I have seen death
Dear readers, mothers, midwives and student midwives,
Life brought me to the most agonizing decision no parent should be facing, life-death decisions for their own children.
The word 'abortion' cracks my heart and I decided I won't be using it anymore. It was slammed in my face by my gynae at the check before the induction, by the hospital when someone was calling my daughter 'product of abortion', by the cemetery when we faught to bury her, by the inscription the usurers wrote on the coffin 'Gloria Coccoli's abortion'.
Terminations for medical reasons are the result of agonizing choices for the love of much-wanted babies.
With all the empathy of the world you really can't understand until you walk the same road.
Remember our choices are not light-heartly taken, remember we all felt torn between the desire to hold on to our babies no matter what and our desire to protect them from suffering which prevailed.
We were the best advocates for our babies, who would want us, not you, not strangers to decide.
Remember we will not go over it, we will always remember and honor our babies. Time won't heal us, another baby won't heal our grief, just mourning them forever, as we feel natural to, can heal our grief.
If you feel like discovering our story and our personal shades of grief and healing, you can read our blog and access to our photos clicking on the button below:
I hope I can be helpful with my notes form the 2nd year!
Update them and help other people too.
Exams are over! Second year came to an end for me too, after hard work, veeery hard work!
It was the hardest on the academical point of view, but felt lighter on the placements, because you know what you are doing and you just have one core placement in the whole year.
I finished my last specialist placement almost one month ago now.
Nobody in the class was happy to do 1 entire month in general nursing, counting 1 long day and 3 short days a week.
Not before the final exams, not at all for the subject itself, because really not relevant to our midwifery degree.
I started in a respiratory ward, with very sick and terminal patients, most of them requiring assistance of two people for daily living activities.
The first day was a complete shock. I was sent wild to clean some of my patients without knowing how to do it, what to get and where to get it! People were hard to understand because of their breathing machines and they were sick of being there, of life and of a stupid student like me that could barely understand them.
I cried like I never did in my life on my way back home thinking that I couldn't cope for one month in those conditions.
The days passed and the first week ended. In the second week I got to know better the conditions, surgeries and treatments my patient went through and actually and more importantly I got to know THEM. In the last two weeks I changed ward and went to a postoperative private ward.
First difference with maternity is that you really get to know your patients, because they generally stay a longer period of time in the hospital. You get to know their story, their life, they will call you by name and ask for you if you weren't around anymore.
I got to know how humbling can be helping them in something you think at first might be disgusting such as toiletting. They are greatful for you to be there, they are ashamed to be in those conditions and the least thing they want to see is your disgusted face. And you actually don't need to pretend anymore to cover it, because the more time you spend with them the more you see your parents, grandparents in them. You take care of them with love.
You get to know nurses. The underrated nurses. That always with calm and a smile don't complain and take care of everything. They are little doctors, little pharmacists, little physios, little dietitians, little angels. Their knowledge, patience and team work utterly struck me!
I see nurses and old people in a different light.
This placement was not related to my studies, It was too long, it was in the worst time ever and before the exams, but it changed me deeply and gave me something inside that I could never discover otherwise.
I advise students undergoing to their general nursing placement to:
Dear readers, this is not the usual placement article, with information, bliss of the placement and happiness about how nice is to be a student midwife.
But this is real too. This is actually more real than anything else.
When I tried so badly to get into midwifery in the UK I was disgusted by all those who got and place and dropped. I believed that they were just those who didn't want it as much as I did, just lucky people getting a chance who others would have used in a better way.
Well, I realised in the last half a year that those people who dropped are perhaps the people who whould have been the best midwives, the most caring and emphatetic ones.
I am one of those sensitive people who are been hurt and broken by the reality of midwifery. I'm investing all my energy, my money and my all to be here in Ireland studying midwifery and I'm struggling enormously to keep going.
We study sociology and we understand how we really can't make things change, how we are insignificant in the maternity services. I understand how all my efforts to meet women's needs are not what those assessing me want. All my efforts from the academical point of view are not enough either. I failed the assignment I cared about the most, about the thing I'm the most passionate and that I want to focus when I'll be a midwife.
