Oh, and...

The school, of course, couldn't just let me graduate without some drama. A scant few weeks before the licensing exam, already having paid the fees, and with a "you need to repay in full if you can't be there" notice on my fridge, I get:

"We can't officially graduate you and release your transcripts until..."

Well fuck me, you don't say? I am pretty sure that I, in fact, have to do next to NOTHING on that list. I read my handbook and can quote it. And I did, with only moderate amounts of snark, which got me out of some but not all of the things on their list.

The easiest thing is to roll over, do as I'm being asked, and watch the red tape dissolve. My preceptors think I'm ready for practice (are referring a few people to me, actually) and are interested in making sure I can take exams and get licensed on time; they've humored the school in providing a second set of evals just two weeks after their last set (what do they expect to have changed?), and working with me to be able to sign a few things that if the system worked as it should, my program coordinator would be signing for me.

There are several reasons this pisses me off:

- We had a check in last quarter that made it sound like I was about done, and said NOTHING about several of the items on that list.
- Some of those requirements aren't in the handbook, meaning that they AREN'T requirements and the school has no right to hold my transcripts while they wait.
- In fact, the school has no right to hold my transcripts AT ALL. The state needs transcripts to show that I've done the coursework, they don't need my graduation papers for me to sit the exam, just before the license. The school is effectively holding my papers hostage. The transcripts are mine. That can't be legal.
- The NARM skills checklist - a 22 page long list of things our preceptors are supposed to sign off as we master - has a "safety" where if you don't manage to do some of the skills, the program director should be able to see that you've covered them in your coursework and sign you off. Which the program director is REFUSING to do. This is not OK, it really isn't. Why say you have that safety there if you don't? There are skills on that list that I'm not going to get to do. My preceptors can sign off after we review and drill; but this is something that the program director is supposed to be able to do, since we reviewed and drilled in our courses. So why not fucking sign? I passed those parts of the curriculum. I thought that was the stated reason for the hefty curriculum at this school; so that we have knowledge that we need when we encounter those things that aren't so common, that we'll not see in our practicum. Why are they being such ASSES about signing it off? I have all of 3 things left. My preceptors haven't seen me do them any more than the program director has...but my program director, unlike my preceptors, has access to my exams and course work and could verify that I know what to do. I don't get it. It feels like making life hard just for the sake of making life hard. It feels, again, like holding my papers and transcripts hostage.
- I have to do a fucking EXIT INTERVIEW before you'll release my transcripts? Again, not in the handbook. Those documents need to be at the state office...and you're telling me that I need to do this, oh yeah, and you're going on fucking vacation next week? I think fucking not! I need more notice than "do this or else, oh yeah, and it will be extraordinarily hard to do this and you don't have enough time."

Until this point, I haven't had issues with the school largely because however much asshattery I encounter, it's been forewarned in handbooks or at some point in our education. BUT NOT THIS. This is NOT OK. Setting us up for failure, much?

Yes, I'll get it done. Yes, I'll be OK. That isn't the point. The point is that I could very easily NOT have been able to, and I wouldn't have had the warning I needed to ameliorate that. The school has told me over and over again that I'd be able to take the exams in August. THIS IS THE KIND IF SHIT I WAS TRUSTING THEM TO TELL ME ABOUT, and they don't even have the "it was in the handbook" excuse, because it FUCKING WASN'T.

Mad, mad, mad.

Car Dramaz!

I thought, yesterday as I went in to clinic, that I'd just do a quick couple of visits and leave in time to see my Fran off to work (starts at 1pm). I sweated my way through clinic; in Washington the temp was over 100 yesterday, which is truly exceptional here, and the clinic building (typical for Washington) has no A/C and was, effectively, a solar oven. I walked out to the car thankful to be gone during the hottest portions of the day.

And it didn't start.

Crap, crap, crapcrapcrap.

As I sweatingly encouraged the car to start *with the force of my will and strong words* I got several offers of "I don't know what I'm doing but can I help?" which were of course not helpful, and which caused in me an irrational hatred (I said it was irrational) of those not-terribly-helpful people and their terribly-functional car A/Cs.

What else could I do? I called my man to help. That's what we get married for, right ladies? Kinda?

