I had a great clinic day yesterday. I am learning in a setting with five different midwives who are all fantastic to work with. When I got there yesterday, one of them had an IUD insertion for her first visit, so I asked if I could join in, even though I was supposed to be with another midwife. She said, "sure thing!" So we went in to consent the patient, and then had an easy and fast IUD insertion. Wonderful! I think that's the 5th one I've put in. The more I can do as a student, the better.
Then I went off to work with Midwife A. She's a really fun lady, easy to work with, and her patients love her. She was having a tough day. Something about a patient with fainting spells . . . but being that she was trying to get out of work, this somehow didn't seem quite as believable as it might under other circumstances. When I walked in, A was practically cross-eyed in trying to figure out how to deal with this client. One of the OBs was there, and they were discussing it. I'm not really sure what happened . . .
In the meantime, I took her next patient, a lovely woman who was transferring her care because she had just moved back to Washington after living in Italy for 3-ish years. She was there with her 2 year old daughter, a blond cutie who was quick to warm up to me. We had a lovely visit, doing an intake, which can take a long time. I really like long visits. I enjoy building rapport with women, learning about their lives, their medical and personal histories, etc. She told me her birth story - laboring for 3 days (really just 48 hours), and then finally having a cesarean section. At 9 centimeters! Bummer. It was an induced labor, and those always go more slowly and painfully - and I don't mean only pain in the true sense of the word, but figuratively, also. Poor thing. She wants to try to labor this time, so we discussed what that might look like. She mentioned that she got really sick of being pregnant last time at about 38 weeks. Not uncommon, but if she really wants a trial of labor, she'll have to be more patient this time! Waiting for spontaneous labor is always trying on one's patience, but it is the best thing to do if you want to have a vaginal delivery, especially after a previous cesarean section!
My next patient was a 6 week postpartum visit. Sadly, she didn't bring her baby for us to meet . . . but that's selfish on our part. :-) Her parents were visiting, so she left the baby at home with them, and with her two year old son. She seemed pretty sad. She said she'd been having some postpartum "blues" and needed some help. We talked about ways to take care of herself while also being a good mom and wife. Her husband sounds like he helps a lot when he's around, but has long working days. He encourages her to take care of herself, too, which is good. She's staying well-hydrated, but not eating much. She stopped breastfeeding after about a week because it "took too long." Her daughter is a slow eater, so she felt like that's all she was doing. Poor thing. I'm sure she's right, but the thing is that breastfeeding can help with mood by giving you good bonding time with your baby, AND by releasing hormones that make you feel good. Too late for that now. I just wish she'd known that. Anyway, she'd done some counseling the last time she had some blues during postpartum, so was happy to get referred for counseling. I hope she eats and takes good care of herself in the weeks and months to come.
Then I scarfed down some lunch in about 5 minutes!
On to midwife C for the afternoon. She's been a midwife for years and years, and has amazing experience and expertise. She's done home, birth center, and hospital birth over the years. Our next client was 36 weeks pregnant, just in for her weekly checkup. Her baby sounded great, and was head down. Her belly measured well. It was a quick visit. She asked about taking a birthing class, and said she wanted to try an unmedicated labor. Good for her! But, hmmmm . . . most of the time, women (in this country) take a birth class to learn some coping techniques, and do lots of reading, and more . . . but I guess that's not true everywhere. She has a friend coming to her labor, who can hopefully act as a doula, so I hope she does well. She's young and healthy! And the epidural is there if she needs it.
Side note: When I visited a friend in Saipan last year, I observed on the L&D floor while I was there. They don't offer epidurals to everyone. It just isn't done in that hospital. Epidurals are saved for cesarean sections, or other surgeries, not for normal birth. So women there did not have that choice, so they just labored. They just did it. It was SO DIFFERENT from the way things are done in this country, generally. Now, even at most small community hospitals, epidural is offered to almost everyone. This was not the case 20 years ago . . . or even just 10 years ago. There was something really nice about women just laboring. There wasn't as much fear of the process, either. I liked it.
My last patient of the day was a woman who had gotten pregnant accidentally while using her birth control pills continuously. Well, except for that week when her prescription ran out, and she didn't have any more, and then her husband came home from a business trip . . . she's 27, and excited about this pregnancy. Her history is fascinating, though. She was morbidly obese 2.5 years ago. She had high cholesterol, high blood pressure, and a bad family history of high blood pressure and heart attacks. (Her father had a quadruple bypass at age 40!!) So she was able to qualify and get a Roux-en-Y - a version of gastric bypass surgery. And she's down to 150 pounds - less than half of her previous weight! Awesome! But then, about 4 months after her surgery, she got a bowel obstruction, which can be quite dangerous (life-threatening) so she had surgery again. All better, except for some chronic pain from nerve damage done during the surgery. Pain killers were required, and then she became addicted to them. After a year or more, she went into an inpatient treatment center and got clean. She's just finishing up her treatment now, and will continue counseling for the next year or so. She's been clean for 6 months. And now she's pregnant! Pretty intense. Baby looked great when we did the ultrasound. Wiggling around, moving, pushing against the wall of her uterus - just having a great time. I hope mommy can work out her problems and make her addiction something positive, like being a great mother, or studying to finish her degree. I think this lady has lots of potential, but I also worry about her because she's been dealing with a lot recently. Best of luck to her!
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