Home again

We have all arrived safe and sound back in Vancouver. It is overcast today but everything feels so clean - it was great to feel the quality of rain in the air. We lucked out with great weather in Holland, kind of grey in Paris but avoided the need for umbrellas in both countries. I have to start on my new placement tomorrow which is sure to be quite the change from what I've been up to the past 8 weeks! I will come back and write a conclusion to my Dutch experiences when I get time.

Final week in Doesburg

Things are winding down for me here. Have been saying goodbyes to some of the babies and families I've met over the past weeks and even took a day off call. I had another delivery on Sunday night after a long day of trying to finish up some school work. It was a second time mom, who had a previous postpartum hemorrhage so she was to deliver in the hospital. Everything was very normal with the delivery, but I needed some coaching with coaxing out some sticky shoulders. The baby was a whole kilogram less than our real shoulder dystocia baby, but still looked kind of big to me afterwards! There were no problems with bleeding afterward, and the placenta was bipartite (bilobed). It was very interesting (to me at least) and the dad took a picture of it so I have to see if I can get him to send it so I can post it for you.

Holland's smallest city and births #8, #9 & #10

I went with one of the midwives to the nearby city of Bronkhorst which is famous for being the smallest in the Netherlands (city rights granted in 1482) and also has a museum dedicated to Charles Dickens! The church dates back to 1460. I'll post some pictures. It was very lovely. I also attended some more births this week. I'm having some trouble remembering dates and times now, but the first one was a hospital birth with a tight nuchal cord. I got some help clamping and cutting that one and the baby was fine. Mom had to go to the OR though as she had a previous placenta increta and this time the placenta would not come out either. I tried, the MW tried, the hospital MW tried, then the OB came and tried. I was glad to be in the hospital already. Birth #9 was a another homebirth, 2nd baby. Her first was born in hospital because of very bad back labour and need for an epidural for pain relief. This time, she laboured at home with a TENS machine, calling at 6pm to say her water broke and all was fine. We made a plan to eat then see her at 630pm. At 620 her husband called to say things were getting heavy and the TENS wasn't working. We arrived and she was 8cm, so we set up and I started the delivery, slooowly the head was born to the nose and the midwife asked me if I had the head and I said not yet. She then stepped in (mom was side-lying) she delivered the head and said "Hands and knees" twice and the mom flipped over. It was a shoulder dystocia and the MW did 2 moves to get the baby born. She was huge and floppy 4780g. She had a great heart rate, but took a full, long minute to start crying well. I'm so amazed to hear about my sister clasmates managing these emergencies on their own - I felt so relieved that the MW helping me was there. There was no problem at all with third stage, and I delivered the placenta without cutting and clamping it off the baby - that was a thrill! The next birth was at home again 3rd baby with a mom who delivers quickly. She was about 6-7cm when we arrived. We sent up and went to drink a coffee downstairs. An hour later she said we could break her water. About 1/2 hour later she was pushing. 10 minutes of pushing and a straightforward delivery with no need for suturing. Yay!

Home birth set up

1 teeny oxygen tank, infant bag & mask
home birth bag containing: IV supplies, suture equipment, catheter, gloves, extra instruments, soap for cleaning instruments
visit bag: BP stuff, gloves, doppler (not pictured)

In addition to this, all women receive a box of supplies for the delivery or postpartum period from the company that is doing their care in the home for the first week. As far as I can tell the box is the same whether or not you are having a planned homebirth or hospital birth. It contains blue pads, gauze, pads, cotton balls. Everything you need postpartum ;)

another home-y

We had a surprise birth yesterday afternoon. First time mom, in early labour at noon (2cm). At 3 pm her husband called to say things were picking up and what could we do? The MW explained we could come, do some massage for her, get her into the shower blah blah blah and he said, ok no problem, we're fine. An hour later he called again and said that she felt like pushing. We were on the move, hoping for 5-6 cm and were so happy that she was fully dilated! Because it was so quick I wasn't able to take any pics of the set-up at home, but I have some shots of the midwifery supplies that I can post later. There was another mixed methods approach to the placental delivery - this one took 24 minutes to come out and I was really dreading if it would be retained. But the midwife was able to convince it to come out and the blood loss was more than usual but not terrible (800 ml). I saw them today and they are all doing well.

Bevalt snel!

Two more births, both very quick home deliveries. Both of the women had previous births that went fast, so they had been told to call when they felt the first contraction! The first one was about 20 minutes drive away, the mom had said she wasn't sure she was in labour but felt some tightenings. When we got there she was getting more active, but still coping great. We set up our stuff and she went to the bathroom, came back to the bed and said "I feel pressure." That sounds almost exactly the same in English as it does in Dutch so I understood it and put my gloves on. One push and her water broke, then another and there was a screaming baby. SWEET! Then this morning at 2 am I got a call that we were going to see a woman who had been checked last week after having some hours of contractions, and we knew she was 3cm then. She had an hour long acupuncture appointment here in the clinic yesterday so we knew it could be anytime (she was 8 days past her due date and very ready for the birth). She was 4 cm when we got there (took 30 min) again we set up, her water broke, the baby's head was right there. I got on my gloves and the head was born between contractions. We were home by 5 am. I took a picture of the sky it was so pretty but cold - 4 degrees. The fields had some very low cloud. Beautiful. It was a great day! I will make it my mission to take some pics of the home birth set up - I'm keeping my fingers crossed for another home delivery.

Hands on delivery * with gory details

Yippee! I got to catch a Dutchling! A very nice plump baby girl was born on the early morning of the 25th. It was sort of a strange labour, not really powerful contractions until transition, but they did the job. There was a unorthodox management for the third stage as this mom had a history of postpartum hemorrhage. So we did give oxytocin, then to my surprise my assistant started to massage the uterus. I think it is because she was already bleeding more than normal, but I have never seen fundus fiddling prior to placental separation... anyway in 10 minutes the placenta came and that was the end of it (thankfully). So I guess I can tell you about the other placenta delivery I saw. It was at the home birth. One of the marvels of the midwives here is that they go from the office to a birth in their "work clothes." So the midwife I was with was wearing a dress with some long necklaces and pumps. (We usually leave our shoes on in the houses - so I was crawling on the bed to get fetal heart tones trying not to get my feet on the bed.) Anyway she delivered the placenta out and up by the umbilical cord magically trapping all of the extra blood that usually gushes out of the placenta and membranes - when I do it at least - and placed the whole thing on a blue pad. And she did it all with one hand, in her dress and heels, without getting a spot on the bed. I'll really try to do it myself - and get photos!!