Wednesday, July 22, 2015

#lifeofamidwife: To Teach

Perhaps one of the most oxymoronic aspects of my career as a midwife is my role as a preceptor. It is challenging- outright maddening quite often- but also a source of great inner learning and reward. I try to keep this in mind on the particularly rough, frustrating days when I feel as though I am barreling down a one-way street called Give.

I'm a midwife yet very rarely do I catch a baby. My hands are often not the first hands to touch a fresh new life- they guide and meld the hands of two student midwives as they create and hone their own skill. 

We had a mom recovering from delivery in one birth room, when another mom came in. This patient was a repeat patient of mine, who had had her first baby under mine and Glen's care. When her baby was crowning, I switched places with Mary, moving from between the patient's legs, taking the Doppler in my hand, and switching to the role of monitoring baby. Mary moved in to "catch."
The baby's head is at a full crown and mom's perineum at a full stretch. Mary is nervously touching the baby's head, as if giving a head massage, obviously feeling the need to do something with her hands. We (midwives) often speak of the importance of "sitting on our hands." It's easier said than done for some. 

"Stop," I quietly say, nearly inaudible. 

Mary is oblivious to me. 

The baby's head delivers, direct OA. Mary starts to apply pressure to the baby, gently downward on the baby's head as if to facilitate delivery. 

"Mary...stop," I gently and discreetly say. 

She reminds me of the many physicians (and  yes, even midwives), I have witnessed who apply traction immediately after the delivery of the head, expediting delivery even long before the woman has the next contraction. So many practitioners do this as a means to actively manage (the threat of) a shoulder dystocia, but what it inevitably ends up doing is the opposite. Facilitating delivery prematurely only increases the likelihood of an impaction, as the baby's Cardinal Movements and specific, intricate movements to maneuver through the pelvis are not allowed to be completed, with the baby being brought down into a non-ideal position. Further, it's common for downward traction to be applied while verbally instructing the mother to push even in the absence of a contraction, which is not nearly as powerful as when she pushes with a contraction. 

I see Mary in her I-feel-like-I-should-be-doing-something nervousness, and I think of this. I briefly make eye contact with Shelby and she cocks an eyebrow at me. We can read each other's minds without saying a word. "What in the world is she doing?" I know exactly what Shelby is asking. 

"Stop touching the baby, Mary." I outright, very matter-of-factly say. She catches herself and retracts her hands as if she has laid hands on fire. 

The baby restitutes to the maternal left leg, and with the next contraction, is born. 

These women are legit. It takes a special person to be a student midwife, yet an even more special one to work under Glen and myself. Our expectations are incredibly high, we don't allow room for excuses, and we don't hesitate to say what could be and should be better. If they stick with it, these women have the potential to be two of the very best midwives. 

Later we debrief from the birth- how it went, how we did, what could have been done differently...and Shelby and I make fun of Mary's nervous shenanigans. She's a good sport. We all joke that Shelby is the 'Golden Child.' The joke will be short lived, I'm certain. Soon Mary will be licensed and Shelby will be catching babies. I'm thankful that so far neither of them have flushed a placenta down a toilet or flooded a birth room. I can't think of any student midwife that would do that. ;-) [Reminiscing back to my apprenticeship...]

I think and laugh to myself that an apprenticeship is a special sort of hazing.