He got to the clinic at about the time he was supposed to get to work, all three kids in tow. He succeeded in starting the car, which ran limpingly (and stinkingly) in the parking lot, and as we were about to caravan our way to the mechanic, the office manager ran out "[client] is pushing! [midwife] is coming, be ready to jump in her car!"

Of COURSE after a week without a birth *this* would be the moment!

I left my husband with the car problem, the kid problem (erm, they're in a parking lot at 105 degrees, and I can't even say it was a dry heat), and the not-at-work problem, and ran off...we figured there would be a baby, I'd be gone 3 hours total (how long it takes to catch a baby, monitor everyone for complications, clean up, and leave), so maybe they could just wait for me?

Our mama/client/patient was not pushing when we arrived. She is a wonderful, wonderful person, and I don't hold that the least bit against her. It was just inconvenient.

She birthed in a home in the shade, which was about 20 degrees cooler than the clinic building for most of the day. That bit was at least a little convenient.

In the meantime, my family went to several air conditioned establishments in the Olympia area, spent too much money on purpose (which my husband tells me was a twisted act of passive-aggressiveness) - too much money being $50 all day, at this point.

To make a painfully long story short, they spent 10 hours in Olympia, a baby was born healthy if a wee bit early, Fran got the car running AGAIN as I came back to the clinic, and we dropped the car off at the mechanic's shop at the bright and early hour of 11:15 pm.

---

So, a few words of not-explanation?

I don't know what to do with this blog anymore. I wrote a lot when I was staying at home and writing kid-foibles. I wrote a lot when I was in Vanuatu, and had no need to worry about anonymity.

Last week I went to three births in 24 hours. Which is something to write about, except that it isn't. They aren't my stories to tell. They are significant in my life, yes, but in many ways it has transitioned into being what I do. It feels odd to say it, but birth is my work, and you wouldn't write about the minutiae of your work day either. The interesting bits aren't mine to tell, and (darn those federal privacy laws - kidding, really, it's an ethics thing) this isn't a protected space to talk about anything that could identify anyone, which in my community is pretty much anything at all.

I am tired of being broke, and ready to stop being a student. That much hasn't changed.

Approaching licensing, I feel anxiety. My preceptors believe I am ready for independent practice. I know that I can handle independent practice, and yet, I'm scared of that responsibility. In that way, being a student is a sweet deal; there are some people that are more my clients than my midwives', but if I did something wrong they'd be there to either catch it or take the blame. Not that I do wrong things, just that there's a safety net there that I'll be going without shortly.

I also feel anxiety about starting up my practice and money. I've been whining about money a lot, I know. We are at a place we've never been before, without enough money to pay our monthly expenses and at the end of our credit limits on our credit cards, scrambling to figure out how much we can charge on which cards to pay whatever car repair expense we need to pay. And starting up a business costs money. A medical business more than most; I have equipment to buy, yes, but I also have malpractice insurance to buy and in this state, you pay for a year in advance...and I don't have that money. I'm taking this thing one step at a time, because I can't just make money appear so I can't do anything differently. At the end of my student time, I'll probably need to find paying work that isn't my profession, so that I can make enough money to start up. Which is galling, because once I start up I'll have money. Business loans are next to impossible to get when you make what we do and have as much debt as we do. Funny how your school loans count against you for that.

I didn't mean to start whining about money again, but there it was. I know a few people who are students are reading this. Hopefully in a year my song will be different. Right now things are difficult. I'm not burnt out on midwifery, I'm not soul-dead from my student-hood...but things are difficult in this transition time.

Where's the Calm?

I think I just have to face it...I'm not done with practicum yet. Technically I am, but there's this pesky contract, so last month I still averaged 40 hours of clinic and birth work per week, without counting drive time (and the occasional day stuck in Olympia just because it costs $15 to make a round trip home, and I'm not doing that even if it means I'm stuck without anything I really *want* to be doing for 4 hours...I have escaped, from time to time, into a fiction book at a park). And then there's fact that I don't really WANT to pull out of practicum early (on time? before my contract ends, either way), not when every new thing I see there is one more new thing I don't have to do solo later.

