BABIES/COLD/POVERTY/MISCELLANEOUS

BABIES: The one great thing about being a Registered Midwife, is that I get to care for newborns up to six weeks old. I used to do that as a CPM, but when I became a CNM~~ that was deeded out to the nurses and pediatricians or family practice doctors.

I do the newborn exam, sometimes show a new mom how to change or bathe her baby and that is quite a delight. I had forgotten what a privilege it is to be in the presence of a new baby. To look at them, and to talk to them. They are the Dalai Lama and Albert Einstein in one little bundle.

While a CNM, many kind women would offer their baby for me to hold, especially when doing hospital rounds postpartum, but I mostly deferred, unless I was needed to. In the uniquely special newborn time I felt I needed to support the Mother/Child relationship and not get my own baby fix! I must confess, when I see midwives or nurses greedily holding a freshly newborn baby for their OWN interest and not as a provider or helper to the mother in some way, I think unkind thoughts about them. Now I have a purpose again to touch the baby, besides helping gently usher them into the world.

JAUNDICE: We have had a run on jaundice and one of my theories is that houses are SO COLD, that babies are really bundled up to keep warm. This bundling makes them sleepier and so they don't wake up to feed, and then they get dehydrated or are new to breastfeeding, and the baby is so "good"... Because literally every house I have been in is heated primarily by wood stove, only one room is warm. No one would think of placing their baby by a window for a little sunshine because the windows are single pane. Maybe not coincidentally, all the babies were of Maori heritage. I could not find any good data on links, but since Asians (especially Chinese) have the highest rates of jaundice--is it possible that Maori--related to South Pacific Islanders has an increased rate as well?

POVERTY: Up close and personal. Don't like it. I was at a house, always well-kept, the family lives in one room, although they do have an an unheated kitchen to cook in. When I do the visits, I mostly stand or squish myself between the bed and toddler bed, as that is the only furniture. Have you ever done a postpartum visit where the Father was in bed, dressed, trying to stay warm, and watching a golf game as you were doing the visit? Okay, well, I have--and I just laughed to myself. Anyway, at this same house, with a great, loving family--I asked if I could heat up a cloth to warm up baby's foot before I did the PKU test. That was when the mom very apologetically told me they have no running hot water. Just one example.

GUARD DOGS: A couple of houses I have to call ahead and tell them I am coming so that they can tie up the dog. Being permanently scarred on my face from a dog bite--I take this seriously. There are some houses where they SHOULD tie up their dog before I come. These are not those smart sheep dogs from the classic movie "Babe" the talking pig story. The dogs are pitbulls, just like I see in the poorer areas of my own fair city. What would a sociologist make of this phenomena? Do economically-challenged people the world over have higher rates of pitbull ownership? Curious observers want to know.

UNHEATED BATHROOMS: Every single "toilet" I have used in the country of New Zealand (and I am not kidding) has been unheated. Even in our own lovely home, the toilet or bathroom is unheated. This is NOT the room to linger in. Seriously, freezing your ass off is a real fact in NZ. Also, the hand washing room, with the shower or bath is in a separate room. I am wondering if people use good bathroom hygiene if they have to go to ANOTHER room to wash their hands???? hhhhmmmmmm?????
Okay, even in the patient houses which I would consider living in, because they are so beautiful--they have no heat in the toilet (room). This crosses all economic classes.

MASCARA: I went into town (the bigger city an hour away) to pick up supplies for the maternity home. I needed mascara, so I went to a recommended shop, and found my usual brand. Went to pay for it, and nearly dropped my jaw. It cost $25 NZD. Miss Plastic Face, obviously not concerned about the price of make-up, asked if there was a problem? I stammered that this was a bit of sticker shock, because in the USA I would pay about $8 USD for the same exact Maybelline mascara. I am certain she wanted to drop her jaw, but knew she could not, otherwise her make-up would come off in little, bitty pieces. She told me that was the going rate. I looked around and there were several US brands, but I surmised it was because I had come into the store that was like the local Daytons but not quite that good. Anyway, about 40 minute later when I stopped at Woolworth's grocery store, I found my same mascara for, yep---$25 NZD. OHMYGOSH.

LEVI JEANS: In one small-town store I saw a paid of women's levis for $175 NZD. Obviously, I am not buying any in this country. Clothing is very expensive, which my Lonely Planet explains because there are less people, so less consumers to bring the cost down.

