Working on the knife's edge!

One thing, one of the many things, about my job as a midwife, is how close one gets to "the edge" on a daily basis when working on labour ward. Now in this entry I do not wish to frighten anyone away from labour, and for ladies to remember that billions of women through the ages have given birth safely and without hinderance, and God himself, has declared that mankind is to multipy and replenish the earth- and so as such, that women are built for birthing babies!

Alas, this does not take away from the fact that so many things can go wrong so very easily in pregnancy. Uterine rupture, postpartum or antepartum haemorrhages, cord prolapses, shoulder dystocia, maternal sepsis, eclampsia, babies born "flat", placental abruption, puerperal sepsis, fetal bradycardia's etc. However, a word to reassure, these emergencies are on the rare side, and I mean 1 in many thousands for the most part. The majority of women deliver without things going pear-shaped. I think though as a newly qualified midwife, these potential emergencies can play havoc with one's confidence occasionally. I was blessed, or maybe not blessed to not once come across a true emergency of the above during my 3 years of training (which goes to show how rare these obstetric emergencies are), and thus my concern was whether I would recognise an emergency in time to pull that "emergency buzzer". Would I see the turtleling of the vertex, or pick up on the mother's abdominal pain being different from contractions, or act quickly enough if a baby was born flat.

Blessedly, the first emergency I had, the co-ordinator was in the room when the lady "decided" to haemorrhage (PPH) on me, before I had worried that I wouldn't recognise a PPH, but gosh- there's no mistaking it, the sheer volume of blood which escapes a woman in such a short period of time, I knew most certainly that the emergency buzzer needed to be pulled to alert the Doctors to the situation. Women are robust creatures, even though the lady lost so much blood, she was still conscious, and if it wasn't for the fact that I could see copious amount of blood being lost, from the woman's behaviour, I would not have guessed for a moment she was haemorrhaging.

There are so many things to keep track of when caring for a labouring woman- especially if the woman's body decides to become high risk... can I advocate the MEOWS chart here for all midwives!! I didnt realise until the last week (after it was highlighted to me by the risk manager) that I needed to be keeping a MEOWS chart for labouring women, and filling that in as well as the partogram... gosh there is a lot of repetition in our note-making, but now speaking from personal experience, this really helps flag up women who are taking a turn for the worse side- those white, yellow and red alerts- really pointedly help one see that the woman needs reviewing! Temperatures, pulses, blood pressures, fetal heart, cervical dilation, position and presentation of babies, urinalysis etc etc, certainly is one heck of a list of things to keep on top of in the care of a lady. I love it when I get a nice low risk woman, I love my high risk woman for the sheer miracle that they are... but its so nice just having to listen in to the baby every 15 mins, and letting the women mobilise as much as they desire, without having to constantly readjust those blinkin toco's and transducers!

Its hard core is my job at times. Its scary and stressful at times. Its gross at times. Its tragic at times.

But I love it (at almost all times!). Because, I am in the business of helping babies be born!