I honestly don't know what I'm going to do with myself once my clinic obligations are over. Imagine whole weeks stretching in front of me without the structuring influence of clinic time, or even *gasp* being on call. Any way I start up, I get at least a month with absolutely nothing structured for me. THAT is a crazy concept.

This week, I have reaffirmed that I detest prelabor rupture of the membranes. Stop sending that scenario my way, please. Enough hospital transfers with nonexistant labors. Enough prodding women who really, if they weren't ruptured, we'd tuck into bed and see a week later in actual labor. This phenomenon is seriously getting on my nerves, and I harbor no illusions about it disappearing when I've set up my own practice. I just dislike it. A lot.

Despite all of this, I have rediscovered fiction books. Or the fact that my library has them and can order more of them. And the fact that I read quickly, after all, something I'd forgotten in the haze of TRYING to read hundreds of pages of very dry text every week.

Also discovered that the weather still dislikes me, at least a little. Yard sale day dawned with lots of thunder. Not a lot of rain, but effectively chased off the (not so big) masses. And off to Goodwill we go, 'cause I'm not into hanging on to this stuff.

Three

Three births this week. Some drama at one of them, but it all worked out in the end. It would have been four, but I put myself off call to do some babysitting and missed one.

So much for slowing down after graduation, eh?

Yesterday I mailed out very-slightly-belated thank you cards, put checks in at the credit union, and promptly withdrew a largish cashiers check to pay NARM for the privilege of taking their licensing exam.

We are, this month even more than in the recent past, finding rent at the bottom of our pockets. I am looking forward to getting paid for this work at some point, and wondering if I'll have enough money to continue paying for gas to get to and from clinic in the meantime. I'm tired of it all, and at the same time, aware that I'd miss it terribly if I stopped. I think that it is more that I am tired of the pace than that I'm tired of what I've been doing, if that makes any sense.

Closed

I turned in my senior paper today, two copies neatly aligned in their binders, ready for cataloging.

This morning, I presented to a mercifully small audience, all of whom were familiar to me in some fashion or another. The presentation went smoothly. I'm happy with how it went, for the most part, although there was one question asked in the Q&A that I misunderstood at the time and could have answered much better.

For once I am not sitting on pins and needles. I know I have passed.

There may be little red-tape spiderwebs hanging unexpectedly in the corners, but I'm walking over the bridge and graduating tomorrow.

Moving from juggling children and school and clinical placement, to juggling children and business tasks and my own clinic. I'm not ready to face that, quite yet, although my preceptors have been encouraging me to. I don't know how long I'll need after this placement is over to feel human again, to be ready to retool myself as my own midwife. I expect it will be short, and don't want to be sitting around twiddling my thumbs and waiting for the papers to go through when I'm ready to go.

The births last week were gorgeous. Healthy happy moms and babies in clinic earlier this week, adjusting to their new lives together.

I'm looking forward to the deep, deep sleep of the not-on-call tonight.

The numbers are DONE

Two births in the last two days, and my primary birth requirement is DONE.

This is a good feeling.

Technically, we have a 60 birth minimum and I'm hovering just under 120. I don't think 60 would have been enough to be competent.

I'll have a busy week next week getting my last few things checked off for school.

I have a couple of clinical requirements that remain unmet, but when I look them over, the list is mercifully short and won't be difficult to polish off.

The need to finish off the senior paper and prepare it for presentation looms large in my mind.

Still no more babies

I was hoping for an overnighter over the weekend. Tonight wouldn't be bad either.

Awaiting a couple of multips who live faaaaar (one of them about 2.5 hours straight out my door to hers) from my house. Oh so totally not excited about the driving. Give me some clients out my way and I'll be a happier student-midwife-thing.

Submitting my application to NARM soon, once I can scrape out $700 to pay the exam fees (scroll down, reference earlier rant on the ridiculousness of that fee - yes this is in addition to the state fees, which are already paid). They've got us here, pay or no license. Additionally, it needs to be in the form of a cashiers check or money order, which makes me nervous. I know NARM is legit, it's not that, it's sending a (for me) big already-taken-from-my-account check through the mail that makes me upset. I'm not understanding what all the bother is about with refusing personal checks, either, since they can always just hold their approval until the check is cleared. And I think it's easier to counterfeit a money order than it is to get a personal check through and rescind it (I did business on ebay, remember, I haven't tried any of this personally but it's aaaaaaalllllll been tried on me).

