A few things: L&D

A Few Things I'm Going to Miss (some of you will have no idea what I'm referring to herein-that's ok)

• Zero Epidural Rate
• Women who can push out a baby in one or two pushes and who think a long push is over 15 minutes.
• Women who want to walk and move around in labor and are surrounded by female family members that think birth is natural and not scary.
• Fast labors
• Women who want to go home in early labor
• Women who labor at home until things are really cooking.
  
• The hard working and under appreciated nurses (somethings are the same no matter WHERE you are)
• An understanding of what a midwife is WITHOUT having to explain it.
• A preference for midwives as birth attendent

A Few Things I'm Not Going to Miss:

• Putting my foot into my shoe in the middle of night to feel a cockroach (a large one) squirming around in there. (Insert high pitched scream and shoe flying across the room).
  
• Sleeping in the linen closet on a gurney.
• Routine episiotomies (by OTHER practitioners)
• Latex gloves that are moldy and disintegrate as soon as I put them on.
• Lack of systematic health care
• Going to the "delivery room"
• Lack of adherence to Universal Precautions (gross and scary)
• Chromic suture as the only suture
• The lack of a neonatal crash team (hmmm I think there is a name for this but I've been without one for so long...it's like some sweet memory) Good thing bad babies are so few and far between.
• Lack of urgency when a crash csection is called.
• 20 minute Decision to Incision Protocol
• Women who refuse induction when they are REALLY, REALLY, REALLY overdue.
• Babies going straight to the nursery because there is not enough staff to monitor babies during transition.
• Lack of position changes for delivery.
• No IUPCs
  

My Friend Had A Baby...

And I Nearly Had A Heart Attack

I was really looking forward to the delivery of my friends’ Melanie and Paul’s baby. Though I’d taken care of my friend Carol during her pregnancy here, she decided to have her baby off island, an understandable, though sad for me decision. So Melanie was going to be my first friend to deliver!

Luckily, I am a seasoned midwife and I know not to get any fantasies going about how things are going to work out. I wasn’t going to jinx this birth with thoughts of an easy, effortless labor where the baby miraculously appears with little effort, into arms free of exhaustion and tears of joy and champagne corks popping.

But I’m not a doom and gloomer, either. I have great faith that things will work out if you don’t ignore what you don’t want to see. Hope for the best, prepare for the worst, is my motto.

Melanie’s labor took a couple of days to kick in with a few jump starts. Nicely, Ona and she waited until after I had recovered from my Sunday night shift and had a full night’s sleep on Monday night. What great gals, eh?

We’d planned to do early labor at home, with Carol who’s a NP as well as a long time L&D nurse, as support person and attendant. Melanie had bought a fetal heart monitor-not a bad one I must say for the home type-so we could listen in on the baby. Melanie bought a wading pool at my suggestion, which Paul attended to when Mel was in labor.






I came by at lunch but had to go back to the clinic. It was nice and peaceful there in comparison to the labor ward-I had a really hard time going. Carol brought Scott, her baby, to hang out for a while too. Not long after I got back to the hospital, I got a call from Carol that Ona was starting to feel the contractions now that Melanie was having hard labor. They came straight into the hospital.

Low and behold, little Ona was not having a great time at her Birthday party. Even though Melanie was moving quickly in her progress it would be too stressful on Ona to wait. So I had to do what I dreaded and make the decision for a cesarean delivery. No warm and fuzzy delivery for us today! Plus that would sign up Melanie to 2-3 days in the unairconditioned, low-rent Maternity Ward and Ona to the nursery!




Things went well, Ona was out in a very short period of time, after unwrapping the umbilical cord from her neck twice and proving my assumption that she had been in what we call a “posterior” position, meaning her head was down but she was looking up at the ceiling instead of the other way around like she should have been. That was probably the best position she could manage with her short umbilical teether. So her stress explained, she transitioned well in the beginning except some fast breathing that she eventually grew out of, aka transient tachypnea of the newborn.

I won’t lie to you, it’s stressful when someone is near and dear and their well-being lies in your hands. I don’t know why it should be different then all the other people I care for, but it is. It probably shouldn’t be that way, but I tell you if I had a heart attack every time I had to decide that a baby was in distress, I would have a lot more gray hairs than I have now-and I’d be in another business all together. I think it’s fine to take care of people you care about, I don’t think it clouds your judgment, I just think it puts the caregiver into a temporary state of split personality. A state that is a relief to let go of when it’s over.

I loved taking care of my friends and would do it again in a heartbeat. I just wouldn’t trust anyone else to do it as well-haha (sorta). I am so happy to have been part of Paul, Melanie, Ona and, big sister, Emma’s experience. You can Melanie and Paul's account of the experience on their blog, don't miss their fun review of the hospital, I mean the Tropical Medical Center.


Now I just need to go and take a nap . . .

Happy Birthday Ona Lily Brown, born May 6, 2008