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…