tag:blogger.com,1999:blog-9654820035171531912024-03-14T09:07:50.281-07:00Learning the Midwifery WayMelissa Nhttp://www.blogger.com/profile/08471361326091236891noreply@blogger.comBlogger45125tag:blogger.com,1999:blog-965482003517153191.post-35810697413870038792014-10-31T11:18:00.003-07:002014-10-31T11:31:02.217-07:00To the midwives-to-be Note: <br />
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I just found this in my archives. I wrote it back in March, and meant to publish it, but didn't! How weird is that?! Anyway, I read over it and felt like it could still be useful to people so here it is, more than 6 months "overdue" :)<br />
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That's it. Just one week. On Friday night at midnight, this girl is going off call and will never again be on call as a student. That's pretty surreal.<br />
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The last few months have been a whirlwind. I was determined to blog more often in this last semester but it just didn't happen. I ended up following extra midwives over the course of the semester, which has been enormously enriching but also made for being even busier than before. I actually even started keeping track of my hours, just to see. Word of advice: don't do that. It just gives you more leverage to feel sorry for yourself. (i.e. the slowest week I've had since I started doing that was 55 hours. The buiest so far was 80 - and most of them lean more towards the busier side).<br />
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And now here I am almost done, with a lot to say and very little capacity to actually say it.<br />
More than anything, this week I have reflected on what I would tell someone that was walking into the shoes that I wore at the beginning of this year. So I wanted today to share a few "pearls of wisdom" from the light at the end of the tunnel (which actually just feels like the beginning of another tunnel). <br />
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#1. I know, I've said it in almost every entry I've made in the last few years. But please, don't forget to take care of yourself. Make sure you enforce your need to do the things that you love. At least once a week! Whether its exercising, or snuggling up with a good book, or whatever. You need to do it. I let that one go this semester (I know, despite all of my preaching) but I paid for it again. It's probably the most common mistake that midwifery students and midwives make, and I strongly believe carrying that habit over the long term is a recipe for burnout. <br />
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#2. Read the Policy and Information Handbook *very* carefully. It was created to give you guidance on expectations in the course. It changes over the years. It's meant to support you. It says very clearly that students are expected to have the clinical load of "slightly less than one midwife". It lists your minimum and maximum numbers of births for each course, tells you the number of clinic visits you should be doing each week (15), and clearly states how much off call time you are entitled to (4 days per month). Why is this important, you ask? Because your preceptors may not pay as close attention to this - as they should'nt - because you are an adult learner and it is your responsibility to regulate your learning. Many clinics are based on shared care models, where you are sharing your time between two or more midwives (who are probably not in constant communication about how many hours you're spending with each of them). In these scenarios, clinic loads may be high and birth numbers may also be high. Its your responsibility as an adult learner to make sure you are meeting expected requirements, to keep track of them for your own records, and to advise your preceptor(s) if you are going over or under these expectations. The most important reason for this is that more often than not, the clinic/birth load in your placement will be higher than what is expected of you by the program. <br />
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Ah, you say, so what? I'll work hard, and then I'll play hard when the semester is over. And the more I do, the more experience I will get! I've heard that a lot lately, and while I understand it (at least theoretically, I have a lot of reasons to disagree with this (the most relevant personally being that because I'm a mom, my family responsibilities mean that when I work hard, I only have to work harder when it's "play" time) First off, academic responsibilities are as important as clinical responsibilities. Most semesters, "one half-day per week to prepare for assignments and tutorials" (given to us by the program) is *not* enough to meet academic responsibilities and expect to excel. You might need more time than this sometimes, and you might not get it at your clinic if you haven't set the precedent that you are doing more than what is expected by the program of you. Your preceptors probably won't even realize that you are doing too much unless you tell them, so this is a hard one to go back on. As per my point #1, you also need to take care of yourself, and even with the guidelines you will feel overworked sometimes, so try to make sure you are balancing it when things are slow without feeling guilty. But also, make sure to think about the next students that your preceptor is going to be teaching. You might be able to handle a heavier workload, but the student that comes in after you're finished might have very young children, be caring for an aging parent, have a learning issue, be suffering from mental health concerns, or any other situation that might mean that she *<strong>needs</strong>* those guidelines to be able to make it through the program. And your preceptors most recent experience, and the expectations that she will place on that student, will be the foundation that was set with you. <br />
