Interprofessional appreciation

It has been forever since I wrote, so I’m not sure where to exactly start.
It’s been nearly four years since I wrote.
I’m in a new job and live in the city.
It will be nearly three years at this job.
Over these past few years, I’ve gone through a lot of mental health work to move through challenges I was having. I might get into that another time, but today I’m more motivated to write after a conversation I had with a medical resident last night.

Yesterday we waited all day for a planned Caesarian for a breech baby. It got pushed back all day as the ward was busy. We joked how labour's take time and this was nothing different. Finally I got called to come. In my community I get to be in the OR with families and remain MRP for the babies.

After the preop debrief the OB had with the medical resident he and I had talked a bit about birth. He had a multip at 5cm/100% effaced and “chilling” as he described. He said he had lots of time, in my mind that baby just needs to rotate and it will come quickly assuming she has contractions.

He asked about midwives and assumed there were more of us in rural. I loved his assumption. He thought it would be essential and just made sense to have midwives integrated that way.   I like talking with residents. They all seem to appreciate our participation in the overall care. I don’t get any superiority complex because their scopes are greater. They recognize midwives as appropriate providers for low risk births. It’s lovely.

It’s nice not working in a toxic environment.

It gives me great hope for the future.

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?