Thus, can I still say all this is worth it?
What before was holding me steady in keeping going was my passion for midwifery now it's fading brutally under all these circumnstances.
I physically removed all the posters about midwifery I had in my room and getting close to placement or hospitals makes me feel physically sick.
What have I done to reduce me like this?
At the present I really long to go home, in my supermedicalised country, where i can get my degree easy, doing just one year more. Then I could anyway be whatever kind of midwife I want to be. I need to go home and restore what they have stolen to me. I need to find back my love for my biggest dream.
Yes, this is midwifery too.
here comes my community placement for this year.
The last placement will last 4 weeks and will be general nursing (I'm not longing for it at all).
The placement in community midwifery was a very good experience and made me notice the different athmosphere of working outside the hospital setting.
In Dublin the D.O.M.I.N.O. service allows low risk women in certain areas to have a early transfer home and daily postnatal visits shared between community midwives and public health nurses.
The day passes really fast between home postnatal visits and clinical antenatal ppointments, the midwives have their own schedule every day and they move with their cars to reach the different places.
The main duties of the day are:
What I suggest students to do:
my second specialist placement is finally finished!
I just have left 2 more, community midwifery and general nursing, to complete the year.
I didn't start with a good mindset, because of many reasons. I received the day before starting a fail in an exam i really cared about, the placement was just after theater, so treating the same things but in a complete different way and environment (and working hours...)
All this set me completely off for the only week passed there.
The gynecologic ward is a very fast and busy ward headed by nurses mainly who handle both day hospital patients and in-patients.
The main duties of the day are:
I was really nervous about being in a different environment and I didn't know what to expect.
The competency document was much shorter this time, with just one initial and end interview with your allocated preceptor, in which you have to discuss your learning objectives for the placement.
The theater is divided in various theater rooms and a recovery room.
Every room of the ward has a page with the daily schedule of the surgeries happening for all the rooms.
My first day was in recovery room and the main duties are:
During the next days I followed a registered nurse in her daily routine in different theater rooms.
There are different kind of nurses in the theater rooms: circulating nurse, scrub nurse and anesthetic nurse.
The scrub nurse will help the surgeon during the surgery, so she will wear the sterile scrub and will be counting all the sterile instruments opened at the beginning until the end of the procedure. She will also set the different trolleys and pass all the asked instruments to the surgeon and set the needles for the suturing. At the end she will bring the instruments to sterilize.
The circulating nurse will help the scrub nurse bringing instruments needed during the operation, opening the instruments over the sterile trolley, signing and completing the paperwork.
The anesthetic nurse will help the anesthetist from setting the airway ventilation, to placing the blood pressure cuff, heart monitor stickers and preparing the fluids needed.
The other people present are the main surgeon, the second surgeon helping the first, main anesthetic doctor, anesthetic doctor helping the first.
What I learnt from them and what I could do:
The lunch room: everybody from cleaners, midwives, nurses to the doctors were having lunch together and talking friendly between each other and with me.
The atmosphere were so nice too, music in every room and nurses always smiley and helpful made me feel home everyday.
I would definitely like to work in theater!
Bliss of the placement: a mother I spoke with and tried to make feel better and less scared before her cesarian section asking for me, saying I made the difference for her, being the only one holding her hand during the spinal anesthesia!
Why it was useful for me: I think it's a great experience for being prepared of receiving postnatal mothers after a cesarian section, you know what they went through and what it needs to be prioritized in their care.
Advice for you going to theater for your next placement: ask to anyone in the room about everything!!! the more curious the more you will love it and learn a lot. YouTube search the surgeries and document yourself about them. Check daily schedule of surgeries and write them down, ask to follow the most interesting ones!
Here we are. 2nd year already.
This year will be full of assignments and exams, but we will do 3 placement-blocks of 6 weeks each, just one core placement of 4 weeks (antenatal, postnatal or intranatal) and the others just specialist placement (theater, public health nurse, community midwife, gynecologic ward, NICU)
For me the only core placement of this year was postnatal and I loved it as usual.
