Waiting for Agnes

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An unexpected career addition June 3, 2011

Now that the beloved has become a Sacred Vessel the time is ticking down on the clock of my part-time work (when I refer to ‘work’ in this post you can just assume I mean work-outside-the-home – I’m fully aware that staying home is work). Our arrangement is very simple: between us we need to earn the equivalent of one full-time wage. We work the same job, at the same place, so this is pretty easy to arrange. When small was new, I didn’t work at all and the beloved worked a lot. As small has got older, I’ve picked up my hours and the beloved has dropped hers. Income stays the same, one of us can always be with small and work is happy. The beloved has done a sterling job at being the primary wage earner for the past two years, with barely any complaint, and I’d love to imagine that, come the end of the year, I could just pick up my hours to full time and smoothly, uncomplainingly change places. But I just don’t think I can do it. It’s not that I don’t want to do actual work, although if both of us could just stay home with our babies and money magically appeared in our accounts I’m sure that would be great. It’s more that the idea of going back to being a full time, shift working, ward based, hospital midwife makes me want to cry. I love Midwifery with a grand passion and it will no doubt be my primary career for the rest of my working days. So if working in hospital only meant full time Midwifery, I would be as happy as a clam. But it doesn’t. Working in hospital means a little bit of Midwifery, mixed in with a whole lot of Obstetric Nursing, a whole lot of Crappy Hospital Politics, a fair bit of working with People That Make Me Want To Stick Pins In My Eyes and all too regular exposure to Seeing Women Being Ignored, Abused, Belittled and Mutilated. It’s not all awful, there are other excellent, skilled and compassionate midwives and doctors to join forces with in our efforts to Combat The System. But it’s an old, entrenched System and it’s exhausting to be in a near-permanent state of Combativeness.

Ah, woe is you, you may think in a sympathetic fashion. The following may temper that a little – a couple of months ago I did have the opportunity to go back to my caseload midwifery job, the one where I take on the care of five women per month and follow them through from early pregnancy to post birth, going on call for their labour and birth and working closely with a team of three other great midwives. Caseload is brilliant, far less soul-destroying than ward work, challenging in a positive way, better paid and overall deeply satisfying. But it is also exhausting. Being on call means a constant awareness of the women in your care who are nearing term, or who have particular issues earlier in pregnancy. It is an enormous emotional, mental and time commitment for yourself and the people close to you. You cannot plan to do things on your days on call, and if you do make plans you need to be able to drop them at the last minute. Your family has to tolerate you being called away in the middle of a meal or the middle of the night. Last year, when I found out that one of the LMFs was leaving her position in the caseload team to go on maternity leave, I was keen to fill her place. Then obstacles kept jumping up – life with small got more and more challenging, the caseload team manager drove me round the bend, the beloved became a Sacred Vessel and I slowly realised that I had things going on in my life that I wanted to be able to do on a regular, planned basis, commitments that I didn’t want to give up on.

One of these things was seeing my personal trainer, who is awesome in her energy and enthusiasm and commitment to her clients. Like most people, I’m basically lazy when it comes to exercise. I either need a project to work towards, or it needs to be something fun and difficult (which explains the ten years of circus arts being my primary exercise), or I need to be bullied into making a long-term financial commitment. It also needs to be nearby, not outrageously expensive, not lonely but not in a big impersonal group and mainly indoors. So that rules out joining a gym or running, thank god. This year the beloved started seeing the awesome personal trainer, who lives and works in the next street and whose enthusiasm stretches to being hugely encouraging without actually making you cry or vomit. Then the beloved talked me into going, too. At the time, I was driving a million miles every week to do hula hooping with my old trapeze coach. He’s great and also hugely encouraging, but mainly in a brutal, tell you to suck it up and run round the block wearing a bin bag under a jumper until you are much skinnier kind of way. Hula hooping was also getting challenging with a toddler on the move, who wanted to be closely involved. So on the whole, a personal trainer in the next street, who was cheaper and didn’t advocate any kind of bin bag wearing was quite appealing.

