Monday, September 3, 2012

Book Review: The Midwife of Hope River by Patricia Harman

Occasionally I get books from Penguin to read and review.  The books typically involve midwifery in some aspect.  I was absolutely delighted at the latest sending!  I've read other books by author Patricia Harman, such as The Blue Cotton Gown, and absolutely love her work.  Her newest book, The Midwife of Hope River, did not disappoint.

This fiction piece focuses on Appalachian midwife Patience Murphy.  Patience has come to midwifery in a roundabout way, having left her most recent job as a wet nurse, she meets an established midwife in the city. They eventually move to the Appalachians, on the run from political activism resulting in the death of Patience's husband.  Here, they find a population in desperate need of midwifery care.  In the midst of segregation, depression era conditions, and Patience's own fears and loss, she discovers a new chance at life.  She becomes involved in both white and black communities, tending to their childbirth needs, in conditions that I could never imagine working in.  She rediscovers a woman's capability and strength to overcome and triumph the harshest conditions, even falling in love again.

Being a midwife, I found the political climate and conditions shocking.  I couldn't imagine having to work under those conditions.  This book is easy to read, as Patricia's other books are, and I had to pace myself to not get through it in a couple days!  I recommend!

The Latest and Greatest

Have you missed me?  I've missed you.  So thought it was high time to write a damn post.

I'm still plugging away as a midwife.  It's been so wonderful to have my passion back for being a midwife.  I'm still in the same practice that is much closer to home for me and overall have been very happy.  There have been some struggles but I'm overcoming them now that I've been here for over a year.  The biggest two struggles have been the large religious population that comes to this practice and a midwife who was specialing lots of the patients.

Why would the religious crew be a struggle, you ask?  Well, I'm not a religious kinda gal.  I have a more alternative look about me which doesn't jive with this crowds' look.  I just don't fit it in.  So, I've had some issues with gaining their trust.  But, boy, once they birth with me, I'm their new best friend!  LOL.  I have mad labor and birth skills and I know it!  Just kidding....sorta....

What I've noticed about the crowd out here where I live is that, there's definitely this dependency vibe going on.  Once they have birthed with you - there can't possibly ever be another midwife who can support them.  Hence my partner (now ex-partner as she moved on to another opportunity) specialing so many women.  She had been there for quite some time and had built up quite the following.  It's crazy, cause they become so dedicated to their midwife.  So when my partner moved on, it was hell to try and get some of the women who stayed at my practice to give me a chance (and the other partner - who hasn't worked out very well in terms of fitting with the practice).  In fact, there were a few who decided to have the doctor attend them in labor instead of getting to know us two remaining midwives.  I don't understand that.....if you truly wanted midwifery care then why would you give that up so easily.  Then I realized that for some, it wasn't about midwifery care....it was about having a provider they knew well.  I have had to coach myself to not take it personally....considering that many never even met me!

My current remaining partner hasn't been a big hit....frankly, she was the doctor's choice, not ours.  She doesn't even know why she became a midwife....there's no passion or genuine love for midwifery.  It's puzzled me more than once.  I really like her sense of humor but I think there are some issues with her communication style.  I've now found myself being asked frequently to special patients.  What a 360!  I'm trying not to do it too much but it's hard sometimes saying no.  I have a greater appreciation for those struggles with my ex-partner (who I do miss very much even though her leaving has made a huge improvement in my satisfaction with my job).  So my current partner is moving away and it will just be me for awhile.  I'm excited but nervous as I've never been a solo midwife.  I'm hoping it doesn't get too busy and I get too overwhelmed.  That could potentially take a toll on my health.  We do have someone in mind for replacement but I'm not sure yet if that is going to go through.  If it does, it will still take a couple months to get her up and running.  I'm totally psyched for this midwife as I think she will be a good fit and I really like her.

Meanwhile, my old partner is lobbying for me to come join her at her new practice.  I'm torn about that.  I am so much happier being out in the sun now, instead of in the shadows.  Would I really want to put myself back in that position?  But on the flip side - her place has health benefits that would be very important to me and my family that my current practice doesn't have.  I don't have to worry about a decision now since they aren't ready for a new midwife yet.  But when the time comes, that won't be an easy decision to make.

