#midwifelife

move to the midwest they said

Zwei Gründe verschlugen uns in die Hauptstadt Nigerias - zum Einen „Big Boss is coming back“ 🙌 und zum Anderen ein Auge benötigte einen Notpass 😂.

Durch den Vorfall mit dem Reisepass, mussten wir bereits einen Tag vor dem geplanten Trip nach Abuja aufbrechen. Das Erhalten des Notreisepasses war nicht so leicht wie gedacht und wir können nur sagen, es war uns eine Lehre des Lebens - „don‘t let anyone deal with your passport when you are not around“ 🙃.

Da unser „Big Boss“ einer der drei Vortragenden auf der Design & Health Conference in Abuja war, hatten wir die Ehre ihn als seine Auge dahin zu begleiten. Das Hauptthema war die Salutogenese, sowohl in der Medizin als auch in der Architektur. Die Konferenz war sehr spannend, da sie auch einen kritischen Blick auf die bereits wahrgenommenen Probleme geworfen haben.

Am nächsten Tag hatten wir noch ein Meeting mit einem Hauptverantwortlichen der für die Familienplanung in Nigeria zuständig ist. Zwischen dem „Big Boss“ und dem Herrn wurden weitere Punkte bezüglich der Familienplanung und deren Koordination zwischen Österreich und Nigeria besprochen – es klingt nach einem sehr interessanten Projekt 😃.

Natürlich gehört aber auch zum Arbeiten etwas Freizeit 🤗

I often hear women saying “I can’t do this!” while giving birth. Sometimes they are afraid, because they have never done it before and don’t know what their body is capable of doing ever so beautifully. Sometimes they have been made afraid, because of wrong choice of words from health care workers who, most often with the right intentions, tried to address risks and possibilities with them. Sometimes, they have a gut feeling something is not going quite right, and they are trying to save themselves and their baby from complications.

When women claim they Can’t Do This, the first question that should come to mind is why she feels she can’t. By just stating that “Yes, you can, don’t worry about it”, the problem won’t go away. Even in between the waves of contractions is a better time to find out what’s going on underneath the fear, than to bluntly dismiss their feelings and leave the room. I have guided multiple woman during childbirth, who at first really felt they couldn’t do it, and by talking to me about their fears they birthed their baby calmly and in rest.

And sometimes, the feeling of Can’t Do This isn’t said out loud but only suffered in silence. Dilation not progressing as quickly as you’d expect it to, baby not descending, mother in more pain than usual… with all these things, and more, it’s important to keep in mind that her mind may be filled with dark clouds of fear and insecurity. Be the person who helps her through it and make this birth a joyful experience to look back on.

"De niña nadie te dice que tienes un útero, y creces sin moverlo, sin sentir su excitación, su latido; ves a las mujeres de tu alrededor vivir con posiciones rígidas, sin mover la pelvis ni el vientre, sin ver ni vivir las pulsiones uterinas. No hemos aprendido a mover el útero, ni a sentirlo; porque con la inmovilización de los músculos que forman la bolsa uterina se pierden también sus conexiones neuromusculares. En algunas culturas, la rana era el símbolo del útero, que salta y palpita y se mueve, (por eso también los test de embarazo se llaman los test de la rana). En otras culturas se decía que el útero era un pez, por su manera de moverse. Estos símbolos expresaban la existencia del órgano; y por eso, a pesar de que el útero es interior y no se ve, era algo conocido que desde niña te llegaba: y podías relacionar esos símbolos con tus propias pulsiones.

Los músculos del útero, cuando no se utilizan se ponen rígidos, pierden elasticidad y funcionalidad; solo cuando te escayolan una pierna un mes luego hay que hacer ejercicios de rehabilitación para recuperar la funcionalidad de la pierna. Imaginemos lo que sería si tienes la pierna sin mover desde que naces hasta los 20 años, o si te tapan un ojo al nacer y te quitan la venda de mayor: tendrías el ojo atrofiado. Pues eso es lo que pasa con nuestro útero. Antiguamente la mujer frígida era la que tenía el útero arriba bien quietecito, y de ahí viene el calificativo de 'histérica' porque 'histérica' viene de 'hysteron' = útero en griego.

El parto con placer se produce cuando el útero se abre suavemente, relajadamente. Con cada latido los músculos uterinos se distienden, se aflojan y el cuello se va relajando y abriéndose, poco a poco, con cada latido que al mismo tiempo es una oleada de placer. En cambio el útero rígido que en lugar de latir se contrae con espasmos, produce dolor, el dolor del calambre, que es el dolor de las famosas 'contracciones de dilatación'. Filogenéticamente está previsto que el parto sea un acto placentero; lo que no está previsto filogeneticamente es que la niña se haga mujer sin desarrollar su sexualidad, con el útero rígido, espástico.