Never fear – I am slooooowly winding my way to the point. Other than being positively enthusiastic about training her clients, our personal trainer is always on the lookout for new and interesting classes to add to her group training program. So when she heard I was into hooping she decided I should teach classes for her. After the initial feeling of EeeeeeeeeeeeeeeeeamInotvastlyunderqualified?eeeeeeeeeeeeee, I got excited and then I got Really Excited. Now I am five weeks into teaching an eight week course for beginner hoopers and I am Loving It. And now our lovely PT is planning some kind of hula hooping empire for me, so I continue to be Really Excited. Not only is teaching hooping fun (and often hilarious for all), it means I have an option for mixing Midwifery with Something Completely Different in my quest to both be the primary wage earner for our family and be emotionally and mentally satisfied at the same time. I don’t ask for much, do I?



*This is Not Me. This is Gypsy, the daughter of my lovely but slightly brutal trapeze coach…she is awesome.

Stay tuned for Chapter 4: an impulsive decision to Move House…


Not so odd really December 5, 2010

Filed under: Midwifery — titchandboofer @ 6:37 am
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Most of us are such well behaved, people pleasing suck-ups. At least in the context of attending appointments with health professionals. By and large, we show up on time (despite knowing we’re likely to be kept waiting), we come prepared with relevant documentation, we’re polite, apologetic even (despite having been kept waiting), we readily divulge enormous amounts of deeply personal information – often to someone we’ve never met – trusting that it won’t become the subject of idle gossip and intrigue, we submit unquestioningly to intimate physical examination, we somehow maintain faith that the system’s purpose and ours interconnect, we pay for it (private, public, we pay for it all in some way), and then, often, we head back out to reception and book in to do it all again another day.

And it is by no means dreadful to be a well behaved, people pleasing suck-up. It keeps the system ticking along nicely. Not just the smaller system of, say, a fairly large public hospital, but the larger system too, of general social interaction. It would be utterly exhausting to spend every day in conflict, constantly shoring up our defences against personal scrutiny, fiercely guarding our intimate information from prying eyes and ears. And from inside my particular system, it is useful and expedient when people behave themselves. We midwives get to tick all our boxes. Statistics line up neatly. Clinics run a little closer to time. We feel liked and appreciated. The women feel like they get all their answers right (because somehow being quizzed about your personal life can seem just like a test that you could well fail). The computer system doesn’t implode. Everyone goes home happy.

Well, kind of. For the midwife who sees the system as an unwieldy, impersonal production line, all this nicey-niceness, pleaseandthankyou, I’m so normal and uncomplicated, I’ll just agree to float along the mainstream, just tell me what to do, can leave you a bit cold. For us contrary beings, we like the slightly less expedient. We like the women who question, who educate themselves, who pick and choose which interventions they will accept or decline. We like the women who see us for the service-providers we really can be and use us in kind. We love the women who stand up and take responsibility for themselves and their babies. But it’s easy to love these women. Because on the whole, these women are still people pleasing suck-ups. They’re just very good at being politely assertive. They’re working pretty damn hard to anticipate how we want them to behave and what they’ll have to do get what they need from us. It’s an absurd paradox that the best educated pregnant women spend the most time justifying their decisions.

And then there is the small group of women who manage to be simultaneously the hardest and easiest to love. They are the least expedient, the least well behaved. Pleasing you is the last item on their agenda. In fact, you seem to have pissed them off before you’ve even met. I met one of these women this week. From the look she gave me when I called her name, coming to her first antenatal clinic visit was about as much fun as sticking pins in her eyes. And I didn’t even pronounce her name the wrong way. Some excerpts from our conversation:

The beginning:

Woman, arms crossed hard, slumped in her chair, glaring – What do you want from me?

Me, quickly revising usual chit chat in head – Urhh, really I like to approach this more as ‘what do you want from me?’


*   *   *

So, this wasn’t a planned pregnancy. How do you feel about being pregnant?

(still glaring) Happy. Obviously. Or I wouldn’t be here. Jeez, what are you? Stupid?

*   *   *

Nuh, never been sick. My family don’t get sick.

Have you ever had any surgery?

Yes. I’m not telling you what though.

That’s fine. You don’t have to tell me. I only want to know if the surgery would affect your pregnancy, labour or birth. Do you think it could?

I don’t want to talk about it.

*   *   *

And they were the high points of our forty minutes together. Yes, it was unpleasant. Yes, it made my job harder. Yes, it’s irritating knowing that the very patchy history entered on the unforgiving computer system will no doubt come back to bite me in managerial form. Yes, I hope that, at some point, the pregnancy-relevant bits of her history will come out so we can care for her and her baby safely. No, it didn’t leave me with the warm glow of trust and rapport. But at the end of that day I didn’t care about any of this. Because it’s not so odd really, is it? It’s not so odd to be cautious about revealing yourself to a strange midwife that you probably won’t see again. It’s not so odd to be cautious about what’s expected of you. It’s not so odd to be distrustful of the impersonal system, with its jargon and machines that go ping and its one-size-fits-all approach to care. Kind of seems reasonable, if you ask me.


