The College Responds

Well, I asked where the response was from our college: It was there, out there, but hidden away on back pages, not making it to the internet lists of headlines, certainly not on the fromt pages of our papers. I know not many people read here, but maybe, somehow, this will help to spread the word.

The following media releases are a good start:
Midwifery care is safe
Dominion Post Rebuttal
Sally speaks


But are they enough? No, because they are not seen, except by us, and our supporters: How do we get the media to accept that we are safe, and reasonable, and responsible professional practitioners? We are not crazy hipy's attending births in secret and fear: Midwives globally are not the witches and baby killers we are made out to be. Not here, not in America, not in the UK (I would link to Agatha, but she has been chased out of blogging, by breaking the "rules" which say you can't mention a problem in public without getting shut down! NOTE: Agathat did not break any rules, but readers will know that her blog has gone. This is because she was accused of breaching the same rules referred to in the linked article. I read her blog avidly, and did not see her bringing the profession into disrepute, or being unprofessional, nor breaching patient rights: she just argued for change. Apparently, censorship is OK if you are the NMC, regardless of your members opinions!) any of the places we are still fighting to be treated as normal professional human beings!

Karen says in her article in yesterdays dominion post: We are saying enough is enough.

We support and believe in women's right to seek an investigation into events, and answers to their questions, but that DOES NOT make all midwives answerable for the actions of one. We do not accept that this should be done through the media in a blatant show of sensationalism not applied to any other medical dispute. We say NO to the idea that a midwife be tried in the media, instead of through the appropriate and LEGAL process developed by government for ALL health care practitioners to be mediated. We will NOT be accused of being unsafe and dangerous by people with no knowledge or basic understanding of who we are, what our job is and what our training entails.

Midwives of the world, we face the same fights: It comes in different forms, but the fight is the same. And we fight it because we dare to be women, working mainly for and with other women. Let's do this together! what works for one, can be held up to all as an example... and at the end of the day, midwifery improves outcomes and saves lives. Lets shout that to the rooftops, as loud as we can.

Tagged

My big sister, Denise tagged me with the following assignment:
1. Write the title to your own memoir using SIX words.
2. Post it on your blog.
3. Link to the person that tagged you.
4. Tag 5 more blogs.


She had a very cool and pretty image to go with her title, but I am not that clever (well, I am clever, but not having an artistic bone in my body, cause she got them all, I have to make do with merely writing!)

so, what would I call my memoir?

"why I never travelled the world"


If you are around and have the time, I tag

Kristina at Red spiral
Agatha
My very special friend the Jewish midwife
Pamela
Barb

and now the chance to stand up.....

Already, we are in the news again: with the call that we must Let the Babies Live and the suggestion that us midwives should be better trained and supervised as Baby's death was avoidable. Now. I do not know the details of this case.... It doesn't look great, does it, from reading those two articles? But, mystery recently qualified independent midwife, whether you were right or wrong, my thoughts are with you. If you need words of support and care, find them here. As you walk into the fire (along with your "midwife supervisor" whatever that may be), know that I am walking along beside you, in spirit if not in body.

So, the next question.... why aren't midwives fighting back in the papers? Why aren't we pointing out that we are over worked, under paid, and often under supported? When the senior and junior doctors strike, who supports the labouring women? US. When the cleaners are on strike, who picks up the slack on maternity? US. Are we thanked for this? No. Are we paid for this? No. Are we given annual pay reviews, and offered what we are worth? No. Do we do what we do because we love it? Yes. Otherwise, Goddess knows, we wouldn't do it for the money or the glory!

As Karen Guilliland said in this months Midwifery news, midwifery issues are global, and women who are cared for by midwives have better outcomes: So why WHENEVER anything goes wrong, is it always us "dangerous" midwives being hauled over the coals? Why when doctors stuff up (and we all know they do) do they come out of it unscathed, unphotographed, and certainly unjudged? Why do we say "well, they are only human, they can't be perfect, they do their best" when doctors err, but mount a full scale witch hunt against ALL midwives if a midwife makes an error?

Why are we held to a higher standard? why must we be perfect, to prove our right to do what we have ALWAYS done, care for women? Sometimes, awful things happen. sometimes, babies die. sometimes, mothers die. sometimes, people get sick, or hurt and sometimes we can't fix that. But most of the time, we get it right. Most of the time, we improve the outcomes. Most of the time, we FIX problems. When does that get to be front page news? When do we MAKE that front page news?

I am sorry to my sisters.

