To shadow an OB/GYN for a month
This month has been very different for me. Well, every month has been, but this one in particular has challenged me and amazed me in ways I hadn't thought possible.
My OB placement has so far been WAY different than I expected it to be. I'd heard from other students about 24 hour OB shifts at larger hospitals, where a student could expect to go to 7-15 births in a shift. The advantage of this is a large volume of experiences put closely together. It can rapidly increase skill in things like suturing that us midwifery students worry so much about developing.
Apparently, an OB placement at a small Level 1 hospital is not at all like that. In fact, although I'm on call a couple of days a week, I have yet to go to a birth with my OB preceptor in three weeks. And frankly, part of me is terrified. I had really looked forward to this placement as an opportunity to gain skill in suturing, and I'm just over a week until the end of my placement and it's likely there won't be a single opportunity at all. When I realized that, I had a major feeling of let down. I'm thankful at times like these that my Normal Childbearing placement was so busy and full of these types of opportunities. Hopefully this means that I won't be too far behind my classmates who enjoyed the benefits of repeated births in the same night to hone their skills. I'm also super thankful for one of the lovely midwives in this community who took me under her wing one night and brought me to her client's birth.
The great thing about this placement is how much gynecology I'm being involved in. I'm going to all of my preceptors gynecology clinic and surgeries, and there is SUCH a wide variety of experiences that I think it's amazing. I've heard from other students that many OB preceptors don't allow involvement with the gynecological patients but mine does and I am so greatful for it. The way my preceptor sees it, although our scope is limited right now, perhaps eventually we will become more similar to the Nurse-Midwife model in the U.S. where the midwives provide well-woman care throughout life, rather than just the childbearing year.
What has thrown me off, is how alone I feel. Opinions and management choices come up sometimes in OB clinic that I really struggle with. Sometimes it's because I'd prefer to present them differently (prenatal screening like ultrasounds or group B strep), and sometimes because I simply have a really strong bias that I haven't gotten over (like topics such as VBAC and circumcision). It's hard to hear the medical perspective when you've walked on the wild side your whole adult life. Sometimes, I'll have a typical day, but I'll end up crying all the way home and I can't even figure out why (and no, this isn't something that usually happens for me, only the odd day since I've started here). I think it's an internal battle. I believe in midwifery care, I would fight for it to the very end, and I made pretty radical choices as a client of midwifery care myself. So I think I'm fighting with myself because sometimes the explanations that my preceptor makes for the way that she practices make total sense. But it still goes against the way that I do things. It's hard to sit with that feeling - I like to know what is right. But it seems like maybe there isn't always one right answer. I should have already known that!
Anyway, the whole experience is pretty humbling. These doctors do not always deal with the same people that midwives deal with. When I have a day in clinic in midwifery care, I am usually very happy and feeling confident. I walk into a room with a client who is also usually very happy, have a great discussion full of respect and choice, give her good prenatal care, and am on my way. In this scenario, we have some of that, but we are also seeing those women who are not lucky enough to be in midwives care - those who are suffering from infertility. Those who are recovering from a miscarriage or abortion. Older women undergoing hysterectomies. Women who have lost their husbands and are now facing other health issues. Not a day goes by that someone doesn't cry in a clinic visit (or ten), because an OB/GYN, just like most doctors, are not always the bearer of good news. Sometimes these women are being called in to find out that they have cancer, or that they'll never be able to have the baby that they've so desperately wanted. Certainly midwives aren't always the bearers of good news either, but we definitely see it a LOT LESS. And in the midst of this, I see my preceptor as an amazing doctor. A little while ago, I looked into the window of the operating room to see her with a patient who was about to undergo emergency surgery.... and she was holding the woman's hand as she waited to fall asleep. How many doctors take the time to comfort their clients? I don't know, because this is the only one I've spent a lot of time with. But I hope she's among many like her.
Wednesday 21 November 2012
Friday 9 November 2012
Ping pong
Well, I've done it again. Things got all busy and all of my good intentions to post went out the window. I marvel at how much I used to post in first year. I felt like I was so strapped for time. I know I was very busy then, but I think at that point I hadn't really learned too much about prioritizing.
So, third year, you ask - how is it? Different! Dynamic, unpredictable, and exciting - combined with boring, predictable, and sometimes troubling. I've been bounced back and forth between so many different places and each one puts me into a new learning environment with new responsibilities and expectations. I love it!
For those who don't know the nitty gritty, third year consists of inter-professional placements - for me this semester, that means 4 weeks with a nurse in labor and delivery, 2 weeks in a breastfeeding clinic, 2 weeks in the neonatal intensive care unit, and 4 weeks under an obstetrician. Next term will be some elective placements and a virtual online placement. I can't emphasize how greatful I am for having the opportunity to see into the world of these other professionals. I wish that all of these disciplines had this amazing opportunity to witness the lives of their colleagues. I'd bet that it would breed a lot more compassion and respect between disciplines.
