Midwifery is catching

I’ve been wondering about a few things recently.

• The purple line and its relation to dilation - meaning that lots of VEs were done on women as they progressed through labour to see whether there was a correlation. 
• Why we wait until 10cm to be convinced that a woman is dilated.
• Where the 10cm rule came from.

"There is a rule of labor that forbids a woman to push with contractions until her cervix is completely dilated to 10 cm. Women are warned that to push before this doorway is completely open and out of the way will result in a swollen and/or torn cervix."

I’m curious to hear more on this topic and when I’m done with my current paper, I’ll look into it some more.

I’m developing a style of practice that is being hands off and observational, which is often in conflict with the hospital system that I am learning in. I get that I am a student and that I have to learn before I can be. I also get that I am the midwife I will be in the future; it’s in the heart and soul, not in the textbooks, but I need the knowledge and skills to catch up to that passion. But wow it’s hard going to be trained in The System when I don’t agree with so much of what I have to do.

I think if I ever get bored or completely disenchanted of being a midwife (yes, that’d mean "after I’ve graduated" and "after I am a midwife") (and possibly "shortly after Hades freezes over"), I’d like to specialise in something like maternal fetal medicine. That’s where I spent a day last week - following around an amazing woman who is responsible for providing midwifery, women-centred care for women and babies who come under the heading of "complicated heavy duty stuff related to pregnancy" at the Women’s and Children’s Hospital here in Adelaide.

The day started off simply enough - feeling each other’s approaches out, working through some basic stuff, and getting ready for the day. That was after I struggled to find the lovely Beck, as she is a bit of a nomad around the hospital, and I’d been less than prepared in contacting her yesterday to make sure I knew what the plan was for today. Anyway, I met up with her and got a crash course/refresher in the things that go awry for both mothers, and their babies. After a few visits and file collections and trips to the lovely basement (I love basements of buildings! They’re so gorgeous and interesting and out of the way of your average Joe Public!) we had a much needed coffee and a chat about stuff. The afternoon had us attending the hospital round for complicated cases and there was a huge range of issues covered, none of which I can cover here for privacy’s sake. But I was also amazed at the dial-in of people from Darwin Hospital, who had a really rare case that was a lot like a really rare pair of cases that the WCH had recently regarding the umbilical cord (I think - at this stage I was short on food, water, oxygen and brane cells so I can’t really remember) and it was fascinating seeing the video conferency technology applied to medicine as well.

I love learning and I love learning about complicated issues as well. So today was fascinating for me. I also got to see situations where technology is needed, and is the sole reason that women remain relatively healthy and babes join us earthside. Whether I agree or not with the amount of effort that goes into this, when people are homeless and bankrupt and unhealthy, is a matter for another post but it was a good reminder that hospitals do amazing work when they are needed.

That’s my GPA at the moment in fact. I am fabulous at some types of university essay type work.

In other news, when midwifery is hard, it is really hard. Today was a hard day. Yesterday was exciting and challenging (emergency c-section with classical incision, which was the first I’ve seen!) but today was just awful and amazing all at the same time. I can’t go into specifics but when there are two extremes of life - awesomeness and awfulness all at once - it wrings you out, chews you up and rips shreds off your soul. And in a professional sense you have to keep your shit together while inside you want to throw up, throw something, or throw your arms around the nearest person.

A long long time ago, I wrote a post about how much a homebirth cost. It is my most popular post by far and I am feeling the need to update it.

*EDITED* to add that these costs are not for private births per se - the ones Anna gave me are for New Zealand and not for Australia.

The costs that I quoted were from enquiries in Sydney, so let me upate for Adelaide. Rumour has it (as in, I’ve never felt the need to ask midwives directly but people who have had homebirths have hinted around these numbers) that a privately attended birth here will cost $2,000 - $3,000 rougly: a little less here, a little more there, up to $4,000 one person reported to me (but that included a few extras). The hire of a birth pool is usually extra to this. 

A few of the comments have questioned the $50k figure I put on business costs. I wasn’t clear there but I will say that those costs would be that high to cover the cost of self-insurance if that’s the way that I wanted to go.

Anna gave me me some New Zealand figures to work with:

4 births a month @ $2,000 each roughly, from the NZ government = $8,000
$900 in business costs a month = $7,100 / year
If I assume one month off a year, that’d be $78,100 a year

Homebirths cost $400 more to the midwife because of the calling in of a second midwife so potentially up to $17,600 less, so $60,500 (but perhaps this is balanced out by being the "second midwife" occassionally?)

So there you go, an update and a reflection of how it might be in Australia if we ever had a homebirth policy! 

Please go and read about this and see what you think.

Add to this - if you want a physiological third stage in a hospital setting, the words "lotus birth" will guarantee that no one severs the cord. Even if you have no intention of keeping the placenta until the cord falls off on its own, it will keep people from cutting cord, which is one of the only ways to insist on letting the baby get its full compliment of blood.