred. I feel like they're definaly doing defensive practicing (which is what some midwives call it). essentially what that means is they're practicing with the assumption they're going to get sued and they're doing what they can to avoid it.

So the doctor is there, saying that if this goes bad we are going to get a c-section sorted for her.

The woman looks super unsure.

I'm standing there as a chaperone/assistant, thinking. Lady. How did you think women had babies?
Like your 38 weeks and you have cholestasis. The baby needs to come out. Your liver is not doing well, your body is suffering. The kid can't stay in there. Like eventually it comes out either through the vagina or through a surgical opening. The end?. Like. Hello. ... whats the hesitation?

Maybe her english wasn't good enough.

Then the doctor puts the gel up and she squrims so bad, and cries its like she's getting raped.
Like. Okay bad analogy perhaps but honestly, perhaps she never had sex properly and that's why she could never get pregnant. Like seriously, that's a possibility (an expensive one). But if she has vaginismus, perhaps, its not in her history.

which, btw is a totally legitimate reason for IVF.

Women who have vagininismus who want to get pregnant anyway are pretty brave.

Although, like, who wants pain. Every woman feels it - vaginismus or not - Unless your that weird 1-5% that has some sort of orgasmic/painless experience.

Anyhow. I just had no idea why she was so unsure. I'd only met her 2 minutes before this conversation went down. Which is not really how gold standard midwifery is supposed to work.

But here we are In the imperfect hospital system. Me trying to keep my registration 2.5 years after graduation

Can you believe it's been 2.5 years?

some women can predict their labour
One lady, from ?Africa. 4th baby. The first 3 were pretty quick.
4th baby so she knows how this goes.
Each other time she's had a baby - stretch and sweep is all it takes to get her going and 4 hours later the baby will be born.
So she can literally predict when the kid will be born. delay the S+S until the date she wants (within a reasonable timeframe, of course). Poor thing had diabetes with insulin so the doctors were keen for her to hurry it along.

These women get booked for a foleys and induction - its like, why bother with this whole bullshit.

She's going to go into labour the moment the midwife touches her cervix on the foleys day. But here we are booking her for an induction anyway the day after. Just because thats the protocol.

I wonder if she does end up having her baby right after the S+S. If I remember I'll follow it up but I'm fairly certain this time next week I'd have forgotten about her.

Frequently I feel like I'm no more than ( an obstetric nurse )