We don't support each other enough. When the going gets tough, we judge and whisper. We owe each other more than that. We owe each other more than "there but for the grace of God (or Goddess) go I" as we bow our heads to avoid judgement by association. So, the next tme a midwife is being balled out, in person or in the media, I will stand up with her. Bala Naidu made some mistakes. She wasn't perfect. But the witch hunt that took place, and her abandonment by her sister's during a three year ordeal due to mistakes that ANY ONE OF US could have made.... (And when the proceeding rather than just the judgements are released, we will be able to see that this is true) she did not deserve that. I have never met Bala, but I apologise to her, in this forum, for not standing beside her in her hour of need.

But, Bala's is an extreme case. I also would like to apologise to my sister's who I have seen or heard being run down or attacked by colleagues in the staff room or public. To the ones who are called lazy and uncommitted, when I KNOW they are neither of those things, but just trying to avoid Bala's fate. To the one's who are called "dodgy" cause they believe women have a right to choose where she births. I daresay that the same is said about me when i am not there to defend myself.

The shortage of midwives in NZ should bring us together....instead it seems to drive us apart and make us attack each other with undue cause. I am sorry to my sisters for being part of that. It stops today.

Whoops, where did the time go?

How did it come to be the end of JUNE? I am mind blown that it has been so long since I was last here! So, personal updates, which may explain my absence to any who care... I moved house, to a bigger, prettier, more expensive house ten minutes from where I was before. I had a student from Scotland come stay and follow me around for three weeks (Hi Karen!!!!). I caught six babies, supported three women through Caesareans and missed one birth (the first one I have missed!). My little man turned seven, and I did a whole lot of crazy prep work for my partner joining me in January (Blonde Ambition will be on board soon). Sorry for abandoning you all, work recommences as of now.

On a quiet day...

I sit and see the wind blowing through the trees, visible in the leaves moving, the boughs bending. I hear the rustle of the leaves, and the whoosh of the air moving. But wind is invisible. Not there to be seen. It can be felt, it can be heard. So it is with so much in our lives. The eividence of a phenomenon exists in the doing, in the feeling, in the hearing. But not actually, tangibly present.

That's all.

My first birth....

Well, inspired again by NG's call for us to share our stories, I thought, what a way to procrastinate doing any of my required reading and other hard work. So here is the story of how I came to be Alyssa's mum. It was a bit of a typical first timers tale, but here goes anyway. At the ripe old age of seventeenn years and 25 days, I began "labour" with my daughter. Well, I say labour. I thought it was labour. But, like so many other first timers, I had NO IDEA what I was expecting. I started having (what I now know were very mild) contractions, every ten minutes at about 11 pm. All night, I stayed up, timing and counting and waiting for more to happen. Nothing much changed, except I got really tired. I went to the hospital at 11am, and was sent home, not dilated. I went back at 3 pm and was sent home, again, only 1 cm dilated. Noone explained to me what was happening. Noone told me about latent labour, or how to cope with it. Just, "go home and come back when it get's worse". So, back I popped at six pm. And now I was the magic three cm's. So I was given the gas, and an ARM. Time to "get on with it".

Wow, oh boy, is there a good eason for not going to the hospital early? the impact of an ARM is understated hugely. They told me it would get things moving (no mention of risks like cord prolapse or infection, mind you). They didn't tell me that my pain, if not my labour, was about to enter warp drive! For half an hour after the ARM, nothing much happened. I got in the bath, but I didn't like it, and halfway down the hall to return to my room, the contractions hit. And how. Every two minutes, I contracrted for a full minute. Now, prior to that I had been having these pissanty little 20 second tightenings... I actually thought I was quite a tough girl, and that labour was nowhere near as bad as everyone said... screaming in pain I was given the gas and put on the monitor. Now just take a second and look at this picture:



Ok, so WHY did I need monitoring? I was 17, in perfect health, and labouring spontaneously (albeit with an ARM). But, instead of support I got my machines, and my gas, and I got left, on my back, on the bed. (by the way, it was 1993, and GHD's did not exist, and my hair ALWAYS looked like that. *shudder*) Back then, that was what labor care consisted of. My GP came and went, through the night. At around midnight, they decided my progress was slow, and I needed an epidural, so that I could get some sleep. I said no, thanks. they said, you have to have one. I said,it hurts. They then called the anaesthetist, who was busy at an appendectomy (I remember that being the joke), and I waited. Now, my memory of this is that I had no choice. I know now that I had a choice, but then, I thought, literally, that I had to have the epidural.

