Because I can't change everything all at once...

...it's important to try to remember the times when I may have done something that changed one person's mind or experience a little bit.

The normal newborn exam. At my most recent birth, the family doctor wanted to examine the baby, but the mother was reluctant to give her up. I asked if it could be done where mother could see. The doctor said sure, and motioned to the infant cart, which was several feet away against a wall behind the mother's head. I asked if it could be moved closer. The nurse pointed out that it was under the warmer, which was bolted to the wall.

I mused about how at home they do the newborn exam beside the mother on her bed, but too bad that the hospital bed was too small for that. The doctor then suggested that perhaps he could do it with the baby right where she was - skin to skin with her mother. Sometimes the indirect method works better than my asking for something for my clients outright. I wonder if he'll think about doing that at his next birth?

Pushing. Once, I had a client in hospital with a medical student observing. She was beginning to push, and needed to pee. The nurse, per protocol, did not want the mother pushing on the toilet - they always think the baby's going to fall in. With a first baby, when a mother's just begun to feel pushy, the risk is vanishingly small. I said something of the sort, and the nurse agreed to let the woman go as long as she promised not to have the baby there. :-)

When she came out of the bathroom the mother asked me for help understanding a squatting position. Before she got back on the bed I demonstrated squatting by holding onto the bed and squatting on the ground. I intended to help her do this on the bed, but she got right down beside me and began to push in a very focused way. The nurse was a bit flustered, and whispered that she was concerned about not being able to see what was going on. So I turned on the mini maglight that hung around my neck, and the nurse and I proceeded to sit or kneel on the floor and watch the mother's perineum by flashlight.

I was thrilled that all of this was happening, but even more thrilled that it was happening in front of a med student. She got to see a midwifery-style labour in the hospital that night. I was pleased that we had a nurse who was flexible and willing to let curiosity override custom.

IV for antibiotics. GBS protocols have been a moving target over the last ten years. A few years ago the standard of care at the hospitals around here was to start an iv in active labour, hang a bag of antibiotics, and keep the iv running with ns or rl for the rest of the labour. Then I attended a home birth with a client who was GBS+. When the time came, the midwife started an iv, ran in the antibiotics (hanging the iv bag from a coathanger hung on the edge of a door), and then disconnected the iv tubing and capped the iv port. Four hours later, she reconnected the iv for the next dose of abx.

So, the next time I had a hospital birthing client who was GBS+, I told her this story. She asked her ob about it, who said "I don't see why not" and placed instructions in her chart. From then on I encouraged every client to talk to their doctor about this option. At first the nurses thought it was odd, but they are now encouraging it for clients who want an unmedicated birth and want their freedom of movement. I'm sure hospital policies have not changed because of my small handful of clients, but I'm sure their requests didn't hurt.

There must be more - I'll try to dig one up whenever my flagging spirits need a boost.