On the personal side of things.....well, wow - lots of change there as well.  As you recall, I have a sick husband - he's doing quite well after having a LVAD (left ventricular assist device) put in earlier this year.  There's a whole other blog about all that sort of drama (that blog reveals everything about our real identities so you gotta give me a heads up if you want an invite to that).  But he's doing amazing and also still waiting for a heart transplant.  Our kids are their usual pesky and lovable selves.

So, last post for another 8 months?  Maybe.  Maybe not.  We shall see!

Friday, December 9, 2011

Hello? *echo*

Hello everyone....still here?

I've had a lot of changes since I was last here.  You already know I switched practices and that continues to have been a great decision.  My 'new' practice, aside from small bumps here and there, continues to be great.  It's such a nice feeling to work with doctors who actually care about women's choices and aren't jerks if the woman makes a different decision than what is being recommended.  It's a great feeling knowing that if I am worried about something that the doc I work with will come in, no questions asked, and evaluate.  We did have some drama from the third midwife.  After working with us for 2 months she took off and went to our competitors.  It was a tough few weeks for me as I felt very betrayed.  I struggled to get that damn knife out of my back.  But I got to a place where I was able to forgive and reinstate our friendship.

We have a new midwife that started recently - and she seems to be really working out.  She has a sense of humor that is like mine and we have fun working together.  I think she will be around for the long term.  She's a new grad but has been working for years as a L & D nurse.  This wasn't important to me but was important to the doc I work for.  We are getting her settled and I am thankful for the extra help cause it has been crazy busy.  I had patients come with me to my new practice plus patients already there plus all the great word-of-mouth plus my ties with the birth community.  Busy!

The nursing staff at the hospitals I deliver at are great, but very different environments.  Hardly any idiots at these facilities so very nice to not have those struggles.  They have been adjusting to midwifery care for a couple years now but with more midwives coming in and those of us who perhaps practice a little less medical, the staff have had to adjust a bit more but are doing great.

There's a practice whose docs are notoriously against any midwifery care, now hiring a midwifery service.  I guess they got tired of all the transfers to our practice :p  It's so hypocritical but yet, the more midwives in the area, the better!

I've become so lax in my blogging but am going to try to get back with it and get back to visiting other people's blogs!  I've missed the blogging community.

Tuesday, February 1, 2011

I'm Still a Midwife

When I last 'talked' to you guys I was contemplating leaving midwifery and had started to set some plans in motion. I was applying to school to do another specialty.

Since then, I have switched jobs! I no longer want to leave midwifery anymore :) I have a new position that is considerably closer to my home and far more supportive environment. I'm working with a wonderful midwife I have known for about 4 years. Even better, one of the midwives from the 'old' job will be joining us soon!

I miss the midwives but absolutely nothing else at my old position. Things had only gotten worse and I was thinking about taking up drinking - haha. I was gonna call it group therapy though.

I am still planning to pursue an education in another specialty, waiting to hear if I have been accepted. I feel like it's important to have a back up plan :)

Sunday, October 24, 2010

That Would Be a Good Post

I have had many moments where I have thought "Wow, that would make such a great blog post".

Like the time when a postpartum nurse called me to let me know that a patient's H&H was 6.something. So I ask for vital signs, previous CBC results, and symptoms the patient was experiencing if any. The nurse had none of these things readily available. Hello! You are my eyes and ears Nurse. You gotta give me some info.

So what's been going on? I'm burned out. That's what is going on. I'm so done. I'm tired of my employer and his idiotic and disrespectful management. I left the office an hour early one day (after insuring that someone else would see my last patient if she showed up). Now mind you, leaving early is a once in a blue moon kinda thing. I was informed a couple days later that if I did that again, I would be charged an hour of PTO. This tempts me to keep a running tally of all the times I stay late, work through lunch, come in to help out, etc. What an ass.

I am so burned out that I am thinking about leaving midwifery, or at least trying to find aother job. I would rather be a 'medwife' than deal with the struggle I am dealing with now. We are expected to provide the midwifery model of care in a medical environment. I'm so tired of all the fighting the fight and not really getting anywhere.

