Monday, 3 November 2008

Mother and Baby Day One

I have previously mentioned how I thought my Mother and Baby sub-placement, a week around and about the maternity and midwifery hotspots of the current Trust I'm working in, might be a waste of time. I feared this, and had images of me just stood prone not allowed to do anything, being both a man and a student on the wards for one day each. However, like most placements, it turns out it's what you make of the experience.

Today was an early shift up on the labour ward. After arriving in the wrong ward and rushing over the right one just in time, I was quickly assigned to a midwife and a pregnant woman, whose labour was in the earlyish stages, because I was more likely to see something there. Obviously, I will be keeping things ever vague to protect anonymity, but on asking the lady was glad to have me there, which is a lovely liberal attitude to hold in this day and age. I would it difficult to interact at first - asking if someone is alright when they're clearly not is just a silly idea. Generally, because her partner was unable to get onto the ward until later on, she was grateful for the support, if a bit standoffish since she didn't know me as of yet. And I was annoyed at myself for standing around very much in the style of a lemon for a bit, but then I remembered this was a total and utterly new thing for me. Maternity and midwifery is unlike standard nursing, and that's a lot to take. The midwife I was working under was equally lovely, and answered my myriad questions well, guiding me and talking to me about the issues involved. I think she was something of a (very skilled) rookie, having asked her superior for advice on a few occasions, but second opinions are important.

From starting at about 8am, the woman was in something of a state already, but still very calm, considering. She had requested no pain relief, and was simply annoyed at being linked up to machines. Things began to drag for her from there, as contractions slowly but surely gathered in pace and pain. I had found my nursing mojo and had been chatting to her by now, in between shadowing and helping the midwife. Some time later, due to somewhat suspicious clinical presentation, the midwife advised the woman to lie on the bed so we could track the heart rate of the baby and some other things more clearly. And this is when it began to kick off.

Pain and distress, although the woman was bloody well brave about it all, requesting no pain relief until much, much later down the line. The husband arrived soon, which helped, and gave us time to make some decisions. The midwife finally decided that, although it'd make the contractions hurt a bit more, a hormone delivered by IV would make them more consistent and prompt a smooth labour. The patient agreed and so off we went. Things accelerated from there - not quickly enough for the woman who was tired, in pain and generally fed up (but still immensely brave and doing everything right). I was crouched by the bed by this point, opposite her partner, having my hand squeezed in the vice-like grip only pregnant women manage to bring into play. After picking up on the things the midwife had been telling her, I took over the role of pregnancy cheerleader, helping her with her very light pain relief and the breathing she needed to be doing to 'breathe through the pain'. Once you've been an actor and learnt how to effectively improvise, this bit flows quite easily off the tongue.

Now, whereas she had not been near the 10cm of dilation necessary for delivery for the morning, the early afternoon was to herald some changes. She was the kind of woman whose status could change quite quickly and so I had half an eye on the tracing machine and the other one and a half on her, encouraging her along.

The one bad moment of the day came when a doctor came to examine her. To cut a long story short, he wanted to look and she was very sensitive. There was a point when he was inside her when she was screaming at him to wait, and I'm aware than sometimes we in the medical profession do things patients don't like and these things need to be done, in this case to assess the safety and health of the baby, but when you're being told to stop you really should. Just go away and document the patient said no, y'know? Anyway, I was close to actually speaking up when he stopped and got out of the way (and the room). Leaving the midwife, the husband, the woman and I.

From there things got really crazy from my standpoint of utter inexperience. After spending the past hour telling this lovely woman who was desperate to push NOT to push and to keep breathing, now she'd hit suitable dilation that she SHOULD push. I'm surprised she didn't smack us upside our collective heads, but she did excessively well in the push on. She was very concerned for most of the time before that the baby's head was nowhere to be seen (in the literal sense) but that soon changed. Cheered on by yours truly, primarily, the father more of the strong, silent type and the midwife busy getting things ready for what could be a quick crescendo, she pushed like a bloody trooper, and soon this beautiful little person was coming out of her. Just the head, then the face. The hard bit over, this baby was all out and the midwife was clamping off the cord, placing him right on his mother's chest. Silent at first, he soon piped up with some skin to skin contact and after a quick dry with the towel, and the woman was so relieved it's untrue. Smiles all around, despite the crying out of the lovely set of lungs of the newest person in the room. The father, elated, snapped some pictures and cuddled with the pair. The harder work over, I helped the midwife retrieve the placenta, which seemed relatively painless, and it was over. Just under an hour before the end of seemingly the longest shift I'd ever been on, and I was let go by the team, mission successful. And I felt good. The baby was absolutely beautiful, perfect even. The mother and father thanked me, to which I had to say it right back. It meant a lot to me to be involved in that special experience of their lives. I said goodbye to the baby, having a go in his father's arms after some very valuable skin2skin contact, and made my merry way home. A day of good work, indeed!

Earlier in the shift, the midwife asked me I'd considered midwifery. I said yes, but was put off by the job opportunities and difficulty getting onto the course. Asked the same question at the end of the day, the answer was still a resounding yes. I LOVE the core, even the midwifery one. They're not nurses and don't much like being associated with them, and I can see why. Their work is a world apart.

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