My little blue book has grown fast for postnatal checks on mums and babies, but I also felt much more confident and independent, which made my 4 weeks placement more intense and tiring compared to the first.
Helping a fist time father to debrief his birthing experience. This was the most inspiring encounter of the placement.
I simply asked him how was he feeling, how was HIS birthing experience. He was so positively surprised and grateful! He started winding out all his thoughts and worries, he used hard words to describe how the whole pregnancy care made him feel during the whole pregnancy 'A SPERM DONOR'.
His wife was breastfeeding and even if breastfeeding is the best for mothers and babies and he was supporting his wife 100% he admitted to feel excluded and to be considering it as a phase to wait to be over to be able to bond better with his child.
I explained him how to be included and sharing the baby also at this stage, such as skin-to-skin while the mother was performing some breastmassage, changing the baby, helping his wife with words of encouragement (something that really makes a difference!!!), preparing nice meals (healthy and nice warm meals will help the milk supply!), tummy time with the baby, black and white early weeks books etcetcetc!
Please, if the fathers are in the room, write down their names on the chart, talk to them, childbirth is their experience too!
Debrief their birth experience and help them sharing this early phases! The gift you are making them is priceless.
HOW TO BE PREPARED TO AN EMERGENCY
What can you practically do during an emergency
Exams are over for me and it's the right time to make a summary of all 1st years examinations you will need to pass in Trinity College.
The assignments as well have been very challenging for the referencing system and because of my difficulties with the Irish-Enlglish structure of the essays.
Now let's enjoy the holidays!
And the final placement arrived, the one I was waiting for since years.
In our hospital the delivery suite is divided in assessment unit, in which women with possible onset of labour, threatened preterm labour and post-term pregnancy and the labour ward, in which every woman in established labour has her own room , is admitted and will stay for the rest of the labour. The labour ward is also subdivided in two sides: high dependency (high risk and bereavement rooms) and normal labour rooms.
I was excited and at the same time very nervous about starting this new placement, because of rumors about how midwives and ward-managers are unhappy about their job and tense above all with students.
Unfortunately, I have to confirm this rumors and sadly admit that it has been the most stressful placement and I couldn't wait it to be over.
Saying that I don't mean that it has been all bad, but the high pressure everybody and everything puts on you, especially first year student, is incredibly hard to bear.
In my first week I've been assigned to the high dependency rooms and the first thing I learnt was how to check the birth environment to be safe. Everything had to be ready-to-use, the resuscitaire had to be complete with all the necessary bits and all the machines and tools had to be checked and be perfectly working.
In this side of the ward I witnessed how painful is for both families and doctors to deal with a threatened preterm labour that will give the newborn almost no chances to live or will give him complicated health issues.
I also witnessed for the first time to a intrauterine death, absolutely the hardest emotional event of this placement. However, I was there, I was holding her hand in a too bright room while she was sutured, I was there in my silence hugging her silence, next to the baby, dead since one week and started to change the 'normal' baby appearance. I was scared not to know how I would have reacted to this. I was scared to be scared. I was scared to see this baby. I was scared to be next to a broken warrior of a woman. I looked at the cot and I loved the baby, he wasn't a stillborn, he was a baby, another angel as any of the ones I've seen so far, there was no place for disgust, no place for fear.
On the other side of the hospital I witnessed to my first birth, a baby girl who literally flied into the world in 10 minutes, with her mother still shouting for an epidural! Even too quick to be emotional :)
We have one room with the birthing pool and there I observed for the first time a first stage of labour and assisted a beautiful couple. He was massaging her and dancing with her in this room with dim lights and their music. I was just helping in protecting her birth territory, bringing some water, starting the partogram and the regular observations. She also used the pool to cope with the contractions and tried her best to visualize positive images. I didn't have the chance to follow her for the whole labour. She dreaded interventions and for this reason before going back home I made her promise me not to let herself think she failed because of the epidural she was going to receive. She fought and she was still fighting until the end and she was going out from that room as a winner and a warrior. She has been a bliss of my placement, saying that I will be a great midwife and that i made a difference for her.