What all of these placements play out in reality is so complex. Sometimes, I'm observing. Sometimes, I'm thrown into the midst of things when I don't expect it. Mostly I'm somewhere in between. I have both loved and hated going from place to place so often. The great thing is that its helping my social skills - I'm meeting new people every day and needing to quickly establish rapport with them, which is an interesting skill that I have definitely NOT mastered. The other great thing is that I've gotten a taste of every hospital that I'd consider working in. Each one operates so differently! The social infrastructure is also very interesting to navigate sometimes. We're really in this unique place in these placements where we're following nurses and OB's, and observing conversation that sometimes involves slogging midwives. I've never explained what my scope of practice is so many times in my life - nor have I had to defend homebirth so much. (And after a few interesting conversations, I've decided to just not mention my birth history for fear of being judged too harshly).
But as challenging as that aspect of it has been, I find it such a privilege to be able to do these placements. I feel like I've developed a much better understanding of what sort of follow up care our babies that go to the NICU get. My NICU placement what such a pleasure. Although I saw more bottles and formula than I would have liked, shift work and predictable hours are lovely things and the staff at the NICU in Brampton have such a lovely working relationship with one another. I was also able to follow one of the nurses into the high risk births that occurred while I was on shift, which helped me to feel more comfortable observing cesareans and instrumental births.
My labor and delivery nursing placement was at the hospital closest to me, which was great for driving. The midwives here are newly implemented so it was interesting to observe the dynamic as they became established in a hospital that has never had midwives before. It was especially interesting to hear the nurses' side of the conversation, since I am (obviously) used to hearing any conversation about hospital relationships from the perspective of the midwives. Working as a labor and delivery nurse at a birth was also very interesting - there is much less freedom to manage the birth as I might choose to do it because the nurse is not the woman's primary caregiver. I found that very frustrating, not because I didn't respect the decisions the doctor was making, but because of the fragmented care that the woman was receiving, which was being split between a number of different people.
My breastfeeding placement was definitely the highlight of my year so far. I was enormously lucky enough to be placed at the Newman Breastfeeding Clinic and Institute. The doctors and lactation consultants at that clinic are amazing. I like to think of them as "breastfeeding midwives". Each woman that enters their clinic leaves there having received the combined recommendation of two lactation consultants and a pediatrician (and usually a student or two). I'd been aware of mixed opinions about the clinic before I came there, but truly, their approach is amazing. I am so grateful for the opportunity to immerse myself in their environment for as long as I did, and those of you who are entering third year - even if its not close to you, this placement is *so* worth the drive. I think it's made an enormous difference in how I'll be managing breastfeeding issues.
I've just begun my OB placement this week. I'm still new to it, and I'm quite certain it's going to deserve a post all on its own, so that one will wait for another day.
So, third year, you ask - how is it? Different! Dynamic, unpredictable, and exciting - combined with boring, predictable, and sometimes troubling. I've been bounced back and forth between so many different places and each one puts me into a new learning environment with new responsibilities and expectations. I love it!
For those who don't know the nitty gritty, third year consists of inter-professional placements - for me this semester, that means 4 weeks with a nurse in labor and delivery, 2 weeks in a breastfeeding clinic, 2 weeks in the neonatal intensive care unit, and 4 weeks under an obstetrician. Next term will be some elective placements and a virtual online placement. I can't emphasize how greatful I am for having the opportunity to see into the world of these other professionals. I wish that all of these disciplines had this amazing opportunity to witness the lives of their colleagues. I'd bet that it would breed a lot more compassion and respect between disciplines.
What all of these placements play out in reality is so complex. Sometimes, I'm observing. Sometimes, I'm thrown into the midst of things when I don't expect it. Mostly I'm somewhere in between. I have both loved and hated going from place to place so often. The great thing is that its helping my social skills - I'm meeting new people every day and needing to quickly establish rapport with them, which is an interesting skill that I have definitely NOT mastered. The other great thing is that I've gotten a taste of every hospital that I'd consider working in. Each one operates so differently! The social infrastructure is also very interesting to navigate sometimes. We're really in this unique place in these placements where we're following nurses and OB's, and observing conversation that sometimes involves slogging midwives. I've never explained what my scope of practice is so many times in my life - nor have I had to defend homebirth so much. (And after a few interesting conversations, I've decided to just not mention my birth history for fear of being judged too harshly).
But as challenging as that aspect of it has been, I find it such a privilege to be able to do these placements. I feel like I've developed a much better understanding of what sort of follow up care our babies that go to the NICU get. My NICU placement what such a pleasure. Although I saw more bottles and formula than I would have liked, shift work and predictable hours are lovely things and the staff at the NICU in Brampton have such a lovely working relationship with one another. I was also able to follow one of the nurses into the high risk births that occurred while I was on shift, which helped me to feel more comfortable observing cesareans and instrumental births.
My labor and delivery nursing placement was at the hospital closest to me, which was great for driving. The midwives here are newly implemented so it was interesting to observe the dynamic as they became established in a hospital that has never had midwives before. It was especially interesting to hear the nurses' side of the conversation, since I am (obviously) used to hearing any conversation about hospital relationships from the perspective of the midwives. Working as a labor and delivery nurse at a birth was also very interesting - there is much less freedom to manage the birth as I might choose to do it because the nurse is not the woman's primary caregiver. I found that very frustrating, not because I didn't respect the decisions the doctor was making, but because of the fragmented care that the woman was receiving, which was being split between a number of different people.