So, eventually epidural sited, I went to sleep... and woke up, alone, in pain, and with my birth partners shooed from the room. I could not reach my call bell, and was completely terrified in the half dark, where I lay for twenty minutes till my partner came in to get something from his bag. I ordered him and the other two back in the room, and someone (I don't know who) came and topped up my epidural..... THEN examined me and told me it was time to push. It was three am.

I had a full and complete numb all the way up to the top of my belly. I couldn't feel someone touching my leg or foot. But, it was time to push. So I did. or, rather, I tried. I pushed whenever the midwife nodded at me that it was time. I pushed like I was "going for the biggest pooh of my life" flat on my back with my feet held up in the air. I pushed and pushed..... and nothing happened. Absolutely nothing. They decided that I wasn't very good at this and after nearly two hours of this, they suggested a c- section, and left to organise it. while they were gone, my big sister and friend who were there, helped my completely unresponsive body up into a squat, supported by them. And in that position, I pushed. And something happened: my baby starting to surge down the birth canal.

The midwife called the GP who returned to catch my baby girl as she flew into the world. No tears, not grazing, nothing, just a ring of fire burning that hurt like hell, but was oh so sweet cause it meant I didn't have to have surgery, which terrified me. Again, my birth was so typical of first timers: I knew nothing. I was told what to do and when to do it. But unlike others, I was lucky enough to survive it with not only a healthy baby, but an intact perineum and abdomen to boot! Alyssa weighed 7lb 5oz. And this is the first photo of her.... If you look really closely between all those hands, you can see her little leg!


Seventeen months later, I was back for Erika, and a very different birth. but what stayed with me, forever, was just how lonely I felt, and how little I understood what happened to me. Not long ago, I snuck a peak at my labour notes in my hospital records: They do not tell my story. I do not even know how to tell my story, cause so much of it, I didn't get told about. I don't know if I had a syntocinon (pitocin) drip. It was awful. but, from that xperience, a midwife was born.... and so was my beautiful, wonderful, intelligent daughter, now nearly fifteen: Alyssa.

Horizontal violence in midwifery....

Well, here goes, a serious post. My experience referred to here has finally settled enough in my brain for me to dissect and analyse all the places it led me to over the ensuing weeks. Horizontal violence in midwifery is something that we who work in this crazy profession have all heard of, and I anticipate, have all seen. It is encompassed by judgement of each other, suspicion of practices we are not used to and anyone who sits out of the box even a little bit has probably experienced. But, it isn't even just those who sit outside of one box that feel it.... It is all of us, cause we can't quite sit in every box.

So, if you are a direct entry midwife you can't sit in the nurse first box. If you do homebirths only, you can't sit in the hospital supporting midwife box. If you don't do home births, you can't sit in the home birth midwife box. If you look after VBAC's, some midwives will view you with disdain: If you don't others will call you uncommitted. If you work with obstetric staff, you may be viewed as a traitor, and if you don't, a dangerous cowboy. We are, quite literally, damned if we do, and damned if we don't do ANYTHING.

So, midwives, what are you? The catch cry of the late eighties and early nineties in New Zealand midwifery was "A midwife is a midwife is a midwife" and at the end of the 2006 NZCOM conference we called out the same cry. Whether you work in a hospital or out, in homes or in specialist areas, we are all the same, we cry. So, why, when I go to a birth in hospital, and roll my birth ball down the hall to my Mama, do I get rolling eyes, and sighs, and feel judged? Why when I tell my old colleagues on the PN ward that my lady has flattish nipples, but a strong commitment to breast feeding, do I feel myself thinking "not that you will actually help". And why when another midwife ends up in the newspapers, do we all jump on the "well I would have..." bandwagon?

In her post on WHO's a midwife NG asks what makes a midwife... and in asking those questions, she sparks me to thinking... Am I a midwife? I don't do what Barb does... I work in a completely different system, and some of her comments are as alien to me as computer language! And Agatha routinely forces me to remember that we have a different reality to each other, even though we are doing the same job. And yes, on the good old SMS we have banged heads over issues that we see differently. I hope that Agatha knows that I hold her in high esteem, despite our occassional differences of opinion. In fact, it is SMS that most makes me aware of the very real and continuous issue of horizontal violence in this industry: It comes up all the time, with students abused and confidence destroyed over and over again by overbearing, mean midwife mentors.

Why do we eat our young? This question was asked in an article I read a few years ago, and midwives were exhorted to stop doing it, to support the up and coming new midwives... and yet, as a "new" midwife, I still feel like I am at least being tenderised on a semi regular basis. But it is not just me: staff midwives bag indy's, Indy's bag staffies and at the end of the day, WOMEN SUFFER. It tires me, it hurts me and it makes me want to cry.

