Friday, January 9, 2015

Catching Babies: Come All Ye Faithful

December. There are times when I wonder why it is that I do what I do. Through the months I’ve been writing this blog I’ve shared some of the highs and lows and as we draw the year to a close, this final month has brought more of the same.
It’s always difficult when some on loses a baby. But when it’s someone you know, a colleague, it’s always worse. When something awful happens, we always question ourselves. Did we not do enough? Act quickly enough? Make the right decision? It’s a million times worse when you know for a fact that but for a single element the outcome could have been so very different. This is the situation we found ourselves in December, the week before Christmas. I can’t quite describe the pall that fell over the labour ward that morning as our shift ended and we knew that one of our own was mourning and we had been unable to prevent it.
Christmas week passed in a blur of emotions and a mass of patients giving us barely time to breathe but still giving us enough time to ask each other “Why? Is it worth it?” It’s an internal discussion that we as midwives are all very familiar with and every time you start to think that maybe it isn’t, something else comes along to tell you that perhaps it is. Like the two babies who came into the world at only 26 and 25 weeks and against the odds, are doing very well. The patient who clung to my hand while she was anaesthetised for a caesarean section, terrified she wouldn’t wake up and so very grateful that I didn’t leave her. Or even just the patient who I gave a pain relieving injection to who sang drunkenly through the last half of her labour. So as we start our new year by delivering the first baby in Scotland we pick each other up and carry on regardless. It doesn’t always make sense. It isn’t always fair, or happy but there isn’t another job quite like it in the world and despite those extreme highs and extreme lows, we’ll keep on catching babies.

Thursday, December 4, 2014

Catching Babies: Babies Having Babies

November. As the holiday season rolls in we start planning for staff parties which always end in carnage of the alcoholic nature. No one knows how to blow off steam quite like the emergency services. Throw a Christmas bauble at any party night in December and you will almost certainly hit a Nurse, Midwife, Doctor, Fireman or Police Officer. We spend most of the year throwing our hearts under the feet of the general public and when given the excuse to throw off our public persona we do it with just as much passion.

Meanwhile in the labour ward the younger generation has also been throwing their passion around and every second person who comes screaming through our doors (usually quite literally) is barely a teenager, let alone an adult. I find pregnant teens to be some of our most challenging clients. Take all the hormones of youth, throw in some pregnancy hormones, immaturity and a healthy dose of fear and you have a situation which brings as much sympathy as it does aggravation. It always makes me sad that these girls and boys are having babies when they are babies themselves in most cases. These girls bodies are often just not ready to push out a 7lb baby when they are fourteen or fifteen and the pain and terror when they go into labour is really hard to watch. They just don’t have the maturity to cope with it, never mind the actual raising of a baby. It can be really hard to calm someone down when all they want to do is scream, cry and shout for their mum. And if you think it’s hard to get a teen to do what you ask in everyday life then try doing it when they are in pain. Even when you tell them it might mean the health or life of their baby their first thought is often only themselves. It’s almost always a battle of wills that leaves you exhausted. I feel even worse for the girls’ mother’s when they come with them to the labour ward because it must be so awful to watch your child in pain like that and know there is nothing you can do to help. Sometimes, in those scenarios we find ourselves looking after their well being as much as that of the patient or arguing with an overwhelmed parent over management when they only see their child in pain or sick.

This week I looked after a 17 year old girl whose waters had broken early and was showing significant signs of infection. The baby was breech and the doctors decided the only option was to deliver her by caesarean. It was a challenge trying to explain to a young teen why it wasn't a good thing that we had to deliver her baby two months early and try to get her to understand that the baby might have significant health issues for the rest of its life as a result of prematurity. Then to manage her as she woke from a general anaesthetic having had caesarean section, confused and in a lot of pain. Knowing she had no idea what was in front of her. She sobbed in pain, groggy from the morphine, clutching her 17 year old boyfriend’s hand while the paediatric consultant explained the condition of the baby in ICU. I met the eyes of both of their mothers over the bed and saw the knowledge in their eyes of the hard road their children had to face and my heart hurt for all of them. I hope that the cautious optimism of the consultant is well placed because both the new parents were going to have a lot of growing up to do, very quickly. 

Bring on that Christmas party because I have a serious need to let my hair down and get involved in some alcoholic carnage.

Catching Babies: Doctors and Nurses and Midwives…oh my!

Ah October. The temperature drops with the leaves on the trees, rain washes in, the wind blows harder and the nights get darker. The delivery rate has dropped and we all take a big sigh of relief. And, this October at least, half the hospital staff decide it’s time to have a baby. Truthfully, I’ve been away for most of this month doing my other job so it seems to me that the delivery numbers have gone from OH MY GOD to OK THEN in a blink. I missed the gradual decline. Now it seems that every second patient is a nurse or doctor, this is unusual. It’s like nine months ago there was a party I wasn’t (thankfully) invited to or that the staff newsletter had a two for one offer on maternity care.

It’s probably wrong but looking after someone with any kind of medical treatment is on my list of Things I Don’t Enjoy Doing. Nowhere near the top mind you cos this job has certainly introduced me to many, many things that I don’t like doing. They are hard work, no matter the speciality they work in, in fact it’s worse if they haven’t done any training in maternity. It makes everything you do that bit more fraught, from putting in drips to taking them to the operating theatre. It makes you anxious in case you screw anything up because they are mostly going to know you screwed it up, this adds to the pressure of making sure everything goes well. Then there is the knowledge factor. They know just enough to think they know enough. Maternity is a speciality, there are differences. Losing 500mls of blood when you’re pregnant is different from losing 500mls of blood at any other time. If you lose that amount of blood during any other time it’s a major haemorrhage. But there are also similarities. It’s really hard to reassure someone that they will be fine in those circumstances when they know the risks involved.

This month though, almost everyone behaved themselves while I was there. No major dramas, no big highs or lows. It’s been nice for a change that there was nothing especially memorable to write on this blog. The most memorable thing that happened was the night I looked after a woman in labour wearing a ‘dip me in chocolate and throw me to the lesbians’ t-shirt and her partner with the badly covered-up white supremacy tattoo and even they were no problem. Let’s hope the rest of the year proves to be as restful…but I’m not holding my breath.

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


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.

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.