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Tribe for Midwifery Students 2008!!

74K views 2K replies 133 participants last post by  maxmama 
#1 ·
Our other thread was really getting long and I thought maybe it'd be good to start a new one... appropriately on New Years Day 2008!

This year will be full of wonder for all of us, Dear Ones- I can just feel it!

May your studies progress most appropriately to completion with ease, may your eyes see clearly, may your hands touch gently, may your trust in birth bring comfort and support to the women, babies, and families you will touch this year.


J.
 
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#378 ·
I'm in school and homeschool my 3 kids. I do a distance learning program and study when I can. So far it's worked out great. By the time I'm done with the book work and start apprenticing the kids will be around 6, 7 and 8 years old. My parents live a 1/2 hour from me (when they're not in Florida!) and I have some really great neighbors that would take the kids in a second if I had to run out and attend a birth.

Could you contact the local high school (or private school) and post up a job ad? Are there any local kids (13-18) that might drop what they are doing to watch your kids for a couple hours? Can you count on one of your parents, in-laws, brother or sister? What about calling the local day care place and making some kind of deal with them?

With as many times as you will be gone in a month, I'd say that having 2 or 3 solid sources would be best. That way if one can't, you move down and call the next person.

No, it's not impossible! Good luck....I hope you are able to work though this!!

 
#379 ·
Quote:

Originally Posted by CNM2B View Post
Hi Ladies! One of my closest friends just found out that she is pregnant with her first child. I am so excited for her and would like to give her a book that will help her through this journey. I was thinking of Ina May's Guide to Chilbirth, but I also thought of Heart and Hands. She is pretty mainstream
Anyway, I want to give her a book that might plant some seeds about more natural childbirth and hoped you all might have a suggestion....

Thanks!
I agree with "The Thinking Womans Guide" and also highly recommend "Gentle Birth, Gentle Mothering" by Dr. Sarah J Buckley.... it is one of the most holistic books I have read yet.

Tia
AAMI #1940
 
#380 ·
I have been homeschooling my oldest this year for K. next year she will actually be going to public school as I will be in El Paso from August until Nov. I am honestly not sure what we will do when I get home, if she will stay in school or come back to homeschool. I can see there will be some major challenges if she homeschools as it is really hard for me to find childcare for children who are school aged but not old enough to take care of themselves. I don't know what the right decision is, I don't know what is going to work out to be both the best educational option for my child as well as something that works for the whole family. We are just kinda fumbling through it.
 
#384 ·
Quote:

Originally Posted by Mavournin View Post
Question for all you ladies...

How many of you homeschool? How do you balance it with being a student yourself? With attending births?

Thanks mamas.
We unschool DD. I'm lucky enough to have DP a WAHD, and he's very supportive of my path as a mw. when it's appropriate, dd comes with me to pre-natals and births. She's becoming a wonderful little birth attendant. (though I never take her to a birth unless there's someone around who takes responsibility for her).
 
#385 ·
Hi everyone! I got to go to another birth last night! It was absolutely beautiful. Mom labored so peacefully. I feel like it's such an honor to get to witness these births!

On the homeschooling note: I'm home/unschooling my kids. We do some academics 2-3 hours a day, 4 days a week. When I start being gone more, the girls who come to baby sit can help them with their school. My babysitters are all homeschooled too which is cool!

Question for those who are apprenticing: How much do your preceptors mange the third stage? Mine definitely manages it. I don't think excessively so, but maybe a little. She does fundal massage every 5 min. for the first 20 min. and then every 10 min. for the next 30 min. and then every hour or so until we leave. The three births that I have been to, the moms all got misoprostol (Cytotec) and one got pit and methergine (she was definitely hemorrhaging.) It seems like she's a little quick to jump to the misoprostol. The mom last night was clamping down nicely and had no where near as much bleeding as the others did. After 20 min. though, they gave her the misoprostol because she was passing a lot of clots.

The thing is the misoprostol gives the moms such horrible shakes. The fundal massage is so painful (even though she's as gentle as she can be.) I'm wondering if it's necessary for the third stage to be so uncomfortable.
She seems to approach it from a better safe than sorry mentality. I was curious what your preceptors do. (Not criticizing here, just trying to learn...) It's really humbling how much I have to learn.

I hope you all have a wonderful day!
 
#386 ·
Quote:

Originally Posted by cfiddlinmama View Post
Hi everyone! I got to go to another birth last night! It was absolutely beautiful. Mom labored so peacefully. I feel like it's such an honor to get to witness these births!

On the homeschooling note: I'm home/unschooling my kids. We do some academics 2-3 hours a day, 4 days a week. When I start being gone more, the girls who come to baby sit can help them with their school. My babysitters are all homeschooled too which is cool!