So, if anyone has any idea of WHY we do this, let me know.... I want to avoid it!

Over it.

Why should I listen to you?
What exactly do you have to offer me,
that I can't get from myself?
honestly, what?

I am done, and sick
and tired and just plain
OVER IT'
Stop talking at me, and try hearing me!

You are my friend
be my friend
stop telling me
start hugging me

Please.

Home birth and other things

Well, I have now caught two babies in their homes, and I am more committed than ever to the beauty and wonder that is homebirth. It rocks. Life has not been the most wonderful thing ever in my home of late. BA has been having some personal stuff, and I want to take a moment to tell her I love her, just cause this is my blog, and I can. The Mad Rocker, also known as my OH, was made redundant unexpectedly last month, along with beginning my post grad study. Slowly. And on the work front, I have had a difficult run of breastfeeding problems and the like to distract me from the wonderful world of the internet.

I am very happy to announce that I am officially on holiday (well, sort of, I have no babies due now till May, so have very little work to do!) and will be heading off to the bottom of the North Island for a rest and recuperation period. REALLY looking forward to that.

So, for a momentary commentary on how I realised that I really am a midwife now. I was called to a birth, just as I was eating my lunch. I finished my sandwich and dashed to second time Mum's house upon hearing that she was "doing stuff" from her very excited sister. That would not normally be enough to drag me from my food, as any who know me are surely aware of. But, I had a feeling. So I went, and quickly. this was a planned hospital birth, and when I arrived at Mum's home, I quickly realised we were nearing "now or never" transfer time. So I asked if I could do an examination to determine that my gut was telling me the truth. Upon VE, Mum was six cm's dilated, with a nice low head and a very buttery cervix. This from about an hours worth of good contractions. I told Mum it was go now, or have a baby at home. She decided to have a baby at home.

As it played out, that was a very good call. I had a second midwife on the way, but the baby couldn't even wait for that, and withing half an hour of my announcement to mum, she was pushing. Spontaneous rupture of membranes occurred, revealing thick meconium liqour. Bugger. vertex was already visible, so no time to change plans now. I quickly manoeuvred my Oxygen and suction bulb just a bit closer, and poised to catch a beautiful squirming boy child. Who proceeded to Not Breathe. Noone else there, purpling baby boy, meconium everywhere...... Double Bugger.

Thankfully a bit of suction and some free flow oxygen were enough to get him to gasp, and further stimulation got a cry. But seriously, I knew what had to be done, and did it, but GODDESS I did not like it! I am glad we were at home. I am glad I had all my supplies easily reachable. But I do not want to do that again! The second midwife arrived moments after the placenta delivered by maternal effort.

But, I am a Midwife now, because Mum and dad had no inkling of my heart palpitations. They knew baby needed some help to get going, as I explained it all to them as I went. But they felt calm and trusted me to do what needed doing, and I did not panic or run away: so I am a midwife. I was with woman, and did my job, despite my desire to be anywhere else in the world but there!

As to my earlier comments on horizontal violence in midwifery. I am building a little list, which I anticipate being done with in the next few days. It links in to recent posts by Barb about midwifery education. so watch this space, more to follow soon!

And another thought...

So, the other day I had a really hard birth, with a long latent phase, augmentation, slow progress, and finally a "crash" section for fetal distress. I am not going to discuss that birth here, as I am not ready yet. Suffice to say, I sought help at appropriate times, but the help I got made my life much more difficult. But it raised something else which I do want to process.

Horizontal violence is often discussed in midwifery, but I realised during that birth that it is alive and well. The backbiting and sniping that can be associated with attacking others practice is painful and not at all helpful to anyone. So, although i don't have time to go there now, I will be following up this issue soon.

On another note, remember my domestic violence posts? Imagine my surprise when I picked up the local paper only to see that the "man" in that case is there on the front page, in court on charges after assaulting (allegedly) two couples on the beach front in the last two weeks... one of the victims required brain surgery for her head injuries. But, of course, he wasn't a violent man.

Books.......

I got sent this, and thought, well, okay then. So, if you are reading this too, have a go at your own blog!

Instructions:

Look at the list of books below. Bold the ones you’ve read. Itilacize the ones you want to read. Leave blank the ones you aren’t interested in.

Movies don’t count!!!!! (K. - Damn.)



