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Archive for June, 2007

I’m now half through my holiday, and bored rigid. Hubby and I won’t be having a ‘proper’ holiday this year due to my fear that the minute I fly off to tropical climes the twins will decide to put in an appearance. I was looking forward to spending time in the garden, tidying it up and taking my troubles out on the soil but, thanks to the weather, I have only managed one and a half days cultivating the rest has been spent being a domestic goddess, a role which I am not at my best in. There isn’t quite the same scope for physical aggression when cleaning out the larder as there is when drastically pruning a vigorous shrub. Yes, strength is required when attempting to separate a tin of golden syrup from a melamine shelf, glue manufacturers should investigate the adhesive properties of syrup, it seems more successful than superglue in my house and has the added advantage that, if you do get it on your fingers, it doesn’t stick them together but is a real pleasure to remove with your mouth. There were moments for quiet deliberation on vegetables. Carrots, sneaky little tap roots. There is always one that has escaped the vegetable rack and has lain, undisturbed for weeks, could even be months and has remained undetected due to it not becoming offensive. Carrots, in a dry environment, mummify. Very different to those stored in plastic bags, they are capable of inducing nausea. That horrid milky stuff, almost phlegm-like, reminds me of the ‘sputum round’ when I worked on the chest ward, and the carrots themselves, pick the bag up and squeeze one of the orange veggies and it is totally soft. Disgusting. Potatoes, now if those go off and are left hanging around it is tantamount to keeping cats in the larder and not cleaning out the litter tray, and the smell lingers, at least they give themselves away though.

On Monday Hubby and I are jetting off somewhere, not abroad though. It is within easy return, should Van and Lorry wish to appear, but somewhere that neither of us have ever been before. Since it is only for 5 days it won’t be the end of the world if the weather is inclement, should be plenty of expeditions we can undertake, but if the sun should shine, one day would be good, there are lovely beaches. A complete change will be lovely, with enough relaxation to re-invigorate us.

On daughters house move, things are still floating around in the ether that is a solicitors office but friend in shining armour has ridden to the rescue, well he has certainly taken some of the pressure off. He rents out property, and he phoned yesterday to say that if daughter wants to they can move in to an empty property he has just finished preparing for rental, and he says they can have it ‘gratis’. It’s ideal. Just down the road from where they are now, but much bigger. Daughter is now much more philosophical about the whole fiasco as she knows that she won’t have to try and cope in a house that is really not suitable if their moving saga continue at it’s snail pace.

Son and fiancee came round with some news during the week, they are getting married in May next year. Not sure what has spurred them into action as they have been living together for five years, the girls have their suspicions that they are planning a family, I don’t think they are far wrong.

The bad luck continues for Jack and Izzy’s Mummy and Daddy. A month ago he came off his motor bike whilst racing and broke his arm in two places, he also injured the thumb on the other hand, but the hospital said it was just a strain. Wrong. This week he went to have his arm checked, and re-plastered as it hasn’t healed, and they decided to investigate the thumb and found that he has torn the tendon, so now that wrist and hand are plastered as well. He is ‘armless, practically speaking. Daughter is having to do everything, literally everything, for him and she is exhausted. A 3 year old, 5 month old and a 30 something ‘would be’ Valentino Rossi are more than enough for anyone.

Off packing now. Mac in a Sac top of the list.  

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Back again

I'm like a butterfly, flitting here and there, unsure of where to land really. I like this blog realm, except for the fact that I can't seem to stop being in USA. Not that I have anything against being in the States, but it's not true, I'm in England! In good old Blighty I'm a midwife where, apparently we have more support from our medical colleagues than midwives enjoy the other side of the Atlantic, although if you read NHS blogdoc you would have a hard time believing that there is any form of respect from the medical establishment, god bless them, toward the 'madwives'.

Presently I am in a state of perpetual anticipation as one of my daughters is 28 weeks pregnant with identical twins and is stressed to the max with trying to move house before the new babies arrive. We know that they will be born by 36 weeks as she has her caesarian section booked, her previous section plus the identical twins made the mode of delivery a foregone conclusion, but with all the stress, the size of the babies, each currently larger than a singleton, and still working I have this uncomfortable feeling they may decide to come earlier.