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#3 The last thing is - relish in those moments of success. I know sometimes it can feel overwhelming when your failures feel like they are outnumbering your successes. It can be really therapeutic to go back to your evaluations from earlier courses and see how far you've come, how much you've really learned. Save every encouraging evaluation or card you get from clients so that when you have a hard day, you've got a pile of evidence in front of you that you're actually GREAT and having just that - one hard day (or week). <br />
<br />Melissa Nhttp://www.blogger.com/profile/08471361326091236891noreply@blogger.com2tag:blogger.com,1999:blog-965482003517153191.post-35900427461797806352014-10-31T11:10:00.002-07:002014-10-31T11:10:37.920-07:00Settling inWell, here we are. It's been four months since I've made a blog entry and trust me, it's not for lack of thinking about writing one. The last few months have been very busy and hectic. I started working at my new practice in July, which as you might remember from my last post was unbelievably overwhelming at first. I'm very happy to report, though, that settling in didn't take very long and I have quickly come to find myself very comfortable there. I'm feeling immensely lucky that I have found such a great practice that is supportive, friendly, and shares my agenda for what is most important to me in providing midwifery care.<br />
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Sadly, after a torrent battle with esophageal cancer, my Grampa - who was basically my father and mentor - passed away a few weeks later, with all of his closest family by his side. I will forever be thankful that I could be counted among those people. Time since then has had a strange way of moving - like molasses in the days that followed, and yet somehow one has to return to normal life as though nothing has happened. He's the first person that I've ever loved that has passed away, so this journey into grief has been so painful but also full of discovery. It's given me a deeper sense of compassion and understanding towards those who are dealing with their own grief. I'm so thankful that he was with us as long as he was. He's always been a bright star, with laughter and silly faces, even when everyone around him is glum. I will miss his hugs the most.<br />
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About a month after he passed away, we moved. I'm so thankful for the friends that came to help us on that weekend, because I know it was far from an easy job. Apparently a year and a half is *just about* enough time to forget how hard it is to move. From the challenge of moving all the furniture, to the cleanup, and the going back to work two days later, it was a busy weekend. I think the hardest part has been finding connections - luckily I know the people in my clinic but other than that we don't really know anyone around here. It has been lonely at times, but I remember that feeling in Guelph as well and eventually we found our connections and it started to feel like home. I'm hopeful that that feeling will come soon. <br />
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And now it's the end of October - I've had the whole month off call to s<strike>it back and relax</strike> unpack my basement. It's been truly great to catch up on life, and yes I actually have had some time (for the first time since I was accepted into the program) where I could sit back and do *nothing* and not feel guilty about it. I had the wonderful opportunity to go to a conference that renewed my passion for herbal remedies, was lucky enough to sit in on a day of a doula training with my <a href="http://tenmoons.ca/" target="_blank">favourite doula in the world</a> and share space with a room full of keen and excited new doulas. We also made it to my Grampa's special memorial, apple picking, Wonderland, my Mom's 50th birthday party. It has been really nice to be avaiable and able to say "yes" to just about everything this month. <br />
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It's also been a great opportunity for me to reflect on how lucky I am to be living my heart's desire and actualizing my dreams. To know that now, we settle into "normal life" (for us), rather than coping with a constant stream of transitions - from classroom, to clinical and the hours it makes me keep, from practice to practice, from city to city. Now we can relish in how far we've come in the last five years and start building new dreams - like <strike>paying off debt </strike>buying a house! And travel! And hopefully the strange version of stability that I've been waiting to be able to provide for the kids as far as financial and living arrangements go. <br />
