Another placement finished

Two more assignments submitted and suddenly I'm halfway through the course. Everyone told me that the time would fly past and they were right, it really has flown. I'm looking back at all I've done and learnt and feeling quite proud of myself and yet I can still look at all there is to learn and feel overwhelmed by it all. Over the past 18 months I have seen a variety of women with very different needs,and a variety of different midwives with different ways of working. I've seen normal births and I've seen births that needed high levels of expertise in order for mother and baby to survive - all of which I have learnt from. Sometimes it can feel like what we do at Uni, is a distant cry from what we do on placement. After all our first 18 months of training has been focused on normality but of course what we see on placement can be very different. One thing I have learnt is that remaining focused on what is normal, helps to identify when something isn't within the realms of normality.

A simple example of this is when we first palpate the uterus to see what position the baby is in, in a woman who is 40 weeks pregnant. Focusing on normality, we would expect the baby to be in a head down position so if the baby is not in that position, we can identify this and then act appropriately. At the beginning of my training I didn't really have a clue what position the baby was in but with practice I soon began to be able to tell. I even managed to identify a baby in the breech position. As I've continued in my training, I've become more and more confident and even at an earlier stage of pregnancy, can often identify the position. That said, I am not afraid to say when I'm not sure and to ask the midwife I am working with to have a feel and see what she thinks. It's essential to be comfortable enough to say "I don't know". There is no shame in not knowing something, there is shame in pretending that you do.

It's not unknown for a doctor to request a second opinion and I've witnessed qualified midwives ask for another midwife's opinion. Yet I know it can be difficult to say 'I don't know'. I'd say it's probably more difficult at the beginning of your training because you don't know yet whether or not you should know the answer and whether you'll look foolish if you don't know. I still maintain that you look far more foolish if you pretend to know the answer....you will get caught out. These days when I come across a term I don't know - usually when booking someone, they mention a medical condition I've never heard of - I'll ask the midwife I'm working with, or I'll look it up. We can't know everything after all.

So if you are about to start your first placement then there is your first bit of advice - don't be afraid to say you don't know something. BUT don't wait for someone else to find out for you - look it up - google is your friend!

A weighty family matter

Tonight I shall continue the story of my sister and her life - my last post finished with the birth of her son and a mention of her depression. 

In the months following the birth of my nephew, my brother was diagnosed with a second brain tumour and began further treatment, Christmas came and went, I gave birth to my first child, my brother's tumour stopped responding to treatment and shortly after the birth of his son, he lost his fight for life. My sister, sister-in-law and I used to meet up weekly with our babies. We'd have lunch, chat and try to be a comfort to each other. We were all grieving in very different ways. I don't really remember much of that time, lost in that haze of bereavement but I know there were times when we laughed and times that we cried.

During this time my sister's depression was increasing and her dependency on others was also increasing. She was drowning in grief and it wasn't just grief for my brother but also for the life she once had, the life that she thought she'd had, the happy daughter that had been stolen from her, the security that she'd once known. My parents went away and my sister's dependence switched heavily to me and my sister in law and lost in our own grief, and trying to deal with being parents, we didn't handle it very well. We argued, over something ridiculous really, but that afternoon my sister attempted to take her own life. I will be forever grateful that she didn't succeed that day, and forever grateful to those that helped me and her. It took me a long time to forgive my sister for what she'd tried to do and for me to gain more understanding of depression and helplessness that she must have felt. I can remember the relief that I felt when I collected my parents from the airport, that it wasn't my responsibility anymore. I'm not very proud of how I handled things back then. Over the coming months my sister had counselling and she got better. It wasn't a sudden thing, it was a gradual process and sometimes she'd have backward steps along the way. The good days eventually outweighed the bad. Time passed, we healed but we continue to grieve and that will never change. My sister has a new partner now and life has changed a lot from that dark time. 