I think I'm rambling. At least I'm posting, right?

I did my first solo suturing/repair job on US soil last week. I was pleased, my preceptor was pleased, the woman was pleased, I feel really good about it. This was one of the few remaining skills on my checklist (overseas preceptors can't check you off, which I think is really inconvenient but makes sense since they didn't really look at what they were signing). The rest I probably won't actually get to do. I don't imagine I'll be manually exploring any uteri, for example, until that moment when there is no more experienced midwife present and I just need to do it. Like all the other skills before it, there will be the need and it will happen, and I'll have done it.

Can't Complain

Seriously, I can't.

I have lots that I COULD complain about.

But it can't really override how happy I am to have warm weather, sunshine, visiting family, and a *very short* time until graduation.

Happy, happy, happy.

Happy, happy.

Happy.

And in case you didn't notice, happy.

A great birth on Thursday night, and then straight to school for some seriously pointless class time (happy to see my classmates, though, which I always enjoy!). Pointless as it was, there was a nice walk involved, nice visiting time, and I got a few more pre-graduation things off my checklist.

I think the knowledge that all I've really got left is my senior paper is really nice. I have only two weeks to finish it (a little less, actually), but it is almost there and I'm sure it will be fine. Our topics this year are really boring, so I don't even anticipate a lot of people at the presentations.

Off to something fun today. On call as usual, but das' ok.

Jumping the Hoops

The check to the Department of Health did not bounce, thanks to a very-appreciated infusion of cash from my parents. <3 I love you Mom and Dad! Your little note made me feel so good it's hanging above my dresser for a bit, too.

I got the graduation invitations in the mail today, so they'll be heading out to all my peeps tomorrow. Some of them will get hand delivered, as there is a serious lack of notice issue going on here (grad is in just 3 weeks!).

The house has been hit with some sort of mini plague that seems to mainly involve annoying coughing and really pissy children. They'll get over it eventually, I'm sure.

I've been attempting to wrap up the senior paper, to move that off my checklist; this endeavor has been only semi-successful, since I don't really want to think about it anymore and since sunlight and gardening beckon. If only I could write the damn thing with my subconscious while I did more interesting things with the rest of my brain. That would be some serious multitasking right there.

Despite the fact that I'm approaching graduation, my to-do list grows paradoxically longer. Argh.

The stars aligned and births happened in their time last week, and this week we rest, or so it seems. Since there is someone in dates, I'm not technically off call. But it felt good to have the board relatively clear.

Just one birth this week, and not as a student; I watched a good friend catch her own baby. It was the most amazing birth I've ever attended, and not just because she was my friend. Much love to her and to her baby, as they babymoon now.

Thankful

Thankful for friends who watch my kids on little/no notice.

Thankful for grandparents who spoiled Boyness yesterday :).

Thankful for two births far away on the same day, saving me many hours of driving.

Thankful for sunshine on my patio, growing tomatoes, and happy children running amok in their pjs in the early afternoon.

Wishes, and scattered updates

My wish this week is that I could schedule babies to come on my husband's day off. Or while I'm already at clinic. Or during the night. Just not in the evenings, basically. At my old site we had this great thing worked out (not sure what kind of magic this was...) where my preceptor would call about 5 minutes before my husband got home from work for the night, and I'd get home before he left in the morning most mornings (he'd shuttle the kids off to a prearranged location if not...mornings aren't a big issue for us). The problem is that he doesn't get home until 11. Who the heck wants to watch someone else's kids until 11pm, if I can't get them in the meantime?

It would be way easier if I could tell babies not to come (or be in the process of coming) between 6pm and 11pm.

There are also too many people postdates or needing to have babies soon, and I am a bit apprehensive that there will be a bad scene involving multiple births at once. And I keep telling my preceptors that my student midwife friend's birth is where I'm going if there is any kind of conflict, but I'm not sure they quite believe me. They have the link to my blog, and if either of them is reading: I'm serious. That's where I'm going.

