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.
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