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Anyhow, it's Halloween, and the school bell will be ringing soon! Snow is forecasted for this afternoon, which surprisingly is delightful to my Halloween-obsessed son. It's time to get bundled up and get ready for a night of trick or treating (and maybe a cider or two for Mommy, since, you know, I'm still off call for three more days...)Melissa Nhttp://www.blogger.com/profile/08471361326091236891noreply@blogger.com0tag:blogger.com,1999:blog-965482003517153191.post-44647625915754817562014-07-11T07:33:00.004-07:002014-10-31T11:12:58.978-07:00Reflections from a one week old midwifeThe day that I've waited over four years to begin came last week. After over 3 months completely off call, I got an email saying that ministry funding had come through and I was a registered midwife last Wednesday afternoon, and bright and early the next morning I was in the clinic to start my first day working as a midwife. <br />
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The last week has been a very big one in my life. The drama of waiting for funding, and therefore not knowing my start date, was starting to become pretty stressful by the end. We'd had plans in place for the kids to make sure I could work, but as time kept ticking by and I still wasn't working, we started cancelling some of those childcare plans. The notice was very quick though once it all came through! <br />
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I felt a lot of relief that the day had finally come, but also a lot of fear. Three months is a long time to let your head play games with you. Will I remember everything I've been taught? Will I miss something really important? How am I (and the family) going to cope with my being on call and all of the madness that sometimes brings to our schedule? <br />
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I forgot, at that point, that once you're doing it, you just do it, and it all seems to work out. And that is, indeed, the answers to those questions. Yes, I had some things in my first week that I may not have remembered. And the mad-crazy on call schedule and all of the logistical things that involves when you have kids has already come up (and there hasn't even been any births yet for me). But in the moment, you just do it, and you keep doing it, and it all falls into place one way or another. <br />
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I won't lie. My first day of clinic was really hard. I had no idea what to expect and it was a long and challenging day with very steep learning curves. So many things are done differently in this community and I'd forgotten how it felt to come into something so different. Little things tripped me up all day long. Ridiculous things like where's the light switch, how the chart opens is differently than how my old charts used to open, where the tape measure is, where's the bathroom, etc. Meeting so many new people at once can be overwhelming - both the many midwives in my practice group and the many clients, some of whom have been waiting quite some time to meet me. And being a week into it now, I definitely won't say Im over those learning curves but none of them feel nearly as steep as the ones I overcame in my senior year of school. It didn't feel do-able on the first day, but only a week into it feels more than do-able. My senior year preceptor gave me so many skills that I didn't even realize she gave me until I found myself using them to help me settle into this new environment and find my "place" and my "way" (or at least mostly "mine" - I'm sure it's at least a little bit preceptor-coloured). <br />
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The great part about it is how much I already love this job. I have fallen in love with midwifery all over again and it feels even better than when I had before. I am looking forward to getting to know my clients and the other midwives in my group so much, and despite many of the newbie bumps along the road, I'm enjoying my days so much. I know it won't feel like a dream come true every day, but today it does, and in reality - this WAS my dream, and it IS truth now!<br />
<br />Melissa Nhttp://www.blogger.com/profile/08471361326091236891noreply@blogger.com2tag:blogger.com,1999:blog-965482003517153191.post-46632686957340251032014-06-03T18:49:00.002-07:002014-06-03T18:49:27.959-07:00Feeling so goodDo you ever just have those days where you just can't believe how sweet life is? I'm having one of those kind of days. I'm having them a lot lately, actually, and up until the last little while, I would have told you it's been a long time since I'd had any of these kinds of days.<br />
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The kids are in school. One of them is home a couple days a week, but I still get at least 3 days a week to myself at home. Sometimes with Jamie, sometimes on my own. I'm indulging myself by going to the gym, or a run, or a good yoga session, pretty much daily. I'm finally starting to feel stronger - in body, mind, and spirit. This is EXACTLY what I had been hoping would happen during that transitional time between school and working.<br />