I need to cleanse this negativity and work my way back into a place of knowing it will all work out. Which somehow, it does. Two discouragingly long births with hospital transfers back to back last week, and a bout of illness, and my mood has tended to the depressive for a few days. It'll swing back into balance.

In other news, there is another student at my site now. HALLELUJAH. *see the relief emanating from my body* less clinic *see the happiness*.

My preceptors seem to think that they are entitled to the number of hours I was putting in before the arrival of the second student, and have decided to give me some "projects." Maybe it was the look on my face, or maybe it was always their intention, but the projects are thus far things I'd need to do for my own practice anyway. And totally things I can do at home. I don't care how much I need to do at home. I just want to *be home* sometimes.

(Money rant ahead...no worthwhile text in the remainder of this post...)

I mailed in my midwifery license application yesterday, complete with a check that I don't have money in the bank to cover. Ack! This process is SO expensive. And we wonder why more low income women don't become midwives. Seriously, DUH. It is hard to come up with this much money. THREE TIMES what I was paying for rent during most of my studenthood. OUR MONTHLY INCOME. This money is not easy to come by. Why is that so hard to understand, oh people-who-sit-agonizing-over-why-more-women-don't-do-this? At this point we HAVE to come up with the money or it has all been for shit, but damn, it's not even about not having this kind of money "laying around," it's about living paycheck to paycheck with less than a tenth that money left over every month for "nonessentials" like car repairs and kid shoes.

In short, *NARM THIS IS YOU* where the hell do you get off charging that much (ahem, $700 test fee for student midwives WHO HAVE YET TO MAKE ANY MONEY AT ALL) on top of what we're already fucking paying the state, who at least has an excuse (this is the only time they get money out of us and they need to administer the program)...AND THEN COMPLAINING THAT MORE MINORITIES AND LOW INCOME WOMEN AREN'T MIDWIVES.

What. The. Fuck.

It must be easy, those-who-set-fees, to be in a position of relative financial stability and say "oh, they can come up with that money, they have time to prepare." Yeah, when? While we're racking up student loans with no pay? While we're demanding our spouses refrain from taking overtime, and stay home with the kids some days while we're at marathon births, not earning anything? While we're expending massive amounts of money to commute ridiculous miles to clinic and more births than we'd ever DREAM of doing in a month in our own practices? WHEN, WHEN, WHEN are we supposed to be building up this money?

It's all bullshit. I don't know how I'm getting that money into my account. I just know I have to.

It's funny

How doing way too much clinic can make an onsite week seem like a walk in the park. And allow a few literal walks in the park, too. I missed just one birth, someone who wasn't particularly attached to me (I like her, just don't have any special connection).

Fighting off a UTI and hoping that the weekend is easy on me.

Meanwhile, last week we challenged (dairy-allergic) boyness with a milkshake after 4 years of dairy avoidance and 6 months since his last exposure...and he didn't react. He turned around and told his Nana that he didn't react, who went ahead and overdid the dairy. And now this evening I can't tell if he's acting like a little ass because he had many dairy things to eat or because he just came back from his spoil-them-rotten-can't-say-no Nana's house.

He is not the only child to get on my nerves lately. It has taken Girliness three days (not counting the sleepover days at Nana's) to fold *one load* of laundry and get it out of the living room. I don't need that shit. Just fold your laundry, Girliness, and we can get down to the fun parts of our lives.

The wrap-up post

This is the wrap-up post for the Vanuatu trip. You know, the post I never wrote, and now feel the need to include in my blog, here a month and a half after my return. The one where I muse on all things going-overseas-for-clinical-rotations.

I'm still not going to do it, not really anyway. If you want to know what it is like, read the rest of the saga, it is fairly complete.

You should also read T's blog, which is fairly complete as well, and has more pictures than mine:

http://farawaybabies.blogspot.com/

Her experiences coincide with mine, but many times we were either not present for each other or were solidly sitting in separate roles even while at the same birth.

---

I would do it a again. I gained so much from this.

I don't feel bad about invading someone else's culture/space/whatever, an objection that I understand but didn't see as some big deal here. I didn't go as someone totally clueless, to make mistakes; I went as someone almost ready to start up independently here at home, in need of experience, and I gave good care in a place where it was very much needed and appreciated. Neither did I go to change how things were done, to be some sort of know-it-all rescuer or some stupid shit like that. I went to learn, to experience, to participate. And I did.

