baby lambs. term break. ipod. work. ethnicity/race.

Oh what a happy day to go out to a sheep farm and hold baby lambs. We initially greeted in the paddock with a mother sheep who had a dead baby lamb with only the head hanging out of her lady parts. The farmer had to extract the dead baby, and then pulled out the live one, much to the relief of the girls. We learned a lot about sheep, and our consensus is that we like the black ones the best--maybe because they are less common? But any cute cuddly one, without lots of poo hanging from it's behinder is great.
Three girls are still begging for a pet lamb, but they do require feeding three-four times per day, and we are not home that much.

Until now...as today is the first day of term 3 break. Yep, those Kiwi students and guests go to school for 10 weeks, then get 2 weeks off. Summer break starts December 10- and they start their new school year on February 2nd. Girls are going horseback riding on Monday. Some place where they get to be for 4 hours, caring for their "own" horse/pony and riding, etc.  We are laying low for term break, as we are saving our tourist/vacation activities for when Aunt Kelley, big brother Matthew and his partner Katie join us for a visit. Come on October and November!

On Monday, at 0900 I am off-call for 7 whole days. I have been on for the past month, and am ready to not shoulder the responsibility for a few days. Although, I am going in to meet with the plumber and discuss the installation of our new birth tub!!!!!!!!

IPOD~
Did I mention how much I love having my little nano??? Last year traveling to Pakistan without one, I swore I would never travel without some way to drown out the noise...now I need it for something to entertain myself while I log miles doing homevisits. I am not a AM station-kind-of-gal, and this is one of my survivor techniques. Plus my work car happens to drive very loudly. Anyway, I thought about how I must look heading out to visits. After dropping my kids off at school, I carefully put in my earbuds and pull down my sunglasses, rev up my engine and take off!

Speaking of sun protection...some of these Kiwis would do well to wear sunglasses and sunscreen. Some people look older than their years due to the sun damage which is so quickly received here, in this ozone-missing part of the world.

Medication NZ-style~

I prescribed some zofran for a patient who was incapacitated with morning sickness. I personally stopped into the pharmacy to make sure this country stocks it. {[You can only get your medicine Mon-Friday here!] The closest pharmacy is 40 minutes away.} Okay, so they do stock it, but can only give her 10 days worth. Fine, she needs it. I spoke with her a couple of days later and she was elated that it worked. However, she told me it cost her $50 NZD. As I started to apologize she told me, no she would gladly have paid twice that to feel better. Jeesh. When they said it was in-stock, I thought it was another one of the $3 co-pay meds. Wouldn't it be nice if the midwife knew these things? Oh lordy, the things I am learning, while flying by the seat of my pantaloons.

Maori Cultural Safety and Treaty of Waitangi Workshop~

I attended my required course to be a full-fledged registered member of NZ midwifery. I found it very interesting, because I love learning about other cultures. What I thought was that if we just substituted American Indian or African-American, it was very, very similar. Poorer health, less-educated, etc. All the problems that stemmed from colonisation I learned. It was interesting when someone asked--when does it stop? When will it even out? When will the NZ/Europeans stop being blamed for causing all the problems?  The instructor kept saying he would like to be out of job, teaching Maori culture safety in the next few years. I mentioned that then the Kiwis might need other culture safety since they are relying on a constant stream of immigrants to prop up their country--especially in health care and farming. [I also thought to myself--those racist brats in Tuatapere who continue to mock my Chinese daughters need a little culture safety training.]
Maori language tip: W's are pronounced like F's. Our instructor kept using a long word that looked like whuckawuckamunga. But of course it came out with a different pronunciation. ;-)

More ethnicity~

A fair number of my patients are direct immigrants from: Germany, 2, South Africa, 1, UK, 3.  When my born and raised in South Africa patient wrote down European to describe herself--I had to say: You are from the continent of Africa, your birth country's name is AFRICA, why would you not claim to be African? Well, because I am not black. Oh, I said are you Afrikaans then? No, my great grandparents were from France. Have you ever been to France? No, have you even been to Europe? Nope. HAHAHAHAHA.

When filling out forms for NZ my choices are:
NZ/European
Other European
NZ Maori
Middle East
Samoan
Cook Is Maori
Tongan
African
Niuean
Tokelauan
Fijian
Other Pacific
South East Asian
Chinese Indian
Other Asian
Declined to state
Don't know
But since my people have not been from Europe for a very long time, and since we all descend from the mitochondrial Eve--I could call myself African with about the same inclination as I would say European. Looking at this list leaves out the whole Hispanic world doesn't it? Little musings from someone who has lots of time alone driving around the countryside of NZ.

