Progress

Friday I had another US and more blood work (having every other day appointments now) and it looks like my follicles are maturing faster than expected.  My RE said we are on track for retrieving 8-12 eggs, but she is not sure if they will all be mature enough.  I am going to have a follow up US and blood work done on Sunday. If the follicles are plentiful and the sizes are good (indicating proper maturity), then I will have my egg retrieval on Tuesday.  My RE says it is a fine balance between retrieving prior to ovulation and ensuring maximum number of follicles possible and that the eggs are mature.

My estrogen is also doubling and increasing nicely.  So far, so good!

I've stayed at 375 IU for Gonal-F each p.m., 1 vial of Menopur each p.m., and 10 units of Lupron BID (twice daily).  Sadly, no decreases in the Gonal-F for me.  This means that I have gone through 3 pens of Gonal-F, and had no more pens after last night.  We never knew the meds would be so incredibly expensive, and when we drained our savings for our 4 rounds of IVF (2 fresh and 2 frozen with Attain), we had no money left.  When the pharmacy called and said our meds would be $3500 and that our insurance would not cover it, I almost had a heart attack.  Literally, I ended up in the ER with PVCs (pre-ventricular contractions).  We ended up having to take a personal loan to pay for our medications.  Our insurance only covered the progesterone and Lupron, so the $3500 was for the Gonal-F ($900 a pen x 3) and Menopur ($80 a vial x 10) alone.  With the RE office not ordering enough pens for me in the beginning (since they are so expensive, they are cautious not to order too many), I was in a panic when I realised I would run out of the Gonal-F on Friday with no way to buy another pen at $900 a pop.  Thankfully my doctor's office donated a pen to me.  Wow - what a blessing and such a relief!  One less thing to worry about.

On the midwifery front, I have made progress in my clincals as well.  I caught another sweet baby boy yesterday increasing my count to 12.  (This count is only my US births and does not count the babies I caught in Ghana.)  My program only requires 20(!) births, which I think is far too low to call myself experienced/ready to practise on my own, so I am setting a goal for myself of at least 60.  I would ultimately like to make it to 100 (they say you feel comfortable with births after your 100th catch), but anywhere between 60 and 100 would be sublime for me.  I also sutured my first patient yesterday with bilateral labial lacs, and a wonderful MD taught me how to tie one handed with my left hand (non-dominant hand).  Now, I can hold my instrument in my right hand and tie with my left without ever having to switch hands or put down the needle.  Woo hoo!  So exciting!

I needed a day like yesterday.  It was such a moral booster.  I made wonderful progress in both my IVF course and my studies this past week.  Excited to see what this next week brings!

Rounds

This week has been all about rounds and rounding.

On the trying to conceive front, Friday was my day 1.  I'm beginning my 4th and last round of IUI treatments.  I pick up my Clomid today to begin taking days 3-7.  I have my US and blood work on Monday, August 8, and then my IUI will probably be 2 days later if all goes well.

This week was my 2nd week in hospital and I did heaps of rounding on postpartum patients.  I saw 4 patients and their teeny, tiny, adorable babies.  Four patients may not seem like a lot, but postpartum rounding takes a long time.  It is the first and only time the patient sees a midwife during the day and they have loads of questions stored up to ask on top of all the questions I need to ask them and the exam I need to complete.  Then there is also time I have to allot for discussion of their birth and fielding any complaints they may have.  The pressure arises as the clock tick-tocks away knowing that I have patients one floor down in labor that I must get back to and round on as well.  It is a great juggling act of time management, to say the least.

This week I caught 3 babies (bringing my total to 4) and they all went so much easier than last week.  I was able to both protect the perineum, provide space for the baby if needed in the vagina, and coach the patient on breathing and pushing.  I really feel like it is coming together so nicely.  All of my babies had nuchal cords - one I lifted over the baby's head and the other two I helped the babies slide through them.  The transition from catching to tummy is going smoothly now too.  No more fuddling and fussing.  We had a few lacerations (or lacs as we call them), and I began to learn how to repair.  I have not yet attempted it on my own, but I experienced a lot of relaxed teaching time.  I look forward to my first hands-on experience.

