Gorgeous. Reaffirming.

My credentialing at the hospital should go through in the next few weeks, and I'm working to actively prepare for my first shift back in labor & birth since integration ended in March. Again reviewing some journal entries, and wanted to share the one below. Happy Labor Day to all workers, to all laboring moms, to anyone whose life feels laborious at this moment - just keep pushing through!February 20121. Never turn your back on a multip pushing.2. One of the midwives I worked with this week spoke about midwifery as a marginalized profession, which puts us at higher risk for health problems, depression, stress/anxiety, etc. This week I really experienced what that means, in terms of our group as a marginalized profession in this setting and its impact on myself and other midwives in terms of our stress, anxiety, and isolation in practicing the type of care we believe in for our patients. She spoke about the average length of time a graduate spends practicing in midwifery as ten years, and how few of her classmate’s were still practicing now. It also says volumes about how many midwives I know who are divorced, how many midwives in this setting are looking for other jobs, and much older I feel after two months at this location.3. Preface: during morning rounds, the Attending mentions how he wants to deliver his own patients today because he didn’t make as much money from the cesarean "pool" last month. Speed forward: Our primip patient, without pain meds, wanted to walk around. She had slow progression after 7cm. We initiated IA, and had hours of her strip showing a Category I tracing. An Attending with whom I have had a great experience in the past asks me if the patient in Room 1 delivered. I said no, she’s still laboring. He asks if I know the patient isn’t on the monitor. I responded that she is up and walking around and we are doing intermittent auscultation. Attending looks past me and asks the midwife I’m working with if she knows that the woman isn’t on the monitor, she says that the patient is up and walking around and we’re doing intermittent auscultation. His response: “Is that something new we are doing around here?” Then tells her to go break the patient’s water. With risk reduction in mind, the midwife and I go into the room to break her water and labor sit with her for hours, to stay out of the way of the Attending. The midwife says that all of our moves from now on have to be careful, to ensure that we don’t give the attending any reason to section her, which is clearly the only thing on his mind. The woman stays on the monitor the entire time with a beautiful strip. A very, very slow birth of the head, lots of perineal stretching, amazing. The nurse asks why we aren’t cutting an epis, and the midwife mis-hears her and thinks she has asked if we want to help the woman pee, and gets me a straight cath.  Beautiful delivery. The Attending is outside waiting at the board, carefully watching all the EFMs, does not look at us. If we had any other patients, or if there had been any decels, even during pushing, or if her cervix had taken any longer to dilate, she would have been sectioned, vacuumed, cut for an episiotomy… all because he wanted more money. The strip was beautiful the entire time, she was just a primip in labor. My faith in labor was challenged, and not because labor wasn’t going as expected.4. Next morning, same Attending on, a woman admitted in active labor, multip, wants a natural birth and to walk around. We have her wait until 8am for the Attending to leave. I turned around to put on gloves and the head was almost completely out. Mom grabbed her own baby, brought him up to her chest, rocked back and forth crying and smiling. Gorgeous. Reaffirming. Scary that those kinds of births are taken away from women every day.