My breastfeeding placement was definitely the highlight of my year so far. I was enormously lucky enough to be placed at the Newman Breastfeeding Clinic and Institute. The doctors and lactation consultants at that clinic are amazing. I like to think of them as "breastfeeding midwives". Each woman that enters their clinic leaves there having received the combined recommendation of two lactation consultants and a pediatrician (and usually a student or two). I'd been aware of mixed opinions about the clinic before I came there, but truly, their approach is amazing. I am so grateful for the opportunity to immerse myself in their environment for as long as I did, and those of you who are entering third year - even if its not close to you, this placement is *so* worth the drive. I think it's made an enormous difference in how I'll be managing breastfeeding issues.
I've just begun my OB placement this week. I'm still new to it, and I'm quite certain it's going to deserve a post all on its own, so that one will wait for another day.
Monday 17 September 2012
Tired, bewildered, stressed, and happy
Can I feel all of these things at once? Sure.
Third year started with a (loud) bang for me. We started off the first week of September with a 6-day intensive that I was totally looking forward to. It was definitely nice to see classmates again, but I hadn't really thought too hard about the level of content that was going to be covered in those 6 days - they mean it when they say intense! What struck me most about it, though, was the switch from "Normal" (our first two years) to "abnormal". It jarred me a bit, to go from figuring out how to get my hands to do the right things when I'm catching a baby, to managing obstetrical emergencies, just like that.
After that, we began our interprofessional placements - a series of 2-4 week placements with other professionals in the field learning clinical skills from them and discovering their role and the unique benefits and demands of being a part of their profession. What a unique opportunity this really is. Its a great chance to learn clinical skills more quickly than I would with midwives. Its also a great chance for me to see how really happy I am to be in midwifery. I'm placed with a labor and delivery nurse first, and although I've only had a couple of shifts, I'm noticing quite a few differences that make me very thankful that we as midwives have such a wide scope and flexibility so we can maximize continuity of care. Just when you really get attached to a woman, your shift ends and you might never see her again. But then again, your shift ends, and your family knows when you expect you - and if you've read any of my previous posts, you'll know how happy they are about that!
Rather unfortunately, we had a major childcare crisis and a threat to my son's safety to deal with after my first day at the hospital when I came to pick him up. I also was faced with the much-greater reality of relocating for my senior year placement - something that I've always been afraid of, despite being aware that it could be a real possibility, but it now seems to be a much greater one. Couple that with some OSAP complications as well, and I had me a pretty emotional week. Thankfully the childcare problem is all cleared up now and the summer-long quest to find a replacement for our much loved (but now far away) home daycare provider came to a close the other day when we met "the one". Phew! There's a load off. I'm also working days this week and got to be part of some really great experiences today, so things are looking up!
Third year started with a (loud) bang for me. We started off the first week of September with a 6-day intensive that I was totally looking forward to. It was definitely nice to see classmates again, but I hadn't really thought too hard about the level of content that was going to be covered in those 6 days - they mean it when they say intense! What struck me most about it, though, was the switch from "Normal" (our first two years) to "abnormal". It jarred me a bit, to go from figuring out how to get my hands to do the right things when I'm catching a baby, to managing obstetrical emergencies, just like that.
After that, we began our interprofessional placements - a series of 2-4 week placements with other professionals in the field learning clinical skills from them and discovering their role and the unique benefits and demands of being a part of their profession. What a unique opportunity this really is. Its a great chance to learn clinical skills more quickly than I would with midwives. Its also a great chance for me to see how really happy I am to be in midwifery. I'm placed with a labor and delivery nurse first, and although I've only had a couple of shifts, I'm noticing quite a few differences that make me very thankful that we as midwives have such a wide scope and flexibility so we can maximize continuity of care. Just when you really get attached to a woman, your shift ends and you might never see her again. But then again, your shift ends, and your family knows when you expect you - and if you've read any of my previous posts, you'll know how happy they are about that!
Rather unfortunately, we had a major childcare crisis and a threat to my son's safety to deal with after my first day at the hospital when I came to pick him up. I also was faced with the much-greater reality of relocating for my senior year placement - something that I've always been afraid of, despite being aware that it could be a real possibility, but it now seems to be a much greater one. Couple that with some OSAP complications as well, and I had me a pretty emotional week. Thankfully the childcare problem is all cleared up now and the summer-long quest to find a replacement for our much loved (but now far away) home daycare provider came to a close the other day when we met "the one". Phew! There's a load off. I'm also working days this week and got to be part of some really great experiences today, so things are looking up!
Tuesday 21 August 2012
Another summer day....
has come and passed. The breeze is cooling and the end of the summer is approaching.