Question for those who are apprenticing: How much do your preceptors mange the third stage? Mine definitely manages it. I don't think excessively so, but maybe a little. She does fundal massage every 5 min. for the first 20 min. and then every 10 min. for the next 30 min. and then every hour or so until we leave. The three births that I have been to, the moms all got misoprostol (Cytotec) and one got pit and methergine (she was definitely hemorrhaging.) It seems like she's a little quick to jump to the misoprostol. The mom last night was clamping down nicely and had no where near as much bleeding as the others did. After 20 min. though, they gave her the misoprostol because she was passing a lot of clots.

The thing is the misoprostol gives the moms such horrible shakes. The fundal massage is so painful (even though she's as gentle as she can be.) I'm wondering if it's necessary for the third stage to be so uncomfortable.
She seems to approach it from a better safe than sorry mentality. I was curious what your preceptors do. (Not criticizing here, just trying to learn...) It's really humbling how much I have to learn.

I hope you all have a wonderful day!
Women generally have shakes in fourth stage (after delivery of the placenta, I'm assuming, since that's what you're describing) regardless of whether they get miso.

Fundal massage is sometimes useful, but a fundal check is always useful.

In terms of recovery postpartum, yes, I think assertive management of bleeding is important, because fundal checks/massage are brief though uncomfortable, while recovery from excessive blood loss is long and unpleasant.
 
#387 ·
hotwings, 3 months at casa sounds awesome! i'm considering going sometime in the next year or so, but would probably only stay for 2 weeks-1 month. i think i'll aim for winter, cuz i'm not sure how well i'd handle the summer heat in el paso!

i just received my information packet from national midwifery institute and it seems like this program would be a really good fit for me. i just wonder if there would be some way to create a sense of community among students in a distance program (maybe an annual retreat? or a yahoo group? any other ideas?). is anyone familiar with/enrolled in this program?

i'm so excited to finally be starting my "official" preparation to become a midwife! any suggestions for how to approach potential preceptors about taking you on as an apprentice? there are some awesome midwives in my area, but i'm not sure about how i'm supposed to go about that whole process.
 
#388 ·
Rachel, just gather up the courage and call or email them and straight out tell them who you are, what you are studying and ask them if they could help you gain experience. It is scary and intimidating, but it is the only way to let them know that you are looking for an apprenticeship. I could be totally wrong in my approach, but I think just being totally straightforward with what you are seeking is the best way of finding someone who can help you out. I think when the timing is right and when the student is serious about getting the experience and diving in, the rest will fall into place somehow.
 
#390 ·
i feel like i'm in total limbo right now! i just don't know which direction to take.
NMI definitely looks like a good program, but AAMI is also a great possibility. is the CPM PEP process really that much more complicated/difficult? i'm just not sure that NMI is worth the extra $8k when i keep hearing about the high quality of education through AAMI... advice?
 
#391 ·
Quote:

Originally Posted by cfiddlinmama View Post
Hi everyone! I got to go to another birth last night! It was absolutely beautiful. Mom labored so peacefully. I feel like it's such an honor to get to witness these births!

Question for those who are apprenticing: How much do your preceptors mange the third stage? Mine definitely manages it. I don't think excessively so, but maybe a little. She does fundal massage every 5 min. for the first 20 min. and then every 10 min. for the next 30 min. and then every hour or so until we leave. The three births that I have been to, the moms all got misoprostol (Cytotec) and one got pit and methergine (she was definitely hemorrhaging.) It seems like she's a little quick to jump to the misoprostol. The mom last night was clamping down nicely and had no where near as much bleeding as the others did. After 20 min. though, they gave her the misoprostol because she was passing a lot of clots.

The thing is the misoprostol gives the moms such horrible shakes. The fundal massage is so painful (even though she's as gentle as she can be.) I'm wondering if it's necessary for the third stage to be so uncomfortable.
She seems to approach it from a better safe than sorry mentality. I was curious what your preceptors do. (Not criticizing here, just trying to learn...) It's really humbling how much I have to learn.

I hope you all have a wonderful day!
Congrats on the birth!!! It is soooo special to witness birth.

At the 5 homebirths I've been a doula at (I'm not apprenticing yet), this is how third stage has been managed:

First birth: About 15 minutes after baby, mom was bleeding more than usual and the placenta had not come yet (and baby had been nursing for at least 10 minutes--she came out starving and rooting like crazy!), so the midwife gave the mom an IM injection of pitocin. The placenta came about 5 minutes later, and the bleeding stayed within the normal range of blood loss.

Second birth: the amount of bleeding was completely normal and the placenta came out about 15 minutes after baby was born. No fundal massage or drugs were used, mom nursed soon after birth.