More sense November 26, 2010

From the excellent Ina May Gaskin…





It’s not only obstetricians who think I’m batshit crazy – I tried explaining this concept to a student midwife the other day. If only I had had this video to hand, she might have been a whole lot less ‘back away from the hippy midwife before she tries to hold my hand and sing’ and a whole lot more ‘why yes, wise and passionate teacher, I totally get you’.



Filed under: Midwifery — titchandboofer @ 12:33 am
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If you have worked with birthing women, the following conversation will be familiar. If you have had a baby – or been with someone having a baby – in a hospital, this is the conversation that the midwife and the obstetrician were having outside the room sometime after you arrived:

Obstetrician – Has Trixie Whosibob arrived?

Midwife – Yep, she’s in room 23.

Is she in good labour?

Yes. She’s an uncomplicated primip (first time mother), well in pregnancy, no risk factors.

How many centimetres is she? (meaning: how open is her cervix? not how tall is she)

I haven’t done a VE (vaginal examination) as Trixie doesn’t want one.

When are you going to do one?

Not as long as the woman doesn’t want one. (grinding teeth just a little)

So, we don’t know if she’s in labour. (huffiness is kicking in about now)

She is in labour. (oh dear, I see where this conversation is going)

So you have done a VE? (elevator music?)

No. My clinical judgement (as a goddamn health professional, with eyes) is that she is in labour. She’s contracting 3/60, the head is…….(trailing off as am talking to a fast retreating back)

Just page me when you’ve done a VE. (as her baby will be unable to come out unless someone touches her cervix, you mad hippy midwife, don’t you know this is a hospital?)

(kill me now)

*     *     *


I used to wonder how an eight hour shift with a labouring woman could be so draining. I’d leave the hospital absolutely washed out, just capable of steering the car home, not interested in any post-work action more taxing than lolling on the couch and mainlining tea. How could it be so very tiring, when much of my time was spent sitting quietly in the semi-dark and writing stuff down? For a while I thought it was the pressure of responsibility – eight hours of a voice in my head chanting ‘two lives in your hands, two lives in your hands, two lives in your hands’. And that is kind of tiring, but the acuteness of it fades after the first few months in. Then I thought it could be the politics, the non-stop jostling for recognition, understanding, autonomy, respect. And that too can be tiring, but it’s also oddly invigorating, the constant justification of my professional judgement. Hard to get in a rut if you have to talk about it all the time. It could be the hospital itself, the hideous fluorescent lighting, the constant hum of air-conditioning, the alarms, the phones, the visitors, the doing everything in triplicate, the glacial pace of change. But even all of these things slide into the background over time.

Now I think I’ve got it figured out. It’s one of the best parts of midwifery, but also one of the least understood and respected by our medical colleagues (and, disappointingly, by some midwives). It’s this… if you’re open to it, midwifery is a job that engages every one of your senses and something more, something utterly intangible.

Yes, if a woman lets you, you can stick your fingers in her vagina and feel how open her cervix is. But that is just one piece of information and it’s not as illuminating as so many people believe. You can put your hand on her belly and feel how often her contractions are coming and how long they are. And you can feel her belly all over, feel what position her baby is in and how far down the baby’s head is. You can do all of this and still not know very much. Where it gets interesting is beyond touch, beyond the measurable.

Sit in the room with this woman. Not up in her face, but off in the corner. Be quiet. Pretend to occupy yourself with notes though, so you’re not just sitting staring at her like a zoo exhibit. Now watch. Listen. Smell. What is the look in her eye? What does she sound like when she’s getting through a contraction? What is the smell on her breath? How chatty is she? How restless? How out of it?

Beyond this again, what do you feel? Can you sense momentum? Do you just know that this labour is steaming ahead, relentless. Are you with a woman who is so quiet, so still, but somehow you know you cannot leave this room, that her baby will be here in minutes? Or is it an absence of momentum? Are you watching a woman who is making a good show of being in labour, because that’s how she thinks she should act? Or is she stuck in a labour that is going nowhere, that is every bit as intense, but is somehow stalled? Is this feeling of absent momentum her? Or is it you? Are you impatient, wanting her to birth on your shift, at your pace? Are you hesitant, willing her to hold back, fearful that her reportedly ‘big baby’ will get stuck in your hands. How are you, even subconsciously, pushing your needs into this space?