Leboyer, autor del libro Por un nacimiento sin violencia, habla de lo innecesario e injustificado que son los partos violentos de hoy en día. Los úteros pueden abrirse suavemente, con ternura, con un palpitar suave, como explica muy bien en otro libro: El parto: crónica de un viaje .

Hemos perdido el útero porque hemos perdido la sexualidad. Mereló-Barberá afirma que la mujer se socializa en la ruptura psicosomática entre la conciencia y el útero.Nuestra manera de vestir dice mucho de nosotras, con ropas ajustadas, sujetadores y bragas que nos separan de nuestro cuerpo. Las mujeres que llevan túnicas o chilabas van desnudas por debajo, están mas cerca de sentir su cuerpo. Pero lo peor no es vestir de cierta manera si no el creer que nuestras pulsiones y nuestros flujos son algo sucio, lascivo y pecaminoso. Te socializas sin saber de tu propio cuerpo, incluso sintiendo asco hacia él en algunos aspectos; como si el útero fuese una víscera más como el esófago o la vesícula."

So, on delivery suite a typical day (is there a such thing?!) goes as follows. I’ve included things from different shifts, all of which I’ve seen happen in a day - just changed slight things to ensure confidentiality.

0730- Enter the hospital bright eyed and bushy haired! Get scrubs on and attempt to look vaguely human for the ladies I will be meeting during the day! I’d love to be one of those people who could just get out of bed looking fabulous and glam- it doesn’t happen. So ladies, if you see me looking slightly worse for wear at this time - I haven’t been on nights, it’s just so early, ive tried though!

0745- shift starts, head into the office for handover accompanied by a tea trolley (that is the only accurate part of One Born! We only have them if it’s quiet, or during handover!). The co-ordinating midwife will go through the board and explain a little about each lady we have on the unit - parity, gestation, risk factors (if any), events during the pregnancy/night we need to be aware of and a brief rundown of why she is on delivery suite. It all sounds very formal - it is, but prior to handover beginning it is also a time to catch up briefly, this is usually the only occasion on shift everyone is together. We have moments of sheer hilarity, along with moments of sadness. This, however, all fades to the background once that door opens and we hit the unit!

0800- check instruments for assisted delivery (ventouse machines, forceps trolleys) and equipment for emergencies. I do this pretty much straight away. The one thing I’ve learnt from delivery suite is expect the unexpected. Always be prepared!

0815- check empty rooms for equipment which needs changing or stocking up, then potter around!

0900- Emergency buzzer - fetal bradycardia during active second stage. Phoned the registrar who is on his way. Mum not attached to CTG, gone and found CTG to ensure continuous monitoring and prepping for instrumental delivery.

0905- Bradycardia resolve Healthy baby born vaginally, no need for instruments. Mum and baby are amazing.

1000- Make sure meals are ordered, make up delivery packs.

1200- Check who can eat and give out meals

1300- Lunchtime!

1400- Asked to assist midwife with suturing - this entails opening things aseptically and generally talking with the women, trying to distract them from what’s happening! It’s a lovely part of my job!

1410- During suturing some clots start to come away, MW asked me to rub the uterus which was boggy and above the umbilicus (usually you’d expect it to be firm and contracted, below the belly button). Second emergency buzzer of the day! Consultant and co-ordinating midwife come in and begin the postpartum haemorrhage (PPH) protocol, giving fluids, giving certain drugs to try and contract the uterus down to stop the bleeding. I’m busy focusing the woman into me, getting her to concentrate on her breathing and focus on staying as calm as she can. She was amazing, so easy to get in the zone! I feel like I really connected with this lady. Bleeding resolved without needing any further input. The woman was fantastic.

1500- have a bit of a wander and see if there’s anything which needs doing!

1630- Emergency buzzer - fetal bradycardia, registrar requests fetal blood sampling (FBS) from the top of the babies head to assess the oxygenation and chemistry of the babies blood (a good indicator of how distressed baby is getting, lowering oxygen levels can cause fetal bradycardia). FBS failed, so because there is no reassurance avaliable and a trace which is abnormal, the decision is made to take the lady for a category 1 Caesarean section. Cat 1s are sections which need to be performed and have the baby delivered within 30 mins. It is sometimes called a ‘crash section’. Help the team round to theatre and tidy up the room, remove antenatal monitoring equipment and stock up on cannulas, inco pads and blood bottles.

1730- give out meals then go for my dinner

1900- A midwife has asked me to give breastfeeding support to a lady with a sleepy baby, I go in and strip the baby down, put him skin to skin with his mama and watch him latch himself on! Went on like an absolute dream, I stop in the room for a little while just to provide support and chat!

2000- A lady for induction has arrived so I show her to her room, get her some water, so her obs and check her urine. Everything’s lovely!

2015- prepare for nightshift coming in, tidy up and make sure trolleys are ready to go!

2030-2045 primarily includes waiting outside the office for handover to be finished! Go home and do it all again tomorrow!