In all honesty, I spent most of my time in school dreading this summer. It is the only long period of time that I will have off throughout the entire program. For someone like me, who has increasingly identified myself as a bit of a workaholic, this was terrifying. I figured out a long time ago that I'm not cut out for stay-at-home parenting. Four months of it felt like a bit of a nightmare.
And then April came along in placement. In my last two weeks of placement, I attended 9 births. What a way to go out with a bang! And what a way to make me really appreciate the benefits of a long vacation. By the end of it, despite the amazing variety of mostly positive birth experiences I got to witness in that long string of births, I was exhausted, drained, and desperate for sleep and a good meal (or ten!). The day my summer vacation started, was the day I stopped dreading it.
We have made it work so far. The kids have been in daycare part time, which gives me a chance to do a little bit of work and allow myself the space to get other things done that I had completely let go of last semester. And here we are in August and I feel all caught up. Dare I say, I'm almost starting to feel an inkling of excitement for third year to begin. But not before I get some more fun out. Oh, and a few births, but that's beside the point.
This summer, I've had to very realistically reflect on how the midwifery lifestyle impacts my life. When I was entering the program, I felt like I had a good handle on what it would be like - after all, I had been a doula for a number of years and was used to being on call and making backup childcare arrangements. But the midwifery lifestyle is much more demanding than the one I led as a doula, and it is particularly demanding for students. Students, who need as much experience as they can get, get very few days off and (if they're lucky) will be very busy on the days that they are on. I know this, and I accept and eve love this, but it is much more difficult in practice than it is in theory.
I have grown used to the unpredictability of birth and midwifery already. It feels selfless, it feels purposeful. I know it is making a difference in people's lives. I've grown incredibly fond of it. Although it has its dark moments, I look forward to hearing from clients. I enjoy not knowing where I will be an hour from now. I love surprises, the spontaneity of picking up and changing everything.
My family, however, does not. Throughout the course of my studies last semester, I grew to learn that no amount of preparation I did could have prepared my family for what it was really like. It wasn't my absence - they anticipated that. They knew I would be away much more than I'd be home, and they knew I'd need to rest much of the time that I was home. No, it wasn't how busy I was. It was how unpredictable it was.
I can't say how many times I arrived home just in time for dinner, only to get paged away 20 minutes later, kids on my lap. Or right in the middle of the bedtime routine. Or just as I'm preparing them for the morning. People, I cannot stress it enough - prepare your family for this. Make them read this if you want! It is so important.
Kids are so resilient, though. They got used to Daddy doing just about everything for them - he cooked them dinner pretty much every day, put them to bed most nights, took them to school and daycare, made lunches. Everything that they were used to me doing, or at least used to us sharing. My partner pulled through for me in so many ways, and I know (because I know him) that he will continue to do so, but it is not easy for him! Many of us midwifey folk have discussed trying to band our men together so that they can form a support network of deserted midwife husbands. And while I was aware that he was struggling a great deal during my placement, it wasn't until I was off and had the time and energy to check in with him that I realized just how hard it had hit him. Our relationship had become extremely fragile because amidst how busy I was, and my efforts to compensate for it by taking over household chores and childminding while I was home, I had nothing left at all to put into our relationship. The result is that we found ourselves in a crisis.
And so, this summer, our partnership has been the real focus. Sure, I've caught up on chores and fun with the kids. But most of my transformative energy has been put into building steel bonds with the man who has proven himself to be the backbone that holds me (and our entire family) up when I feel I might crumble to the ground. The crisis that we found ourselves in allowed us to realize that we don't just need eachother, but we want to be there for eachother and understand one another better, always.
In all honesty, I spent most of my time in school dreading this summer. It is the only long period of time that I will have off throughout the entire program. For someone like me, who has increasingly identified myself as a bit of a workaholic, this was terrifying. I figured out a long time ago that I'm not cut out for stay-at-home parenting. Four months of it felt like a bit of a nightmare.
And then April came along in placement. In my last two weeks of placement, I attended 9 births. What a way to go out with a bang! And what a way to make me really appreciate the benefits of a long vacation. By the end of it, despite the amazing variety of mostly positive birth experiences I got to witness in that long string of births, I was exhausted, drained, and desperate for sleep and a good meal (or ten!). The day my summer vacation started, was the day I stopped dreading it.
We have made it work so far. The kids have been in daycare part time, which gives me a chance to do a little bit of work and allow myself the space to get other things done that I had completely let go of last semester. And here we are in August and I feel all caught up. Dare I say, I'm almost starting to feel an inkling of excitement for third year to begin. But not before I get some more fun out. Oh, and a few births, but that's beside the point.
This summer, I've had to very realistically reflect on how the midwifery lifestyle impacts my life. When I was entering the program, I felt like I had a good handle on what it would be like - after all, I had been a doula for a number of years and was used to being on call and making backup childcare arrangements. But the midwifery lifestyle is much more demanding than the one I led as a doula, and it is particularly demanding for students. Students, who need as much experience as they can get, get very few days off and (if they're lucky) will be very busy on the days that they are on. I know this, and I accept and eve love this, but it is much more difficult in practice than it is in theory.