Now get out of the room and summarise this for the obstetrician on shift.

Is Trixie in labour?

Yes. I can feel it in my body.

No obstetrician is going to give two hoots for what I can feel. They want a quantifiable measurement. They want a number they can pass onto their colleagues without fear of ridicule or criticism. They want a timeline, a schedule, a plan. This isn’t really their fault. We work in a big system that thrives on order and predictability – not feelings.

This is why my job is draining. I’m sitting quietly in the semi-dark, writing stuff down, with every nerve-ending on high alert. I’m as open as I can be to absorbing this woman’s labour, to sensing it, integrating it into my body. It might sound mad, but it is based in something real: hormones are catching. I’m sure every one of you has experienced sensing someone else’s mood. Have you walked into a room and been stopped short by tension or anger? Have you ‘caught’ someone’s ‘infectious’, buzzing happiness? Wisdom has it that what we say accounts for far less of how we are perceived than how we say it (ie body language matters more than words), but even that isn’t the whole story. So, I’m feeling all of this, absorbing all of this. Then I walk out of the room, push it all down, look the obstetrician square in the eye, put on my best serious health professional voice, summon the magical phrase ‘My clinical judgement is…..’ and hope like hell that it’s enough.


Dear Woman, November 16, 2010

Filed under: Breastfeeding,Midwifery — titchandboofer @ 7:17 am
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It’s a pleasure to meet you. No, really it is. I love the anticipation of peeking into your curtained cubicle at the start of my shift, not knowing you yet, not knowing whether you are crazy high on post-birth endorphins, wrung out exhausted, wary, pissed off, fretful and anxious, or just mellow and cruising. I want to know you, hold your hand through these next eight hours of your motherhood, listen to your rambling reflections on your birth experience, make you a decent cup of tea, kick out the visitors that you didn’t want, coo over your gorgeous baby, make your bed up with fresh, cool sheets. I want you to feel able to call on me for whatever you need, to feel cared for and mothered. Please don’t apologise for pressing your buzzer to call me…unless it’s just to tell me that your baby moved her arm. That is excellent and thrilling, but not absolutely buzzer-worthy. Good grief, I’m rambling already. It happens a lot, sorry. Anyway, before we get started there’s something I must show you. Look over here.

Let me gesture to my impressively enormous Bias – there it is, right out there on the table. I call it ‘Yay-Breastfeeding!’, or YB! for short. It’s quite large now, as I’ve nursed it well (no pun intended) over the years. We get along famously, my Bias and I. It’s like one of those friends you had as a kid. You know, the ones that your mum called a ‘bad influence’ because whenever you were together you were a little bit hyper, a bit wild and loud, prone to that screechy shrieking that six year old girls have perfected? My Bias follows me most everywhere and sometimes we get a bit rowdy. Often, Bias makes me get kind of wild-eyed and preachy, waving my hands around and gesturing helpfully at my own breasts. And sometimes, when we’re standing up high on our matching soap boxes, shouting ‘Breast Is Totally The Best!! Chuck Out The Rest – Of Your Tins Of Dehydrated Cow’s Milk!!’ I guess Bias and I can be a little bit intimidating.

So you’ve met my Bias, dear and lovely woman. You’ve met, the slightly awkward do-we-hug-or-shake-hands-or-just-kinda-nod? moment has passed. Now, just excuse me for a minute, while I escort Bias out of the room. She can wait in the tea-room and hang out with the other midwives when they’re on a break. I love her, but I do try not to let her distract me while I’m working. I know she’s not everybody’s cup of tea. Mmmmm, tea. Oh, sorry, easily distracted. In my fantasy world everyone would love my Bias and we’d all hold hands and sing and dance and be BFsF. But this is not my fantasy world. This is a public hospital. You have your own fantasy world, your own issues, your own hopes and dreams. You have your very own Biases, I’m sure, and you don’t have to be friends with mine. I’ll still be your midwife.

But I ask you just one thing – be straight with me. Don’t pretend to like my Bias. Don’t tell me what you think I want to hear. If you truly think you could love her, I will move mountains to get you well acquainted. I will pour my heart and soul into hooking you up. But don’t be all nicey nice about her to my face and then slag her off to the next midwife that comes along. Really. I mean it. Our time together is short. Don’t waste it.