The women at the maternity ward there do amazing things with the cast-off and donated equipment - much of what is donated having been used for years before arriving in Vila.

I met some infuriating people. Some exceptional people. And many, many beautiful laboring women and their families.

It all seems like some sort of alternate reality, now, back in my own midwifery-USA world, back to the grind with my family in tow. On call all the time, driving insane distances to clinic and births, and over-thinking everything. Working with women who are taking for granted that babies are going to come out alive and healthy, who are living under the expectation that we are capable of stopping the horrible extremes. Who hire us to prevent something that we might not be able to prevent. THAT is the big burden of midwifery. THAT is why we often intervene too much, why we transport for anything that raises risk the slightest little bit, no matter how small that magnitude. I'm not sure that we're always safeguarding women and their babies when we act the way we do. I think we're often safeguarding the expectation that we're safeguarding the women and their babies.

Which is, oddly enough, not to say that we do anything wrong, really. Just that we are perhaps bringing an energy into this whole thing that isn't as much about keeping women safe as it is about keeping the image of safety safe.

This was perhaps not the morning to write this, with the kids yelling in the background and the caffeine and sugar from my morning coffee unalloyed by protein to keep the shakes at bay...but I'm not finding a good time, so it just had to get written and placed in the past where it belongs, so that it can gather some perspective.

Home again, part 2

I got one day at home before we left for Oregon, to spend a weekend with the step-in-law family. It went fine, but it wasn't home. On Easter, the kids ran about finding eggs obviously hidden by the grown-up contingent, we drew chalk mandalas on the sidewalk, and before we departed for our 8 hour return drive, we all ate chinese food on our hosts' patio while the children ran around in sugar-high bliss.

And into clinic again. Clients mostly welcomed me back warmly (one in particular that the midwives didn't think would want me there after the break smiled when I entered the room and said "now you're ready for my baby, right?"), and none with "who the heck are you again and why do you want to be at my birth," which was nice. On Thursday, a whirlwind tour of the Aberdeen area. I am having difficulty wrapping my head around the fact that there are clients out there, more than two hours from my home, whose births I am supposed to drive to. They have been warned it may not happen. I have heard of midwives who have two hour or more radius' for practice, and I can't see how that is workable.

Tired, tired, tired, and ever-so-happy to arrive in Friday, where my only obligations are a little kid-shuffling and playdate action.

Lest this become a whine-only post, I have a kid funny. While in Oregon, we went out to breakfast. BittyPrincess climbed into my lap and commented: "Mama, you smell bad. You smell like coffee, but not like our good coffee at home, you smell like bad coffee." That's my little PNW pre-coffee-snob.

Home again, home again

I'm too busy enjoying being home again to give a comprehensive post. Not that anyone really cares about my flights and such.

I do need to share that I wound up staying 3 hours for a second "last day," during which I found out that the mec-decels-two-Nikis-there woman named her baby Niki (not sure about the spelling).

I'm heading down to Medford, Oregon to spend Easter with some extended (read virtually unknown) family. Not entirely happy about leaving so soon after I got home, but I know as much as I want to just sit around with my family, the kids would be restless with that. It might be good to be with them, but busy. I hope.

Last Day in Vanuatu (I think)

I went to what should have been my last day at the hospital today.

Only we were so busy that I didn't get all my papers signed. "Come tomorrow, first thing, we'll get it done right away" the nurse in charge said, working on her 3-o-clock report at 5:30pm. I went to say goodbye to the ladies working evening shift, and they gave me hugs and handed me a wrapped package, which (curiosity got the better of me, that and the certainty it wouldn't stay wrapped through customs) turned out to be a lava-lava. If I ever get a chance to wear it, I'll remember both them and all the laboring women walking the halls in their lava-lavas here.

I did two births today. Shortly after I arrived, I did a CTG strip for someone who had been at the hospital overnight already, and found some pretty significant late decels (with every contraction). I took her off the CTG for long enough to put a new admit on and seek consult (which turned out to be less than helpful).

