Midwifery is catching

So - tomorrow is the big day. Day 1 of my classes. Well, kind of day 1. I have to rearrange my timetable again so that I can work a little on one day of the week. I’m not sure that I can, so I’ve been told to turn up to a tutorial tomorrow and see what happens.

I’ve spent the afternoon auntying and that’s been very fun. It’s my birthday soon and it struck me today that the A family doesn’t really consider that a big day on their calender. I schlep to various dinners and parties and such for their birthdays but mine will pass without celebration… and the same is said of my family. My dad will call, my sister will call, and that’s about it. And yes that makes me sad, even though I am going to be 27 this year and some may say that I really should be over things like birthdays. But I think that I’ll never get over the fact that it’s the one day of the year that’s kind of MINE, MINE, MINE and I want people to make a fuss out of me. Hell, I’m about to start to learn about the fuss associated with people’s true birth day, so maybe that’s why it’s my calling.

I’ll have to buy something fantastic for myself instead I think. New watch? New wallet? Crumpler bag (oooh maybe not at > $200 for that one!)? I’m not sure yet!!

Today was orientation day. Instead of o’week, I had a day. Woo. And it wasn’t even for my course - it was for about 200 nursing students as well. Most of them were fresh out of school so I’m going to share a bit of advice with them…

If you get to class early, SIT IN THE MIDDLE OF THE ROW. Cause otherwise people who arrive later have to (and will) clamber over you, and if they have a hard wooden parasol they may just "accidentally" hit you with it.

Also, if you are late, don’t make the whole freaking theatre rearrange itself so you can sit with your friends. And - DON’T TALK. Especially not in another language, which is just as irritating as if you were whisperng in English. And turn off your mobile phone before class. Or at least put it on silent. Do not, under ANY CIRCUMSTANCES, think that covering your mouth with your hand makes your conversation quiet. It doesn’t.

Lecturers - mind you Ps especially into a microphone!! You don’t have to shout if you have one of those in fact… but loud Ps hurt the ears! If you are a career counsellor, please note that SPECIALISM is NOT A WORD.

Third years students must wear black it seems - all 9 people on the panel had black on. First and second year students must wear teeny shorts and pale coloured singlets. Unless you’re me and then you wear polkadots.

Lastly - midwifery is NOT THE SAME as nursing. It is just simply not. It is a genre of nursing and one that I’m proud to be a part of but it’s a different program, a different industry and different subjects. So please don’t pretend I am the same as the nursing students and we need the same information… like being told our placements start at the end of semester 1 in 2nd year, when in fact they start in 8 weeks.

Oh and perhaps the fact that the panel discussion was dominated by midwifery students indicates that they have lots of students and your average nursing student doesn’t because more information has been given to the nursing students… so a SEPARATE induction would have been good.

Wow I obviously needed to get that out. I just went and bought $300 worth of textbooks and will hopefully get another $100 worth tonight. I have:

• Student nurses clinical survival guide
• Midwifery Guide to Antenatal Investigation
• Ramsay Midwifery Pack
• Mayes Midwifery

and the books collectively weighed a tonne! I have my first tutorial on Monday hopefully - another timetable mishap that I’m HOPING will be sorted out!

 

First of all, it’s only a few days until my birthday:

and we will be having a housewarming that weekend as well… invites soon.

I’ll work backwards here as today is freshest in my mind. I got up today and toddled off to uni to organise my student ID which I’ll need for Friday (eep!). I then took an hour or two to tour around the various buildings and see how they’re numbered/named, and where most of my classes are going to be. I also peeked into the bookstore and was thrilled at the books available but overwhelmed with the cost. I found three 2nd years so that was nice - they seemed friendly enough though mentioned the whole "it’s a lot like nursing" thing that I’m not entirely sure about. I mean yes, I want to be with women through a medically-type thing but I don’t want to be a nurse so I’m not sure what to expect from that. They didn’t expand and I was struck shy by the whole overwhelming process.