Your Midwife


Pearl clutching: an example November 11, 2010

Filed under: Midwifery,Parenting — titchandboofer @ 11:12 am
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The following conversation, from a time back before I grew so wary, is one small example of why coming out at work can be so problematic.

10pm. My night shift starts. I attend a birth as second midwife. The woman is having her second baby. Baby is born, tumbling quickly into the hands of the other midwife. Other midwife leaves for home. Baby breastfeeds. Mother rests. All is well.

Midnight. The night is getting busy. Birth rooms are in demand. I need to move the woman and her baby to a shared, postnatal room. Packing up her things, taking the walk down the corridor, she is shaken out of her post-birth haze. The questions begin.

How old are you?


You look so young!

Well, it’s early in the night. Here’s your bed, bathroom just there….(etc etc. I’m holding her baby while she organises her things)

So, what does your husband do?

(hm, straight to me having a husband, curious)

Uh, I don’t have a husband. My partner is a woman.

You’re A Lesbian!!!

(looks deeply shocked, snatches baby back from me as though I might be contagious)

You don’t look like a lesbian! You look quite feminine! 

(now looking kind of angry, as though I should look more like a lesbian, you know, to give people fair warning)

Urh. (Oh dear, mistake)

Did you have a bad relationship with your father?

(gotta give the woman credit, she didn’t hold back. considered lying, but didn’t seem worth it now and was actually a bit curious to see where all of this might go)

Non-existent, don’t really have a father.

Ah, well, there you go then. That would explain it.

(had I been quicker off the mark, I would have asked if all straight women have bad relationships with their mothers, but sadly I missed that boat)

Hmm, I don’t know about that.

You know, I think more and more women are becoming lesbians.


It’s because they’re smart.


The government will have to legislate against it.

I think they’ve got that covered.

(was realising that my further involvement in this conversation was largely unnecessary)

No, I’m serious. If they don’t, no one will be getting married and having babies.

I think I hear a buzzer going. Better go check that.

(holy crap, it’s still only 1am, six and a half more hours of this conversation to go)


The revolving door November 9, 2010

Filed under: Midwifery — titchandboofer @ 12:17 pm
Tags: , , ,

Midwifery work often dances precariously along the line between professional distance and intimacy. Every shift, every scenario, every woman draws out, demands even, different degrees of personal exposure, disclosure and committment. I’ve looked after couples who’ve elicited nothing other than professional information and education from their first clinic visit of pregnancy, right through to the time they wave me goodbye from their doorstep, baby tucked tight in their arms. And then I’ve spent as little as a handful of hours with couples who have grilled me on every aspect of my personal life, education history, marital status, parenting choices, thoughts on reincarnation, favourite foreign languages, nothing off limits for the fierce interrogator.

I know that women and their partners do this for a few different reasons:

General curiosity – women are universally (slight generalisation, but stay with me) fascinated by other women’s birthing experiences, collecting them and filing them away as sources of inspiration, horror, joy, fear and justification. What’s the biggest baby, longest labour, shortest labour, loudest screamer, biggest pain in the arse whiner that you’ve seen?

Wanting to trust – amongst the technical negotiation and the general birthy chitchat, couples slip in little personal questions, subtly probing…Who is this woman? Does she see us? Does she hear us? Does she know our life? Who is she to touch me? Can I believe her? Will she keep us safe?

Distraction – 99% of people in the same space as a labouring woman will, at some point, seem to feel an overwhelming urge to fill the lulls of labour with conversation. And I get it, it can be an odd experience to be awaiting so much action and yet to be in the midst of so much seeming inaction. The woman labours, sometimes loudly, sometimes not, but always with pauses for rest. Her head is buried in a pillow, blocking out the world. The midwife sits, close but not intruding, maybe murmuring encouragement but not filling the room, not dragging the woman into her thinking brain. So there is quiet. People aren’t very practiced in being quiet, silent, still. They are there to support and silence challenges their ideas of what it means to be supportive, to be helpful. They don’t know the power of simply being present. Undistractedly, purposefully present. So, into this quiet they press questions – How many days a week do you work? Do you have kids? How many babies have you delivered? How much do you get paid? How old are you? And on and on and on. Quiet, brief answers and some people will get the hint – Shut Up. Some won’t.