The DaVinci Code (Dan Brown)
Angels and Demons (Dan Brown)
Pride and Prejudice (Jane Austen)
To Kill a Mockingbird (Harper Lee)
Gone With the Wind (Margaret Mitchell)
The Lord of the Rings: Return of the King (Tolkien)
The Lord of the Rings: Fellowship of the Ring (Tolkien)
The Lord of the Rings: Two Towers (Tolkien)
Anne of Green Gables (L.M. Montgomery)
Outlander (Diana Gabaldon)
A Fine Balance (Rohinton Mistry)
Harry Potter and the Goblet of Fire (Rowling)
Harry Potter and the Order of the Phoenix (Rowling)
A Prayer for Owen Meany (John Irving)
Memoirs of a Geisha (Arthur Golden)
Harry Potter and the Philosopher’s Stone (Rowling) Fall on Your Knees (Ann-Marie MacDonald)
The Stand (Stephen King)
Harry Potter and the Prisoner of Azkaban (Rowling)
Jane Eyre (Charlotte Bronte)
The Hobbit (Tolkien)
The Catcher in the Rye (J.D. Salinger)
Little Women (Louisa May Alcott)
The Lovely Bones (Alice Sebold)
Life of Pi (Yann Martel)
The Hitchhikers Guide to the Galaxy (Douglas Adams)
Wuthering Heights (Emily Bronte)
The Lion, the Witch and the Wardrobe (C.S. Lewis)
East of Eden (John Steinbeck)
Tuesdays with Morrie (Mitch Albom)
Dune (Frank Herbert)
The Notebook (Nicholas Sparks)
Atlas Shrugged (Ayn Rand)
1984 (George Orwell)
The Mists of Avalon (Marion Zimmer Bradley)
The Pillars of the Earth (Ken Follett)
The Power of One (Bryce Courtenay)
I Know This Much is True (Wally Lamb)
The Red Tent (Anita Diamant)
The Alchemist (Paulo Coelho)
The Clan of the Cave Bear (Jean M. Auel)
The Kite Runner (Kaled Hosseini)
Confessions of a Shopaholic (Sophie Kinsella)
The Five People You Meet in Heaven (Mitch Albom)
The Bible -- Yes i used to do regular bible studies... what ever happened to me!
Anna Karenina (Tolstoy)
The Count of Monte Cristo (Alexandre Dumas)
Angela’s Ashes (Frank McCourt)
The Grapes of Wrath (John Steinbeck)
She’s Come Undone (Wally Lamb)
The Poisonwood Bible (Barbara Kingsolver)
A Tale of Two Cities (Dickens)
Ender’s Game (Orson Scott Card)
Great Expectations (Dickens)
The Great Gatsby (Fitzgerald)
The Stone Angel (Margaret Laurence)
Harry Potter and the Chamber of Secrets (Rowling)
The Thorn Birds (Colleen McCullough)
The Handmaid’s Tale (Margaret Atwood)
The Time Traveller’s Wife (Audrey Niffenegger)
Crime and Punishment (Fyodor Dostoyevsky)
The Fountainhead (Ayn Rand)
War and Peace (Tolstoy)
Interview with the Vampire (Anne Rice)
Fifth Business (Robertson Davis)
One Hundred Years of Solitude (Gabriel Garcia Marquez)
The Sisterhood of the Traveling Pants (Ann Brashares)
Catch-22 (Joseph Heller)
Les Miserables (Hugo)
The Little Prince (Antoine de Saint-Exupery)
Bridget Jones’ Diary (Fielding)
Love in the Time of Cholera (Marquez)
Shogun (James Clavell)
The English Patient (Michael Ondaatje)
The Secret Garden (Frances Hodgson Burnett)
The Summer Tree (Guy Gravriel Kay)
A Tree Grows in Brooklyn (Betty Smith)
The World According to Garp (John Irving)
The Diviners (Margaret Laurence)
Charlotte’s Web (E.B. White)
Not Wanted on the Voyage (Timothy Finley)
Of Mice and Men (Steinbeck)
Rebecca (Daphne DuMaurier)
Wizard’s First Rule (Terry Goodkind)
Emma (Jane Austen)
Watership Down (Richard Adams)
Brave New World (Aldous Huxley)
The Stone Diaries (Carol Shields)
Blindness (Jose Saramago)
Kane and Able (Jeffrey Archer)
In the Skin of a Lion (Ondaatje)
Lord of the Flies (Golding)
The Good Earth (Pearl S. Buck)
The Secret Life of Bees (Sue Monk Kidd)
The Bourne Identity (Robert Ludlum)
The Outsiders (S.E. Hinton)
White Oleander (Janet Fitch)
A Woman of Substance (Barbara Taylor Bradford)
The Celestine Prophecy (James Redfield)
Ulysses (James Joyce)

seeking self

Are you in there?
I used to be so in touch with you
Used to hear your voice everywhere I went
Used to believe everything you said to me