Time to flap off again now. Hubby and I are taking a few days off and I really need to pack.

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Work and Family overlap

Increasingly, over the last month, I have found myself more and more worried and agitated about pregnant one. Back in February, when they found out they were having an addition to the family they put their little two up, two down house on the market. They could see that things may become a bit overcrowded for them when the new baby became mobile so thought a move to a larger house would be a good idea. In a buoyant housing market they found a buyer quickly, they were told he had sold his flat so was all ready to move. They heated up their house viewing then, when they found out they were expecting twins, quickly adapted their requirements and found a house suitable for their expanding family. All appeared well. The vendors had found the house they wanted and that owner was emigrating, so they were one link away from the top of the chain and one away from the bottom, this was the end of February. It is now the end of June and the deceit is positively racing out of the woodwork. Above them all is well, but fraught, below them a cascade of time wasting is threatening everything. Day by day new obstacles are thrown up, whilst day by day daughter is getting closer to giving birth to the twins. Their estate agent has been worse than useless, he is of the opinion that he will be paid for doing sweet ‘fanny adams’. Their purchaser’s solicitor has failed to respond to communications from daughters legal bod, and his mortgage company failed to pick up on ongoing applications when one of their employees left. Daughter is now stressed to the max. Her Braxton Hicks are kicking in with a vengeance, last night they were so ‘uncomfortable’ that her partner wanted to take her to the hospital, her blood pressure is still normal but rising, she is having frequent nose bleeds, and is now so worried that she isn’t sleeping.

Her comes the overlap, I’m her midwife and her Mother, and I want to kick someones ass so hard they can never sit down again! Before now, if one of my patient’s work have not carried out the risk managements they are supposed to for pregnant employees, I have dropped them a line reminding them of their responsibilities. If they have told women that they cannot have time off for clinic appointments I have sent them a letter advising them that they are in contravention of statutory maternity rights, in this case, which is potentially damaging to my daughter and unborn Grandchildren, I can do nothing, except seethe and worry.

All I know is that if I were one of these solicitors I would have been hauled over the coals and would, by now, be plastered all over the tabloids for failing to do my job. Can you sue a solicitor?

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Perspectives

I decided to do my own little sliver of research as to how I should address the women I care for.  This all came about due my my favourite G.P, during one of his diatribes about midwives, saying ‘I have never understood why, because a woman is trying to deliver a baby, it is assumed by midwives that she can be addressed by her first name.’ I thought about this and began to question whether I had just assumed that women would prefer being addressed informaly, I set out to discover how the women I care for feel about it. Usually I call the women in to the consulting room using their Christian names but for the last two weeks I have used their title and surname. Once in the room I have asked them if they would like me address them like that or use their first name. Without exception they have all said that I should use the informal approach, often qualifying this by saying things along the lines of ‘due to the intimate type of relationship midwives have with women this is far more appropriate’, or pointing out that I don’t introduce myself as Sister Midwifemuse but Iuse my Christian name. One of the women today said that when I use her surname and title she feels as if she has done something wrong. I began to ponder Dr Crippens assumption that women prefer to be addressed formally. Perhaps the answer lies in how Doctors in hospital, and some G.P’s address their patients and, perhaps more importantly, how they introduce themselves. Working in the hospital I only very rarely hear the Doctors introduce themselves by their first name, on the whole they refer to themselves, and are referred to by the staff, by their title and surname. They are maintaining a relationship on a formal footing. Why? Musing to myself, and with no evidence other than personal observation and anecdotal, I think it has to do with the type of interaction that is in play. A midwife is attempting to form a relationship with the woman through her pregnancy, labour and following the birth. I don’t anticipate becoming ‘best buddies’ with her, but I would certainly like her to trust, feel at ease and able to discuss anything with me. Once in labour a Doctor has only a fraction of the contact with the woman and her birth partner that the midwife does. S/he is generally only in attendance if labour is deviating from the norm and then that is for reviewing purposes, so short bursts of contact, or to expediate the delivery by instrumental or operative methods. This hardly adds up to the many hours that a midwife may spend in reassuring, encouraging, and soothing a woman (and her birth partner).  Another aspect to be considered is the use of titles. Mrs, Ms, Miss, we may be in a permissive age when being unmarried and pregnant is no longer considered socially deviant  but some women would rather not have this information broadcast around a crowded waiting-room however, by using a title, this is effectively what we are doing.