I have grown used to the unpredictability of birth and midwifery already. It feels selfless, it feels purposeful. I know it is making a difference in people's lives. I've grown incredibly fond of it. Although it has its dark moments, I look forward to hearing from clients. I enjoy not knowing where I will be an hour from now. I love surprises, the spontaneity of picking up and changing everything.
My family, however, does not. Throughout the course of my studies last semester, I grew to learn that no amount of preparation I did could have prepared my family for what it was really like. It wasn't my absence - they anticipated that. They knew I would be away much more than I'd be home, and they knew I'd need to rest much of the time that I was home. No, it wasn't how busy I was. It was how unpredictable it was.
I can't say how many times I arrived home just in time for dinner, only to get paged away 20 minutes later, kids on my lap. Or right in the middle of the bedtime routine. Or just as I'm preparing them for the morning. People, I cannot stress it enough - prepare your family for this. Make them read this if you want! It is so important.
Kids are so resilient, though. They got used to Daddy doing just about everything for them - he cooked them dinner pretty much every day, put them to bed most nights, took them to school and daycare, made lunches. Everything that they were used to me doing, or at least used to us sharing. My partner pulled through for me in so many ways, and I know (because I know him) that he will continue to do so, but it is not easy for him! Many of us midwifey folk have discussed trying to band our men together so that they can form a support network of deserted midwife husbands. And while I was aware that he was struggling a great deal during my placement, it wasn't until I was off and had the time and energy to check in with him that I realized just how hard it had hit him. Our relationship had become extremely fragile because amidst how busy I was, and my efforts to compensate for it by taking over household chores and childminding while I was home, I had nothing left at all to put into our relationship. The result is that we found ourselves in a crisis.
And so, this summer, our partnership has been the real focus. Sure, I've caught up on chores and fun with the kids. But most of my transformative energy has been put into building steel bonds with the man who has proven himself to be the backbone that holds me (and our entire family) up when I feel I might crumble to the ground. The crisis that we found ourselves in allowed us to realize that we don't just need eachother, but we want to be there for eachother and understand one another better, always.
Saturday 19 May 2012
Reflecting on second year
Ahh...the summer. The breeze, the warmth, the kicking and screaming children. I had almost forgotten this part of life existed!
Normal Childbearing is done - all 16 weeks, assignments, and exams. We're done! I am officially halfway through the program - although, given how much of a challenge the program was and knowing the rest of school is placements - I kind of still feel like I just finished the introduction.
I fully intended to have a new blog post out the second I finished placement. But just before I finished placement, I had a string of 8 days where I went to ....oh gosh... I cant even remember now, something like 10 births?! Needless to say, once I finished my last day of placement (and some very interesting detours getting home thanks to my GPS), I fell into recovery mode, and 3-4 weeks later I'm starting to get my head back on straight. That being said, I'm out of midwife mode for the next little while and totally forget what questions most people have been dying to know about the placement, even though I know there are many. So please dont hesitate to ask away!
There is so much to share about what these last four months have been like for my classmates and I. All of us have had such diverse experiences from one another, though, that I can only really speak for my own experience. I'll probably make a number of posts over the summer in little bits and pieces. I'm also planning to post a couple of the papers I wrote, as they're in pretty understandable language and I think they're pretty darn interesting (I try not to write a paper about boring things, generally).
For today's post, I wanted to follow up on where my learning is at now, compared to where it was when I was only two weeks into my first midwifery placement. At that point, I was already being directly involved in all aspects of almost all clients care, from prenatal visits, to birth and postpartum visits. I felt awkward, didn't know what to say often, fumbled, made lots of mistakes. I also was undergoing a humongous adjustment to the midwifery lifestyle. The scale of change for me was so big - easily as big of a change in life as the birth of my first child. And for anyone who's got kids, you might imagine that means every aspect of your entire life is different. My family had a major adjustment to go through as well, especially my partner, who had to give up a great deal of his work and identity to be only Dad. For a man as passionate about his music as I am about midwifery, this was a huge challenge for him. Musicians often get gigs at night. (no childcare) Midwives often go to births at night. (no way to predict which night) You get the picture.
Everything that we are learning and capable of handling with minimal assistance is within the scope of Normal Childbearing - normal, common, or variations of normal. Obviously, though, we can't always predict when that'll be, so most of us were exposed to a hearty share of not-so-normal situations as well. I mentioned in my last post that my faith in the process had gotten seriously put to the test in my first few weeks of placement after a string of situations that I had never viewed from the care providers perspective before. Thank goodness (for myself and my future clients!) that faith got restored with many, many positive, straightforward beautiful strong women and their births to show me that birth is a normal life event.
Of course, the focus of our later courses will be on managing and consulting for some of the various complications that came up over the course of our learning. By the end of the term, I found myself REALLY curious about those complications. This, to me, is a sign that I'm comfortable with the "normal" stuff.
Seriously, I feel like I've said absolutely nothing. But there's so much more to say! Since I got into recovery mode, my writing hasn't been as strong as usual! Please post unanswered questions in the comments. I just might make another post about it!
