breech birth. and coercion.

i have a family in care with a stubbornly persistent breech.
they are almost 38 weeks.

they've tried everything. inversions. acupuncture. homeopathics. moxabustion. an external version attempt by an OB. nothing. baby is frank and that's the way she wants to be.

this week we decided to let her have her way.

the parents are committed to a vaginal birth (first baby).

they've weighed the risks and benefits. they are doing their research. they know if they need a section, they will accept one. but they are not electively choosing one.

i've been doing my research as well. watching videos. studying. refreshing.

it's the directive of the doctors at our hospital to call in a more experienced person who can assist in breech births.

we've discussed the potential for fear mongering and the use of coercion to dissuade them from their decision to attempt a vaginal birth.

i'm actually fairly encouraged by our hospital. they really are trying to practice evidence based, and are progressive. example, they are trying to redefine active labour as 6 cm and that you can't diagnose labour dystocia before then.

think about the profoundness of that ideological shift.... that is a lot of potentially avoidable c/s.

we've talked about the potential for the midwife to remain primary, under supervision of an OB. i've talked about my (lack of) experience. my comfort level. this couple, even addressed this, they understand that the success of breech birth has as much to do with the skill and confidence of the care provider.

i'm sure there are those that would disagree, but i'm 100% behind this couple.

they feel this support. this positive energy. regardless of the outcome, it's good to know that they are going into this with that energy. that support. they are not having to fight. they are not having to scramble. they are not looking at a booked section. they are awaiting spontaneous labour. they are also seeking out breech friendly OB's. this couple is smart. they want to know the OB's so that when they go into labour, whoever is called, knows them, knows their belief, know's that they have educated themselves, that they are prepared.

as a midwife, i never want a family to feel coerced into any decisions or actions.

i had a client (GBS neg), who's water broke on a friday morning and she had prodromal labour until sunday morning. contractions were finally starting to get regular. i was fine letting her labour until she was active. i was in no rush. i gave her a few options. go home until more active, go walk and reassess in 4 hours, or get an epidural and start a drip (she probably would have got an epidural friday, if i had "let" her). i left her and her sister to discuss. i came back and she wanted the epidural and pit. ----> as soon as that plan was made, she started contracting every 2-3 min. she got her epidural and baby was born 5hours later. no pit needed.

when it came down to it, she and her sister thanked me. the mother was able to make every decision, no pressure, no negativity, no judgement. she did what was right for her. not what i wanted her to do.

birth can look like so many things, but ultimately it's how families feel after the experience.

for me the whole process is preparing them to be parents. i want them to enter parenthood confident, knowing from the beginning that the choices they are making are for them and their families. that they are the right decisions for themselves. because no one can really share the same lived experience, i want to support families to trust themselves to know what is best.

if parents are coerced into actions throughout their pregnancy and birth, how are they going to be prepared to be parents?

waterbirth. communication. and reflection.

i went to a waterbirth workshop with barbara harper a few weeks ago, with one of the women i work with.

she was a fantastic road trip companion.
brought new inspiration to me about my practice and waterbirth.

we have a lovely tub at our birth centre
(which is 3 minutes from my door. this is also quite lovely).
(this also helped last thursday when we had two babies born overnight, 12hours apart)

11 births so far.
3 in the water.

this weekend, i had a mom come in and 13 minutes later birth her baby in the tub.
she arrived. got into the tub i had waiting for her, pushed, and when i helped her forward into a squat, pushed out her 4.53kg (10 lbs.) baby girl.

i felt as her head emerged. she sat there between contractions. coming back from the conference i brought with me something from cranial sacral therapy.
a way to communicate with the baby.
i gently touch her temporal bone, above the ear.
helping her decide which route to take into the world.
she restituted to the left. and spun out into this realm.

this weekend was spent saying goodbye to my sister and her family as they move back to calgary. i've been lucky to have them living at my parents house this last 9 months. i've got to watch as my niece developed into this little person, who when see's me come into the house, reaches to be in my arms.

it was spent watching as a new life transitioned into it's own autonomous self.

it was spent fulfilling the simple chore of shovelling my driveway and sidewalk. a simple task that grounds me.

it was spent continuing to flush all the toxins from my body from eating grains when i shouldn't have been.

it was spent in sweat. and in meditation. and practicing yoga.

it was spent in quiet reflection.

i'm inspired. 

making plans. 

i feel this year. 

on being 34. nesting. and moving forward.

it was my birthday on saturday.

one year ago i was in toronto. i turned 33. i had graduated midwifery school and was embarking on registration in canada.

it was last november that i first interviewed for the position that i now hold.

it's amazing what can happen in a year.
it's amazing what can stay the same.

but i'm here.
i'm moving forward.

in my 33rd year, i registered as a midwife in saskatchewan. i returned home. witnessed the birth of my niece and the growth of my sister and her husband as parents.

i returned home.

for the first time in more years i care to count i have a home. i pulled it off some how, but i bought a small house.

this road warrior is settling down.

man, it's been a struggle. but i have not doubted this course for one minute. i know to the core of my soul that i was meant to be exactly where i am right now.

i'm mourning the loss of a relationship. not quite accepting that it's over and still trying to overcome the impossible.

but i'm moving forward.

so what will this next year look like?

growth.
as a midwife.
as a woman.
focus on building community.
birth community.
arts community.
friendship and support community.
healing my body.
healing my heart.
creating art.
moving my body.
moving my soul.
writing.

my goal is to write more.
i've fallen off. lost focus.
not knowing how to approach this new space.

this year, my focus it break myself wide open...

this is 34.

sunday morning in bed. with an on call phone.