Whilst my sister was battling the dark cloud of depression, my eldest niece was fighting battles of her own. She'd fought her father in court and "won" but the scars left behind were far deeper. It wasn't a simple case of getting him behind bars and that was that. She was entitled to counselling from the NSPCC because of her father but she wasn't able to have it until after the court case. It took a year for it to get to court so by the time she went to counselling, she'd reached a stage of locking everything deep inside her. She was too old for a child counsellor and too much of a teenager to really open up to anyone new. When she turned 18, we discovered she had an eating disorder. She's now 21 and has just recently been admitted as an inpatient into a unit for people with eating disorders. My sister is documenting her experiences in a blog of her own http://psychomum-todaystheday.blogspot.com/ so I'm not going to do the same. Life with someone with an eating disorder puts more pressure on a family than I ever imagined.

I mentioned in my first post that my sister fell off her pedestal for me when I was 12 years old. And I am sure I have raised some memories for my sister that have been difficult, she may well be wondering what I think of her now. She has faced a parent's worst nightmare and she has always been there for her children even when they have pushed her to the absolute limit. I have only touched on some of the things that she has faced. She doesn't consider herself a strong person but she is one of the strongest people I know. When I was 12, the sister I held on my pedestal was not really my sister but just who I imagined her to be. My sister is not perfect, who is? She still on occasion battles depression but she's winning the fight. I am proud to call her my sister. I am proud of how she has handled things, especially the last few years. Life has dealt her a difficult hand but she remains big hearted, generous, kind, and steadfastly loyal to her family and friends. She is an amazing person and I am honoured to be a part of her life. So sis, chin up and lets take on the next battle together, hand in hand. 

Part 2

It's possible I may have concerned my sister with which direction this series about her and her family might take but she need not worry, all will become clear. However in order to alleviate her worry, I have decided to continue the tale this evening. 

Yesterday I told you how we found out that my niece had been abused by her father and our lives changed forever. Naturally the police and social services were involved, however it took over a year to get her father behind bars. During that year, we rallied together as a family but it was almost too big for us to handle. During that time we first discovered that my brother was ill, and I was planning my wedding. My sister made the arrangements to sell the house that they had once shared as there was no way she could afford it on her own and started the wheels in motion for divorce.Now I get a little hazy as to the order in which things happened but during that year my sister sold the house she had once shared and her ex-husband halted the sale at the last moment, despite being in prison at the time. The result instead was that the house was repossessed but even that was not the process it should have been. As you might imagine with all this going on at the same time as my brother being desperately ill, my niece struggling with everything that had happened to her and the court case at which she testified, life for my sister was incredibly stressful and quite frankly awful. I was really quite worried about her at this time - she had some friends that I just wasn't sure about and she was going out a lot, drinking a lot. Frankly though it was nothing to do with me, there was nothing specific to worry about and goodness knows she needed the break. Everything just felt a little bit crazy. And then she discovered she was pregnant and it was as if the baby was sent to bring her life back on track. It might seem crazy to some but I truly believe that this baby came for a reason, despite all the odds. He came to give her hope again and to remind her of the future still there waiting. That it wasn't all hopeless as it all must have seemed. 

Life that had been so crazy seemed to settle back down. She still had the repossession to deal with and as I said that didn't happen as it should have done. Everything took a long time to happen, longer than it should have done. There were no guarantees that she would be housed, that she could be initially placed in a bed and breakfast with her three children, whilst pregnant. Thankfully when the day finally came, she was housed and by some miracle she was housed directly opposite my house. That evening her waters broke and the next day her second son was born. I was her birth partner and that day is very precious in my memory. I was already pregnant with my first daughter at this time, and my sister in law was also pregnant and I was looking forward to us all having babies so close in age to each other. 

At this time it felt to me like life was on the up, or at the very least was settling to a new kind of normal. My sister was beginning a new life which seemed more hopeful than it had just a week earlier, my brother was doing well, I was excited about my new baby...life was full of hope. The truth was very different - my sister was battling severe depression and my brother was shortly to be diagnosed with a second tumour. 

Family matters...

This post is not so much about me as a student midwife but about me as a person, about my family. I've already told you all about losing my brother after all. I know I've mentioned my sister but I don't expect I've told you much about her and her family. This is all heading somewhere but I just feel that the background is vital....there is no point me telling you the ending without you knowing what came first and I believe that the whole story plays a part in where we are today. It's a part of what makes me who I am. It's a part of what makes up the relationship that my sister and I have today.

