Friday, October 3, 2014

Catching Babies: Oceans of Sorrow and Rivers of Blood

I’ve already posted a little bit about what happened in September and if you follow me on facebook you know it kicked my ass harder than usual. Since I needed time off in October I ended up working extra shifts, so it was own fault really. Traditionally September is the busiest month in the baby business and this year was no exception. We had anywhere from 10 to 20 inductions of labour every day on top of the people who had the audacity to go into labour on their own, the routine caesarean sections and the various other admissions. Into the ‘other admissions’ category fall the people who have sadly lost their babies. Most people don’t think about what happens in this case but these babies still have to be delivered and after a certain stage of pregnancy this happens in the usual way with a midwife looking after you. For the first couple of weeks of September I was that midwife.

It’s heart breaking, stressful and at times unpleasant but it is so, so important. Perhaps one of the most important parts of my job. And just like any other delivery there are those which stick with you forever. This time it was twins, a threatened miscarriage. They were too far below the time at which they could be successfully resuscitated. Their parents and I waited for two long days hoping against hope but knowing deep down that they were coming and nothing I or they could do would stop it. We discussed several scenarios, among them the possibility that the babies would show signs of life when they were born. When the awful, inevitable moment occurred that’s exactly what happened. Their parents decided to hold them until the passed away peacefully. It was terrible and yet, somehow it wasn't. They got time to say goodbye.

In the way of medical professionals everywhere I moved from bad to good without breaking my stride. I soothed away my sorrow in the raucous squalling of new life as I delivered baby after baby and September rolled on. We discovered a new trend for September – antepartum and postpartum haemorrhages. It seemed like every second person who came through our doors was attempting to pump their life’s blood onto our beds and floors. It became almost routine as we moved through each emergency like a well-practiced, well-oiled machine. As I sat down for a moment to catch my breath after another major haemorrhage and contemplated changing my blood spotted scrubs and cleaning my shoes someone stopped by to tell me there was a gift waiting for me in the office. After I cleaned up I went to claim it. It was a huge box of chocolates and a lovely card. “Thank you for looking after us so well and giving us precious time with our babies.”

Well played September, well played.

Wednesday, September 3, 2014

Catching Babies: Black Wednesday

Once a year in the UK, not only in Maternity Services but across the board there is a time that brings dread to the hearts of nurses, midwives and pharmacists. New Doctors week. It happens in early August. Someone, somewhere, once upon a time decided it would be a good idea to move all the junior doctors to new departments at one time and throw some new graduates in to the mix too. Just for fun. Go ahead. Google Doctor changeover day. I dare you. I warn you though, you might decide to turn to Google again and self-medicate if you ever become unwell in August.
We all know that for the first few weeks in August we will be spending time we don’t have giving the new doctors directions, teaching them routine and protocols, checking prescriptions for them and waiting for them to check with other doctors before things get done. It’s a pain in the arse for them and for us and a totally stupid way of doing things. But as with many things in the NHS it’s the way we’ve always done it and it will take a disaster before anyone is willing to change it.

All through this, the babies keep on coming. So many babies we are running out of cots for them and beds for their mothers. The powers that be have reduced our staff and our beds based on the number of patients we had last year. The problem with that is that we have already surpassed that number and the year isn’t over yet. We are all exhausted and that gives us less time for teaching the right way to do things. Whether with new doctors or with new mothers. September is on the horizon and we all know this is traditionally our busy time. Something has to give.

Into the mix comes an eighteen year old girl who is twenty-six weeks pregnant. Her waters have broken several days ago and she is showing signs of infection and that infection is most likely in her womb. There is no choice but to try and induce her labour while treating her with antibiotics before the infection worsens and possibly kills her. We all know the odds of the baby surviving the procedure and the delivery are slim. That the chances of it making it hale and healthy after that, slimmer still. She is not my patient and I am glad. I see her relatives coming and going with grief in their eyes and am glad that on this occasion it isn’t me who has to try and hold them together while they wait.