sunday morning lie in. coffee in bed.

on my way to a postpartum visit

the sun is shining.
it's the equinox.
time for change.

the leaves turn colours and fall.
we shed our skin. releasing all that no longer serves us.

the on call phone sits beside me.
quiet.
two mothers-to-be past their dates.

a new baby arrived a few days ago.
welcomed in our little birth centre.
bringing birthing back into the community is such a lovely thing.

so many first time mothers are choosing this option. knowing we can travel the hour into the nearest hospital if more pain relief is needed. they are trusting in their ability to safely have their babies close to home.

we may not be able to offer home birth right now. but the option we are able to provide is something that local families want.

i'm looking forward to this fall. every month we are full, with the majority of families intending to birth in the community. some are still reticent about being so far from an operating room and anesthesia. for some making that drive feels like the better option. being able to offer choice of birth place, is important.

i found where i'm supposed to be at this time.
plans for the future. but living in the present.
i bought a house. i'm building a home. i'm staying for awhile.

following this journey.

4 months

I’ve been working at the women’s health centre for four months now.

Totally new perspective on things.

So much to learn.

not because things are unknown, but because experiencing a women’s story never ends.

Forever changing.

Many perspectives.

Always learning.

Stories.

A major difference between my training to be a midwife in the states and now, is that where I would identify abnormalities, run tests, and diagnose, and then refer as necessary. I now am the one to also treat and follow up with care.

For the most part.

Obviously cardiac and what not conditions need referrals, but we are able to care holistically for so many women. And by holistically we mean we can care for women in all aspects, working with specialists when needed.

Working with a nurse practitioner for prenatal clients, enables our moms to be seen and get treated for any ailments outside the midwives scope of practice quickly. 

For the first time I work in a place where the physicians refer women’s health needs and prenatal care to the midwives and nurse practitioners.

We have the time to spend with women, however much time they may need. 

We have a womens’ helper, who guides women spiritual, culturally and in times of need. She will transport women that need rides and works with our health navigator to aid women with whatever complex systemic needs they may have. We have a psychologist. Ultrasound. and amazing admin staff.

We’ve had 3 births so far in our birthing room. Two water babies, and one that came quickly on the land. come the fall, most of our births are planned to be in the community. 

Everyday is different.

On Monday I got the results of my Canadian national exam. The last barrier to my unrestricted license. 

I passed. 

My license application has gone back to council to remove the restriction, and grant a full license. The registrar said I would know by next Wednesday.

My safety net of the last four months is being removed.

Time to fly solo.

…..

of course I have the collaborative knowledge of the women’s health centre behind me.

#luckymidwife

after the exam

it's a drizzly sunday morning. perfect for writing.

i've been m.i.a. for the last bit.

why?

living life. settling in. working hard. and planting my garden!

that last bit, some will know is true happiness for this vegabond. when you move around as much as i have, a garden isn't possible.

roots. i've planted roots!
****
work.

i'm loving the "job".

i get paid, so i guess we will call it that. but when it's your weekend and you can't wait to get back to work, you know you've done something right.

i wanted to do a big post on the career fair i went to, but i never took photos of my booth, so...
but yes, i went to a career fair at one of the local schools. there were lots of other, definitely more career related booths, but i was the lady handing out condoms and information on sexual health and STI's.

births.

one of the most exciting happenings is that we have had our first birth in our new little birthing unit!

finally women who chose, can give birth without having to drive the additional hour to the city. we are already getting calls from women an hour + away about wanting to birth with us. i hope the hospital is saving their pennies to hire another midwife!

overall births have come in spurts, with a lull in between. a much slower pace then what i'm used to, and something that i'm not minding. i've been granted privileges at the hospital in the city and am getting all of those small details slowly worked out.

this fall is shaping up to be busy. and exciting. i can't wait until we transition into attending most of our births in our community hospital. it's wonderful that the family doctors are so supportive. we have a few that worked in rural scotland, so they are used to midwife-led birthing units. and the younger doctors, well they are eager to learn.

the exam.

this is the big one.
on thursday i wrote the national midwifery exam.
now to wait for the results. 5-6 weeks. bleurg.

failure is not an option.

the future is wide open, but the present moment is filled with clarity and all the rewards i could have ever imagined after this long journey to becoming a midwife. the fact that i returned to where i grew up, after all the travelling i've done, all the places i've been, the fact that i have returned, and feel at peace. i'm not sure there is anything better than that.

until next time...

first month

i'm at the end of my first month working as a midwife in a women's health clinic at a rural hospital.

the first week included three births, one of which was my sister's.

into the fire.

this position is much different than any of my experiences during my training.

i see prenatal's most every day, most of who's births i'll not be attending. working within a funded health care system also allows women access to testing and screening that they need. and access to prescriptions. this is one of the biggest transitions that i'm making. writing prescriptions.

i have a great support network with the women that i work with here. another midwife, nurse practitioners, a psychologist, and two women's helpers that are probably one of the most important part of our care team. most of the women who come into our clinic are in shared care with an OB in the city, but it's easier and more comfortable for them to see us.

i'm grateful for all that i'm learning. there are some significant social and medical problems that affect the women who come to our clinic. hepatitis C, HIV, domestic violence, racism, drug addition, food insecurity, transportation. but there are also women of all ages who utilize our clinic. yesterday i sat with an 84 year old woman. she just needed to talk. i wasn't advising on her health care. just there to listen.

one of the most exciting parts of this new position is the low-risk birthing unit we are opening. i can't wait. i live about three minutes by car to the hospital and once the weather clears up and the snow melts i'll be able to ride my bike to work!

hello, call the midwife!


#mynewreality