Outcome……….I shall continue as I have been. I have never had any complaints about it, my caseload at the moment are happy with me addressing them in friendly terms and I really don’t feel comfortable being addressed as ‘Sister’ and one of the women today said it makes me sound like a Nun, and that makes her uncomfortable!

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News for the good?

Loopy Lou had her homebirth, and all went fantastically. I went to visit her today and she is really happy with everything, baby is lovely, feeding well, and her stitches, yes stitches are comfortable. I asked how it was being sutured and she said that the worst part was the local anaesthetic, when she says that she screamed, but that after childbirth it was nothing! I am so pleased to admit that I was wrong.

Another midwife had been out all night at a homebirth so I was sent to cover her clinic in an area I am unfamiliar with. It all started so well, I guessed at the best route across country to get there, and I was right, well almost, if you don’t count getting on to the motorway by mistake and then having to drive an extra 6 miles until I could get off and then going to the wrong surgery. Not my fault, I went where I was told to! The clinic was a smaller affair than mine so having looked at the appointment list I felt quite relaxed, and it was an enjoyable experience until the last, thank heavens it was the last, pregnant woman. At 32 weeks, and having already changed the hospital she was booked at twice already, she had been to see another one at the weekend and had decided to go there. I explained that I was a locum and so was unsure how to go about booking her for the new hospital, perhaps she could wait and see her usual midwife. That was not acceptable, she thought her midwife procrastinated and was not organised, that put me firmly in my place, so the phone call chase to contact the new hospital, way out of our area, was on. An hour later it was all arranged, and to be fair she was extremely grateful. I found myself really questioning my motives though. The media’s recent tongue-lashings about midwives has made me quite paranoid and I am finding myself constantly ‘looking over my shoulder’. I had seen on her notes that she worked within the media industry and she did, at one point, mention the recent press coverage, it certainly did the trick though as it made me jump to her tune. Supposing though that she had not been the last patient, would I, should I have dedicated so much time to her desire or should I have insisted that her midwife deal with it at a more appropriate time? As it was it just made me late finishing and her happy but at a different time it could have inconvenienced 7 other, equally deserving, women. I’m just going to put it down to the power of the press not really working in everyone’s interest.

Readers of me in my other blog will know that I am soon to be minus a job-share as she is moving away to retirement land. I have been becoming very stressed about this, coming as it does, just when I need the flexibility a job-share offers due to the increasingly imminent arrival of the twins, Van and Lorry. Tonight though the phone rang with what could be very positive news, one of my ex-colleagues was told about the prospective vacancy by my ex-manager and rang to ask me if I would be happy for her to apply. Happy, I’m ecstatic, we have worked together before, I cared for her during her pregnancy and labour, she delivered my first Grandchild, I can’t think of anyone I would rather work with. Fingers crossed that it works out.

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Family

My family are a huge part of my life. We all live within a twenty mile radius so do see a great deal of each other and for that reason I see myself as incredibly lucky. As I am likely to refer to them in blogs I had better introduce them to you.

Jack Jack           Amythinking-amy.jpg            Izzyprincess-izzy.jpg

These are my Grandchildren. Jack is 3 and his sister is four and half month old Izzy, they are the children of my youngest daughter. Amy is 2 and her Mummy is my eldest daughter who is expecting identical twins in September. We know that we will not have to wait until September to meet ‘Van and Lorry’ as she going to be having a caesarian section in August, if she doesn’t have them before! I was lucky enough to be invoved in my daughters care care during their pregnancies and births and they each, in their own way way, gave me whole new perspectives on childbirth. With the twins my input has been extremely scant as this pregnancy is considered high-risk, identical twins and previous caeasarian taking it mainly under the care of a Consultant Obstetrician but I have been able to go to a few of her 8 scans with her and love watching Van and Lorry cavorting around and bumping into each other.

I also have a son, no Grandchildren from him….yet, although the conversations seem to be leading us in that direction. I have said to him and DIL that I would love it if they could wait a year until they join in the family expansion process as, come August, I will have run out of cots and chairs to put all the babies in!