The first birth was the mom with the decels, which hadn't improved but hadn't gotten terribly worse over the 5 hours since I first saw her. The student nurse who was supposed to be assisting me totally disappeared ("I wen lunch," he told me, unhelpfully, later). I grabbed a newcomer from Australia who shared my name (Niki and Nicki), and who, had she come earlier, would probably have been a great friend. I have done births solo here a few times (maybe 5 or so?), but the slow labor for a 3rd baby, the mec, the late decels...I wanted someone else there. The meconium got heavier and heavier until it seemed like it must be coming straight from baby out without any dilution at all. The decels got worse with pushing, eventually not recovering and hovering at 60 even between two contractions. Oxygen to mom, I ordered (easier said than done...). Some recovery. Not back to baseline, but up into the triple digits. Baby was born, thankfully, less than 10 minutes later, and did not require anything more than a little suction and stimulation to come around.

So many moms here have meconium. So many babies are totally fine. My feelings are now pretty thoroughly mixed on the subject of meconium, after managing so many births with meconium that it just doesn't seem significant anymore. I know that this isn't acceptable in the Washington-State-out-of-hospital type practice, have no fear. I'm just not scared of it anymore. Neener-neener.

The second birth of the day looked to be pretty easy. 42 year old 2nd time mom, who had her first baby 17 years prior, but seemed to be laboring along nicely all day. She got to complete and wouldn't push. "Tired!" she cried at us, over and over. "No push, me no save push! Me no wantem push!" When the midwife-in-charge came in and authoritatively ordered her to stop whining and start pushing, she made a disgusted face and solidly ignored the commands. Four hours later, three of which she spent rotating her baby from OP to LOA to OA, her baby was born with the aid of a vacuum. Shitty last birth for me, really. She was also the first to be visibly disappointed to have a girl. "Thought it would be a boy," she sighed, and turned away. "Yufala sure?" she rejoined, moments later. Yes, we were, that was a little girl that was dragged reluctantly from her body. (Hopefully this doesn't sound too harsh. I spent a large part of that labor rubbing her back, her shoulders, her legs, speaking encouraging words and waiting for her to get down to business and push out a baby.)

Shitty last birth, maybe, but I'm leaving knowing that I'm far, far more ready for practice than I was when I got here. This is a good feeling.

We'll see tomorrow, I suppose, if I get dragged in for another "last day," since I don't actually leave until 2pm.

Newborn Exam Day

I did no fewer than 13 newborn exams today. I did not, of course, catch all of those babies (I caught one and observed two others); there was a baby backlog when I arrived and a steady stream of babies in preparation for discharge. Today, there was a dad that WANTED to be there for the birth, supporting his wife and crying happily once his baby girl was born, following her to the warmer and taking pictures, and then singing along to some R&B type music he had on his phone, appearing to mesmerize his daughter with his swaying. Luckily nobody in the packed-full labor room seemed to mind, one mom in a world of her own across the hall, the other right next to him humming along, his own wife rather engrossed in hating being sutured (not that it was awful, but who in their right mind would LIKE that?).

No drama on the ward today. Two of my favorite people were on day shift, so that's what I did. A nursing student (they are not assigned shifts the same way I am, and I think they just have a number-of-hours requirement) that I'd signed off on one of her first vaginal exams a week or so ago assisted at a birth today; she was too busy standing there crying happily to administer the syntocin that they do routinely around here, which was such a lovely thing that I couldn't get upset. She'll get over that eventually, but hopefully never completely.

I left a little after 3, which left me enough daylight to go get changed and walk into town for some food at the waterfront. Chicken and fries and oversugared soda cafeteria style right next to the water, sharing a table with a woman and her shy 3-year-old granddaughter who were on the island for the weekend from "the next island over that way," which pretty much meant nothing to me. It was good to sit and talk though, and hear about her family. I think I understood most of it.

On the way back to the "resort," walking through the village-in-a-city area, I heard the rather unlikely sounds of a trombone and a trumpet, practicing two different scores simultaneously.

Back now, it's dark outside, and should I decide to leave the TV on I would have a choice between Meerkat Manor and rugby. Maybe I'll try to figure out the rules of rugby (football, as they say here)? It seems to involve short-shorts and jumping atop one another. Beyond that, the rules elude me.