The top three questions: Do you have kids? (ie Have You Suffered As I Do?). Are you married? What does your partner do?

So it is that I can be in the unusual position of having to decide whether to out myself every time I go to work. I know some couples won’t really care about the answers to their questions. They are filling space and time, making noise. Or they are curious, but not invested in the answer. Some are surprised. Some are interested, especially about how we came by the small person. Some are neutral.

And some are horrified, shrieky-clutch-their-pearls-horrified. It is these people that make me wary. It is the experiences of seeing someone shrink away, shielding their baby from the scary dyke midwife, that make me pause. Fair or not, I judge. I weigh up the likelihood of their trust in me hinging on my answer. Conservative, foreign couple, large tutting and tsking family in attendance? I’m straight as can be, married to a generic ‘health professional’. Kind of hippy, patchouli scented couple, with doula by their side? I’m out and marching. They’re the easy choices, but my there is a whole lot of grey in between. I know this flies in the face of ‘being true to one’s self’, that it shouldn’t matter to me what near-strangers think of their midwife’s sexuality. But it does matter. It isn’t about my hurt feelings, or my objection to being grilled about whether I’m gay because I was poorly parented. It’s about the fragile string of trust I hold with a woman and her family. She needs to feel safe. Don’t I have to be what she needs me to be?


Wounded October 28, 2010

Filed under: Midwifery — titchandboofer @ 12:34 am
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Once upon a time, during a gripping nursing lecture, we learnt about cheese. More specifically, swiss cheese. My memory of the precise details is a little hazy – I was pretty busy at the time, bitching about our lecturer with my posse. In a mixed bag of lecturing delight, she was grim. Equipped with a lapel-microphone, a constant supply of Fisherman’s Friends and some kind of sinus complaint, her lecturing was from the inspirational school of ‘You Will Kill Your Patients. It’s Just A Matter Of Time’. Anyway, in keeping with this theme, she was talking about some academic’s theory of clinical risk prediction. The gist of it was that people are swiss cheese. Everyone has weaknesses, or holes. Some times, some days, people are more holey than other days. If all the holes in all the people in a clinical scenario line up, the patient falls through all this holiness into a big, dark hole. So as my Argentinian hula coach would say – One sample:

Woman is having her fourth caesarean. Small hole.

Woman drinks 2 litres of Coke a day, in lieu of water. Average-size hole.

Woman is also heavy smoker. Large hole.

Midwives/Obstetricians providing antenatal care don’t discuss with woman(well, they might have, but as They say, If It’s Not Documented, It Didn’t Happen) the impact of Coke and smoke regime on potential wound-healing. Average-size hole.

Surgeon writes vague post-operative orders re wound dressing. Everyday-size hole.

Midwife sending woman home doesn’t check caesarean wound. Big hole.

Caesarean wound morphs into enormous, pustulent hole. Bigger hole.

Obstetrician readmitting woman thinks conservative management is wise. Bloody big hole.

Theatre staff bump woman’s wound-clean-up surgery for three days. Bottomless pit.

Kerching! Kerching! Kerching!

Or any other sounds approximating pokie fruit machine rows lining up and flashing wildly.

A long way down this bottomless, pustulent, grim pit of wound dressing hell is me, with my best ‘I’m so fine with this seeping, odorous situation’ face and the biggest bottle of hospital-grade hand sanitiser I can find.

I love realising that not every nursing lecture was crap. I hate nursing.


Not in the zone October 5, 2010

I’m feeling very gloomy this evening. A bit short and snappish, preoccupied with the unfolding of events at work over the past two days. Usually it’s other people’s inadequacies and crappy decision making which send me home fuming, but tonight I’m just gloomy about my own.

I cannot count the number of times I have heard other maternity care professionals justify their decisions/refusals/interventions with the phrase “I’m just not comfortable with ______________” (insert any of the following: waiting for you to go in to labour on your own/allowing you to birth on the floor/you using the bath during labour/not giving you antibiotics/not doing this test/not giving this drug/letting you go home yet…). The list is endless and the language is always saturated with notions of permission-giving and implications of women being naughty, rule-breaking girls who don’t give a fig for their babies’ welfare. This notion of practitioner comfort as a guide for practice irks me as much as the statement “If it was my wife ____________ (having a breech baby/questioning the necessity of a test/being female and pregnant and conveniently oppressed by archaic obstetric care) I would advise her to _____________ (just do what I say even if it’s based on nothing but fear or financial incentive/not question me/just shut up already). Midwifery and obstetrics and having babies are not meant to be about being comfortable, not for anyone. As an aside, there is never a dumber question asked of a labouring woman than “Are you comfortable?”. This job of caring for women as they step into motherhood should be about understanding the normal and knowing the evidence for intervening in the abnormal. It should be about providing the information and honouring the woman’s ability to make decisions for herself and her baby. Should should shmould.