All in all my clinicals are going quite well.  I am learning heaps every day and growing by leaps and bounds in my practise and knowledge.  I am also working at the same time with the new OB/GYN interns that have just started and that is a neat experience.  It is fun to be "babies" at the same time and grow up together.  My midwife preceptor teaches the interns as well on the low risk side of labor & delivery, so we are learning side by side.  Hopefully one day what these new interns learn from the midwives about normal, low risk births will make an impact in their own practise with women.  I already hear some interns calling what they do catching instead of delivering.  Wow!  So exciting!  The word of midwifery is spreading.

First Catch!

Most of this blog has been consumed with our attempts with trying to conceive.  It might make one wonder if I do anything else!  Trying to conceive does seem to overtake almost every waking thought I have, but I am still pursuing my dream of becoming a nurse-midwife.  I am doing about 36-40 clinical hours each week now - 2 clinic days and 1 hospital day.  This past week was my first week in the hospital AND my first official catch!  Wahoo!

As a labor & delivery nurse there have been a handful of times where I have caught a baby due to a precipitous birth where the physician did not make it in time, but those times were usually more of a surprise and panic type situation where I was wondering when the physician was going to arrive while catching the baby and simultaneously calling other nurses and techs into help me.  In contrast, my first official catch happened in a very serene, calm, controlled and beautiful way.  We had a patient who was a G2P1 having a natural birth at 40.4 weeks gestation.  She had a doula and did amazing throughout the whole labor.  She walked and rocked, sat on the birthing ball and tried a variety of positions until she found what worked for her.  But at 0300 and 8 cm she wanted to give up.  She started crying and saying she just could not go on, and that she wanted an epidural or something to make the pain go away.  I encouraged her to get in the bath tub and she did.  She sat in the warm water, pelvis open, rocking side to side and moaning with eyes closed breathing through every contraction.  In 15 minutes time she said she felt like she needed to push.  She walked back to the bed and began her delivery.  Half a dozen pushes later she welcomed her healthy, beautiful baby boy into the world.

For my part, I protected the perineum during the crowning and then supported the head as it birthed.  I then gently pulled traction down to release the anterior shoulder and then the posterior shoulder slid right out along with the rest of the baby.  It was quite easy as the mother did all the work, but I still need more practice with my hand placement and coordination of catching the entire baby with both hands and then placing on mom's tummy.  I am sure though that will all come together in due time with practise.

The birth though was just so magical and beautiful.  I know I have said beautiful several times now, but it really was a picture perfect birth experience. The baby needed a bit of transitional support and the nurse even gave the baby oxygen on the mom's belly.  In the end, the mother got all that she wished for - a natural birth with no interventions, no lacerations and she was not separated from her baby after the delivery.  A perfect birth for the mother and baby, and a wonderful first birthing experience for me!

Ready, Set, Ghana

I booked my airline tickets about a month ago and today I finalised my balance payment.

It is official!

I am going to Accra, Ghana, Takoradi more specifically, in September. I am so excited I can barely contain myself!

I am going to be working with Work the World - a UK based company that provides medical, dental, nursing, midwifery and physiotherapy electives and placements in Africa, Asia and South America.

In the UK, unlike the US, nursing students and midwifery students do electives abroad during their training and some even do gap year placements. My university had nothing on offer for a study abroad program, so I have decided to create my own experience via Work the World, a company I had heard about from other midwives and nurses when I worked at Guy's and St Thomas' NHS Foundation Trust.

As I have never been to anywhere in Africa, I was not sure where to go, but chose Ghana as it is a placement that allows for direct and highly involved care. There are 3 other locations in Africa - Dar es Salaam, Mwanza and Arusha, Tanzania, but for some reason Takoradi, Ghana spoke to me. The testimonials from other midwives in Ghana are quite inspiring as well and are what helped confirm my choice.

I am quite excited to go... a bit nervous, as always when I travel to a new country and do not know what to expect, but more agog and breathless than anything. I feel assured that Work the World will take good care of me and provide an easy and engaging experience. The process thus far as been worry-free. Work the World provides a 'My Trip' webpage for each candidate and it has easy hyperlinks to click through to learn everything possible about your upcoming trip along with what to do and when. My last 'to-do' is to secure my visa and pick up my malaria tabs.

Easy peasy.