My sister is 5 years older than me. As a child I idolised her, I wanted to be just like her. I don't really know why...she wasn't very nice to me - I was her nuisance baby sister. Our mum used to occasionally dress us the same - not a problem for me but I am sure it was pretty embarrassing for her. She wasn't really mean to me but she'd want to sit and read her books and I wanted her to play with me so she'd often tell me to go away and leave her alone. If she wanted to play however, she'd make out she was doing me a big favour and sit and play with my flower fairies and my little ponies with me. We used to share a room until I was 10 and she was 15, and we moved house. We had bunk beds and we both wanted to sleep on the top bunk so she'd tell me to stay awake and maybe she'd let me sleep on the top bunk. I am sure I was often asleep when she came up but I can certainly remember the occasions when I managed to stay awake and she wouldn't swap.

However for me, her halo slipped when she was 17. She had a new boyfriend and we didn't see much of her. When she was at home she'd be in her room, when she wasn't in her room, she was a typical teen and all you'd get was hormones. Then all of a sudden she left home. My parents were out one day and my sister was "in charge" of me and my brother. She left a note for my mum with me and she left. As it turned out, the note was to tell my parents that she was off to live with her boyfriend and she wasn't coming back. My parents were devastated as you can imagine. I was only 12 but I can remember a lot of hushed conversations at home. One day at school, one of the girls asked me if my sister was pregnant which I denied. When I told my mum however, it turned out to be true. There followed discussions with my sister and her boyfriend and his parents and eventually it was decided that they were going to get married, and they were both going to move back in with us. My sister's halo didn't slip because she left home, it didn't slip because she was pregnant, it slipped because she upset my parents so badly.

I recall it being around this time that I was allowed to get my ears pierced whereas my sister wasn't allowed until she was 16. My sister moaned for years about this fact - she didn't realise that in part it was because of her I was allowed mine done early. I don't know what I did, but my mum told me I was a big help to her at that time. Anyway my sister married her boyfriend and shortly before she turned 18 she became a mum. I have loved being an Auntie ever since and I was honoured to become her baby girls godmother. My sister and her husband moved into their own place and a couple of years later had a little boy. Life got better and they managed to buy their own house and 5 years later had another baby girl. I was so proud of them. They hadn't made the best choices but they'd pulled their socks up, worked hard and made a life and a home for themselves. I used to visit my sister weekly at that time, her youngest daughter just a baby. We used to go shopping a lot.  Life went on....there were ups and downs but generally life was good, life was "normal", life was uneventful - oh wasn't that nice! Then followed a catalogue of events that sometimes blurs in which order it all happened. It's the part of our lives that we sometimes think people wouldn't believe. However I am going to focus on the events directly involving my sister and her family, although it was around the same time as my brother falling ill and me getting married.

My eldest niece was 13. My sister and her husband had separated and although we were all initially shocked, it certainly seemed to be the best decision. Then came the bombshell. My niece confided in a friend at school. Her father had been sexually abusing her. Our lives changed in an instant, although of course, hers had changed some time before when it had all begun.

There is so much more to say that it is simply too much for one post alone so I shall tell the next part of the tale next time....

Fear

Becoming a parent can, for some, be the most frightening experience in the world. You can ask about others experiences, you can read all the books, you can look on the internet but nothing can really tell you what it's going to be like. It is quite normal for first time mums to focus on the labour that is ahead of them and read all you can on the subject or alternatively, completely stick their heads in the sand and not think about it at all. I was someone who had to read everything I could. For me, as a future midwife, as someone who has been through labour twice, as a mum who wonders what parenthood will bring that day, I wonder if I can help alleviate some fear? I certainly hope that I can, for women that I work with and with friends who are to become parents in the future.

Labour is certainly something that holds a lot of fear and it's understandable that it does because anything that involves pain, is something to worry about. Instinctively, as humans, if there is pain then there is something wrong. However labour is unique in that, it is the only time that pain is actually a good thing. If you are someone that has had a tough pregnancy, or you go overdue, or you've just had enough of waiting, you may even find yourself wishing for the pains to start. The one time in your life, you will wish for pain?