Another beautiful birth, the first in which I had my first hands-on, was a beautiful woman on her 2nd child, coping silently to her pains, slowly breathing her baby out, standing first and then choosing to lie down.
I supported the perineum, slowing down the fast descent of the head and helped the baby towards her mum. I cried and I felt so blessed to be with her.
The most beautiful I witnessed was one you hardly see in your hospital midwifery career. This primagravida and his husband were moving together to each pain, changing positions, dim lights, we moved the pillows on the floor as she wanted and supported her choices so much until the end. We assessed her and passed most of our time on the floor with her. She was such a goddess. She gave birth in the allfource position, with no intervention at all, just breathing gas and air, being massaged by her man who made her laugh throughout. The cord clamping was delayed and she had skin-to-skin with her baby for one hour, starting breastfeeding. The power that was shining from her face and body was indescribable.
I learned how to observe all the three stages of labour, the necessary trolleys preparation and use, how to check the placenta and the administration of vitamin K and syntocic drugs.
I learnt how to help during suturing and epidurals and how important is asepsis.
I've seen to many epidurals, artificial rupture of the membranes, lie down positions, continued CTG, vaginal examinations, syntocin administration, and short-cuts during this placement. But above all I've seen paternalism. I've seen disempowerement.
On my last day of placement I've been told that we don’t receive medals for being nice with women, that hospitals need ‘fast hands’, not relationships. I witnessed hypothetically wonderful midwives giving up their ideals because of the harsh life of going against the grain for a right cause, or quitting their jobs for the same reasons. I’ve seen myself looking for an answer to my disillusion about studying and understanding what women really need and waking up in a reality that coerces me to be potentially harmful to them, to be and deal with bodies and not souls. Hospitals can’t be the primary maternity care, inflexibility and scheduling for a smooth factory-like organisation doesn’t match with the changing bodies and minds of pregnant women, which end up being unreasonably violated. Fear can’t be the driving force on both mother and carers’ side and thus information and a culture of souls and relationships is the only way to eradicate it. We need midwives spreading the ancient knowledge of women’s strength, the possibility to give autonomy back to women and for birth to be a positive self-enhancing discovery. Finally it’s true, we don’t receive medals for ‘being with the woman’, but much more: stronger women that make our whole world stronger.
Here we are, at the end of the antenatal placement, my second and penultimate one in this first year in midwifery.
I was in a high risk ward of the hospital with generally women with a very complicated medical history (in acronym 'hx').
My impressions at the beginning weren't so great. The ward was much smaller than the postnatal one and It didn't feel good to start from scratch again, not understanding the handover and not being able to do anything less than observing.
After the first 2 days it went better and I had the chance to practice and hone until the last day:
-Antenatal checks: obs or tpr, abdo palpation, asking edema, bowel movement, eating ok, feeling the baby okay, auscultation of the baby.
-CTGs and the reading of the traces. *Never leaving the mother lying flat on her back cause it occludes the main arteries and she could pass out, plus the baby oxygen is reduced
-Fetal auscultations with doppler and pinnard
-IM injections and venipuncture
-Knowledge about first stage of labour and induction with Propess
-Complications such PET, GDM and the sliding scale, diabetes, PPROM or previous prem labours, giving steroids (BETA), mental and social problems, women with ^BP, heavy drugs addicted women and their SGA (small for gestational age) babies
-Bringing women to the delivery suite and handover her information
-My first nights!
-Open the curtains!!! It's safer and promotes the relationship between the women in the room
I had the chance to work with different people that helped me so much understanding more and more all the listed skills and who gave me good examples of practice.
The bliss of the placement: what students and midwife can do more than in postnatal is talking with women.
I had the opportunity to feel helpful when doing my abdo palpations to a young woman, who admitted to be very scared about the pain and the labour, saying that she didn't really know what to expect from that.
I told her that it's normal to be scared of something we never experienced before and that everyone looks to picture it in a tragic way! But often we like more to talk about the bad parts of the story, forgetting or omitting the best.