There is also my long-suffering Hubby. Being married to a Community Midwife is not the most predictable life, sometimes he goes to bed with me but wakes up in the morning to find a note telling him I’m at a birth, don’t know when I’ll be back, or we may have just sat down to dinner and off I rush, planned events often have to go on hold with the ring of the phone. He has found a way to get his own back, he plays golf, frequently, midwifery is my ‘hobby’ (his logic), golf is his.

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Decision

What follows is a copy of an entry I made in a previous life, blog. I have reproduced it here as I saw the woman ‘Loopy Lou’ again today and am feeling really ambivalent now toward her, and even more worried about her choice of a homebirth.

I love homebirths, under the right circumstances. I suggest a homebirth as an option to all of my women who a) are considered to have no risk factors (low-risk); b) seem to me to be emotionally, temperamentally a good ‘candidate’. Until today I hadn’t really acknowledged that I make this judgement call about their emotional ‘suitability’, perhaps it had never really happened before but then ‘Loopy Lou’ came into clinic requesting a homebirth. I asked why she was considering a homebirth, I find this a good place to start as from the reply I can usually judge whether this is a well considered choice or them just grabbing hold of political and media hype or ‘tree-hugging’ stories on homebirthwebsites. The answer started well, they had attended antenatal classes the previous night where homebirth was mentioned, but then it went a little off, they were making the decision because the hospital was dark when they went there, they had to park, and they had to leave the dog and cats at home. I would see all these points as peripheral to the homebirth choice and certainly not the answer of someone who had really thought about giving birth at home. I continued sounding her out and, just to see if they had thought about everything they would have in the forefront of their minds I asked what they would do with the dog whilst she was giving birth. I explained that dogs may become distressed if their owners are exhibiting signs that they may be in discomfort and could become confused by the odours, particularly blood, which are associated with giving birth. After a momentary pause I received my answer, ‘It’s alright. Its my husbands dog, I’m not his owner’. There was something not quite right with her whole demeanour, I felt as if I was in a Shakespearean play as she kept making ‘asides’ to a person who was not in the room and then seemed to be listening to a reply. As we continued chatting I flicked through her notes; minor psychiatric problem in the past; cardiac abnormality at birth, which has since been corrected by surgery. Right, so when is she next going to see the consultant, she’s not, whoever booked her considered her low-risk. Now, I’m in a dilemma here. I feel I should ask a Consultant to review her, purely due to her medical history and there is a little voice in my head telling me that this lady is not a good candidate for homebirth. I can advise her that in my personal estimation a homebirth may not be the best option and I have told her I would like her to see the Consultant, but she is now questioning why, in the previous 20 weeks, no other midwife has made that referral. Fair point, why haven’t they? Would I have done if she hadn’t requested a homebirth? I just don’t know, all I know is that I feel uncomfortable with her having baby at home. So I’ve taken the cowards way out. I’ve asked my job-share to visit her at home, told her my concerns, admitted I have a strange ‘feeling’ about this case and said that I will concur with whatever decision she comes to. As it stands though midwives cannot refuse anyone a homebirth, we can advise against it but it is a Health Authority’s duty to provide professional care for a woman wishing to have her baby at home. So, if Loopy Lou decides to go ahead with it, all I can do is put on my happy face and go with it. I just wish my gut instinct was not worrying me so much.

Between that entry and today my job-share booked her for her homebirth. She agreed that LL was dotty, not enough for her to question her homebirth, but reported back that the house was filthy and stunk of cats, she added that she hoped she wasn’t called for the birth as she didn’t think it would go well. Either my job-share is thick skinned or I’m losing the plot. Then last week my manager left a message saying that she didn’t think that LL was a good candidate for a homebirth because of her cardiac history and her OCD (obsessive compulsive disorder), I was happy, understatement. That was the day that I should have been seeing her at clinic but I was called to a homebirth so a colleague covered it instead. The following day I discussed LL with the colleague who had seen her at clinic, she agreed with me that LL was not the most stable person, mentally, that she had ever met. Then the bombshell, manager had reviewed Loopy Lou’s hospital records, spoken to one of the consultants and decided that a homebirth would be fine ‘with 2 midwives sooner rather than later’.

