Progress in labour: not linear

Encouraging women through the last part of pregnancy and during early and active labour can be challenging. I realized some time ago, perhaps without this language, that it’s because linear progress is what makes sense to us. What, I’ve had a bunch of contractions and I’m not even 1 centimetre? Or, I’ve been labouring this hard and I’m only 5? But I was 4 centimetres 3 hours ago!

That’s because progress in labour isn’t linear, it’s log.

Getting from closed to 5 centimetres takes days or weeks. Getting from 5 centimetres to 10 takes hours or, if you’re lucky or a second time or more mom, minutes.

I shared this with a laboring couple a few years back, and the husband said, “So it’s the Grouse Grind.”

The Grind is a killer trail up Grouse Mountain in North Vancouver, dubbed “Nature’s Stairmaster”, and is not for the faint of heart. I haven’t seen it myself, but when the website says, “Keep in mind that there is a wide range of mountaintop trails that might better suit the average hiker,” you know this trail is NOT messing around.

So how is it like labour?

The trail is 2.9 kilometres (1.8 miles) with an elevation gain of 853 metres (2,800 feet). The base is 274 metres (900 feet) above sea level and the summit is 1,127 metres (3,700 feet). It has quarter markers, and here’s where it matches that labour curve: the first quarter seems the longest and is the least steep. The second and third quarters are very steep, and the final quarter is more steep than the first but not as much as the second and third. The average grade is 17%, the steepest grade is 56%.  

What’s more? You can’t go halfway up and change your mind. It’s too narrow and too steep to safely navigate down-you get down by a tram line.

From listening to people who have done it, some of the mentality sounds the same. There you are, plodding along for what seems like forever, maybe exerting a little, and then WHAT?!? I’m just at the one quarter mark??

Then the hard part starts. At times it’s so hard you forget what you’re doing and just put one foot in front of the other. Thoughts include, “WHY am I doing this again??”, “Are we REALLY SURE I can’t just turn around and go back?”, and “OMG THIS WILL NEVER END.”

Then you get to the summit. Turn in a different direction, and you see this.

The takeaway here? Your labour is more than just a number.

Also, at the end of it all, you’re up to your eyeballs in Feelgood hormones, you’re filled with accomplishment, and you’re surrounded by beauty. 

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Venturing back….

THUNK

*feedback squeal*

Taptaptap

This thing on?

Hi everyone! Just under four years since my last post, and wow, so much has happened!

The quick and dirty:

Moved to Victoria-my last few posts were from there-where I worked in a great practice with an amazing midwife.

Moved to the lower mainland a year and a bit later, where I worked in a great practice with a few amazing midwives for over two years.

Came perilously close to burnout. You know that thing where the universe gives you exactly what you ask for, and then you’re like, “Uh-oh”? That happened.

Went to Maui for a month, in part to arrest and reverse said burnout.

Started with a new practice, a collaborative, multidisciplinary team, whose model looks a lot like models on the US.

Also did locum work elsewhere in the province.

Went back to Maui earlier this year, got a CNM job in an OB/GYN office, and worked there for a few months.

I’m set to go back in the fall for six months. Meanwhile I’m still working at the collaborative care group.

I had a vision of being a six month resident here and there, just wasn’t expecting it to happen so quickly!

All this time I’ve had my blog percolating in the back of my mind. I use lots of storytelling in my care, and I’ve thought more than a few times, “Wow, I should really start blogging again.”

Last fall I went to a c section first assist course. That’s something I’ve done before, but certification requirements are such that the course I took in 2002 wouldn’t suffice. During one of the lectures I thought to myself, “That reminds me of an interesting story.” During a different lecture I had the same thought. Then I decided to start writing down other story ideas.

Guys, I came up with FORTY THREE things to write about.

That was in November.

It’s taken me until now to get here, but it happens when it happens, right? 

I may need to consider changing my blog’s name to “Nomad Midwife”.

I’m so happy to be back.

 

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Best description of a TENS unit EVER

“It’s like white noise for my body.”

Posted in Cool midwife tricks, Labour pain relief options | Tagged , | Leave a comment

Home labour induction tips

See what I did up there? “Labour”? I’m getting this Canadian spelling thing DOWN!!!

A while back I was, at a woman’s request, going through non medical induction methods. Near the top of the list was, “Have you tried fooling around?”

It’s not an evidence based suggestion, but hey, it’s fun, and besides, the couple is cut off for six weeks after the baby comes. Theoretically, anyway.

She waved me off and said, “Oh, we’re on it. For the past few weeks, in fact. We call it ‘basting the turkey'”.