We all go about our duties and every time we pass the main desk or each other we ask. “Is it over yet?” The day shift passes and the baby is still with us. Heartbeat strong. The girl’s infection has worsened and she is spiking high fevers. The doctors are scratching their heads and throwing antibiotics at it while they wait for test results in the hopes that something will stick. Days pass and suddenly the girl turns a corner begins to get better. Against the odds and despite us doing our best to induce it, she doesn’t labour. We stop trying. The signs of infection are gone and it’s decided, let nature take its course. As I leave my final shift of August news reaches through the grapevine. The girl has gone home. She is still on antibiotics and still pregnant. We are all astonished but as we leave August its clear to us all that sometimes miracles do happen. Whatever the next weeks throw at us we just have to keep on going and we’ll get through it. Whatever will be, will be.

Sunday, August 3, 2014

Catching Babies: The Heat Is On

July

Obstetrician, “Do you know why we put hats on babies as soon as they’re born?”
Anaesthetist, “Isn’t it to keep them warm?”
Obstetrician, “Actually no. You see, there’s a pressure differential between the uterus and the external environment. This means the baby’s head can actually expand and cause intracranial damage.”
Anaesthetist, “Really?”
Obstetrician, “Yes, in fact if left unchecked the cranial vault can actually explode in severe cases.”
Anaesthetist, “Oh wow. Really? I’m ashamed to say I didn’t know that.”
Obstetrician, “Oh. My. God. I can’t believe you actually fell for that!”
Anaesthetist, “You arsehole!”


And thus the tone was set for the hot, crazy month of July. As the temperatures soared outside, so did the heat in the labour ward. The air conditioning was misbehaving again. The temperature in the room Eve and I had got stuck in was approximately thirty degrees and we spent the majority of our time there wearing plastic aprons, gloves and goggles which were actually fogging up so much that I gave up and took them off so I could see. I resigned myself to spending most of the day wet as sweat trickled down my temples. “When this baby is born,” I said to Eve softly as the mother caught her breath between pushes. “We need to get the hell away from this room to the other end of labour ward. Where the air-con is working slightly.” A few more pushes and the baby slipped from its mother’s body and gave an indignant cry. I thought gratefully of a belated breakfast, and air I could actually breathe as I sat down to suture.

Alas it was not to be. Well, we did get breakfast. But no sooner had we finished eating when the phone rang again and we were called back for another delivery and the only room free and clean was the same one we had just vacated. I bit back a groan and braced myself. This was going to be a long day. Our second baby was not quite as quick as the first but he made his way into the world without too much drama. Eve’s eyes met mine in the kind of excitement you only find from a student. “Two in one day, wow!” I smiled back at her. Thinking my god. Two already, and it’s only just past lunchtime.

The next phone call came as we had finished transferring our second patient. The message was that someone was coming to labour ward for more intensive monitoring of her baby’s heartbeat as there had been dips in the heart rate on the ward monitor. It was her second baby so I knew she could labour quickly. We set up our room accordingly, put on our gloves and waited. The patient who arrived was not what I was expecting. She was ranting, irrational, aggressive and totally out of control. It was obvious in the first few minutes that she had psychiatric problems. I couldn’t get her to stay in the room, let alone on the bed to get the monitor back on. I, her partner and another midwife quite literally followed her the circumference of the labour ward and back trying to reason with her while other staff looked on wide-eyed. She sobbed, yelled and beat her fists on the walls and repeated over and over that she was going home. As she got to the exit, that’s exactly where she headed with her partner and the transfer midwife following her, pleading. I stopped at the door having been told by the charge midwife not to follow them. The student looked at me in shock. “So what do we do?”

The answer was nothing. Security had been called. There was nothing we could do to make her stay. It’s a hospital, not a prison and although she had psychiatric issues she had been assessed as fit to look after herself and make decisions. My heart ached for the baby inside her whose fate was uncertain. We went back to the room to document events. As I finished writing the room door was flung open and the woman and her entourage burst back in. She threw herself onto the bed and screaming herself hoarse she gave an almighty push and delivered. For a moment there was silence then the coughing, sputtering cry of the baby broke the tension. Tears stung my eyes as relief flooded me.
“Thank you.” Said the new mother. “I’m so sorry.”
I met her eyes. “It’s okay. Everything is fine, you’re all safe now.”