I told her that our body uses the contractions to create the most powerful natural drugs existing! That if you know that, If you stay with your breath, with the moment and with your 'waves', you can really be 'high' during the contractions! The surges you will feel are like waves that grow in intensity and then come down again. The high peak of pain lasts just max 20 seconds, about 3 breaths? You can do it! And remember what waits you in between them!!! Just don't think about the next contraction and stay with the present, or the magic fades ;)
She was so happy, surprised and grateful that filled me with immense joy and I consider it my best memory from the antenatal ward!
"That's amazing! I won't forget that and it will help me so much during the labour!!! Thank you"
Sooner or later, you will unfortunately notice a common behavior ruling childbirth choices, mainly in hospital setting.
The medical model of care infuses the belief that doctors, or sometimes midwives, with their medical instruments, knowledge and medications, can be enough valid to choose for their patients and women without informing them enough about the possible choices of care. Sometimes it's just a matter of time, incredible workload which puts pressure on the medical team, making them operate in a limitative time framework. For people less fortunate, such as my Sicilian fellows, the medical staff just comes out with a brief "Just be a patient." at any query or doubt about their doctors decisions.
Most of us already grow up with a sort of subserviency in terms of their own medical choices. Better don't know, don't ask, they all know what's best for me.
These behaviors are fueling a hidden fuse of fear. Uncertainty and lack of trust are widely complained in the maternity journey in a hospital setting.
It's important to be committed in your care, to stand for your rights and be an active help for your own health.
Reading the book "Mindful birthing" by Nancy Bardacke brought up an interesting system of questions to ask your caregiver, midwives and doctors to avail an optimal commitment to your informed choices:
B.R.A.N.N= There are always alternatives
-What are the BENEFITS?
-What are the RISKS?
-What are the ALTERNATIVES?
-What about doing NOTHING?
-Does it need to be done NOW?
This can be applied for your whole life, for your birth choices, for your baby, for yourself.
There's no better advocate for your rights than yourself!
Informed parents means healthy babies. Knowing your rights in childbirth can really make a difference.
The way in which a new baby is welcomed into the world during the first hours after birth may have short- and long-term consequences.
Who should receive it:
How to skin-to-skin:
Skin-to-skin contact between mum and baby or dad and baby should ideally start at birth, but is helpful at any time. It should ideally be continuous day and night, but even shorter periods are still helpful. For comfort a small nappy is fine, and for warmth a cap may be used.
Benefits for the baby:
helping the transition from fetal to newborn life:
Hospital protocols can be modified to support uninterrupted skin-to-skin contact immediately after birth for both vaginal and cesarean births.
This is a once-in-a-lifetime experience and should not be interrupted unless the baby or mother is unstable and requires medical resuscitation.
After the birth of your baby it can be possible that in your hospital there's a protocol that consists of a list of care activities and tasks that nurses often feel they must accomplish as soon as possible to get through their work assignments. But remember:
Anything that is not necessary for the immediate well-being of the newborn and mother can, and should, be delayed until after the first breastfeeding. This includes vitamin K injection, eye prophylaxis antibiotic ointment, foot and hand printing, weighing, measurements and bathing.
It's therefore important to specify this in your birthplan, including the dad referral in case of emergency and also reminding them the skin-to-skin if they do otherwise just after the birth.
Mothers who have had a cesarean delivery often mourn the loss of a normal vaginal birth they had hoped for and are especially disappointed by not having their baby with them immediately after birth. Clever Medical developed and designed a surgical drape to facilitate immediate skin to skin contact after cesarean delivery by eliminating the main physical barrier to the standard of excellence of Immediate Skin to Skin Contact.
How to get the drape (Printable form for you physician)
Dear readers, if you're European and, as I did, you're thinking to move and study midwifery abroad, I can give you some advice and explain the difference between the university systems of the main English speaking countries:
These universities were my first choice between all the different universities in each country.
Things to bear in mind when choosing the right system for you:
All things considered, I highly recommend Ireland for people with good grades at school, and for loads of reasons:
"Fiocco di nascita, corredino, bomboniera & confetti & the gift from the new dad to the new mum"
Italians (and above all Sicilians like me) are cheering people and they don't waste any occasion to celebrate! And what is the most joyful event if not the birth of a new relative in the family?