Third birth: mom had hemmorhaged with her previous baby, so the mom and midwife decided prenatally on a routine IM pitocin injection immediately after baby was born as a precaution. The placenta came 11 minutes after birth and there was no abnormal bleeding.

Fourth birth: this was the mom's 6th baby (fourth homebirth) and she had a history of hemmorhage. She took red raspberry leaf tea, nettle, and alfalfa religiously during pregnancy. Mom preferred a natural approach to hemmorhage and midwife and mom agreed prenatally to use an herbal tincture "hemhalt" routinely every five minutes starting at birth and to use a "watch and wait" approach to pitocin--midwife would have the syringe drawn up, but would not use it unless abnormal bleeding occurred. The placenta came 17 minutes after birth and mom recieved a total of 5 doses of hemhalt (2 after the placenta came); there was no abnormal bleeding. In fact, she bled the least out of all the births I have yet seen, including hospital ones where there is a routine IV bag of pitocin after birth.

Fifth birth: the amount of bleeding was completely normal and the placenta came 16 minutes after baby was born. No fundal massage or drugs were used. (FYI, this birth was a different midwife than the first four births)

I have talked to my future preceptor (and the midwife for the first four births) before about 3rd stage management, and this is her usual procedure, when there is no pre-existing risk of excessive bleeding:

As long as bleeding is normal, she does nothing but check the uterus every 5 minutes or so (not fundal massage, just gently feeling the uterus; none of the moms that I have witnessed have expressed pain when she does this) until the placenta comes. After the placenta comes, she periodically feels the uterus to make sure it is hard but doesn't do fundal massage unless the uterus is soft and not contracting down or she suspects a retained piece of placenta.

As long as the placenta comes within 20-30 minutes and bleeding is fine, she is comfortable that. Usually at the 30 minute mark, even if everything is fine, she will recommend an herbal tincture and most of the time the placenta comes immediately. She will use pitocin if there is excessive bleeding after birth (or after the placenta) or if the placenta doesn't come after she administers herbs. She has waited up to an hour for a placenta because everything was completely normal and the mom preferred to let her body release the placenta on its own, as long as she wasn't bleeding excessively or anything.

So, those have been my experiences--hope they help!
 
#392 ·
The mw I assist doesn't do anything except check fundus once or twice (gently)- unless there is more than usual bleeding or hemorrhage. In cases of hemorrhage the mom is given pit, methergine or cytotec, fundal massage, mom nurses baby right away, etc. She practices expectant management waiting for the placenta.
 
#393 ·
Quote:

Originally Posted by pittnurse08 View Post
i feel like i'm in total limbo right now! i just don't know which direction to take.
NMI definitely looks like a good program, but AAMI is also a great possibility. is the CPM PEP process really that much more complicated/difficult? i'm just not sure that NMI is worth the extra $8k when i keep hearing about the high quality of education through AAMI... advice?
I don't think the PEP process is that much more complicated.... it wasn't enough of a complication for me to pay an extra 8K at least. You can go to NARM and print off the paperwork for the PEP process so you can see what it all entails. Basically, you need to have your preceptors sign off each skill and date when you mastered it.

I originally had it very set in my head that I needed to go with a MEAC school. The more I looked at the PEP process, the less afraid of it I was and the more willing I was to hear students from non-MEAC schools talking about their educations. I finally went with AAMI and I am pleased with it. Just today I was working away on a textbook assignment and thinking to myself how much I am enjoying AAMI now that I am through orientation and how much I am learning!

I have heard great things about NMI as well! Lots of tough choices in trying to nail down the right education! I hope you find the perfect fit for you!!!
 
#394 ·
thanks, erika
i know it will all work out somehow, it just hard for me to not know right now (yes, i need to work on letting go! haha). the more i read about AAMI, the more i feel like their philosophy about non-interventive midwifery fits my own beliefs. i think i'll contact carla when the conference is over to ask some questions.

is anyone else super envious of everyone at the trust birth conference right now? i wish i had found out about it sooner so i could have arranged to go. it just seems like such an amazing opportunity to meet so many midwifery and UC pioneers! ok, pity party over! now i just need to be sure to plan ahead for other great conferences. the midwifery today conference in march '09 will only be 2 hours away from where i live, so i'll definitely be there!

i also have a question for all of you about shoulder dystocia. i went to a midwifery mini-conference recently where someone mentioned that she believes that many SDs are caused by provider's "jumping the gun" when the shoulders don't follow the head quickly enough, therefore alarming the mama and causing the mama's pelvic floor to tighten, further impacting the shoulders behind the pubic bone. this makes sense to me... but at what point should you become concerned and take action? one midwife said she waits 5 minutes after the birth of the head. that seems reeeeeally long to me. this is an especially concerning subject for me because there was a 9 minute SD at work a few weeks ago (not my patient, but everyone on the unit has been talking about it) and the baby suffered severe hypoxic brain injuries and died a few days later.
 
