When Even 5 Hour Energy Doesn't Hack It

Student midwife life can be super crazy. Often you work a full or part time job, or doula, and attend prenatals and births with your preceptor. Sometimes you get very little sleep. Sometimes you get the mom's urge of nesting and you clean your house in an entire night and then regret staying up so late. Sometimes you get so moody that no one (including your two young children and boyfriend) wants to be anywhere near you. Sometimes it's a combination of both with a dash of working and still attending births.

Like get up at 4:24am on a Sunday morning after having worked until 11pm the night before, attend a mom in labor, go check on another mom in early labor, head back to work at 3pm, go back out to this mom, leave for a few hours to get some sleep, head back to mom's house, leave for work, work till 11pm again and then attempt to drive back out to tear down the birth pool. At this point, you are really just relying on shots of 5 hour energy and B-complex vitamins. Oh and you get there to tear down the birth pool and the families dog (which is half coyote) wants to EAT YOU!! Yeah.

Sooo.. then you drive back home, in the dark, in the Midwest... yes, curvy dark country roads. With maybe eight hours of sleep at this point with a cold night demanding you turn on the heather in the car, even that 5 Hour Energy won't cut it. I am eternally grateful to the Universe for not sending any other cars down this road. I was all over it. I hit and killed a skunk even. No way I was dodging it. My reflexes where hacked at this point and I probably would be writing this from the hospital instead. I feel like I should go bury the skunk....

I'd double up on the 5 Hour Energy, except my urine was already neon yellow from all the B Vitamins coursing through my system. And you know, they don't recommend it.

**I am just a student who relies on the emergency energy of 5 Hour Energy. I purchase all my own.**

Getting My Name Out There

So I've reached a point in my apprenticeship where my preceptor has given me permission to reach out and start bringing clients to us. Which is great and good. I feel so stoked that she believes in me. Trust me, if she didn't, I wouldn't have this green light! But what no one tells you is that it is hard to start. Finding clients, creating your "brand", encouraging mamas and being able to keep up your home life (and jobs if you have them!) is work. Work that will pay off, but will never get easier. So I've been setting here for the last 7 hours working hard at getting envelopes stuffed with a letter telling locals about me and midwifery, brochures and business cards. The taste of glue is so thick on my tongue that I cannot even use the Starbucks to cover it up anymore.

I know that each one of these letters brings me that much closer to clients, to getting my paperwork signed off and to having my CPM, which is the goal after all. Among other ideas, I'm basically talking to every. single. mother. I meet in any store, fast-food restaurant or bathroom-even the zoo (seriously, on my family vacation this past week I probably stopped 4 moms to make sure they know they have options in childbirth!). Having business cards and flyers on hand at all times and dressing where I'm cleaned up but do not look like I'm not an average mom who just happens to be a birth worker.

It will pay off. It will pay off. It will pay off.....

Practice Guidelines: Urinary Tract Infections

***Please know that I'm a student midwife and my education is every growing. This is my current Practice Guidelines for Urinary Tract Guidelines. I cannot say it is definite or complete. Please seek care from your provider of choice.***

Urinary Tract Infections (UTI)

 

Urinary Tract Infections (UTI) are the most common bacterial infection in adult women. They are 14 times more common in women than they are men. By age 24 approximately 1/3 of women have been diagnosed with a UTI and prescribed antibiotics by a doctor. UTI’s are more common in pregnancy. 5-10% of UTI’s are asymptomatic. They are caused by bacteria entering your system. The most common ways bacteria enter your system is improper wiping, sexual intercourse and holding your urine.

Signs and Symptoms:

      *        Sub- or suprapubic aching pain

      *        Burning upon urination

      *        Cramps

      *        Fever or low grade fever

      *        General fatigue (common if the infection is well established)

      *        Lower backache (may indicate kidney involvement)

      *        Frequent urination

      *        Small amount of urine output

      *        Incontinence

      *        Cloudy and/or unusual smelling urine

 If it spreads to your kidneys:

      *        Chills/shaking/night sweats

      *        Fatigue/general ill feeling

      *        Fever of 101°F or more

      *        Flushed, warm or reddened

      *        Mental changes (confusion in elderly is common

      *        Nausea and vomiting

 

Complications of a UTI:

      *        Miscarriage

      *        Kidney infections

      *        Preterm labor

      *        Preterm ROM

      *        Preterm birth

      *        Uterine infections

Conditions That May Mimic a UTI:

       *        Early sign of an ectopic pregnancy

       *        Premature labor

       *        Torsion of the pregnant uterus (rare)

       *        Incarceration or sacculation of the uterus (rare)

 

Diagnosis and Treatment:

 

Diagnosis: When you do all prenatal care you should test a woman’s urine at every visit. You can observe it for clarity, color and smell. When you read the urine test analysis strip, make sure you have first let it set for the specific time it needs to rest before being read.

