At the hospital where I work, we have one scheduled day a week to do elective caesareans. On that day there is a dedicated caesar midwife rostered on to look after the women and babies throughout the caesarean process. This also allows us to fulfill the the requirements of the Baby Friendly Health Initiative (BFHI) accreditation, such as skin to skin contact and breastfeeding within the first hour after birth.
Sometimes there are elective caesars booked on other days, but unfortunately we do not, as yet, have funding for a dedicated caesar midwife on more than one day, so they are cared for by our regular pool of staff. The midwives take it in turns to rotate through all areas of midwifery, including being the caesar midwife. I thought you might find it interesting to see what its like to spend a day in the life of a caesar midwife.
The caesar midwife starts her shift at 12pm. At that time she visits the women (usually 2, though occasionally 3) scheduled to have an elective caesarean that afternoon. She reassures the mum and support people, ensures the woman has had her blood tests, shaved her pubic area, had her premedication antacid and been formally admitted to the hospital. She has usually met the women previously in pre admission clinic, where the women meet and get assessed by the anaesthetist.
At 1pm she has a break (going into theatre on a empty stomach is a really bad idea). Then at 1:30pm the caesareans are scheduled to start, though this sometimes gets pushed back if there has been other emergency operations that morning (including emergency caesareans). She gets changed into scrubs and waits for the call from theaters to say the woman is “ready”. This means that the woman has had a spinal anaesthesia (similar to an epidural, though there is no catheter to maintain access, just a one time anesthetic injection) cited by the anesthetic registrar and is now in the actual operating theatre.
The midwife rushes down to theatres, through the staff access doors and into the change room. In the change room she washes her hands then adorns a theatre hat and booties. She walks down the corridor and finds the right theatre, grabs a mask and sterile gloves and enters the busy theatre. Inside the operating room the are lots of people. There is an anesthetist, an anesthetic registrar, an anesthetic nurse, a scrub nurse, a scout nurse, an obstetrician, an obstetric registrar and now the midwife. There is usually also a few students, either medical, nursing or midwifery.
When the caesar midwife arrives, she checks the baby resuscitation trolley to make sure the suction and oxygen are connected and working. She also readies a blanket, thermal blanket, vitamin k injection and name tags. Then she waits and watches. She watches as the doctor inserts the urinary catheter. She watches as the doctor uses the cauterising machine to burn through the skin and the registrar and scrub nurse assist in pulling apart the woman’s stomach muscles with hook like tools. She watches as the doctor finally reaches through all the layers, through the uterus, through the amniotic sac, to the baby inside. It sometimes feels like a long wait, inside the cold theatre with the smell of disinfectant and burning flesh in her nose.
Her job is then to receive the baby from the doctor (midwives are also called “baby catchers”). At this time she takes the little squirmy bundle of joy over to the resuscitair for a check over. Sometimes the baby needs resuscitation with oxygen and suction. She also injects the vitamin k (as long as parents have consented), then wraps the baby in the blankets and takes it over to mum and dad for a cuddle.
She stays with the mum and baby and makes sure they get some skin to skin time in theatre. She then takes the baby (with dad in tow) to recovery to be bathed, weighed and measured, before mum rejoins them after being sewn up. This process takes about half an hour. When mum gets back to recovery, the midwife facilitates the first breastfeed. This can take up to an hour. She then accompanies the newly expanded family back to the maternity ward and hands over their care to the ward staff.
She is then required back down in theatre to repeat the whole process with the next woman. After she has finished with the direct care of the women and babies, she then has the mountainous task of completing the paperwork. There really is far too much. It can often take so long that dinner is consumed while hurriedly trying to multitask with paperwork and computer work. By 8:30pm she is utterly exhausted and ready to go home to her own family.
Luckily she only has to do this once a week!