Television doesn't help of course...it gives the impression that when you go into labour your waters will break and you are instantly in agony. I'd hope that most people realise that labour generally takes longer than how it is usually portrayed on the tele. For most women, labour begins with mild, irregular pains. Many women liken them to period pains. You can breathe through them, you can walk through them, you can easily talk through them...not like they'd have you believe in Albert Square. They can be 10-15 minutes apart, they can stop for a few hours and then start up again. This is the main reason women are recommended to wait before rushing up to the hospital. Yes they hurt, some are stronger than others but as it's not a constant pain it's something women can cope easily with. The fear that can accompany those pains however, is what some women find difficult to handle. The not knowing how long it will last for, can be difficult to handle. And sometimes whilst the pain isn't that strong yet, it can still prevent women from sleeping or getting comfortable, and this can have an impact on how well women cope.

I believe that fear surrounding labour and birth should be handled at the antenatal stage, or perhaps pre-conception would ideal. I wholeheartedly believe, that in the delivery suite is not the place though. It's much more difficult to maintain normality when someone is terrified. It's not impossible and I have witnessed some amazing midwives who can calm the most frightened of women, and ground them, manage their fear, soothe them and make them feel safe. I hope to be this kind of midwife. I believe that the overwhelming fear that some women experience does sometimes lead them to choosing an epidural for pain relief. They don't know what to expect and how long it might take. Providing women with accurate information, and helping them to make an informed decision is vital. Being able to alleviate their fear is also vital. I have witnessed frightened women "choosing" an epidural and as someone pointed out to me, how can it be an informed choice when it is a fear based decision. Women should not reach this level of fear.

When I was pregnant with my second daughter, I attended an antenatal group, as previously mentioned in my Inspirational Midwives post last year, where I was given all the information I could possibly need to make an informed choice about where I wanted to give birth, my pain relief options and what to expect if things didn't go to plan. I always wished I'd attended the group when I was pregnant for the first time. What I find incredibly sad, is that group had to stop running due to a lack of funding. Those midwives inspired a number of women to have a home birth, who in turn inspired others to also have home births, and that cycle is still continuing, their inspiration still continues on. They gave women a voice, because they provided the information, they probably saved the NHS a lot of money because a women who knows what to expect, needs far less interventions, would decline unnecessary interventions. In an ideal world, the community midwife would be able to handle all fears about labour and birth during an antenatal appointment. Sadly there just isn't time - too many women and not enough midwives. Midwives constantly thinking about the next woman they have to see....it's not that they don't want to, it's more that it's just not possible.

Fear is the biggest barrier for a woman facing labour and birth. Time is one the biggest barriers facing the midwife. My biggest fear about becoming a midwife, is not having the time to be able to give women the care that they need, that they deserve and becoming frustrated with time constraints. I hope to remember the midwives who managed to give the time without neglecting others, somehow found a way to manage it. 

Sperma berdarah (=Hematospermia)

Hematospermia berarti ditemukannya darah dalam sperma (ejakulat). Darah mulai dari tidak terlihat mata (hanya bisa dilihat dengan mikroskop) sampai dengan darah yang tampak dengan mata. Penampkannya bisa hanya berupa darah berwarna kecoklatan sampai berwarna merah terang. Sering tanpa rasa nyeri, biasanya menyerang diusia pubertas dan terbanyak pada usia 30-40 tahun.

Penyebab tersering adalah infeksi urethra (saluran pipis), kelenjar prostat atau vesikula seminalis. Sedangkan penyebab lainnya adalah :
- Trauma/cedera misalnya akibat aktifitas seks yang berlebihan
- Infeksi saluran kencing lainnya
- Sumbatan saluran ejakulasi
- Biopsi kelenjar prostat atau paska vasektomi
- Kanker (jarang)

Pada umumnya kasus bersifat self-limiting dan akan hilang dengan dengan sendirinya, dan 90 kasusnya berulang. Namun jika ditemukan penyebabnya, maka dilakukan pengobatan sesuai penyebab. Jika ditemukan infeksi diberikan antibiotika. Trauma minor biasanya tidak butuh terapi dan hanya dilakukan observasi saja, sdangkan trauma mayor perlu dilakukan bedah terbuka. Sumbatan bisa dibuka dengan bedah ringan. Kanker diobati dengan radiasi dan kemoterapi.