Oh and let me make something clear on paper here - I’m confident and calm in myself about the process but it’s all new and different to what I’ve done before. COMPLETELY new and different. As alien as I can get without leaving the country. So please don’t tell me that I’ll be fine and it’ll be fun - I know this! It’s more that I’m feeling REALLY overwhelmed at the moment.

Anyway, over the weekend I was lucky enough to go away with a bunch of student midwives for BMID Camp 2007. Everyone was invited but I was the only 1st year UniSA student to go, and there was one 3rd year as well… so it was a little strange to hear all this chatter about a course that isn’t mine! It’ll be fascinating to see how different my course is to theirs, too.

One thing that I did take comfort in was that the 2nd years who had JUST finished their first year were confident about births and seemed to know what they were doing. That’ll be me in a year. It’s a new set of skills to learn but I’ll learn it. I did also notice that:

• A physiological 3rd stage was practically unheard of
• The treatment for sticky shoulders or the more urgent true shoulder dystocia was to stick hands in and pull baby out, rather than the all fours manouver
• I have been pronouncing things correctly

A special HI!! to Sam who knew of my blog - hi Sam! Good luck next week!!

Photos:

 

Following on from my last post about textbooks, I have whittled the list down to:

• Australian Nursing and Midwifery Council 2005, National Competency Standards for the Midwife, Dickson ACT.
• Marieb, E. and Hoehn, K. 2007, Human Anatomy and Physiology, 7th, Pearson/Benjamin Cummings, New York.
• Strube, P 2003, Body works: Physics and Chemistry for Nurses, 2nd, Prentice Hall Health, Frenchs Forest, N.S.W..
• Johnson R and Taylor W 2004, Skills for Midwifery Practice, Churchill Livingstone, Edinburgh.
• Pairman, S. Pincombe, J. Thorogood, C. and Tracy, S. 2006, Midwifery, Preparation for Practice, Churchill Livingstone..
• Sullivan, A. Kean, L. Cryer, A. 2006, Midwives Guide To Antenatal Investigations, Churchill, Livingstone, Elsevier, Sydney.

two of which I can get 2nd hand already, and one that is available online. We’ll see about the others.

Obese pregnant women show uterine contractility impairment
Source: BJOG: An International Journal of Obstetrics and Gynaecology 2007; Advance online publication

Uncovering the reason for the high rate of cesarean section in obese women.

Obese pregnant women may encounter problems with uterine contractility during labor and may be more likely than normal weight women to require cesarean section, UK scientists reveal.

(Of concern because the recommendation appears to be that women who are classed as obese based on BMI would be labelled as "high risk" and be referred for ante-natal anaesthetic advice, rather than being encouraged strongly to lose weight)

Nitroglycerin may reduce preterm birth risk
Source: American Journal of Obstetrics & Gynecology 2007; 196: 37.e1-37.e8

Determining the effect of transdermal nitroglycerin on preterm birth.

Pregnant women who receive transdermal nitroglycerin may have a reduced risk of preterm birth before 28 weeks’ gestation, Canadian study findings show.

From the "what ethics committee in their right mind approved this" file (and also the "what was the point - all it does is give electice c-sections more "credence" because it means no brain damage, to grossly overstate the outcomes of this):

Neonatal intracranial hemorrhage common after vaginal birth
Source: Radiology 2007; 242: 535-41

Evaluating the prevalence of neonatal intracranial hemorrhage and its relationship to obstetric and neonatal risk factors.

More than a quarter of infants delivered vaginally have a small amount of asymptomatic intracranial bleeding compared with none delivered by cesarean section, results of a magnetic resonance imaging (MRI)-based study reveal.

BMI-adjusted chemotherapy doses advised for obese breast cancer patients
Source: European Journal of Cancer 2007; 43: 544-8

Assessing whether obese women with breast cancer should have adjusted chemotherapy relative dose intensity.

Obese women with breast cancer should be given the high chemotherapy doses recommended for their size, say UK scientists, after finding that this does not raise their risk of myelosuppression.

Prenatal diagnostic test shows promise
Source: The Lancet 2007; Advance online publication

Examining the potential of a novel and non-invasive prenatal test.