LIVING MODESTLY: It is much easier to live modestly in the USA than in NZ. Fact. The only thing that is cheaper here, so far, is car insurance and malpractice insurance. Which they really don't even have the later, it is called indemnity and for a Registered Midwife, costs <$1000NZD. Okay, so I admit it that I miss Target. I really, really do. THINGS I HATE: I hate cigarettes and cigarette smoke. THE BUMMER about doing homevisits is that 1) You see how people live and sometimes it is heartbreaking 2) You smell how people live. BLEEEECCCCHHHHHHHH. This is almost, but not quite as bad as cigarette use in Pakistan or China. At least in NZ there are laws about smoking in public places.

The language learning curve

One of the reasons I wanted to live in another country was because I wanted to understand a little bit more about what my immigrant/refugee patients experience in the US.

Even though we are speaking English, I sometimes have difficulty understanding what people are saying, and on the phone it is even worse.

A couple of weeks ago, I was at a pt's house doing a postpartum visit. I asked where I could put the baby scale and she said, from another room, "put it on the bench." I looked in that room, no bench, I looked near the room, no bench, so I asked: "is it okay to put it on the table?" She said: "yes."
I thought to myself, she is postpartum, sleep-deprived, maybe her husband moved the bench...because I saw there was no bench. I didn't want to point out the obvious to her.

NOW two weeks later, I learn that a "BENCH" in NZ can be a counter top or table top. She wanted me to put the baby scale on the "bench" that was the tabletop.

We are speaking the same language, but with different interpretations.

This is even more apparent on the rural country roads which are unfamiliar. The man at the petrol station said: "Go left at the town hall--take your first left, then right over the bridge." So I went left, left and then PANIC. Do I need to go right, before I go over the bridge or do I go RIGHT over the bridge?

MANY times, I fake it. I get about 75% of what they are saying but am too embarassed to say over and over "what?", "can you repeat that?" This makes me REALLLLLLY compassionate to non-English speakers.

I really thought if I talked slowly, in my best Midwestern accented voice, and enunciated my words, using little words, that my patient "got" what I said. I bet they had significantly less understanding than I perceived. And thus, I am humbled a million times over for my English second language or non-English-speaking patients. It makes your brain hurt always trying to grasp conversations.

Kerry's Epiphany

My labor from HELL actually became a tender birth. The patient came in, in early labor when she should have been at home. However, her very together sister-in-law knew that the home environment was not the ideal labor setting. For the first time in my career, the father of the baby did not accompany because in their words he was “too drunk.” My patient also lives in a house with holes, and its only heat source is wood stove. I had to care for a teenage patient with minimal coping skills, in early labor, when there is less endorphins. Just like a toddler, in a bigger body… to put in mildly, it was a long, long night. Pt was 3 cm on arrival, but contracting infrequently and short, 3 cm again, three hours later. An hour later, barely 4 cm, but then labor was established and things progressed nicely. I was at the maternity home, by my lonesome, giving nitrous oxide for the first time, and it turns out it if you turn it on FULLY they actually get a better dose!

Once the labor was progressive, my patient did much better and was willing to try the tub, birth ball and other suggestions. I was so ready for my shift to end because I had been up 24 hours straight, caring for patients, but as fate would have it, pushing started before my replacement arrived and she was late due to weather conditions. My midwife buddy came in as the baby was crowning. A wee baby girl born while mom was hands and knees, passed baby between her legs and then they were skin-to-skin on the bed. Physiologic placenta, and a 1st degree labial laceration that was a flap of tissue. Me, in my brilliance ( Ha!) had already ordered some 4-0 vicryl (from the big hospital) for just such a tear…imagine my surprise when I opened the suture pack and found the needle to be the length of my eyelash!!!!! I could barely fit it in the needle holder, but a more delicate repair could only be called embroidery, and it looked quite nice when I was done.

In the course of the week I attended: A hospital birth, a homebirth and essentially a birth center birth. Our service had two more births Saturday and Sunday when I was off-call. Nice and straightforward. No epidurals requested. ;-)

So here comes the epiphany part: this is New Zealand and NOT the United States…not even North America. C’est la vie has become my new mantra because if I don’t I am going to be in trouble mentally and physically. I had started developing insomnia and headaches…once I decided to chill out more, and not worry so much have not been daily.