Where did you go?
I know I am busier these days,
And not listening as hard….
But I find myself sitting in the silence, wishing I could hear you

Is it that you think I don’t need you?
Cause, I really do.
I am not the way people think I am
Not so sure of myself as I seem

How can I reconnect with you?
I really want to catch up.
I want to hear what you think of me now…
Want to see where you think I am headed

Can you tell that I am scared of you?
You are my truest reflection
Of what I truly am, and what you say
Could shatter my world if it is not what I expect

You force me to take notice,
Show me what is really there.
I know you are really just a part of me
But, goddess, I need your truth.

Post graduate study?

So, I am heading back to uni. I have enrolled to do my honours and will be studying parttime for the next two years to achieve this. I must be mental! But I love the learning almost as much as I love the work. So back to it I go. But the process of applying, and deciding on course structure has raised some stuff for me. I was not a good student in high school. I dropped out, pregnant, at sixteen. I then worked in a series of completely shite jobs, getting nowhere fast.

I never imagined a time when I would be a university student, let alone a graduate with a degree. Post graduate study wasn't even on my radar! And, now that I am doing it, I have this wierd am I getting above myself and pushing to high feeling in the pit of my stomach. Who the hell am I to think that research I might do could be of interest let alone benefit to others? I was the woman I now want to study!

I am constantly surprised by the realisation that I am an educated and intellient person. This is quickly followed by the question "how the hell did they not realise how shit I am?" I really honestly expected to fail out of my degree at every stage. And now, going into post grad studies, I feel the same way, like I am asking to fail spectacularly at something that really matters to me. Friends tell me constantly that I am "uber smart" and other such bollocks, and to me, it is like when ssomeone tells me I have lost weight or look good... the auto denial is right there.

Goddess, this is rambling... my point. In my heart and in my honest moments, I know I am good at this job. I know the stuff I need to know to practice safely and smartly. I am not scared to integrate others knowledge and other ways of knowing into my practice. I am fully and wholly committed to what I do, and if I didn't believe I could do it, I wouldn't do it. But, still I have these masses of self doubt and feelings of being a fraud... Is that just what women do to ourselves? Is that why we birth in the hospital but want a natural birth? Cause we know we can do it, but doubt it anyway?

I am confused. I am scared. And yet, I am excited.

Births, being an LMC and American doctors.

So far this week, I have attended two births, one a VBAC with slow progress but a good outcome in the end, and the other a lovely physiological birth with a primip who was perhaps the most relaxed woman I have ever come across in labour. She laboured while sitting with legs crossed gently on a chair, eventually getting on to her side when she wanted to push. She did the whole thing in just over four hours, with only 20 minutes of pushing. Truly a lovely birth. the VBAC delivery was a bit more difficult. A long latent phase, followed by very slow progress, eventual syntocinon augmentation, and then a long second stage. I had to hand over care to the hospital eventually, due to sheer exhaustion and was appropriately villivfied as being a lazy uncommitted independent midwife. They argued that the woman was needing "primary midwifery care" I argued that syntocinon augmentation with a VBAC is very much secondary care!

But, what am I talking about, ask my non kiwi readers. Well, here is a quick run down of how being an LMC midwife works in kiwi land.

Section 88 is the legislation that governs maternity care in NZ. Under this legislation, Midwives gain the ability to practice at home or in hospitals, by gaining "access agreements" which allow them to use a facility, and receive support from that facility. We provide antenatal care under our own supervision throughout the pregnancy. when labour begins we must attend a woman within twenty minutes of her arrival in a hospital/ birth unit, or by negotiation with the woman in a home birth. We are not bound to follow the protocols or policies of a particular hospital, although there is an expectation that you will be able to well defend any variation. We are able to prescribe medications applicable to common pregnancy problems, and IV fluids, etc. We are responsible to provide all primary midwifery care, either by ourselves or by arranging another midwife to cover from the arrival of the woman at the hospital, until at least two hours post partum.

The referral guidelines list the criteria for consulting/referring or handing over to obstetric care. therefore, if something is a "level two referral" such as syntocinon augmentation, then we are required to inform the woman that we recommend that she allow doctors to coordinate her care. We can stay and provide the midwifery care for these women, or we can "hand over" to secondary care. In most instances, we stay with our women, for as long as we can. But when you have been awake for 27 hours, you are perhaps not the safest practitioner, especially in a complicated labour.