Maybe just some reading time tonight, instead.

Doldrums

This morning all the women were discharged from the ward.

No, seriously, all of them.

OK, so there were two hang-ons whose babies were under 2k, in the extension ward. But the not-anyone-there-ness of it all in the main ward was pretty astonishing.

By the end of the shift, we'd placed two women and their babies on opposite ends of the ward. One caught by another midwife, one by myself three minutes later. Another birth I managed beginning to end, although I did make a consult call for some decels (the mind-boggling answer I got was to break her water...wtf...). Out came a very white looking baby. And by this I do not mean distressed or hypoxic, I mean white; the midwives were looking to see if this woman was married to a white man and even went so far as to ask her the race of the father. I'd gotten so used to dark little black-haired heads that it was quite a surprise to see light-brown-almost-blonde hair and pale skin coming into view. This mom had a history of a prior stillbirth, and in a moment of "something looks wrong here" panic I slapped on the fetal monitor again, to find the heartbeat steady at 140 just as it had been mere minutes previous. I contemplated cutting a cord on the perineum for the first time, as the baby got tied up with a tight nuchal cord and the typical somersault maneuver wasn't working, as there simply wasn't enough slack, and we got a tad-bit stuck at the armpit level. Some breath-holding and cord-stretching and baby-twisting, and everything came out fine. I was of course alone for the ordeal, or the midwives would have been appalled that I didn't just cut the cord (which would have taken at least as long as what I did...).

A teary phone-call with my family this evening. I am ready to go home.

Thanks, T

For leaving the anti-diarrhea meds (...erm...brb...)

Anyway...the woman I was talking about yesterday had her baby overnight and was happily on her way today.

The ward is so full that they are sending women home 12 hours after delivery, sometimes a tad less if they are doing really well. There were 90 more deliveries in March than there were in January.

Nevertheless, today was a very slow day. Sat around doing nothing, or the VCH version of nothing, which involves making beds, folding gauze, making cotton balls, re-reading matron's reports, tallying births for the month, and then finally just.sitting.there.doing.nothing. As I didn't want to kick myself for leaving before something exciting, I stayed for the full shift, and then wound up staying a bit after for someone who had been on the ward for two days and who had finally found herself in labor, a misoprostol (cytotec) induction.

Just after that birth, the reason I am thankful for the anti-diarrhea meds kicked in, and I left the hospital in a hurry.

Feeling much better now, watching some crappy TV. And that pun was unintentional but I'm leaving it.

Chugging along

Another shoulder dystocia yesterday; this time I was not alone, but the midwives (two of them!) who were there apparently didn't understand "hip flexion" "legs up" "need more room here, bring her knees up" and about 5 other ways I was attempting to communicate what I wanted them to do (ARGHARGHARGHARGHARGH!!!!!!!!!) until I finally repositioned the woman myself. And a floppy baby. The midwife refused to pass me the bag and mask, told me I had to cut the cord and take the baby to the station. Goodbye good heart rate. Baby came around after a few more minutes, but had no muscle tone even after she was breathing on her own, for a good 20 minutes. The ped's opinion was that she'd suffered hypoxia - the midwife that was with me uselessly stared and didn't inform her of the dystocia or the rescus, so I jumped in with some information. I am not sure what was going on with the midwife, but her mind was not there and I may avoid working with this particular midwife for the rest of my stay here; the others have been varying degrees of acceptable to great at working together at births. Baby looked healthy and active an hour after birth.

Two more births, without issues.

At the end of the day, I checked a primip that had been in the hospital all day and working really hard. I couldn't figure out what language she spoke, and she was off in labor-land. Not Bislama, but English, it turned out. She was only 3cm. I was not prepared to stay and do a lot of labor support, but did take time to provide her and her partner some information and some coping techniques, kind of an impromptu 30 minutes of childbirth ed. She was very tired. "There is only one muscle in your body that needs to do the work right now," she finally woke up and understood, "think about letting all the rest of your muscles sink down into the bed and rest."

I hope that she delivered without incident last night. If she is still there when I go in (in a few minutes), I'll be glad to provide support and receive information back with full fluency, but unhappy that she hasn't delivered.