09/09/09 and the accidental homebirth

It was a gorgeous New Zealand day, it was her due-date, it was a baby girl after a big brother.  The Mum (in Kiwi-speak) had called Jo to say she was in labor. So I rearranged my day to "not be far away." Actually, I went back home to use my computer, as Jo was at the office using the work one. Soon after, Jo called to say that the patient was on her way in, and that she was pushy.  Hmmm??? So I raced off to the Maternity Centre and Jo was heading to her car, but she hopped into mine and told me that the dad had called asking us to come to them.
We went back through town, and pulled into the drive. Dad was holding the toddler and told us where to find her.  She was involuntary pushing in, of course, the toilet room. Remember me saying how small they are and unheated? Anyhoo, within 10 minutes of our arrival, the Mum gave birth to a gorgeous baby girl, standing and leaning over Jo, who was underneath to catch the baby before she had a "waterbirth" of a different sort.
I was by the mum's face, reminding her to breathe, as dad was holding the toddler to keep him calm. All the while trying to hand things to my partner, close windows, get blankets ready, remember to look at my watch to record times, the usual "second pair of hands," jobs.
It was so joyous--Jo's first unplanned homebirth and well, I have been to enough to know these rapid fire births are often the finest ones of all.
After the birth, we pivoted mum around so she was leaning on me, with her bum on the linoleum. She mentioned I was not the best pillow. It was a fun time for me being in the assistant role.  Shortly after the placenta birthed, per Mum request, we wrapped a beach towel around her and put her in my car, and drove her to the maternity centre where she planned to "postnatal stay"as they call it here.
As we were helping Mum out of the car, recess was taking place next door at the school. A curious gaggle of children watched our slow procession from the back of the car, into the maternity home. Mum holding baby, midwives holding a towel around mum, one midwife without shoes on, the other midwife colorfully splayed with amniotic fluid and some blood. It was quite funny really.
Because Miss T came on such a memorable date, the newspaper came out later for a photo shoot and brief article on three Southland babies born that day.
Since dad is the local police officer, I asked him if Jo and I were exempt from any speeding tickets from now on. [Not that I drive fast--ever--even to get to a birth ;-)] 

I was so pleased to attend two births in a row, with happily married, intact, loving families--regular people without a list of risk factors! This is a very nice job...

Lucky me

Another great birth~The other day, my G4P3003 patient who was 41+2 weeks and destined to be turned over to the big hospital for induction (THE VERY NEXT DAY) went into labor with a couple doses of castor oil. I had just temporarily fixed up the birth room with different bedding, and rearranging furniture, adding plants... and it looked great. Well, maybe "better" would be a more accurate description.

My patient came in at 7 cm and two hours later a chubby, round faced baby girl was born. My patient was accompanied by her husband and their three older children. They big kids came and went while mom was in labor--which is the great thing about being at the maternity home--as they were free to come and go, and no one else was in-house. For the birth, the biggest sister, age 17, was also in the room. I told her to pull up her sleeves and wash her hands so she could help receive her new baby sibling. There was a tight nuchal cord, which meant I had to somersault the baby out and so I couldn't give her as much hands on that I intended. But it was so sweet to see those sisters connected by touch for those brief moments.

The placenta was about 1 1/2 placentas (unusually large) with a velamentous insertion of the umbilical cord. It was rather unique. What an amazing organ the placenta is. Too many practitioners give the placenta a cursory glance--but careful observation can reveal important clues to the baby's full story. For example: closet cigarette smokers can be found out by their nicotine-stained placentas!

Last summer, as I went to brush aside a blood clot attached to a placenta I was starting to examine, I found the identical twin sister of the baby I had just helped welcome via a waterbirth. Twin pregnancies that don't go to term usually manifest as a miscarriage or the twin reabsorbs early in the gestation. However, this tenacious little one stayed for the pregnancy, unbeknownst to the mother and everyone else, until I gently explained my discovery.

She was the size of a ping-pong ball and still very early developed with eye, arm and leg buds. She was attached to the placenta by her own thready umbilical cord. The mom was a bit surprised and took it all in stride at the time. She was so happy to have her beautiful daughter, after two handsome sons. However, like what happens so often with the grief process, she contacted me several months later--wanting to talk and know more about her twin daughter's story.

American students~ so pleased that we have certain commitments from two extraordinary candidates. We had several inquiries from great candidates but we took two who were available at the time most needed and who came from Universities who were willing to work with us in the New Zealand way. One student will stay with us for three months, and the other is coming for a little more than a month. We have plenty of babies due and mothers to care for, so this is a great thing. In exchange, the students get to be a part of normal birth, in a low-key setting.

Dunedin and Southland

Rural Maternity Providers

I went to a meeting hosted by another primary health unit (birth center in USA terms). They are also experiencing a shortage of midwives due to recent health issues of their team. The meeting was health at Lumsden which has a beautiful birth room and postnatal stay rooms.
A midwife from the Winton Maternity Home was also in attendance. The rest of the meeting attendees were various staff and volunteers from the Health Boards or Trusts that keep these birth units in existence.

I was touched to see hard-working sheep farmers discussing the issues surrounding midwifery, keeping birth normal, etc., etc. Some people in NZ government would like to close these primary units and have all birthing women go to a secondary site for care.

This would be tragic for many of my patients. The Southland District Hospital in Invercargill, where our patients go for transfer, transport or consultation has the HIGHEST C/SECTION RATE in the ENTIRE COUNTRY of NEW ZEALAND. Somewhere between 30-40%!!!!! Many blame this rate on the foreign physicians whom they rely on to fill their staff shortage.

I am just a bandaid to the midwife shortage (or a plaster as they are known here) so it was hard for me to be relevant to some of the discussion. What my midwife heart knows, is the work of midwives in the trenches, is that by keeping birth normal we are changing the energy of the planet. Those of you who get it, will get what I mean. We must continue to guard the sanctity of normal birth for the well-being of mothers, babies and families. It would not be cost-effective to send all our patients to the secondary unit, in part because they would increase the morbidity and mortality of our patients. This is not what the NZ government needs. Frankly, I find the hospital to be just that...a hospital. They don't even try to seduce consumers into providing a "home-like" setting to birth in. Florescent lighting, blank sterile walls. Very UGLY.

The midwives who I met that work there are a dedicated bunch with much too much work placed on their shoulders. They are doing their best in difficult circumstances, much like hospital midwives the world-over.