MY NZ REALITY:

1) STAT labs may or may not come back STAT
2) Ob-Gyn who is caring for my patient, will probably never talk to me or write up a care plan that I will see. (I did talk to a nice Ob-Gyn from South Dakota the other day about a patient..whoo hooo…’cause I could understand everything she said!!!!) [Reason being, as that they shuffle in an out of the country, as they need to rely heavily on overseas providers like moi.]
3) Ultrasounds which we would normally order in the US, like weekly BPP for certain conditions, can’t be done due to limited resources and personnel.
4) I live in an area designated REMOTE RURAL MEDICAL, and yes, this does affect the safety of my patients.
5) This is the reality I chose, and partly what I wanted to experience. I think I forgot and assumed because I was not in a 3rd world country that business would be similar or easily duplicated. Ain’t so.
6) The serious shortage of medical providers and the limitations of government paying for health care means that there is not enough bodies or abilities to provide the same standard of care that I am used to being able to access in the good ol’ USA.
7) I have several wonderful prospective students who would be an asset to this practice and like me, get to participate in some BEAUTIFUL births, but I can’t get to them without Internet.
8) Students have to remember that they won’t be able to impose the American mindset to this golden opportunity. The contracts I can do, but the malpractice insurance is a different ball of wax and I can’t solve it in the short-term. So I may have to fore go a student whose University requires it to be tied up nice and neatly in an American-style package.
9) I may never, ever get Internet at my house. Even though today is the 6th day in a row, that it was PROMISED to be up and running. In fact, I am writing this blog sans Internet, while waiting for the tech who was supposed to be here 6 hours ago.
10) The broken phone that I can’t dial out at my house, might never get replaced by the phone company…even though 16 days ago a new one was ordered.


HERE IS WHAT I DO HAVE:
Three of my sweet kiddos with me, who are having cultural experience in New Zealand
A lovely house, food to eat, sheep in my backyard, Spring coming and baby lambs in the field
Opportunity to live and work in a BEAUTIFUL country
A nice set of colleagues and a supportive hospital board. A group of patients who are the salt of the earth, some who are so poor, I think I am in Mary Breckenridge’s Appalachia. For the most part, what they need from a midwife, I can provide with some limitations.
A wonderful, supportive family and friends back home…

More American vs. Kiwi English

American New Zealand
Non-Uniform Mufti
(Also an unmarked police car is mufti)
Ginger Ale Ginger Beer
Pop/Soda/Soft Drink Fizzy Drink
Flock of Sheep Mob (of sheep)
Candy Lolly

Our KIWI home

A day in life...

Up this morning and dropped the girls off at school. Saw a patient's mother and viewed updated photos of the new baby. Saw another patient, talked with her about her recent "scan."

Headed out for postnatal homevists and antenatal visit. At the antenatal visit, I ask my patient how her sister is doing, (also a patient) she tells me she is "not doing good--since her baby has Down Syndrome." WHAT???!!!! Her baby does not have Down Syndrome...she thinks her baby has Down Syndrome? Please tell her I will call her later today to clear things up.

I race back to Tuatapere...what is 100km/hour compared to miles per hour??? That is the legal speed limit in most places.

At the office/maternity home I hastily work on a new ad for the service that needs to be completed today. It just needs a photo, and some artistic fine-tuning.

The phone rings and I answer it: "Tuatapere Maternity Home, Kerry Dixon speaking..." It is a local midwife at a homebirth, her second midwife (who had a heart attack three weeks ago, can't be located). I hesitate, because I just loaned my midwife car to my midwife associate. Midwife to Kerry: "She is getting ready to push, and she lives in town." I get an address and then go find someone to drive me to the birth. I nab the obstetric aide/cleaner, she happily drives me to the birth. I attended a beautiful homebirth. Third baby or second, first homebirth. It is so perfect! A sweet baby girl, born on the living room floor, in a wood-stove, fire-heated room. After all is tidied up, I text my midwife friend and ask her to pick me up. As she walks up to the house she asks the dad and a friend " Is Kerry here?" The dad says " does she talk funny?" Yep, thinks Jo--it is Kerry. But seriously, it is THEY who talk funny.

We head back to the maternity home and I finish the ad. The girls walk over from school and we go home for supper. I make a (frantic/slightly crazed/hysterical) phone call to the internet company who tells me, that there is another delay. This is my nightmare.

I try to call the patient who thinks her baby has Down Syndrome. She does not answer her phone. This is SO, SO COMMON, due to the cost of mobile service.
I send her a text:
"yr baby do not have down synd, just xtra finger. Mybe heart prob. Will chek more later. PLZ call me."