So, what have I done? I have run smack bang into the invisible wall of my very own comfort zone. Let me set the scene:

On Sunday evening, around seven o’clock, a woman gave birth to her first baby. I was not there, but I know she had a spontaneous, vaginal birth, using only nitrous oxide (the gas) for pain relief. She did not bleed excessively and is otherwise well. At birth, her baby was handed straight into her arms and lay, skin to skin, on her chest. She wants to breastfeed but her baby is not interested. Sensibly, she keeps her baby skin to skin with her, allowing him plenty of opportunity to breastfeed. Over night, the midwives help her to try and express some colostrum, but report that they are unable to express even a drop. By eleven o’clock the next morning her baby still has not been able to breastfeed. He has attached on and off a few times but hasn’t attempted to suck. He is settled and remains skin to skin on her chest. He has had a poo, but no-one is sure if he has had a wee (disposable nappies can be tricksy for detecting the teensy wee of a newborn). The woman’s husband is with her, anxiously attentive, lovingly stroking her and the baby. Her mother in law is sitting by the bedside, tutting and tsking as hard as she can, muttering about starvation and formula and glaring hard at everyone. The unit lactation consultant is off for a training day. All very helpful. The midwife looking after her asks me for help. I whip out my breastfeeding cure-all and show the woman how to position herself and her baby to feed lying down (really, it is a very useful skill). Baby has a go at attaching but still isn’t swallowing. He is starting to cry and is no longer easy to console. Together, we have another go at expressing some colostrum. Three glistening drops appear. I suck them up painstakingly with a 1ml syringe. It is twelve o’clock and has now been seventeen hours since birth. Conferring with my fellow midwife, we decide to finger feed the baby these three precious drops of colostrum mixed with 1/2 a ml of sterile water. Gently sliding a finger into his mouth and dripping the liquid in slowly, I hope fervently that this will trigger the switch in his brain – that he will start to connect sucking with swallowing with feeling something in his belly. As he starts to suck my heart sinks a little. His mouth is dry and he is so very uncoordinated, not sealing his mouth around my finger, not bringing his tongue forward but instead using it to push against my finger. But afterwards he turns back towards his mother’s chest and settles again, so we don’t give up hope. I step out of the room and back to into the relentless pace of another October day.

A few hours later, just before we morning midwives finish our shift, I check back with this woman and her baby. No change. It is now twenty hours since birth and he is starting to look truly hungry, crying and crossly pushing at her breasts. She is tearful, her husband more anxious. On the upside, her mother in law has tutted herself to sleep in the bedside chair. I step out again, seeking out the midwife who will care for her next. Hating the words coming out of my mouth, I suggest that while the woman should continue to keep her baby skin to skin and keep expressing, the baby may need a supplementary feed of formula. Then I go home.

Today, I’m back on the ward, every room full. Our lactation consultant is back on deck. She is frantically busy and she is furious – furious that this woman’s baby has been given formula with no medical indication. On paper this is true. The baby is not lethargic, jittery, under 1.5kg, admitted to the nursery, septic, hypothermic or hypoglycaemic (that we know of – no blood sugar measurement was done). His mother is not sick or absent. I feel horrible. I have great respect for our LC and we usually work well together. Usually she respects my professional judgement. Now, buffeted by the wave of her anger, I suddenly find myself questioning my decision. Should I have been more trusting? Should I have waited longer? How long? I ask this and the answer is firm – no medical indication, no formula. But really, how long? Until a medical indication arises. How do I feel? Uncomfortable.