Thursday 19 January 2012
What my first two weeks of Normal Childbearing looked like
Okay, so I've been facing lots of pressure to get some blog posts up here! Sorry to anyone who may have been itching to know what placement was like...I was too, until a couple weeks ago when it started. But suffice to say that my absense in posting is because placement is VERY BUSY! I am going to try and make this post as thorough as possible but please know I might not post again until close to the end of term. This is the one-stop shop, "Heres what a couple of weeks in placement looks like"
Disclaimer: As I'm sure you understand, I have to maintain full confidentiality of all clients. I can't give any details that might reveal dates, names or any form of detail that could identify someone. Therefore I'm trying to remain extremely vague about my experiences.
In our Normal Childbearing placement, which is 16 weeks in duration, we must attend a minimum of 18 births and a maximum of 30. There is variation due to the nature of the clinic workings, but also because we need to act as primary midwife for some of those births, second midwife for some, and are allowed only a small number of observed births (2). Since all women who need oxytocin IV or epidurals are transferred out of our care and we can't conduct the birth (to a certain extent), there will inevitably be more than two observed births. Therefore I anticipate nobody could really make all their other necessary numbers with only 18 births. We're expected to be on call for these births at all times, aside from 4 days per month and every Friday morning for tutorial.
Anyway, on top of the births, we are supposed to attend 15 pre- or post-natal visits per week. This is also something very variable, since some practices have 15-30 minute appointments and can get 15 clinic visits into one or two days. My practice's appointment times are 45 minutes - *such* a treat to have the time to spend with the women, but definitely a bigger challenge to get those numbers in. I've only successfully gotten an entire 15 visits in one of the three weeks I've been there, and I've attended every single visit I could, unless I've been at a birth.
In addition to the clinical duties, we have tutorial duties. The PBL format that I hopefully described about Repro from last semester is used for the rest of the duration of the programming at the MEP - so we're given a situation and we have to extract issues from the situation and go out and learn about them to teach eachother at the next tutorial. Therefore, we need to prepare each week a presentation to share what we learned about the topic that we were to work on for that week. In addition to that, we have to present an informed choice discussion on a basic pregnancy intervention (testing, etc), write a couple of papers about learning issues, create learning plans, write midterm and final exams, and probably some other things that I'm not aware of yet. Realistically, it doesn't look THAT heavy to me at this point. The academic load seems similar to that of ONE course - which is very fortunate since the clinical side of things feels equivalent to 7 or 8. We are also required to have a reserved half-day each week during business hours to work on our assignments. So far, I've been able to keep my assignment obligations within that half day, but I'm sure there'll be weeks where its not enough.
By the end of the term, we are expected to have attended our required births and clinic visits, and to have exhibited basic skill in all areas of caring for normal, healthy pregnant women and their babies. This is a very diverse thing to accomplish, I have learned. Midwifery is a dynamic profession that requires creativity and an open mind at all times. This was probably my first lesson.
My first day in placement was lovely - an orientation of sorts. I joined the group for their practice meeting and got to meet a lovely set of women who work together to create the web of midwifery care that this clinic provides. This particular practice is split into two teams - the team I'm working with has approximately 22 births from the time I started until the end of my placement, but they also back-up the other team, which probably has an equal number of births planned. Before I realized that my team attends all the births in the clinic (and I would be expected to do the same), I was concerned that if I missed any on my day off, I might not make my numbers. Now I'm starting to wonder if I might need to taper the numbers down close to the end of the term as I might hit my maximum.
My first weeks have been busy. I live a good distance from my practice, which is in a pretty rural setting. This means that it takes me at least 45 minutes to get to clinic every day, and the home and hospital visits we do for our new mothers after birth can involve one heck of a commute, since this practice serves an enormous catchment area. Not one word of a lie, I have had days where I've covered almost 600km. And please, let me allow you to think about what it is like to drive the hour to get home, and then get paged right back (especially if its right after a long birth). I also can't begin to describe how hard it is to come home at 1am and leave again at 6am, only to return home at 10pm. I've gone days without seeing my kids or partner. Ladies anticipating placement or considering the program, let it be known that there is blood, sweat, and tears involved in this profession, and they're not only coming from birthing mothers. I could NOT get through days like those without rock solid support (and I mean it, undending, unconditional support), good nutrition available at all times, and a plan to make sure I get sleep at some point in the next day or two. ALL of those things wouldn't be anywhere near within my reach if it weren't for the fact that my partner is pretty much putting his career on hold and acting as stay at home dad. He's cooked almost every day, taken the kids away when its necessary, put them to bed almost every night, washed most of the dishes and laundry, gotten our daughter off to school every morning, and cared for our son on his days home as well. There is no way I'd be able to do this without him.
So really, I shouldn't complain. I knew what I was getting myself into when I signed up for a practice so far away from me, but I also knew the philosophies of these midwives and I wanted very much to be influenced by their practices. I can't say enough good things about my preceptors. Its definitely a challenge having two who have two different teaching styles, schedules, and expectations for me, but its an awesome privilege to glean the best from both of these wonderful, caring midwives.