After supper, we are now back at the Maternity Home to check email. I talk to another of my teen mom patients...she thinks she is in labor. Her contractions are every 2 minutes lasting 10 seconds long. Oh it will be a long night. She is a patient who worries me. Teenager, smoker, drinks about 3 alcohol beverages per week, poor nutrition, limited education, no childbirth prep, minimally parented herself, history of childhood sexual abuse. I go off call at 0900 tomorrow, may the birth angels be with us all.

My first Kiwi baby has arrived! BIRTH STORY

It was at the end of a long day of homevisits, driving over the countryside. When I wasn't looking at the farm map, or stopping at an (empty) farm hoping to ask for directions...tried to remember to look up at the snow-capped mountains or the emerald green hills with cows and sheep grazing...

So I had just gotten home from work with the kids. Took a nice big scoop of Skippy peanut butter, since I had not eaten lunch. Savoring the last of our stock when I received a text message:
" I am in labor" People text here, quite often, to save money. It is now common to get communication from patients or other colleagues by text. Makes me slightly crazy but I am getting faster.
My response: "Who r u? Plz call me!"
Then a cascade of panic filled me, because I needed to make childcare arrangements, wasn't sure if it was a Tuatapere Maternity Home birth or Kew Hospital.

"It is X". So I break down and call her. Screw the money, because I need some information that text can't tell me. It is my teenage patient who is 34+2/7 weeks gestation. I had sent her in the big hospital the night before, for probable pyelonephritis, which she did have. It kicked her into labor, so she was 7 cm, when someone checked her.

I spoke with a Core Midwife who works set hours at the hospital. I explained, I haven't been orientated at Southland, but I can do birth if someone coaches me with the paperwork. She promises to help me out. So once the kids are secured, or at least a plan in place, I do the familiar. I throw on some scrubs and head out. Driving to births from the homebirth days, done hour to get there is not unfamiliar...but it does make me think fondly of my set hours at HealthEast!!!

When I arrived at Southland hospital, I went right to the Maternity Ward to see my patient. She does not look like she was in labor, but she was/is a stoic kiddo. Once I know I didn't miss the actual birth, I went to security to pick up my badge. Turns out the broken printer from 10 days ago is still not back from Auckland, so I get a temporary badge. No one seems to disturbed by this...that I don't have a photo ID, but it also means I can't get in and out of the building easily or into certain areas relevant to me being a midwwife.

One of the core midwives was helping X express colostrum for the baby before the birth, which I thought was awesome. She was hand expressing the patient and turned to me, and said: "oh, did you want to do this?" I said, "oh looks like you have things going great!" Because I seriously, have never hand expressed for another woman. We use pumps where I am from. (Later I saw some Medela pumps in a room, so they are available here too.)

I was supposed to have been orientated last Friday, but had a migraine and called in sick for the first time in 5 years from a job. I know, I am still rattled about it. Annnyyyhooooow, my next orientation day was scheduled for the next day. Instead of orientation, I am dropped into the field learning as I was providing care.

My patients is 16 years old, and has a supportive mate and family. I have only met with her 3 times. All home antenatal visits. That night I spent some labor hours just becoming more acquainted with her and the facility. I have thoughts about how strange this is. I am given her notes to document in, and I try to familiarize myself with the way things are written and done. Very different from my home and hospital midwife experiences in the US. Love that the doptone is Huntleigh--something familiar, and of course birth is familiar territory. I know how to be a midwife, and that is comforting.

After about 4.5 hours, I decide to give her her second cervical check of her labor and find her to be 8/100/0 station with a little sac. I decided to AROM, because I felt she needed the hormone surge to tip her into labor, I mean real labor, the kind you can't talk through. Sure enough, a small amount of clear fluid and then 15 minutes later: "I need to use the toilet!" Aha! Just what I wanted to hear.

So I take her into the toilet(what we call a bathroom in the US), she starts to scream: "I have to take a shit!" No, I tell her it is your baby's head. Remember when I told you, that you will think the baby is coming out the wrong hole? This is just your baby. On the toilet she screams: "I can't!, I can't do this" in a nice Kiwi accent. I remind her that I can't make her, but her baby will. I sense that we need to get off the toilet and a small struggle ensues, because she does not want anyone to see her "in labor." But eventually, with the help of the terrific Kiwi midwife, who is originally from Australia, we get her into the room, and offer her anywhere she wants to be. We suggested hands and knees on the bed, but she can't get up. We get a mattress for the floor. The Kiwi/Aussie midwife pulls the teenage partner forward and she holds onto his shoulders while bearing down. That was totally beautiful to see the two supporting each other through the final moments of birth. I was behind her, crouched on the floor, slathering on gel and trying to support her perineum, and cover up her anus at the same time. Another midwife, blessedly had set up some instruments.