I saw LL today at clinic. Tomorrow is her due date and obstetrically all is well and there were no conversations with invisible third parties so I began to feel slightly more positive, until I talked to her about a stretch and sweep next week if she hasn’t gone into labour. As I began to explain what it involves she asked if it was like a smear, ‘Well, not really. We don’t use an instrument, we use our fingers.’ She looked uncomfortable, don’t blame her really, and then she explained that she always bleeds after a smear. I changed tack and talked to her about raspberry leaf tea, under ripe pineapple and other alternative methods that may encourage labour including making love. Then the flood gates to her psyche opened. Making love is always painful, I asked if she bleeds then, no she doesn’t but it always hurts ‘ Conception was not a pleasant experience’. I wondered if she had sought help, she has seen the G.P and she was told to use plenty of lubrication, that doesn’t help her. She reverted back to the stretch and sweep, she doesn’t want one, she finds people touching her painful, touching her anywhere painful. The conversation meandered around, without me asking she volunteered a lot of personal, very personal information. I suggested to her that perhaps a homebirth is not the best idea, supposing she needs stitching after the birth will she be able to tolerate that sort of touching without the aid of something more than a local anaesthetic, she said she could but then in the next breath asked me to book her for an induction of labour next week, I think that she is having second thoughts.

I’m going to see her at home next week, I have promised not to mention stretch and sweeps and she seemed really pleased that I would be going round. I’m feeling like a two-faced old c*w. I’m trying to turn her off a home birth, I still think that she is a poor candidate for one. She obviously has major psychological hang-ups and I do worry that having the baby at home, with all the touching that involves may tie baby, home and painful, unpleasant experiences together. I’m not a psychologist so have no idea if that could be a reality, or what the outcome could be but I would really like to avoid finding out. I’m going to make her an offer, go into hospital to have the baby and I’ll go with you. She will probably turn me down flat, I may be entirely mis-reading things but I do think that today we hit it off and I believe a ‘domino’ birth could be the best answer for old Loopy Lou.

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Exploring

I might dip my toe in the water. I think I need to find a new home. It's certainly colourful enough here, and I can find my way around easily, I might just have a mini-break.

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Reflecting

Time for some reflection on an experience I had at work when I was the on-call midwife.A woman, having her first baby, booked for a homebirth, had been asked to go into hospital for induction of labour as she was now 11 days past her EDD, expected date of delivery. Previously she had been seen at home and undergone two ‘stretch and sweeps’, on neither occasion was it possible to complete the process as the cervix was long and closed. J had refused to go in to be induced. Her pregnancy had been uneventful and she had no existing medical conditions.This morning I had gone into the office and was told that J was in early labour. The evening before she had called out the on-call who had attended, examined her and found that the cervix was 1 cm dilated, baby’s head was still high and J was having irregular tightenings. The on-call felt that this was very early labour and that it could still be several hours until J was in active labour so having explained this to J and her partner she left. At 1am the on-call was asked by J to attend as the contractions were now more frequent. When the on-call arrived J was in the birthing pool and was experiencing more frequent contractions but they were still quite irregular and short. Eventually J agreed to leave the pool, 1) So the on-call could see how labour was progressing 2) As the midwife felt that J may be using the pool too early and this may be slowing her labour. On palpation the contractions were extremely mild and the baby’s head was still high. An internal examination was performed again and the cervix was found to have thinned and to now be 3 cms dilated but as the head was still so high, and the membranes were bulging it was impossible to determine the position. The midwife was concerned. There had been no descent of the head and this could present a problem in that if the waters break the cord can slip down in front of the head, a cord prolapse. As is usual when a midwife is called out labour ward was contacted, and the shift co-ordinator was briefed on the situation. After involving the obstetric registrar it was decided that J should be ‘invited’ to go in, have the baby monitored and a scan be performed to ascertain why the baby was failing to enter the pelvis. J refused. The on-call midwife was then left sitting downstairs, where the birthing pool was, whilst J and her partner went upstairs to bed, and to sleep. After a couple of hours the on-call advised J that she was going to go into the unit, 5 minutes drive away, catch up with some paperwork, and that J should call when she needed her. 4 am and the call was received, so the on-call returned to their house. Nothing had changed, an examination at 7am revealed that the baby’s head was still high and that the cervix was now 4 cms dilated. J and her partner went back to bed having once again refused to go into the unit and the on-call returned to the hospital to pass care over to me. By now the Consultant was involved, ‘Get her in’ was the message given to me. I phoned J, checked that all was well, labour was still in the early stages and so told her that I would be there in an hour after I had dealt with any outstanding phonecalls and handed my visits over to a helpful colleague. I had a clinic scheduled to start at 1.30pm but I was hopeful I would be able to fulfill that commitment.