The day 1 postnatal ward scenario is VERY different compared to the Ireland one. The babies are not rooming-in with the mum, therefore the nursery is the only way for the family visitors to catch photos, opinions on nose-mouth-head-eyes so similar to mum (generally mother side relative) or dad (dad side relative), with the help of unearthed faded photos of the dad & mum at birth.
The nursery doesn't let people in, for the hygiene issue but above all...to manage the complete chaos!
While in Ireland generally just the very close relatives and friends come to visit at the hospital, in Italy instead you witness the entire family crew knocking down the doors, full of presents, flowers, plants, food, perhaps more than on day per stay!
They run into the mum's room kissing and giving the congratulations, to run few minutes after where the big show starts: half an hour of curtains up on the window wall facing the babies, NO FLASH on the babies, the nurse mimes! Impatient relatives knocking on the glass to ask the nurse to hold the baby, or to just move the blanket a bit away from the baby, soon commenting on how rude she was. Who knows why? :D
"Bomboniere nascita" & gift opening
Then the relatives come back to mum's room and give their presents. In Italy we DON'T have a baby shower party at home and just few people come to visit again once the mum is at home, therefore all the presents are given at the bed side.
The mum will have few favors for the guests to say thank you, very similarly to the baby shower party favors, a little object including a tag with the baby's name and date of birth and few sugared almonds, called "bomboniere"! Everyday the dad makes sure that the bed-table is occupied by a big tempting tray of fresh little pastries and biscuits with the add of sugared almonds colored red or blue according to the baby's sex. The guests are offered the sweets, but they cannot say no to at least one sugared almond! It MUST be done for the baby's luck sake! :)
Dad's present to the new mum
The dad is expected to traditionally bring a beautiful bouquet of red roses to the new mum with a sweet card and a gift. Generally it's a precious ring or jewel, but It really depends on the people involved, it could also be just a spa day for two ;)
Fiocco della Nascita, Birth Ribbon
But this was the follow-up of a 9 month planning and traditions involved. Every mum in the hospital, or her mum instead, starts crafting a beautiful "Birth Ribbon", in Italian "Fiocco della nascita", generally decorated in cross stitches baby trimmings, embroidering the baby's name, weight, length and day of birth. She completes it at the hospital and finally hung it on her room's door or at the bed side and then it will be placed in the baby's room at home.
Corredino nascita, birth kit
This is a tradition very deeply rooted in our culture. And an amazing souvenir to keep forever.
Generally up to either the grandmothers or the grand-grandmothers, the "corredino" or birth kit is a hand-made set of knitted baby blankets (wool or cotton depending on the season), baby cardigans, hats, shoes, or even mini-skirts for the little girls! Then baby bed linen, nappy holder, baby bibs & baby towels decorated in cross stitches or painted, with cute animals and generally the baby's name. The corredino is completed with the "camicetta della fortuna" or the good-luck-shirt, which is a tiny baby sleeveless shirt in red or white which is the first thing the baby should wear, wishing him/her the best of luck :)
This is Italy! What about your country birth traditions?
Here I am, after my first 4 weeks of hospital placement that, I've to say, flied so fast!
The excitement of my first uniform, the anxiety on the night before my first day and all the little precious and unforgivable rewards and objectives achieved (& mistakes done!)
Here in Ireland we have a little blue book, which is our record of checks and skills to achieve and collect during the 4 years course (3 years course + 1 year internship) and a competence book, to fill with our achieved domains, goals achieved and previously discussed in 3 different interviews with your preceptor registered midwife with whom you work with and comments made by the midwives you work with. You receive on for every single placement, to submit to the school at the end of each one.
My learning objectives were:
The gaze of the mothers towards their babies was a daily bless, being there for them was priceless and I hope to keep being enchanted with this privilege every single day I will be working as a midwife.
Gloria Coccoli, midwifery student in Dublin, but born in love with life in the land of sun, Sicily, in 1995
Mother of a baby with wings