I think how challenging a standing birth is, when you know where everything is...but I am flexible. I am focused and everything non-essential disappears from my mind. I never notice who, what or when the peds doc arrives, or where he stood during the birth. As the baby crowns, the mother yells at me to stop, but I quietly remind her, that is just her baby. She breathes her baby out gently, one loop of nuchal cord unraveled. Cord is cut and clamped quickly more, for the fact that I am holding the baby behind her, with a short cord and the pediatrician is waiting to assess our preemie. The Kiwi/Aussie midwife does the honors and the baby is over to the warmer while we get X to the bed. I am completely saturated in bloody, amniotic fluid. Thinking to myself, this is not a hospital where the scrubs are provided, and it will be a long, gooey ride back to Tuatapere.

Baby's initial assessment is good. We bargain with the docs for some skin-to-skin before the nursery. So baby boy is tucked between mother's breasts. They do active management for 3rd stage which I don't, so I decline ecbolics (which I am certain is pitocin). Wouldn't you know, a stubborn placenta, so 20 minutes after the birth, when nothing else has worked, she gets some, and gets back off the bed, squats on the floor as I teased out the placenta. Intact bottom with a couple of small skin splits. They are called a "graze" here in NZ. Baby weighed 2700 grams which equates to 6# 15 oz for you non-metrics like myself. He did end up going to the nursery about 30 minutes after birth for temp regulation and some respiratory distress. My patient continued with her antibiotics for pyelo throughout labor. She plans to postpartum at that hospital and then possibly be a boarder if baby has to stay. Her rounds will be done by the Core midwives until she returns home, then I will do her weekly visits for the next 6 weeks.

Here is what I love so far:
NO BULB SYRINGE is part of the birth kit
I am free to serve women how I see fit
No one cares that I did not document when she was complete
Minimal cervical exams are the norm
Not the expectation to document as much, although I am such a chatterbox with birth stories, I actually wish we had to write more than the basic data
Midwives do all the cares for their patients

Here is what I am surprised about:
Disposable birth instruments, including hemostats
Minimal recycling
Although, they only use plastic for bloody stuff otherwise paperbags
2-0 vicryl rapide is the normal suture

This is what I miss:
Awesome nurses to help care for the patient
Feeling like I know what I am doing in terms of paperwork

Here is what I don't like:
Driving an hour to get to a birth if they are going to South hospital
Driving an hour home in the middle of the night when you can't see anything beautiful

Many more lovely stories to come...

For interested American Midwives!!!

Tuatapere Maternity is looking for you! Beaches, mountains, sheep within minutes of where you will live on the South Island. Ideally an 8-12 week commitment… We are busiest mid-
December through the end of January with 16 women due.

ALERT: We have approval from the Hospital Board...we just found out we need clearance from the NZ midwifery council, which we are seeking. Please be patient, as the details are being worked out!!!!

New Zealand is one of the most midwife-friendly countries in the world. I wanted to experience their version of midwifery when I read about NZ several years ago. I was pleased to discover that American midwife credentials translate into their system of accreditation.
(Well…after a lot of paperwork!) I am the 4th American, at this job, and because of the great work by the preceding midwives, including the awesome Kiwi midwives, the word is out about this gem for pregnancy, labor and postpartum care.

Upon my arrival, I discovered that we are far busier than anticipated and thus, my desire to share a clinical opportunity with another eager midwife student, who may be like me, wanting the opportunity to experience international midwifery…hands on!

Expect to get actively involved in caring for our patients. Both facilities are certified “Baby
Friendly,” for breastfeeding. Email: kerryanndixon@msn.com Please attach a CV and letter of
interest. I will call for a phone interview.

We staff four unique clinical settings:
1) Births at Tuatapere Maternity Home, which is for healthy, low-risk women. This would be like a birth center in America with some subtle differences, like being able to give nitrous oxide for pain management. After giving birth, mothers have the opportunity to postpartum for up to six days at the home. Midwives provide daily rounds, for both mother and infant, and then visits once a week at their home for 5 more weeks. Our patients receive care by a registered nurse or nurse aide round the clock, while at Tuatapere.