I am going back to school to learn another specaialty cause I am so done. I have worked as a CNM for three years now. I would have never thought I would burn out this fast.


Sunday, August 1, 2010

Ode to the Bestie

I just gotta say that my BFF rocks. She really pushes my intellectual boundaries all the time. Lovin' it! We are currently reading the same book together so we can discuss it as we move through the book. I've not ever done that and am really enjoying it.

Can't trust them multips

Had a couple interesting births lately. Both were somewhat complicated with risk factors, which always makes for some excitment :p Both were multips - one having her 4th baby and the other having her 5th.

The first lady came in complaining of bleeding. She was contracting with a good bit of uterine irritability. Was only mildly uncomfortable with her contractions. However, there was enough bleeding that it had ran down her leg prior to her arrival. She has a history of substance abuse and has been in treatment for three months. She had only a few visits in the office, poor historian, being confusing when giving her history. She did not have any of her previous babies, but was hoping to 'keep' this one. She didn't have any idea when her last period was so I only had a third trimester ultrasound for dates (which can be off by 3 weeks either way). She had been measuring appropriately for that EDD. Her exam on arrival was 2-3/60/-1. The baby was very active. By her EDD, she was 38 weeks (which means she could be anywhere from 35 to 41 weeks). After watching her for a bit (she was also having the occasional small variable but otherwise had a very reactive strip) then re-checked. She was 3-4/80/-1 with just a small amount of blood on the glove. She continued to be quite comfortable. I decided to just sit on her for the night and admitted for expectant management. I just felt very uncomfortable with sending her home. Her UDS was negative btw.

Eventually, she got uncomfortable and asked for an epidural at 4/90/-1. She putzed along. Hours later she was 6/90/-1 so I broke her water figuring we were pretty committed at this point. She continued to have periodic bleeding that was always just a little runnier and heavier than normal show. She progressed to 8cms fairly quickly but then kinda stalled out. We flipped her from side to side and she eventually arrived at 10cms with no further intervention. She began to push once she was feeling the urge to do so. She took a good half hour to push the baby out and baby came out screaming covered with a small amount of bright red blood. I expected to see evidence of abruption on the placenta but none was apparent except for a sort of thrombosed vessel at the placental border. Not sure if that was the source of bleeding or what. No lacerations were evident. She was absolutely fine afterwards.

The second lady was being watched very closely due to suspected chronic hypertension. She'd had this issue with each pregnancy and a possible abruption with one previous pregnancy. She would have elevated BPs prior to 20 weeks (which means increased likelihood of chronic hypertension as pre-eclampsia doesn't present prior to 20 weeks). We were treating her with medication for her blood pressure. She came in complaining of contractions, just barely shy of full-term (37-42 weeks). She came in requesting an epidural with an exam of 4/50/-3. She got her epidural and then after a few hours went by, no progress had occurred.

The head was too high for rupturing her membranes so started pitocin instead. I broke her water a couple hours after that, her being 4/80/-2. She took off after that. By 2 hours later she was 9cms. We had just enough time to finish a delivery in another room :p

When I checked her she was 10cms but still very high so even though she was feeling some pressure, I suggested lying on her side (Nurse Crappy was the nurse assigned so you know how that goes!) to let the baby come down on its own. 5 minutes later, it was time. The delivery was great the baby just oozed out on its own. I had dad literally catch. It was awesome to watch!

So you would think that women who have had several babies would just spit those kids out. but not always! In fact, once you get up into 5,6, or more kids, the possibility of complications and labor dystocia increases :p

Thursday, July 29, 2010

Jacuzzi Tub Rationale

I admitted a patient with ruptured membranes, first baby, early labor in the middle of the night one night. I wasn't heading in yet to do labor support as the woman was very early in the labor still...but she was laboring. I left orders for expectant management and to call me when she was a little further along. Apparently the nurse didn't want the woman to get in the tub until I arrived because the head was very low in her pelvis. That's the best rationale I have ever heard to not allow a patient to get a tub. Really? Really.