Scientists have devised a novel and non-invasive prenatal test that enables them to distinguish fetal DNA from maternal DNA, and to determine the copy number of fetal chromosomes in maternal blood samples.

(I think this hugely overstates the outcomes of the trial - the "success" was no better than chance at identifying trisomy 21, and if parents are counselled, able or willing to act on the outcomes of the results, I don’t think it is ethical to offer these kinds of tests. Offering this kind of technology to people who have genetic lotteries is one thing but the economics of it mean that the very few who need to use it to conceive a healthy child will never pay enough to cover the costs of it, so the technology will have to be offered to people who "want" the information…) 

Pregnancy hypertension has long-term cardiovascular impact
Source: Hypertension 2007; Advance online publication

Examining the impact of pregnancy hypertension history in healthy menopausal women.

Women who develop high blood pressure during pregnancy are more likely to develop high levels of coronary calcification later in life than those who maintain a normal blood pressure, say scientists.

Am I reading this wrong? Shouldn’t the study results be being reported in a way other than blaming pregnancy for the woes of heart problems in later life? To me, concluding that women whose bodies don’t cope well with the burdens of pregnancy also don’t cope well with the aging process is different from concluding that management of blood pressure in pregnancy will actually achieve anything. I wonder if there’s any evidence to that argument… especially since the survey was just a survey of what post-menopausal women remember of their pregnancies decades earlier, rather than a controlled study of medical records.

Pregnancy rates after vasectomy reversal

Issue 03: 5 Feb 2007
Source: Fertility and Sterility 2007; in press (doi: 10.1016/j.fertnstert.2006.11.038)

The chances of a woman becoming pregnant after her male partner’s vasectomy reversal is significantly lower if she is aged 40 or more, according to the results of a new study.

Again - am I missing the point here? Shouldn’t the study have looked at the age of the male rather than the female (or at least corrected for the KNOWN DOWN TREND in conception for women as they age)? What was the point of a teeny tiny little study to show what is already known??? 

Organ prolapse linked to vaginal delivery (esp one with forceps)
Source: Obstetrics & Gynecology 2007; 109: 295-302

Comparing levator ani defects and pelvic floor function among women with and without prolapse.

Women who experience muscle damage during vaginal deliveries have an increased risk of pelvic organ prolapse, researchers have discovered.

 

An article in the New York Times recently debates the ethics of doctors assisting patients to select the gender of their offspring. It’s a contentious subject - sex selection either before birth or shortly afterwards is widespread in China and India where social norms pressure the gender balance towards males. For centuries, families without sons feared poverty and neglect. The male offspring represented continuity of lineage and protection in old age. Combined with the one-child policy in China, females have been reduced to a burden that may "accidently" be removed… so much so that in 2005 there were 118 boys born for every 100 girls, in China.

If you want to select for gender, there are two options - before conception by sorting sperm / conceiving in particular positions / eating certain foods, or through gender determination (IVF, sonography, genetic testing etc) and termination of a pregnancy. For some reason, the former is considered ok while the latter is not, perhaps because it is more accurate and somehow more brutal.

Because female-making sperm are bigger than male-making sperm, the former are much easier to sort than the latter. So the technique is more successful for people wanting females than for those wanting males - and in the first world, it’s probably not going to make a big enough difference to skew the gender balance. However, in countries like China and India where is does matter so desperately, the technology will be available (and is to a certain point), and will be used to ensure that more boys than girls will be born.

This is terrible in a lot of ways - in the future, there will be far fewer women to marry and so leave many more men unmarried and this has been shown to increase violence in a given society. Violence towards women tends to increase as the number of women in a society goes down, and the imbalance in social structures, especially inheritance and property distribution, will be interesting to observe.  

My personal opinion - if I had a choice, I would have girls. But I don’t have that explicit choice and I am not hung up on it so I’d also be happy to healthy babies. If it matters to someone what gender their children are, to the point that they’ll go through testing and possibly abortion to change the situation, then I say more power to them. If it suddenly became free to have IVF, gender testing, sperm sorting or similar then I would have a problem if at the same time midwifery care was expensive, prenatal care non-existent for large numbers of Australian women, and insurance unavailable to midwives.