7 Tips menghilangkan sakit pinggang dalam kehamilan

Nyeri pinggang selama kehamilan adalah keluhan umum pada wanita hamil. Angkanya sekitar 50-70 persen dari wanita hamil bisa merasakannya. Nyeri pinggang ini bisa dirasakan di semua tingkat usia kehamilan. Tetapi paling banyak dirasakan saat kehamilan tua.

Penyebabnya :

• Peningkatan hormon – hormon yang dilepaskan saat hamil, akan membuat ligamen (penunjang rahim di daerah panggul (pelvis) menjadi lembut dan sendi2 menjadi longgar dalam rangka mempersiapkan proses kelahiran bayi. Perubahan2 ini akan mempengaruhi punggung wanita hamil
• Arah gravitasi – pusat gravitasi pada wanita hamil secara perlahan akan berubah ke arah depan saat perut semakin membuncit, yang menyebabkan postur tubuh berubah.
• Tambahan Berat badan ekstra – baik dari ibu maupun dari bayi
• Postur atau posisi – postur yang tidak baik, berdiri berlebihan, dan membungkuk dapat memicu/menambah nyeri pinggang
• Stres – stres biasanya bisa menemukan bagian lemah dari tubuh, sehingga wanita hamil akan mengalami peningkatan rasa nyeri pinggang selama hamilnya .

7 tip dibawah ini bisa mengurangi nyeri tersebut:

1: Selalu menjaga/mempertahankan sikap postur tubuh yang baik

Saat bayi tumbuh, pusat gravitasi akan bergeser ke depan. Untuk menghindari jatuh ke depan, maka wanita hamil mungkin mengimbanginya dengan bersandar - yang dapat meregangkan otot-otot di pinggang bawah dan menyebabkan sakit pinggang selama kehamilan.

Prinsip postur tubuh yang baik (harus dibiasakan):

* Berdiri tegak dan lurus.

* Dada ditinggikan.

* Bahu kebelakang dan rileks.

* Jangan merapatkan lutut.

Ketika berdiri, berdirilah dengan kedua kaki membuka (memang gak sopan sih haha). Jika harus berdiri untuk jangka waktu yang lama, istirahatkan satu kaki di angkat sedikit (bisa pakai dingklik).Pilihlah kursi yang mendukung punggung (ergonomis), atau kalau cuma kursi biasa yang ada, maka tempatkan bantal kecil di belakang punggung bagian bawah. Punggung bagian atas dan leher posisikan lurus.

No 2: Pakai sepatu yang tepat

Pakailah sepatu bertumit rendah dengan lengkungan yang baik.

No 3: Mengangkat sesuatu dengan benar

Jangan membengkokkan pinggang jika ingin mengambil sesuatu dari lantai, tetapi berjongkoklah.

No 4: Tidur miring.

Tidur miring dan jangan telentang. Salah satu atau kedua lutut ditekuk. Menaruh bantal di bawah tekukan lutut dan perut juga akan membantu. Atau menggunakan bantal khusus hamil yang men-suport mulai dari dada, perut dan kaki.

Nomor 5: Panas, dingin atau pijat

Gunakan bantal pemanas ke punggung, atau es pack bergantian dengan panas. Menggosok punggung juga mungkin bisa membantu. Lebih baik lagi, minta bantuan ahli pijat profesional.

Nomor 6: Adanya aktivitas fisik dalam rutinitas harian

Aktivitas fisik yang teratur dapat menjaga tubuh menjadi kuat dan dapat meredakan sakit punggung selama kehamilan. Dengan izin dokter, cobalah kegiatan seperti berjalan kaki atau berenang.

No 7: Pertimbangkan terapi komplementer/alternatif

Beberapa penelitian menunjukkan akupunktur yang dapat membantu meringankan sakit punggung selama kehamilan. Chiropractic merupakan alternatif lain yang bisa membantu.

Namun demikian jangan mengabaikan nyeri punggung. Karena bisa saja itu merupakan gejala persalina kurang bulan, yang biasanya disertai dengan pendarahan per vagina.