There's so much learning to be done in the clinic days. I feel so awkward in those visits. Its such a privilege to be sitting in on them. The fact that these midwives are opening their clients up to me, and that these clients are opening themselves up for my learning, is a real gift. I definitely feel pretty stupid most of the time though. I know most of what is being said in the visits, but I almost never remember it when everyone turns to me and says "Do you have anything to add?". I usually remember lots to say AFTER, though, so at least its coming at some point. I need to start writing out scripts for various discussions that take place so that eventually I can take over the midwife's side of the conversation and begin teaching and learning from the client more directly. That process, here in my third week of placement, is starting. Very slowly, but its starting.
So what do we do with women aside from talking? Everything I learned in clinical skills has been put to the test aside from one or two that I've chickened out on so far (I chickened out on IV insertion, and I havent' had a chance to do a Pap). I've already had ample opportunities to feel bellies, measure fundal height, take blood pressure, listen to the babies heart, draw blood, do injections, perform cervical exams, break membranes in labor, catch babies (!! with the help of my preceptors), catch placentas, suture, assess the newborn, administer vitamin K and erythromycin to the newborn, provide breastfeeding support (or rather, mostly observe my awesome preceptor giving her breastfeeding support), and probably a hundred more things that I can't even think of. I've also been witness to a number of complications in labor and birth. As I said - very diverse!! Never a dull day.
Bearing in mind that this has all been within the 17 days that I have been in placement - - lots of clinic days, and SIX births already.
The last thing that I mentioned in the list were pretty hard to swallow. As much as I have learned from some of these complicated births, they weren't exactly typical examples of "Normal Childbearing". I have to admit that, just as I had feared might happen, my faith in the process has definitely been put to the test and I've found myself wondering at a birth what will go wrong at this one. I used to loathe this in birth professionals when I was a mother. I wanted someone with utmost confidence in me. And I still have utmost confidence in women. But now that I've been on the other side of the fence, I've begun to understand that by putting your utmost faith into your midwife or attending physician, the mother (or the doula, in my case) is able to release most of the fear of complications that surround childbirth. But those risks don't go away just because you let go of the fear - you've just got someone well equipped to handle them if they come along. Stepping into the place of someone who is learning how to be responsible for handing those risks is a heavy burden and an enormous privilege. It brings me a new sense of purpose to the profession. It also, sadly, makes me realize that I cannot prevent every unnecessary intervention put upon a mother or her baby, because sometimes we don't know if an intervention is necessary or not, but only that it lowers risk.
ANYWAY! As you might be able to tell, my thoughts are scattered and my brain is tired. The last couple of days there have been no births, and I have been thankful for the chance to catch up on sleep and gain my brain back.
And now, its 10pm, and I'm probably committing suicide by staying up so late!
Disclaimer: As I'm sure you understand, I have to maintain full confidentiality of all clients. I can't give any details that might reveal dates, names or any form of detail that could identify someone. Therefore I'm trying to remain extremely vague about my experiences.
In our Normal Childbearing placement, which is 16 weeks in duration, we must attend a minimum of 18 births and a maximum of 30. There is variation due to the nature of the clinic workings, but also because we need to act as primary midwife for some of those births, second midwife for some, and are allowed only a small number of observed births (2). Since all women who need oxytocin IV or epidurals are transferred out of our care and we can't conduct the birth (to a certain extent), there will inevitably be more than two observed births. Therefore I anticipate nobody could really make all their other necessary numbers with only 18 births. We're expected to be on call for these births at all times, aside from 4 days per month and every Friday morning for tutorial.
Anyway, on top of the births, we are supposed to attend 15 pre- or post-natal visits per week. This is also something very variable, since some practices have 15-30 minute appointments and can get 15 clinic visits into one or two days. My practice's appointment times are 45 minutes - *such* a treat to have the time to spend with the women, but definitely a bigger challenge to get those numbers in. I've only successfully gotten an entire 15 visits in one of the three weeks I've been there, and I've attended every single visit I could, unless I've been at a birth.
In addition to the clinical duties, we have tutorial duties. The PBL format that I hopefully described about Repro from last semester is used for the rest of the duration of the programming at the MEP - so we're given a situation and we have to extract issues from the situation and go out and learn about them to teach eachother at the next tutorial. Therefore, we need to prepare each week a presentation to share what we learned about the topic that we were to work on for that week. In addition to that, we have to present an informed choice discussion on a basic pregnancy intervention (testing, etc), write a couple of papers about learning issues, create learning plans, write midterm and final exams, and probably some other things that I'm not aware of yet. Realistically, it doesn't look THAT heavy to me at this point. The academic load seems similar to that of ONE course - which is very fortunate since the clinical side of things feels equivalent to 7 or 8. We are also required to have a reserved half-day each week during business hours to work on our assignments. So far, I've been able to keep my assignment obligations within that half day, but I'm sure there'll be weeks where its not enough.
By the end of the term, we are expected to have attended our required births and clinic visits, and to have exhibited basic skill in all areas of caring for normal, healthy pregnant women and their babies. This is a very diverse thing to accomplish, I have learned. Midwifery is a dynamic profession that requires creativity and an open mind at all times. This was probably my first lesson.