I arrived at 10 am. J and her partner seemed quite calm. They were not overly communicative but I suspected that this may be because they were feeling defensive so I avoided all talk of ‘invitations’ and just spent an hour chatting and observing how the labour seemed to be progressing. Gradually I suggested that as it was now 4 hours since the last examination, and the contractions seemed to be sporadic it might be wise to examine J and see how much further along things were. They both agreed, actually seemed quite eager, so I performed an internal examination. I already knew from palpating the abdomen that baby’s head was still high but even so I was surprised by how high it really was. Trying to assess how dilated the cervix was now proved to be quite difficult as it had no firm surface behind it and so with any pressure it moved around, I estimated that it was about 5 cms open. Throughout baby’s heartbeat was textbook at 128-148 bpm, at least baby was a happy chappy. I told the couple what I had found and discussed with them what the findings indicated to me. To me it meant that labour was progressing slowly, but, to be fair, I thought that active labour was only just starting so perhaps a re-examination in a couple of hours to discover if faster progress, and descent, were happening would be the favoured course of action. I explained why the baby’s head remaining high caused us anxiety, why it could be happening and what J could try to encourage descent. J wanted to get back into the pool, I discouraged her from this, the contractions were still quite weak and only coming once in 10 minutes and the pool could slow them down even more. I suggested that J spend some time marching up and down the stairs as this movement sometimes helps an awkwardly positioned baby to ‘sort itself out’ and if we could get baby to move down and press against the cervix this would help dilatation and also improve the ‘feed back’ mechanism encouraging closer and stronger contractions. As J marched up and down the stairs I sat at the bottom and suggested to her that when I re-examined, if there had been little progress, and especially if there had been no descent by baby, then it may be wise to go into the hospital as the best course of action may be to break her waters but that there was no way that I would do that at home with baby’s head bobbing around at the top of her pelvis. J and partner appeared to take this on board and so I went and phoned labour ward to update them on my findings and the agreed plan. ‘Get her in’ was the repeated advise, Hmmm, easier said than done! I looked at my watch, it was now after 12, there was no way I could make the start of my clinic so I asked labour ward to find someone to cover it, difficult request as community were now 2 midwives down, last nights on-call was in bed catching up her sleep and I was stuck in my own personal nightmare. Nightmare? Yes. In someone’s home feeling that I was in a lose, lose situation. I was fairly certain that the next examination would reveal little change, J’s contractions were hardly bothering her at all so she would be quite happy just to carry on, baby was oblivious to everything and really happy, but with every minute I could imagine those membranes bulging more and more and just waiting to pop, with a possible disastrous result.

At last. The marching upstairs had beefed up the contractions, J wanted her TEN’smachine on, she had stopped talking through her contractions, perhaps the next examination would reveal good news, hopefully baby moving in the right direction. 1pm, cervix probably slightly more dilated, but baby’s head still high and not moving down even slightly with the contractions. I went off to the bathroom and allowed the couple to ponder the next move, hopefully they would elect to go to the hospital. J was starting to look tired and I was now starting to worry that she would not have enough energy on to cope with the hard work ahead. No. The decision was that we would all carry on and we would re-assess in another 2 hours. I rang labour ward with the glad tidings and then spoke to my manager for support, life was beginning to feel very lonely. I returned to the labouring couple. J was starting to feel she needed gas and air as the contractions were becoming stronger, I positively skipped to my car to get the gas cylinders, hopefully this was progress. The first cylinder was hissing around the tubing, obviously there was some gas escaping, we fiddled around but it still continued. Not good, it would mean that it would run out very quickly, and it did. The next one was fine but knowing they only last for about half an hour I phoned the unit and asked that the 2nd on-call bring some more cylinders out, she couldn’t as she was in the middle of a clinic! My manger promised me that she would get someone to bring more gas. J then decided that she would get back into the pool. I advised against it for the same reason as before but ultimately had to support their decision as this was her choice. She had the information and, if I hadn’t already told her, she should have read it in the ‘Waterbirth’ book lying on the sofa.

