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...