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!!

the bikes & the wedding place

Week 3

It's already half-way over. In many ways it has gone very quickly. Today though, I'm feeling homesick. This morning we all went to the wedding ceremony for one of the midwives here. We biked over - a group of five to the place were the wedding was being held in a teahouse. It was really nice to be invited and welcome but I felt like a total dork when I joined the congratulation line or whatever it's called and after greeting the bride & groom had to say hello to all the confused relatives who were standing there wondering "who the hell is that?" I decided to pass on the next phase of the celebrations which is beginning now. I thought it was Saturday so went to the "market" only to realize it's Friday. Pity! Anyway in good news I attended another birth in hospital on Wednesday. It was quick and straightforward with the mom delivering on the birth stool which was in the delivery suite. This was a different hospital than the last birth I went to, but I heard they reserve this room for the midwives. The weird things about it are there is no shower or toilet in the room! Luckily for our mom she wasn't there long enough to notice. She gave birth at 16:50 and was home at 22:00. Last night I was invited to dinner at one of the midwife's home and we had a really nice walk after dinner to see the sights of the town including a large castle and windmill on the IJessel river. It was a really nice evening. Well I guess there's not really that much to complain about after all. I am just looking forward to my family joining me soon!

Three day rule

I am very impressed with many efficiencies related to childbirth in Holland. After my first day of postpartum visits I noticed at the office that the birth announcements for these very newborn babies were already on display. I have now learned that Dutch families have only three days to register their child with the appropriate authorities (compared to our 30 days). This need for quick registration means that most families have already decided on names and probably already picked the design for the birth announcement long before making labour plans. On display for you here is the birth announcement from my first birth and a lovely array of Dutch treats minus the licorice whips because I ate them.

Herring

I was trying to wait to post some more birth news, but it was a pretty quiet weekend after all. I took a picture of my dinner last night, so I will share that with you instead. My landlady bought the herring for me for a "typical Dutch" meal. I thought it was pretty good - tasted like sushi with a couple more bones. I learned today that it is supposed to be a very healthy thing to eat, so that's great as my diet hasn't been too diverse so far. In other news, I went for my first bike ride in the countryside last evening. It was really nice, but I'm not used to it, so I think I need one of those lamb skin seat covers for comfort. Today I received a really nice gift from one of the clients whose birth I attended - I will feature the items for you in the next edition.

Home birth

Yay! A baby was born. We visited the family in the afternoon and she was just getting into active labour so we said, "See you in a few hours, or call us if you need us!" It was her second child so we thought we might have time to go check on another woman who was in hospital progressing very s-l-o-w-l-y but we had to turn around to come back to Doesburg for the home delivery. I got to boil the water for filling those baby/bed/clothes warming stainless steel bottles with and check out the equipment. Things progressed quickly and a beautiful chubby girl was born after a few pushes. The nurse helper didn't make it in time for the delivery. I was on camera duty again this time, but was got a good view of and was impressed with the Dutch style of placental delivery. I think I might try it, but I'm afraid it will be a lot messier. After that we headed out to the hospital where our woman was still not really in labour, so she got some morphine to try to sleep and that was all for the night. Today I did some more home visits checked our woman in the hospital (who is now no longer our patient as she has an epidural) and hung out in Doesburg a little. I was able to borrow a bike, so I biked over to the office to check my email and read some news! I'm not used to living with no email, no internet, no TV. I have the radio on all the time, but really don't understand much!

Windmill

I spent yesterday driving all around doing postpartum visits and two early labour checks and still no more births! I got to have a couple of authentic Holland experiences though. One was getting a ride on the back of a Dutch bicycle over cobblestone streets (not too comfy!!) and the other was seeing my first windmill up close. I have to ask again what town it's from, but I'll attach a picture of it for you.

clinic week two

It's been a slow week birth-wise but I had busy day in clinic. I got to do a number of finger pricks for hemoglobin checks. They have a cool device that analyzes the results on the spot. Then I did a blood draw and an injection. It was nice to be able to do all that stuff again. Everyone is wondering where all the babies are. They are just not coming in Doesburg at the moment. Tomorrow is another holiday, so I'm just doing PP visits. I'll write more once there is some news. xxoo