My first day in placement was lovely - an orientation of sorts. I joined the group for their practice meeting and got to meet a lovely set of women who work together to create the web of midwifery care that this clinic provides. This particular practice is split into two teams - the team I'm working with has approximately 22 births from the time I started until the end of my placement, but they also back-up the other team, which probably has an equal number of births planned. Before I realized that my team attends all the births in the clinic (and I would be expected to do the same), I was concerned that if I missed any on my day off, I might not make my numbers. Now I'm starting to wonder if I might need to taper the numbers down close to the end of the term as I might hit my maximum.
My first weeks have been busy. I live a good distance from my practice, which is in a pretty rural setting. This means that it takes me at least 45 minutes to get to clinic every day, and the home and hospital visits we do for our new mothers after birth can involve one heck of a commute, since this practice serves an enormous catchment area. Not one word of a lie, I have had days where I've covered almost 600km. And please, let me allow you to think about what it is like to drive the hour to get home, and then get paged right back (especially if its right after a long birth). I also can't begin to describe how hard it is to come home at 1am and leave again at 6am, only to return home at 10pm. I've gone days without seeing my kids or partner. Ladies anticipating placement or considering the program, let it be known that there is blood, sweat, and tears involved in this profession, and they're not only coming from birthing mothers. I could NOT get through days like those without rock solid support (and I mean it, undending, unconditional support), good nutrition available at all times, and a plan to make sure I get sleep at some point in the next day or two. ALL of those things wouldn't be anywhere near within my reach if it weren't for the fact that my partner is pretty much putting his career on hold and acting as stay at home dad. He's cooked almost every day, taken the kids away when its necessary, put them to bed almost every night, washed most of the dishes and laundry, gotten our daughter off to school every morning, and cared for our son on his days home as well. There is no way I'd be able to do this without him.
So really, I shouldn't complain. I knew what I was getting myself into when I signed up for a practice so far away from me, but I also knew the philosophies of these midwives and I wanted very much to be influenced by their practices. I can't say enough good things about my preceptors. Its definitely a challenge having two who have two different teaching styles, schedules, and expectations for me, but its an awesome privilege to glean the best from both of these wonderful, caring midwives.
There's so much learning to be done in the clinic days. I feel so awkward in those visits. Its such a privilege to be sitting in on them. The fact that these midwives are opening their clients up to me, and that these clients are opening themselves up for my learning, is a real gift. I definitely feel pretty stupid most of the time though. I know most of what is being said in the visits, but I almost never remember it when everyone turns to me and says "Do you have anything to add?". I usually remember lots to say AFTER, though, so at least its coming at some point. I need to start writing out scripts for various discussions that take place so that eventually I can take over the midwife's side of the conversation and begin teaching and learning from the client more directly. That process, here in my third week of placement, is starting. Very slowly, but its starting.
So what do we do with women aside from talking? Everything I learned in clinical skills has been put to the test aside from one or two that I've chickened out on so far (I chickened out on IV insertion, and I havent' had a chance to do a Pap). I've already had ample opportunities to feel bellies, measure fundal height, take blood pressure, listen to the babies heart, draw blood, do injections, perform cervical exams, break membranes in labor, catch babies (!! with the help of my preceptors), catch placentas, suture, assess the newborn, administer vitamin K and erythromycin to the newborn, provide breastfeeding support (or rather, mostly observe my awesome preceptor giving her breastfeeding support), and probably a hundred more things that I can't even think of. I've also been witness to a number of complications in labor and birth. As I said - very diverse!! Never a dull day.
Bearing in mind that this has all been within the 17 days that I have been in placement - - lots of clinic days, and SIX births already.
The last thing that I mentioned in the list were pretty hard to swallow. As much as I have learned from some of these complicated births, they weren't exactly typical examples of "Normal Childbearing". I have to admit that, just as I had feared might happen, my faith in the process has definitely been put to the test and I've found myself wondering at a birth what will go wrong at this one. I used to loathe this in birth professionals when I was a mother. I wanted someone with utmost confidence in me. And I still have utmost confidence in women. But now that I've been on the other side of the fence, I've begun to understand that by putting your utmost faith into your midwife or attending physician, the mother (or the doula, in my case) is able to release most of the fear of complications that surround childbirth. But those risks don't go away just because you let go of the fear - you've just got someone well equipped to handle them if they come along. Stepping into the place of someone who is learning how to be responsible for handing those risks is a heavy burden and an enormous privilege. It brings me a new sense of purpose to the profession. It also, sadly, makes me realize that I cannot prevent every unnecessary intervention put upon a mother or her baby, because sometimes we don't know if an intervention is necessary or not, but only that it lowers risk.
ANYWAY! As you might be able to tell, my thoughts are scattered and my brain is tired. The last couple of days there have been no births, and I have been thankful for the chance to catch up on sleep and gain my brain back.
And now, its 10pm, and I'm probably committing suicide by staying up so late!
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