As we leave July and enter August there have been many other babies. As I bid goodbye to my student, Eve, she has delivered twenty-five of her three-year goal of forty. It’s been a busy, chaotic month but that one, very lucky baby has stuck in my mind. I hope she grows to be happy and healthy. I hope her mother gets the help she needs.
I know I’ll probably never find out.

Thursday, July 3, 2014

Catching Babies: The Orphaned Student

This month I thought I’d try something a bit different. Once upon a time when I was a shiny new midwife I started an online journal about my ‘day job’. It was a way for me to decompress from a job I wasn’t quite prepared for and take my mind off of the fact that I was living away from my friends and family for the first time. It’s now been ten years and working for the NHS is still as surprising, funny, sad and maddening as it was when I was just out of the box. So I thought I’d once again share some of the craziness and give you a glimpse into life as a midwife in the UK. Names will be changed to protect the innocent. My plan at the moment is to try to do this at least once a month but we’ll see how it goes. Please feel free to share your thoughts below and I hope you enjoy.
Cait

June
As we barrel our way through the hazy, crazy days of summer in the UK all I can think is that most of the UK must have spent the last days of autumn and the first days of winter last year under their duvets. Together. Because now, nine months later there seems to be plenty of evidence of a job well done. To make matters worse I seem to have picked up a student, Eve, left orphaned and alone when her mentor called in sick, indefinitely. Another casualty of the high stress, long hours and workload that is the reality of our job. I like working with students but she is in the first year of her training, which translates to explaining and doing everything at least twice. It’s a lot of work. Teach me to give in to the pressure that was the combination of my own memory of being a student and gentle persuasion from the University.

Poor Eve has the luck, or misfortune to land in one of the busiest moths of the year so far. Talk about throwing her in at the deep end. Our student midwives in the UK have to deliver forty babies in their three years of training. Within our first three shifts we already had four. One of which was a lady who was pregnant with her fifth baby. She came to labour ward courtesy of a bed and two admissions midwives running her into labour ward fully dilated and pushing. Luckily Eve took me at my word when I answered the call and said to her, “Put your gloves on and open up the delivery pack.” In the corridor outside the delivery room the lady’s waters broke. As we wheeled her into the room she gave a push and the baby appeared as a wriggling, crying, sheet covered shape while the student stood beside her, eyes wide with astonishment. Eve looked at me and said, “I don’t think I can count that. I never even touched her.”
“Well,” I replied, “You were standing beside her and someone’s name has to go in the paperwork. It might as well be yours.” Everyone in the room laughed as relief broke the tension and we finished the job. The baby was dried and placed in her elated mother’s arms and Eve delivered the afterbirth with my guidance. I suppose we can all be grateful those admissions ladies had their running shoes on that day.

And so it continued; seven shifts, eight normal deliveries, three caesarean sections and one ventouse delivery later Eve and I are well acquainted and she hasn’t thrown the towel in yet. I see the beginnings of a midwife in her and it’s kind of awesome to know I had a part in that. I must confess, I do enjoy those first year students, even with all the hard work it entails. We try to ease them in gently, stick to low risk patients (or ‘clients’ as the Uni would have it, they do love their buzz words) try show the students the normality before the reality. I love to give them the exhilaration of being the person to bring life in all its noisy, messy joy into the world. So as the weather heats up along with the labour ward Eve and I drag our tired asses into July. Tired, but not beaten, and ready for the next catch.


Wednesday, December 4, 2013

The Book That Started It All!


I recently went through my bookshelf trying to find and ‘oldie but goodie” to read. Even as my finger drifted across cracked spines and the scent of my old books drifted up to me, I knew which book I looked for. The title was The Flame and The Flower by Kathleen Woodiwiss.