Happy Mother's Day

I went to my first delivery last night/this morning. Our mom’s membranes ruptured in the morning and things were slow to start (third baby). I went with the on-call midwife to assess her at home at 9 pm and she was having some contractions and 3 cm dilated. We made plan to see her again at 3 am or for her to call if she needed us beforehand. At 3 we went back and checked again to find things had picked up she was now 5 cm and we moved to the hospital as planned. We met the nurse who would come in for the delivery, but we on our own with the parents for the most part. The midwife did some paperwork (not too much!) and set up for the delivery. The room was similar to a delivery suite here, but there were some big differences. First one, they really crank the heat for the newborn. I was almost falling asleep it was so warm. Next, they put hot water bottles in the newborn cot and warm the baby's first set of clothes in there. There was no emergency equipment (suction, infant oxygen) anywhere in the room that I could see. Also, no infant stethoscope around. The mom did a great job of delivering her baby - this time a daughter to go with her sons. Everything was great, except there was a serious complication with the placenta delivering. She had received oxytocin, but the placenta did not let go from the uterus. The cord detached from the placenta when the midwife tried to deliver it, so our mom had to go into the OR to have the placenta manually removed. At that time we had to transfer care to the hospital OB/GYN and we weren’t allowed to accompany her during the procedure. I wish the whole thing had gone more smoothly at the end, but I guess these things happen sometimes. It is a real pity after a very straightforward delivery. I'll end on a highlight = breakfast in the hospital! If I get to go back I’m going to take a picture of the food cart that they offer to the moms (& partners?). It was full of single servings of delicious bread toppings. I had bread with chocolate sprinkles, a cheese bread and a hard boiled egg with really fresh tasting orange juice. The presentation is so neat and tidy.

My domicile

Still waiting on the babies, so here I will give you a tour of my place. It is the same one Laura stayed in (and I think all previous UBC students.) I had the camera on a weird setting, so it's really not that scary in person. First is the picture from the outside, that is the bathroom(s) windows. There larger window is where there is a huge tub, toilet and sink. The other one has a shower and sink. My bedroom faces the road, and the window is on the front of the house towards the road. The next picture is my bedroom. The bed looks so small but is actually pretty comfy. The wardrobe holds some dishes and cutlery. There is a small fridge, coffee maker, kettle and radio. Oh yeah, there's a TV but I haven't figured out how to turn that on yet. Today I discovered every Saturday there is a market in the center of town. There were lots of fresh fruits and veggies, flowers and a few stands with hot food. I just browsed today - suggestions Laura??

Something baby related

http://www.movieweb.com/movie/babies/VIpoXvpyuRs7tq

Since I'm still waiting to go to my first delivery, here is a trailer for a movie that looks so good!
It's another gloomy weather day. I was thinking summer when I packed, and now am really glad I threw in a couple of sweaters at the last minute. I'm staying on call for the weekend, but not going to any of the postpartum visits. Right now I'm at the office to do some work that requires internet and having a coffee (made here of course). Don't know how, but I'm managed to avoid caffeine withdrawal symptoms since I haven't been having a coffee every day. I guess the tea is powerful enough. Bye for now!

Rainy day

There's not much news on this side. Spent the morning at postpartum visits - still have yet to actually HOLD a baby! There was a birth last night, but she didn't want a student, so I got to sleep all night (and it was a good sleep). Here's a couple things I learned today: the midwives don't do the PKU blood test for the baby, they have a specialist who comes to the house to do it. Also, if there are any other "medical" needs (we had a mother who was feeling a little dizzy and tired 4 days after delivery) there is another house doctor who comes to take a blood test to check her iron levels. Normally we would just send the person out to the lab for that.
We're going to finish the day with 2 more visits this afternoon, then I have to figure out my weekend plans. Probably I will be staying on call for any births I'm invited to, but maybe not go to the baby visits. Not sure.
That's it for now. Hopefully I'll need to update soon with some birth news!

Liberation day

Today is a national holiday so there are lots of kids around, most shops are closed and there is a party in the town center.
Here are a couple of pictures I took yesterday and today in Doesburg.