We are then required to provide at least five to seven home visits during the four to six weeks following birth. Most of us do more than this. for this, the government pays us as per the schedule in the above link. As you can see, it is not a huge reward for 24/7 on call! However, I don't think anyone becomes a midwife for the money. That is a really basic rundown!

So, having explained that... my issue the other day was that i had been caring for a woman who was secondary care from the outset by dint of being a VBAC attempt, who then had slow progress, ARM, Meconium, syntocinon, etc etc. At the 27 hour point, i knew I could not safely continue. And I was basically attacked, for being lazy and uncommitted. What do you want? Blood? Right, that is that rant over. Onto the next....


My dearest friend in the world, who I will call Blond Ambition, is a beautiful and vivacious 22 year old midwife, working for a different busy hospital. Once a week we move heaven and earth (and shift rotations and labouring women) to get together and spend time catching up on our lives. This week, we went for a lovely walk on the beach, where there was sunshine, small children, and lots of dogs. There was also ice cream (goody gum drops and marshmallow coconut ice for BA, and rum raisin, cappuccino and butternut pecan for me!) and lots of chatting.

During the chat, BA told me about an American doctor, doing an obstetric rotation at her unit. She had a conversation with him, where they discussed the difference between NZ and American obstetric care. She asked him what was the most different, and he replied "you". It really was a challenge to him to work in an environment where most of the labour care happens independently of the doctors, with midwives doing the ordering, and doctors doing the "fixing". It highlighted for me just how different our systems are. Here, a midwife is the primary carer for the vast majority of women. Therefore, obstetricians really do provide "secondary care", just as they should. But maybe, that is why they are so anti midwives... because would you want to give up all your normal births, and only have the complicated and problematic cases?

BA asked the doctor what he thought of homebirth and he responded "I wouldn't touch it with a bargepole". when asked why, he said "well, for a start I would lose my licence to practice". Surely that is not true? If a doctor backs a home birth, he is delicenced? Or is he just concerned that if something went wrong he could lose it? Or so convinced that homebirth is inherently unsafe that he KNOWs he would have something bad happen, leading to the loss of his licence?

Blonde Ambition ended their chat their on the grounds that he was not open to the chat, and she had way more important things to do... but it saddens me that doctors can't see the difference between a normal woman birthing at home, and say a really dangerous situation like a placenta praevia delivering at home. Hmmmm.

Maybe, this then draws back to our language difference. Maybe this basic difference between doctors and midwives is more than a misunderstanding... As pointed out by both Peggy Vincent and Penny Armstrong in their memoirs, doctors view birth as normal only in retrospect, and midwives see it as normal unless it deviates away. If you do not believe that birth is inherently natural and safe, then how could you, ethically, deny women the right to avail themselves of medical care. Think about how you would feel if a woman with twins, placenta praevia and preterm labour with both twins breech requested you to attend her at a home birth... Now what if doctors feel that ALL deliveries are that dangerous?

I don't know how we save the women from this attitude, but I begin to understand why none of our evidence is enough to change the minds of doctors so heavily indoctrinated into a model of birth as pathology.

Wow. BA will read that and laugh her head off, cause it is not where I planned to go AT ALL.

Never mind.

Runs of three

Is it just me or does anyone else have runs of three? Since I entered independent practice, every birth I have attended has been one of three! I swear, it's true, not a single stand alone birth! Last month, I had two runs of three, a week apart. The month before two runs of three, two weeks apart. This month i had a run of three last week, and now already, I have a woman in labour and another in early labour... which could of course all stop, but.... if they keep getting closer like this, will I end up with runs of six? I couldn't cope with that!

One of the deliveries last week was a wonderful primip, so strong and grceful and bave, that I wanted to cry for her! She laboured beautifully to full dilatation with no pain relief except the pool, and began pushing soon after. Eventually, after two hours we got out of the pool. Baby was fine. Slow but steady progress forr the next half hour, but mum's contractions started to go off. The head was "right there" but the contractions just weren't bringing it any closer. Nipple stimulation failed to increase them, and the position was all wrong. Finally, I asked her permission to do an episiotomy. I hate doing them, and never do them, but I did this one, and it was immediately followed by the birth of a good sized pink screaming baby. But my call was a good one. That uterus had had enough, and despite active management of third stage, next thing I knew there was blood, and lots of it, everywhere. Basically, she lost about 1100 mls. So, after her beautiful strength in labour, and completely unmedicated birth, she ended up with suppositories for her stitches, and an IV for her bleeding.... Why does it happen that way?