Kathleen Woodiwiss was my biggest influence as far as finding an unending love for historical romance. She is the one author who grabbed me by the heart and never let go. In the early days of my actual foray into writing, I had a chance to visit with her and she was a wonderfully articulate lady. Her debut novel was rejected by agents and hardcover publishers as being too long. In typical Kathleen fashion, she refused to rewrite her novel and sent it instead to paperback publishers. Avon had the foresight to immediately purchase and the rest is history! I think she singlehandedly changed the course of romantic novels.

I will never forget that phone call with her. I sat on the edge of my chair, my palms sweating, my heart pounding, and excitement like I’ve never known! She gave me so much encouragement to do the thing I love. Hence my historical trilogy including my Keeper of the Spirit, Keeper of the Dream, and Keeper of the Heart.

Now I’m sitting here looking at my very worn original copyright dated 1972, The Flame and The Flower. Years have passed and I’m not sure I’ll ever shoot to the top of the Best Seller list, but Kathleen’s encouragement still rings in my ears.

 

Merry Christmas to all!

Ruby

Sunday, November 24, 2013

Favorite Thanksgiving Recipes

I'm always looking for something new to try. Food wise that is. I love to eat and Thanksgiving is the one holiday that promotes food to the tee. Yum.
Since my daughter works for Walmart, I'm having Thanksgiving's food dishes ready by noon so she can eat before she has to be there by 2. The rest of us can eat with her then eat again on and off all day. I doubt I get out of my comfy clothes on Thanksgiving.
Here's one of my favorite Thanksgiving day recipes.

Sweet Potato Casserole

Ingredients:
3 cups of mashed sweet potatoes
1 cup of granulated sugar
2 eggs
1 tsp. vanilla
½ cup of milk
½ cup of butter



Mix:
Potatoes, sugar, eggs, vanilla & milk. Add melted butter. Pour into a casserole dish.

Topping Ingredients:
1/3 cup of flour
1 cup chopped nuts
1 cup light brown sugar
1/3 cup softened butter

Mix:
Combine brown sugar and flour. Add softened butter until it becomes a crumbly mixture, then add nuts. Mix well.  Sprinkle on top of casserole.

Bake:
350 degrees for 30 minutes or until done.


As I said, I'm always looking for new recipes to try so please share yours here.
Happy Thanksgiving.
Tara

Sunday, November 17, 2013

Wounded Warrior Project

It's my turn to blog again, and, as usual, I had no idea what to say. Seriously, doesn't anyone really care about my crazy life with my three girls, my struggle to find jeans that fit, or my never-ending battle to lose weight?

I didn't think so.

So as I cast around in vain for a topic to write about, I tried to think of something that meant a lot to me. One of the things that came to mind immediately was The Wounded Warrior Project. (woundedwarriorproject.org)

I first learned about this site when I was doing research for my next book. (more on that later) As I explored the site, I became more and more impressed by what this non-profit organization is doing for our wounded military members.

This is a subject near and dear to my heart. My grandfather was the second to last man drafted in WWII, my father was in the Air force, I had two uncles fight in Vietnam, my sister was in the Army for 23 years, her husband was also in the Army and my other brother-in-law was in the Navy. My niece is currently in the National Guard. Service to our country is big in my family.

We have been so blessed that none of our family members was ever wounded during their service, but not everyone is that lucky. It absolutely breaks my heart that people who put their lives on the line for our country come home to miles of red tape, inadequate care, and an overtaxed support system.

 These people are heroes, damn it!

I have spent a lot of time researching Navy SEALs for my next book. I enjoy doing research, but this time, I wanted to make sure I REALLY got it right, because it means so freaking much to me. My hero is going to be a wounded SEAL and I hope to God all the research I've done will do him justice.

Veterans' Day was November 11th, but thanking our veterans and military personnel should be something we do every time we see someone in uniform.

In order to put my money where my mouth (or keyboard) is, when I finally get my wounded hero book written, I'm going to donate part of the proceeds to The Wounded Warrior Project. I encourage you to check out their site and see what they are doing for our heroes.

To all the military and their families, I thank you for your service, sacrifice, and dedication. God bless you and keep you safe.