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.....
Thursday, September 4, 2014
Tuesday, August 26, 2014
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.***
If
it spreads to your kidneys:
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.
Traditional
Treatment Methods:
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
*
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.
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.
*
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 3rd 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
Thursday, August 21, 2014
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!
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!
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