#395 ·
Yes, I am jealous of the conference go-ers. I had been planning to go, but we ran into some serious financial issues this year and that plan had to be scrapped. I have people due now anyhow, so I guess it all worked out the way it was supposed to, but it would have been a great conference!

With shoulder dystocia... I think sometimes care providers do jump the gun a bit. I think 5 minutes would be a long time if the baby looked bad. However, I have had a baby and been at a birth where the baby's head was out for more than 4 minutes without the body following and there was nothing wrong, it was not a shoulder dystocia at all but just took that long for the next contraction. The baby looked great, was looking around, color was good, it was obvious he was just kinda hanging out and waiting for his mama to finish pushing him out. I think sometimes when the body doesn't follow immediately there are some who will lable it a dystocia and start messing with it when maybe it is just the normal flow of that mama and that baby.

So, I guess to answer the question if the mom was having contractions and trying to push and the baby wasn't finishing up, I would probably suggest a change in position after the 1st contraction of the baby not following. If the mom wasn't having any contractions anymore and baby looked good, I would probably suggest the mom try pushing with or without a contraction right around the 5 minute mark or so. if the head was out and baby looked poor or had low or no heartrate, I wouldn't care what the clock said about how long it had or hadn't been and just start right away trying to get the baby the rest of the way out.
 
#398 ·
Quote:

Originally Posted by maxmama View Post
So, we talking true SD (with an impacted shoulder, turtle sign, purpling head, the whole shebang) or we talking sticky shoulders? Completely different things here.
That's what I was wondering. I've seen sticky shoulders but not SD.
 
#399 ·
Quote:

Originally Posted by pittnurse08 View Post
what would you do for both situations? (might as well learn about both scenarios since you mentioned it!)
True SD is unusual. I've seen it twice in six years as a labor nurse. Both times I threw up afterward.

With a turtle sign and purpling of the head, I would be aggressive in delivery of the shoulders. The usual routine on our unit is McRoberts-Gaskin-delivery of anterior shoulder-Woods screw-clavicle reduction-Zavanelli and section. We don't usually have moms push between contractions, but with a true turtle sign, you want the momentum to get the baby out before the shoulders get impacted.

Sticky shoulders, I'd probably put her in McRoberts or Gaskin, whicver was easier, and wait until the next contraction to push as long as baby soudned good.

That's me though. Who knows how I'll practice when I finally finish?
 
#400 ·
Quote:

Originally Posted by pittnurse08 View Post
i feel like i'm in total limbo right now! i just don't know which direction to take.
NMI definitely looks like a good program, but AAMI is also a great possibility. is the CPM PEP process really that much more complicated/difficult? i'm just not sure that NMI is worth the extra $8k when i keep hearing about the high quality of education through AAMI... advice?
Rachel, the PEP process is really so simple.
 
#401 ·
Here is my take on shoulder dystocia:

True SD is pretty rare, like maxmama said. I just attended my first birth with a true dystocia, the day before we left for the conference. It was about 13 min. from the time the head was out to the time the body was born. We could feel no anterior shoulder at all. Baby was 12 lb, 12 oz. About 2 contractions passed before we stepped in to see what was going on. There was turtling, but we couldn't see it at first because of where and how mom was pushing, so it wasn't until I climbed around mom to her back side did I see the turtling head. We called 911 at some point (well, we told dad to), and they arrived about 1-2 minuted after she was finally born. Her heart beat wasn't palpable at birth, and she had poor, poor tone and color. We immediatly began bagging her and chest compressions, and she came to fairly quickly. Her heart rate was over 100 by the minute mark, and by 5 minutes, she was breathing on her own (she had many attempts before this point, but still needed me to bag her for a while). She stabilized so well. We saw her today, at 1 week old, and she is doing beautifully. The EMTs stayed long enough (about an hour) to make sure mom and baby were stabilized and healthy (which they were).

It comforts me to know that the likelihood of me experiencing another dystocia that severe is very slim, though if I did, I would know how to resolve it.

I am just now able to recount the story without crying. I was so, so sure that I would be attending a funeral last week in those moments before she was finally fully born. The time just seemed to drag on, and on.

I have seen births where there is a 5 minute delay in the body, and that wouldn't concern me so long as there is no turtling, or lack of restutitution (sorry, I know that is spelled wrong). Lots of mom's 2nd stage contx are every 5 min. or so, so it would make sense to wait 5 minutes in that case, for the next contraction.

My friend (who just finished her apprenticeship) recently attended a birth of a baby where there was a 16 minute delay between the head and the body. Baby did great, and didn't need any help to start up once born.
 
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