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Month: October 2017

Healing from a Miscarriage

Healing from a Miscarriage

Miscarriages are so incredibly common.  Statistically, 1 in 5-7 pregnancies will end in miscarriage, although many might occur before a woman even knows she’s pregnant. I’ve personally had two.  And I’ve midwifed many women through a miscarriage.  In fact, I’m pretty sure if we all started talking about our miscarriages just a bit more, we’d be astounded by how common this is, and how many sisters all around us have been through it, or are going through it.  But that’s just it…NO ONE talks about it. Which is why it’s important to bring it up, especially during Baby Loss Awareness Week. Tonight I’m going to light a candle as part of the Wave of Light in honour of International Pregnancy and Infant Loss Remembrance Day.  It’s so important that we share these stories. These babies were alive, no matter how briefly. They mattered to us. And our lives will never be the same because of it.

It is hard to talk about.  I’ll certainly give you that.  I can’t speak for anyone else’s experience, but for myself there has always been some element of lingering guilt attached to it: if only I’d taken better care of myself, or been less stressed out, or hadn’t gotten into that one argument, or had gotten more sleep.  As if I had had any control over it in the first place.  It’s hard to accept that most miscarriages happen for no good reason at all.  Or actually, perhaps they happen for the very best reason possible.  If you stop to think about it, a miscarriage is the body’s way (or nature’s way, or God’s way, or the Goddess’s way, or [insert spiritual belief of choice here]’s way) of ensuring that more often than not healthy babies are carried to term and delivered.  Think of all of the miraculous, amazing steps which have to go perfectly right in order to form a baby.  If even one of those steps goes wrong in those early weeks, the implications for a living child could be devastating.  While a miscarriage can be absolutely harrowing, I do believe it’s kinder than the alternative.  And those early steps are pretty complex.  It’s not surprising that something goes awry from time to time.

But this is cold comfort.  And since it’s so rarely talked about, knowing what to do to recover and heal after a miscarriage is very rarely discussed. As a provider I’ve often searched for a resource or a guide to give to clients to help them ground themselves afterwards. And as a woman who’s been through it, I’ve found myself staring off into space afterwards, hands on a suddenly empty belly, wondering to myself: what happens next?  I think the answer to that question is so incredibly personal, for each and every woman.  But I did find this fantastic post by Maisie Hill which is certainly worth sharing: How to Recover From a Miscarriage.  It’s worth a read, even if this has never happened to you, if only to allow you to better support a friend or sister who does have to endure this.  And for everyone else who has had to walk this path, what helped you heal afterwards?

If we all start talking about our own experiences just a bit more often, we’ll stop feeling so alone.

 

Deskilled

Deskilled

How has it gotten to October and I have published nothing for all of September on this site?!?  The time is flying, and to be perfectly honest, I am slightly overwhelmed. Being a student is HARD. Being a mom is HARD. Being both of those together is VERY hard. And let’s not forget trying to be a good spouse, friend, sister and all the rest…there’s too much to get done every day, and not enough hours in a day. We’re currently on placement again now, working in the clinical setting, but in two weeks I have an in-class debate to research and prep for, plus a research activity due which involves critiquing a research study and then sharing it with the class. The first week in November our second 15-page(-ish) assessment is due, which I have started researching but have not yet written a single word for. We also have our Year 1 exams in December, focusing on anatomy, physiology and the role of the midwife, which I have started studying for, but again…this is not something you can do in a single cram session the night before. So, yeah, that’s the homework front. Add to that 12 hour work-days, not seeing my kids for entire days at time (because if I’m doing a day shift, I leave in the morning before they’re awake and come home once they’re asleep) and using my days off to try to desperately make it up to them with quality time…and also using my days off to try to get on top of the mound of homework. This student midwife business is definitely not for the faint of heart!

Clinical placements have been challenging for lots of reasons. The work is fabulous, and it has been such a joy to be attending births again, and particularly births in the lovely midwifery-led unit/ birth center that is part of the hospital where I’m at. But it’s been painful to realise how many of my skills I have lost during the long break I took over the last 4 years where I wasn’t working as a midwife. Things that used to come very easily to me are now things that I am grappling with again. Is that really the right position of the baby I’m feeling on abdominal palpation? Is the baby vertex or breech? Is that the baby’s back? Are those the feet and hands? Is that cervix 7 cm dilated, or 8? What is the estimated fetal weight? I used to be really good at this stuff…now I find myself in the dark with it a lot more, much like I was during my first student experience. Muscle memories that have been forgotten and need to be retrained into hands again. How to press just so on the doppler to be able to angle it upwards into just the right position to find the fetal heart. How to get the monitor straps to be able to hold the tocometer/CTG in the right place. (Annoyingly, the straps are very new to me; in the US the women wore an elastic band over their bellies and you just had to slip the monitors underneath the band and they were magically held in place, without too much fiddling involved. We did have straps, too, for occasional use, but again, they were a different design and not at all like the straps in my new trust, which I think require some fancy angling and folding and tying tricks to get them to be angled/ placed correctly, of which I have by no means mastered yet!)  And don’t even get me started on the hospital policies, the documentation, the pro formas that have to be filled out. The new computer system.  There are even things that I murmur and say during deliveries: “Good job”, “you’re doing great”, “you’ve got this” which sound so American to my ears now. My mentor more often says “well done” instead of “good job”. Tiny things like this which I wonder about, and I wonder if my American-ness is helpful in labour, or if I was speaking better British-English, would that be more reassuring? It’s all new. So in SO MANY ways I feel like a complete novice at this again.

But that’s the part that sits uncomfortably with me. I had gotten used to feeling competent after years as a midwife in the US. I knew the system, I knew how my hospital’s policies worked. I knew exactly what documents needed to be filled out, and how to document correctly.  Feeling competent had become part of my identity. Feeling incompetent again is painful. I have to keep reminding myself that I am a first year student, because I AM. There is so much I don’t know. And in fact, there is a term for what’s been happening to me. It’s called being deskilled, or deskilling: losing skills which I had had in the States and had taken for granted, and needing to re-learn these skills again from scratch. Not fun in any way whatsoever! And in some regards, there are even bad habits I had picked up which I need to un-learn as well. And completely new skills which I never had in the first place, like using a Pinard’s stethoscope or estimating how many fifth’s palpable the baby’s head is in abdominal exam. In the States we would say the baby was engaged or floating, but never had to document exactly how engaged (3/5ths engaged, 1/5th engaged etc.) the baby was.

I was painfully reminded of this awhile ago when I experienced my first true emergency as a student on labour ward. A woman had been brought in by ambulance in booming labour, and was barely into a side-room before the baby had been delivered. And then she began to seize afterwards. The emergency bell was pushed in her room, everyone ran in to help (including my mentor), and I was out on the fringes trying to be helpful but not actually able to do very much. Whatever was called for from inside the room, I was one of the task-rabbits running to get it. I put out the overhead hospital-wide emergency call to bring the larger team to the room, which I had never done before, and didn’t even know what room the patient was in without asking another midwife about it. I got a screen to cover the door for privacy. I brought a table and emergency trolley to the room.  Which is helpful, a bit, but that was about as much as I could do, and I was conscious that if this had happened in my old hospital in the States, I would have been in the room, in the thick of it, being a lot more helpful.  And it was scary. In my 6 year career in the US, I had never seen a full-blown seizure like that. I hope I never do again, any time soon.

Midwifery is a highly-skilled job. It takes years to master the skills necessary to do it well. And years of training and experience in a particular setting to know all of the ins and outs of the job. And I am just at the very start of this journey again, deskilling and re-skilling again.