2) Our other low-risk, healthy women who choose to birth at Southland District Hospital, an hour a way in Invercargill. In that setting, we do all their labor care, because, interestingly, there are no labor & delivery nurses! After the women are discharged from the hospital, within a few hours, most will transfer back to Tuatapere Maternity for their leisurely postpartum stay.

3) Homebirths, we have a few planned.

4) Higher-risk women, who have secondary care by an obstetrician, as well as continuous care by us, birth at Southland District Hospital. Interestingly, we consult with the physician, and as long as all is going well, we might never, ever, see the physician at the birth. This would include: VBACS, hypertensive’s, gestational diabetics, etc.
*We also provide daily rounds for other midwife patients who want to postpartum at the maternity home. After discharge most will receive the remainder of their care

Who we care for:
We are serving women~ teens to grand-multips. In the finest midwifery tradition, we do blood
draws, all our labor sitting, and care for newborns up to six weeks. Many visits will be in the
patient’s home, AP and PP. You will have the opportunity to see normal birth, and because of the way the system works, also be caring for insulin-dependent diabetics, smokers, obese, twins
and other higher-risk women.

Expenses: You need to pay your airfare, and for your food and fun. Also, FBI clearance (~$20)
You need a current passport. You can come on a tourist visa, since you won’t be officially working or studying in the country. That is if you stay < 3 months.

Free furnished housing attached to the maternity home. Groceries within walking distance, you will only need a car if you want to do some tourist activities at the end.

Tuatapere, on the South Island of New Zealand is considered a remote, rural location in terms of medical facilities. The closest hospital is 1 hour by car away. Must be willing to be far from such things as a bank, serious grocery store. After one month, I am still struggling to get internet at the lovely home which I live in. Patience is a virtue, which as a midwife, I should have ample amounts, right???

New Zealand Engilsh vs. American English

New Zealand English vs. American English:
Erasers = rubbers
Woodchips= bark
Backpacks= bags
Meadows= paddocks
French fries= hot chips
“ = shoe strings
Gas = petrol
Dinner = tea


Mia Hill

Some awesome photos!

New Zealand Midwifery

Finally, have a moment in-between patients to post. We still don't have internet at our house, which is really, really challenging. It is contributing to our homesickness!
The 3-4 births per month, has actually become 4-12 births per month. There is a part-time Kiwi midwife to work with me, but we have no CMA or other assistant for AP and PP visits. Thus, my brilliant idea to invite an American midwife student to come to NZ for an international opportunity. Clearly the passion is there, because after one email, I have received several inquiries from some extraordinary candidates. That could solve our personnel worries.
Midwives are the primary providers of maternity care here, and it shows. We are caring for women with a variety of needs: healthy, low-risk all the way to insulin-dependent diabetics, morbid-obesity and others. The higher-risk women need to see a specialist and we will attend their births in Invercargill. If all goes well, the physician won't come for the birth.
Tuaptapere Maternity is much like a birth center in the US. It is such a great place! Women can come here, have their babies and stay for up to 6 days postpartum. While they are here, we
do daily rounds. There is a nurse or nurse-aide who provide the home-cooked meals, breastfeeding support, etc. Because I order all the supplies, sign time-cards, make up the gravida list, be first call every day except my 8 days off, I am utterly swamped.
We are caring for women in 4 different clinical settings. They can birth at Tuatapere Maternity home, or at Southland Hospital in Invercargill an hour a way. If they are higher risk, they have to birth at Southland, but we still do all their care and they consult with an Ob-GYN who won't be at the birth, unless called. We also have some homebirths planned.
AP visit are at the Tuatapere office or in Patient's homes. All postpartum visits once they are discharge from the hospital or home are at the patient's home. Daily visits until discharge, which could be 3-6 days, the next visit at home in 24 hours, then weekly for 5 more weeks. On average each woman gets 9 postpartum visits!!! I feel like all my previous work as a dould, a midwife attending homebirths, a postpartum home nurse for Methodist and a CNM at HealthEast has prepared me for this position. I spent a month attending births with Rondi Anderson, CNM in Lancaster Co., Pennyslvania--so when I am driving around to farm houses, getting my shoes all muddy and once (so far) getting my car stuck in the mud requiring a tow-truck--reminds me of my time with her.
The people are lovely and I will continue this post later...