Domestic violence....

This post was a while ago, but I now have a follow up on the story, that raises more questions than it answers.
I was at the hospital the other day, and ran into the social worker involved in that case. She asked me if I had heard from CYPFS. "Errrm, no?" I replied, slightly confuzzled.

She then told me that my client has been admitted to hospital twice after beatings, and the child is now at the centre of a massive custody battle. The partner is wanted by the police for assault and battery and CYPF's are asking why "something wasn't DONE". WTF? we BEGGED them to do something! Everyone who was involved in the case had nightmares about the potential headlines, and now, although it is not the baby being beaten (to our knowledge) they are coming true, and WE are in the wrong!???

Sorry, got a bit carried away there. I guess my point is, that this woman had the right and the responsibility to avail herself of help all those months ago. While I agree it is sad that she may now lose her child, this was her decision. Her plan to "change him" didn't pan out, and now, the shit has (predictably) hit the fan. but, my question to you, my intelligent and opionated readers, is what could I have done to hellp her make a different, better decision? Anything? Suggestions, please!

Self fullfilling prophecies.

In my everyday life, I believe in self fulfilling prophecies. If you think it, you may make it so. I often use this method to try and get my vacuuming done... but although that doesn't often work, I still believe that what we think might happen often comes to be so. And the more energy we give to that thought, the more likely it is to occur. For example, I believed I would be happier when I started my independent practice. I thought I would have more time for my family, and be more energetic. I believed it had to be better than working in the hospital. And it has so very definitely come to pass.

But, like every good thing, it has it's reverse aspect. negative beliefs seem to be given more mind space, and so often, we believe in a negative. So we believe that we CANNOT. Cannot achieve, cannot succeed, cannot birth. And that is what sparks this post. A woman, who honestly has said to me at every one of her (22!!) Antenatal visits, "I will need a cesarean" in some variation, finally began labour at 41+3. She then contracted for twelve hours at three minutes apart, lasting a minute to ninety seconds, and managed to get to ........ 2 cm dilated. The head was high, the contractions were "unbearable" and slowly, but surely, things went Tit's up. FH was high, and a CTG was commenced. Baseline: 160 bpm. Long story short, after about 16 hours of labour, a cesarean section was performed, with a FH baseline of 200 bpm. At 2 cm's. A normal size baby in OA position was born, with heavy mec staining and apgars of 6&9.

Why did this happen? Did she believe this would happen because intuitively she knew there was going to be a problem? Or did her belief create the reality? Could I have saved her alot of heartache by pushing for an elective CS at term for maternal request? Would she have even been happy if she wasn't "saved" by the doctors who operated to deliver her of her burden? I struggle with this aspect: How do you help the woman who wants to be saved, not empowered? Is it right to try and empower someone who sees herself as inadequate, and doesn't mind?

Agatha raises interesting points about language here and a similar vein of discussion occurs on One Hot Mama's site. Both of these post's struck a chord with me, originally sparked by Barbara. I don't know quite how my ramblings are going to end up linked to their thoughts on language and empowerment, but it is brewing. Just so you all know.

what a year....

Well, it is one day off of the last day of the year. This one has literally whipped past me in a whirl! But what a great year it has been. No really bad things have happened to me or any of mine, and lots of good things have, with engagements, weddings, career changes and all sorts of positive things happening. Professionally, my world has changed more than I would ever have anticipated, and right now, I love my life. I have a great rewarding job, wonderfully supportive colleagues who appreciate me, respect and autonomy up the wazoo. At home, my kids are all happy and healthy, despite the normal road bumps of adolescence, OH and I could not be happier, and are sound for the first time in a long time. I have amazing friends who I love to be around and enough time and money to do stuff with them.

This sounds all very gloaty, but actually, it comes from a place of real gratitude. Two years ago, I was broke, depressed, terrified of failing, on the verge of losing my relationship and my kids and in a bad place in many other ways. This is a message to give hope to those people who are now looking down the barrel of the new year wondering how the hell they are going to survive it. Not only have I survived, I have thrived and my world is a wonderful place to be! Thanks and blessings to the Goddess for holding me to the path that I needed to trudge along to come to this place of happiness. Joy to the people who trudged it with me. Peace and Hope to the people facing such a journey themselves.

My daemon

I just discovered the golden Compass website, and thought I'd stick this in for a giggle. Does it match me?