The gas and air ran out but it wasn’t really a problem as the pool had worked it’s ‘magic’, the contractions were back down to 1 every 10 minutes and J was dozing through them. Just after 3pm we discussed the repeat examination, J was eager to find out if there had been any progress, I emphasised to them that if there had been no progress, mainly descent, then I felt that the best option now really was to go into hospital. J was very tired now, baby was still a happy little chappy but I was running out of ideas as to how to keep J out of the pool and maintain adequate contractions. The examination that followed revealed baby’s head still as high, the cervix still ‘floppy’ and ?? 6cms dilated, and the bag of waters bulging (such a temptation to break them). Finally, at 4pm J and her partner agreed to come into the hospital. I phoned Labour Ward and gave them the glad tidings. At 4.30pm I handed their care over to another midwife, said my farewells and breathed a sigh of relief.

Throughout this visit to J’s home I remained as positive as possible. Having facilitated Active Birth classes for several years now I am well aware of the importance of a positive, relaxed approach and it’s effect on the labour hormones. I was finding it difficult in this case as I felt that we were reaching, had reached a point where I should be more directive. The loop playing constantly in my brain was ‘get those contractions going’, if we could just do that I believed baby’s head would descend and labour would progress better. I/we had tried all the methods within my sphere of practice to encourage stronger contractions, J had an oil for labour which contained Clary Sage, she had used her birthing ball, knelt in all-fours, marched up the stairs, snacked on energy rich nibbles, nipple stimulation had been suggested, there had been limited response to these but ultimately, whether due to pool use, baby’s position, or something I still haven’t thought about, it was to no avail.

All was well in the end. The waters were broken, a syntocinon drip was started and at 8.30 pm J gave birth naturally to a little boy. Not the birth experience she wanted but a safe outcome.

What have I learned from this? That even a well-educated, well-informed woman may need to have a directive approach. I was left with the distinct feeling that I was being tolerated and just used as a safety net until they wanted to go into hospital. My feeling was that I might just as well not be there but from what happened with the previous on-call Midwife I knew that, even if I felt I could leave them, they would call me back after about an hour. Anyway, I didn’t feel that I could leave them because of the ‘what if’. What if the waters did break and the cord did come down and I had gone off to do my clinic, I could imagine the backlash, and I believe it would be right. I am pleased that all was well in the end. Perhaps if we had stayed at home we would have got to the same point, eventually. I have my doubts though. J was getting tired, baby’s head was still high and even if we had reached a point where J was feeling the urge to push I believe that I would have taken so long to get there, and then it would have taken so long to push baby out that we would have ended up with an emergency transfer to the hospital rather than the calm drive and arrival that we did have.

At all times I shared my thought processes with the couple, told them the options and allowed them to make the decisions. We were lucky as baby never gave any cause for concern, if I had become worried at any point I would have called in my manager but my feelings were that ‘kid gloves’ were the best way to handle this situation.

J and her partner were pleased they had been able to stay at home for so long, they believe that this enabled them to have a normal birth. They are right, but I do question the use of midwifery resources. It would be wonderful to offer every woman in labour the advantage of staying at home with their own personal midwife keeping them company but with the configuration of the service at the present time it is unrealistic and places strain on the day-to-day service, taking midwifery time from other women and babies.

Would I act differently if this situation arose again. Probably not. Women do have choice in their care. Midwives are often seen as ‘the bad guys’ and complaints about us being non-supportive are rife. What would I have done if J had demanded that I break her waters? I would have refused and if she became insistant I would have called my manager and a Supervisor of Midwives.

What emotion am I left with after this? Disatisfaction.

P.S The gas and air never arrived!

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