When reading the test strip you will find that the leukocytes and nitrites will be elevated. The best urine for getting an accurate reading is after not having urinated for several hours. The reason these are elevated is because leukocytes (or White Blood Cells) are produced in relation to an infection. Certain bacteria (like the one that causes the UTI) change nitrates to nitrites. If the test is positive for both it means there is bacteria present in your urine likely causing an infection.

 More than 500mg of Vitamin C in the past 24 hours may give a false positive for nitrites. And tetracycline may cause a false positive for leukocytes.

 

Prevention and Treatment: The best treatment for any type of illness is prevention. To help prevent a UTI make sure to wipe properly (front to back), urinate before and after any sexual contact, watch your diet and lifestyle, wear cotton undergarments and urinate when you feel the urge to, never hold it.

 Traditional Treatment Methods:

*        Antibiotics- Common ones are: trimethoprim-sulfamethoxazole, amoxicillin, Augmentin, doxycycline and fluoroquinolones.

*        Increase water intake

Alternative/Holistic Methods:

*        ¼ tsp baking soda in water 3x daily for 3 days.

*        Cranberry pills

*        Hydration and frequently empty the bladder

*        Uva-ursi- 2 capsules 4x a day for 3-5 days then recheck urine

*        Rinse with a vinegar and water mix

 

Reasons Why Women Have More UTIs:

Common reasons that women have more UTI’s in general are:

*        Relatively short urethra

*        External 3^rd of the urethra is close to the rectum

*        Friction during sex allows bacteria into the urethra easier

*        Pregnancy hormones cause the urethra to be a bit more open than normal, which also alters the tone    and movement of it

*        Sugar in the urine and bladder compression because of the growing fundus

 

 

 

 



Tough Ones Come

So yeah, the title is Tough Ones Come. But I'm not speaking about tough in the sense that the labor and birth was exactly strenuous. Because honestly it was the most comfortable home I've been to lately. The mother was laboring beautifully, so beautifully you wouldn't have even realized she was truly having a contraction. Vitals were checked and she was asked if she would like to have her cervix checked. Like most curious mothers, she did. And we were very pleased to find she was at a 6, probably closer to a 7. Everything was lining up nicely. As time went on we decided to move ourselves upstairs so that the mother and father could have some quiet time and progress together without feeling like they were being watched by three women. It was great. Perfect for all of us as it was past 2am and we were desperately seeking some rest. We checked vitals and on baby via Doppler every hour, discovering she's probably a true 8 now. Everything was sounding great. Except mom's contractions have started to slow down and spread out. Not to worrisome at this point as she is a VBAC mom and it was still fairly early in labor. She's rechecked and we find out she's a 4. We ask her to walk a bit outside and this seems to jumpstart the contractions a little bit, though not very much.

Thinking this might have something to do we leave for a couple hours so that she can nap with her husband and hopefully it will be the rest she needs to restart labor. When we come back labor has picked up with a considerable amount of vengeance though there is never any cervical progress. After a while it is decided we will all live. Nothing happens over the next night and into today. Labor keeps starting and stopping. Baby is doing amazingly well, but mom isn't getting any satisfaction. They make the decision to go to the hospital on their own.

Labor wasn't hard. It wasn't a lot of work, but it was hard in the emotional sense. We really all wanted this mom to have her successful VBAC. Her labor was amazingly successful. She was in charge of all decisions during her pregnancy and during labor. She really achieved a lot out of this pregnancy. But it leaves so many open questions. What caused her labor to just not be efficient? There was not obvious reasons, none on the ultrasound that they chose to get earlier today either. There was not emotional roadblocks.

Sometimes the hardest labors and births are the ones we just cannot understand. This one weighs heavy on my mind and heart.

**Edit**
This mama ended up not having a repeat cesarean, but a VBAC! After their decision to transfer and receive some interventions on their terms, they totally rocked a VBAC in the hospital! This is what it looks like when moms/families know their bodies, options and demand the care that they want!