Shopping day

I made it to the grocery store again and had some more time to explore it. Below is my shopping list. I didn’t take my phrase book and took a chance on a couple of the things. I ended up getting a quiche which I knew was spinach and some kind of cheese. It turns out it’s blue cheese - probably not my favorite, but I’m hoping to get 2 meals out of it. The other treat item is the salade nicoise - Laura thanks for the tip about these. I had the bocconcini pasta one last night for dinner and yum! There are some really nice touches I found today, first they offer bread in full or half loaves. Very convenient when shopping for one and having the freezer the size of a small ice cube tray. I also like the huge variety of sandwich/cracker toppings which are packaged in very appealing containers. I would probably never choose it at home, but I got chicken curry which I just tried on a cracker and it was good. I splurged and got a Canadian sized coffee/tea mug. The one in my cupboard makes me feel like I’m wasting tea bags and it was on sale and it was one of the life improvement ideas I had in the early hours of the morning. There was an impressive selection of licorice but they didn’t have my known fave licorice cats by Venco so I passed on that today. I’m going to make some tea now. Maybe tomorrow they’ll be some more midwifery related news for ya!
PS - Quiche update. The “schimmel” in “blauwschimmelkass” translates as mould/mildew. It just did not taste good. A piece of chocolate for dessert should take away the staleness.
PPS - the mug was a success.
item cost €
peanut butter 350g 1, 09
raspberry jam 450g 1, 21
shopping bag 0, 22
ceramic mug 2, 99
chocolate & hazelnut bar 0, 79
chicken salad spread 0, 99
1/2 loaf bread 1, 03
quiche 3, 19
strawberries 2, 29
cup a soup 0, 82
salade nicoise 2, 99
braeburn apples 0, 96
black tea 1, 17

Clinic day one

Day one at the clinic was very nice. Everyone working here is so friendly and welcoming. They are really delightful. Most (well all) of the clinic visits were done in Dutch, so I admit to wishing that I had studied up on some vocabulary. The visits are short compared to the Canadian appointments I’m used to ~ 10-15 minutes, but strangely things don’t feel rushed. I got to do a number of belly checks and meet a few people who will be due over the time I’m here. They all said I am welcome to come to their births. Sweet! The morning started early at 8 am and normally there is a coffee break midmorning but my midwife admits she talks a bit too much, so we had tea in the office and kept going with the visits. We were done in the early afternoon. Then I got to meet another one of the midwives who was on call and we went together to a client’s home who was 36 weeks +3 days and having some regular contractions. She is too early in her pregnancy for the midwives to do the delivery so we had to check what was going on. It turns out she’s not in labour so we were able to head home. I also got my cell phone organized so I am officially on call. Overall, it’s going well except for the past 2 nights I’ve woken up at about 2 in the morning and then toss and turn until I have to get up at 6:45. That really stinks because I really want to sleep. It’s been cool here and rainy the past days but smells really nice with all the lilac bushes blooming and other flowers whose names I don’t know. One day I will take some photos of the gardens around here - there are some serious green thumbs at work. Today the sun is shining!
So now it's actually the end of clinic day number two (and it's only 1pm). There is a clinic meeting right now with all of the owners, so I'm out in the front making use of the internet. Not sure what the rest of the day holds but the sun is still shining so maybe a walk and trip to the grocery store to get some fruit.

Welcome in Holland

I’ve just unpacked - my arm wants to fall off from dragging my mega-suitcase.
The flight was pretty uneventful and I did manage to sleep for 5 hours maybe. It was pretty uncomfortable for sleeping and I never thought I would say this but I’m starting to understand why people purchase (and use) those around the neck travel pillows - Yes you need one! I saw a guy wearing one today that was inflatable. He looked like a total dork, but well-rested.