And there it is. Discomfort. Have I really interfered unnecessarily because I wasn’t comfortable? I come home and haul all my breastfeeding textbooks off the shelf. Am I trying to justify my decision? Or can I find something to stretch the boundaries of my comfort zone a little? There are answers, sort of. Although the authors vary in how many feeds they feel should occur in the first 24 hours post-birth, they concur on one point: if a baby has not latched on and fed by 18-24 hours of age, the mother should be assisted to express colostrum and feed it to the baby by finger, cup or spoon. But none of these texts suggest what to do if there is no colostrum. In a perfect world, this woman would have a sister/cousin/friend who was breastfeeding, someone who could donate some breastmilk to tide her baby over until her own milk comes in. Or we could access donor milk from a breastmilk bank. But this world is far from perfect. This woman’s only family in Australia are her husband and tutting mother in law. And if they were here, the idea of sharing breastmilk amongst family and friends is disappointingly taboo. We will have a breastmilk bank up and running in Victoria soon, but even then it may not have enough to provide milk for babies not under nursery care. So what is the answer? How long can a baby wait?


OMG NVB! September 22, 2010

Filed under: Midwifery — titchandboofer @ 9:17 am
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Some days being a midwife is hard. It’s tiring and emotionally draining, frustrating and noisy, complicated and messy and sad. Days like this pass slowly. A visitor tells you that you’ve got the best job in the world and you feel like snarling ‘Sure, underpaid servant to an overwhelmed public health system. Super’. There are hours of never really finishing an endless string of overlapping tasks, being snappy and snapped at, stomping down the hallways, trying to ignore the constantly ringing phones, running out of everything useful and going home exhausted to slump on the couch and whine. And other days it’s totally fantastic – still noisy and messy, but joyful and energising. A visitor tells you that you’ve got the best job in the world and you smile smugly and give them chapter and verse on which university course to apply for. The work flows, nothing seems like a chore, there is enough of everything – time, rooms, heatpacks, thermometers – midwives joke with the doctors, births are uncomplicated, breasts work, and you go home buzzing on a high that can last for days. These are the days that bind us to the job, that mean we keep turning up despite the crappy pay, the dreadful cafeteria coffee and the rotating roster. Yesterday was one of these days for me.

Yesterday I was truly able to be with a woman as she laboured, breathing with her as she stood and rocked through contractions, kneeling by her side as she knelt, eyes closed, under the heat of the shower, squatting by the bath as she swayed and roared and pushed. I didn’t have to be in three other places. No one interrupted, bursting into the room to yell Have you got The Keys? Her family didn’t ask her irritating, irrelevant questions mid-contraction. There were no complications, no continuous monitoring, no drugs, no doctors, no phone calls, no-one hassling for the room, no machines that go ping. There was simply a woman, encircled by her mother, her aunt, her boyfriend and her midwife.

She arrived just two hours after her labour began, teary, scared and wanting a way out. Already working hard, her labour racing ahead like an express train, destination babyville. She laboured, breathing hard, yelling, swearing she couldn’t do it, really really couldn’t do it, wanting something, she didn’t know what, just something. She knelt in the shower, looking so peaceful in the soft spaces between the rocking contractions. After a while it wasn’t enough. She needed something more, something to hold her tired body up, something to lie her head on, dark, heat. Sinking into the bath, she had a few moments of relief before labour surged on. She pushed mightily, roaring with effort and yelling with frustration, just pull it out, pull it out, pull it out. So soon, her baby’s head is out, waters unbroken, membranes shimmering over the baby’s face under the water. A pause. Then all of her baby, slipping out, gathered up, held to her chest. She holds her daughter, whispering to her, shielding her eyes from the flash of cameras, already a mother, protective and fierce.

She is a mother and yet still she is an eighteen year old girl. Labour over, the roaring labouring woman retreats and the teenager I have never met returns. She is sweet and naive and funny. And she has a posse of bubbly, glossy eighteen year-old friends. About three and a half minutes after she has climbed out of bath and into bed, her naked baby warm against her chest, they spill into the room. They’re all hair and eyeliner and heels and iPhones. Uncertain for all of a minute as to where to look, sit, stand, the excitement takes over fast and they’re fine again. Then it’s all ohmygod!!, look at it I mean her it is a her right? was it like hard? what are you gunna call it I mean her? ohmygodwhat’sthat? is that meant to come out? did you have like heaps of drugs? it’s so cool you’re breastfeeding your boobs are so totally awesome right now! yeah, I put it on facebook already, it I mean she is so cute! you need some pink things, I’m totally buying her a pink dress tomorrow! I can’t believe you have a baby! I am a hundred years old. And I am so proud of her, this teenager I have never met before, as unfazed she lies naked in front of her friends, breastfeeding her new baby girl, telling them how hard it was but how she did it all herself.