 

Basting

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Self interruptus

Me at a recent home visit:

“OK, now that your milk has come in, the baby will probably nurse for shorter periods of time and sleep for longer ones. You’ll probably notice more cramps when he’s nursing, so make sure you’re staying on top of your ibuprofen, but know that it’s a good sign that all of your hormonal pathways are working correctly. You’ll also notice OH MY GOD YOU HAVE  CARDS AGAINST HUMANITY.”

“Yep,” said the new dad. “That’s our litmus test for whether or not someone gets invited back to our house.”

I stopped myself from asking when their next party was. I really need to just get this game and have my own parties.

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Only funny to Gen Xers

Hi everyone! I’ll get back in the swing of blogging nice thoughtful posts, as well as some deets of my past year, but I figured I’d start with a quick and cute little story or two.

A few months back I was finishing up at a home birth. The adorable and energetic two year old ran into the kitchen where I was packing up my supplies.

“STOP!” he commanded

His dad asked in his best Mister Rogers voice, “OK, Brandon, now can you say, ‘collaborate and listen?'”

He obliged with a bashful smile, though it came out sounding more like, “Cab ate an issen!”

He looked very proud of himself as I giggled helplessly.

And of course I had an ear worm for the rest of the day.

Posted in Funny kid stories, Funny stories, Home birth | Tagged | 2 Comments

I looked up and….

…six months? Really?

Well, yes.

I got here in late August, hit a speed bump with getting started, and have been trucking along since mid-September. Getting settled has been emotionally more difficult than I thought it would be. I didn’t think it would be easy, mind you, I just didn’t think it would be hard. Such is the outlook of an optimist.

I’ve had a few Facebook requests to the effect of, “PLEASE! Tell us what’s different! We want to KNOW!”

So here are a few:

MORE POSTPARTUM VISITS.

To all of my former patients: I’m feeling guilty for the years of one home visit 24-48 hours postpartum and one at six weeks. A few years back I started offering a 2 week visit just because I missed you and not because I thought it was medically indicated.

Here? Visits at day 1, 3, 5, and 7, AND at week 2, 4, and 6.

A sad point is that I don’t get to “keep” my patients after that. Here, midwives don’t do family planning, though it’s something the profession may add in years to come.

A happy point is an echo of my old life: We get to end our discharge visit with, “See you at the annual reunion party!”

MORE PAIN RELIEF OPTIONS!

In the US, the pain relief menu is short: narcotics and epidurals. Some hospitals offer water labor, and a few offer water birth.

Here, we have TENS units, nitrous, and just last month I did my first sterile water papules! (Geek alert: I’m linking to journal articles.) To be fair, sterile water papules are available in the US, I was just didn’t want to do it with no training.

(Us birthy types, of course, know that the REAL list of pain relief options is much longer: touch, massage, position changes, presence.)

So far none of my clients have availed themselves of a TENS unit, and I’ve used nitrous a few times. Wait, that came out wrong. A few of my clients have used nitrous. I had a small hand in getting it to them. Another time or two and I may be able to do it without help.

On a mundane, everyday note-like, REALLY mundane-I’ve had to get For Real about recycling. Also, all three areas of Ontario I’ve lived in for the past year have had municipally supported composting. As in, compost gets taken out on trash day just like trash and recycling, in municipally provided green bins with snap locks. I also got a cute little snap lock container for under my sink.

I’ve learned that I produce half a bag of trash per week, and I produce more compost than trash, primarily in the form of coffee grounds.

A few language things:

I haven’t picked up the “eh?” yet, though I did when I was in my clerkship. Not sure what that’s about.

Here, you don’t “call” people, you “phone” them.

A work specific language thing requires some background information. When we assess babies after birth (and the rest of the time under our care, of course), we count their respiratory rate and assess their respiratory effort. Grunting, flaring, and retracting are Not Good Things, each signaling that the baby is having to work a bit too hard to breathe. This is what retractions look like. The pertinent part starts at 0:26. Notice how the lower ribs suck in with each breath.

Here, it’s called “indrawing”. Not a biggie, but I’ve corrected myself a few times in mid sentence.

Finally, I have to pay attention to my spelling. Labour, not labor; favourite, not favorite; paediatric, not pediatric. As teeth gritting as I can be about proper grammar and spelling, this is something I need to be careful about lest I find the shoe on the other foot.

More to come!

Posted in I'm HEERE!!!, Labour pain relief options, Newborn respiratory assessment, postpartum care, Research | 1 Comment