I’ve created a list of my top 5 rookie traveller mistakes:
#1 Don’t be late for the boarding call. I was supposed to be there at 1920, but got there about 1930. I really needed to use the washroom, but decided to go to the departure gate first. Guess what? They were announcing my row to board (thanks god not by my name - though for a second ...).
#2 Time your in-flight washroom trip appropriately. Due to the circumstances of point #1 I really couldn’t wait long after we were all loaded onto the plane and had been flying for a while. I bravely unbuckled and headed to the W/C (that’s european) only to find out I couldn’t see how to open the door. Luckily for me there was a helpful flight attendant stationed right by the door, only she was telling me to go back to my seat because the fasten seatbelt sign was still illuminated. Just as I was processing what she was saying, the light disappeared! She graciously opened the door for me after explaining the dangers of disobedience on board.
#3 I was feeling really impressed with myself for breezing through all security checkpoints and was ready to hop on the train. Here I encountered my first inconvenience related to the mighty euro. For some reason the automated ticket machines (they are very friendly in all other ways) only take euro coins or chip embedded credit cards. My simple plan was to get something small with one of my nice bills so I would be able to get the 15 in coins. Unfortunately for me, the shop I went to only had 2.50 in coins, so I had to go to plan B. I couldn’t see the huge counter that was train ticket info and I wasted time doing two extra laps in the area, and also fretting over the fact that a message saying “embedded credit cards only here.” They took my cash no problems. Only 3 euro down for a water and postcard. Still feeling good. Lesson: have a Visa card with a “chip” in it or just ask where the desk is and save your poor arm an exhausting and annoying workout.
#4 Take a cell phone. My plan was to call from Arnhem to see if one of the midwives would be able to meet me at the next train station (Dieren) and if not to climb on the bus and head to Doesburg. Even though I have a supply of coins, there is not a pay phone in sight. Another helpful and friendly Dutch worker let me use a work phone check in with the on call midwife. She was surprised to hear from me - knowing that I will start my placement officially on Monday, but not expecting me today. Anyway she’s busy so I have to get on the bus. No problem, I’m getting the hang of this travel stuff, except I need the bathroom again...
#5 Use the bathroom even if it costs .40€. You would have thought I learned this one already but I was weirded out first because I think the W/C might have been co-ed plus I wasn’t sure how I was going to navigate with the massive suitcase. I decided I was too weary to investigate and just left. It turns out that was a poor decision because when I got to my place there was a note from my hostess that I should get the key from the neighbour (I expected that one) and a note from the neighbour saying that they had gone for dinner and I should Call them - see point #4 or walk over to the restaurant using his lousy map. I left the arm mangler at the front door and wandered around trying to make sense of the map. Couldn’t locate the “bridge” or the street indicated. But eventually they came back and let me in and here I am. It was an absolutely beautiful afternoon. It had rained really hard but the sun was out and there were beautiful birds all around everyone biking around. I’ll see if any pictures turned out and post them. Hope I can send this tomorrow.

Where am I going?

I thought I should give you some more information about my plans for the next six weeks. I'm leaving tonight and flying to Amsterdam where I will be able to go downstairs to purchase a train ticket to take me to the town of Dieren. From there I will hopefully be able to get a lift to the place where I'll be staying in the town of Doesburg, otherwise it'll be public transit which is also supposed to be easy to manage. The clinic where the prenatal visits are held is near where I will be staying for most of my time. Here is a link to the clinic's website:
http://www.vroedvrouwenpraktijk.nl/
My family will arrive on June 12 and then we will have time for a little European holiday before heading back. I think that's it for now. I've got a lot of packing to do. Wish me luck. xxoo J

Packing up

Only a couple more days before I fly away. My plans for a week of targeted preparation have been thwarted by an ill child who has missed the past two days of school. I had imagined spending the day doing some shopping and picking up a power adapter instead of making tea and toast. Arne came home early, so I went out to help organize supplies for classmates who are headed to Uganda and Nepal. I was able to take donated knit hats for all the Dutch newborns I meet - cute! I'm still trying to figure out how I'm going to pay for anything while I'm away. So far I know that anytime I use my debit card I will be charged $5 and I may or may not be able to access my savings account depending on who I ask. Visa will charge me a fee of 2.5% on every transaction that involves conversion of currency. No problem, I'll just take cash. Now I just have to find any local bank that doesn't need 3 days warning to "order them in." Oh poor last-minute-me.

What are traveler's cheques?

Hello everyone,

Thanks for visiting my blog.

Soon I will be heading to Europe to spend six weeks in Holland as part of my training as a student midwife with the Midwifery Education Program at UBC. The last time I was on an international flight there was no such thing as a Euro, smiling was allowed in passport photos and my wallet was padded with traveler's cheques. Thanks to the internet I learned that those are the dinosaurs of travel! I can't wait to see what else I'm going to learn over the next few weeks.

Bye for now,

Jill