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All of the new midwives in Ontario right now are awaiting approval from the Ministry before we are allowed to work in the place that has offered us a job position, regardless of when that start time was intended to be (for me, that start time would have been a week ago). Last year, approval came through at the end of May. But this year, there's an election happening in Ontario, which apparently means that everything gets put on the backburner until the province's politics are sorted out. I can feel the tension rising as each day passes and we get no news. Personally, I'm not feeling surprised as each day passes and there's no news. I'm setting my sights for a couple more weeks, to be realistic. And although I'm missing midwifery, and really enjoy being busy, and am infinitely curious about what working in my new community is going to be like, and eager to get my feet wet as a midwife who can act on her own responsibility, I'm just taking a nice big breath, and savouring it. Savouring the many opportunities that I'm getting to do whatever I feel like doing. Savouring the ability to put my phone down and not pick it up until *never*. (Okay, I'm not quite there yet, but I relish the detachment I can have from it when I'm off call). Savouring every school drop off and pickup, and bike ride to the park, and leisurely days with playdates, or crafts, or WHATEVER. Because realistically, I probably won't have this much time off for a long long time. <br />
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And so I am resetting myself. Re-setting (gradually) my default to deep breathing rather than reacting with the kids. Re-setting my feeling of equilibrium. Re-setting my level of personal fitness. Re-setting my cleanliness standards! And mentally preparing myself and the family for yet another big, bittersweet change for all of us. <br />
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Melissa Nhttp://www.blogger.com/profile/08471361326091236891noreply@blogger.com0tag:blogger.com,1999:blog-965482003517153191.post-499443616903244752014-04-23T19:00:00.001-07:002014-04-23T19:06:21.824-07:00A turning pointToday was such a great day. The last few days, I've been able to get a sense of accomplishment with what I've done over my time off, tying up loose ends, getting all my paperwork in order for the college, and hospital privileges. I've always said, the month between placements is absolutely evil. I spend the first 3 weeks recovering; then I spend 1 week learning how to be myself again (the real myself, not the "doing whatever anyone wants me to be because I'm a student" self - which admittedly often involves some growing pains that take the form of defiance). And then its over and I'm back in knee deep. I'm 4 weeks into my time off now (I think). And I've got over a month before I'll go back on call. I'm in "rediscovery" mode. And loving the level of introspection that I'm allowing myself.<br />
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Today, for the first time in a long long time, I let my guard down for the entire day. Not the guard that protects you from people or bad things happening. The guard that I build myself to protect me from time. And most particularly, from "wasting" it. Over these years I have become very focused on using my time well, and becoming more efficient or productive (something that's particularly important as a young midwife because your thought processes work slowly at first and it takes longer to come to certain conclusions than it does for more experienced practitioners). I allowed myself a moment to wonder, why do I feel this need to be so "productive" all the time in my life? And what do I use to define productivity? And most importantly, why do I let that take away from my ability to enjoy my life? <br />
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I turned 29 a couple of weeks ago, which has caused me to look beyond, to the big 3-0. And when I reflect on it, I think that I have made a lot out of my twenties! I've got two kids and a supportive family. I've got an amazing partner who has been able to follow his dreams and has enabled me to follow my own. We've built an ever-growing support network of people around us, near us, and supporting us, who I can use no other word to describe except AWESOME. A great home. A promising career. The list goes on and on. <br />
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Why, then, do I spend most of my days focused inward on what I don't like about what is happening? If I'm perfectly honest, I'm usually so focused on what could be done *better* that I don't ALLOW myself to enjoy how great things already are! I haven't been allowing myself to get swept up in the moment and JUST BE. Just play! Just enjoy the outdoors! Just enjoy the company of other people!<br />
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Like I was THERE. (Hillside 2012)</div>
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Well, today I did. I dropped in on a friend and he asked me to stay for coffee and my brain did the usual - "Melissa, its a long drive home, and you only have two days of childcare this week and you should really get this and that and the other thing done before its over". And instead, I listened to the OTHER voice that said "Yes!! I would really really LOVE to!" I know it probably sounds silly to some people, but maybe to those couple who get where my brain has been at, it makes sense. And I let that feeling last the rest of the day. Got swept up in some "low-key spontaneity". Enjoyed the moment. And (to appease the other side of my brain) - the "stuff" still got done! The only difference is I *ENJOYED* it. <br />
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Lots of little messages fell into place for me today. And they all culminated in me realizing that my next life lesson - which is the one I've been trying to learn all along but haven't had the mental capacity to learn anything else - is to learn how to step back, slow down, and enjoy life more. Not a little more. But a lot more. Because really, how we spent the moments of our day, becomes how we spend our lives. <br />
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Also, for some extra motivational reading, I stumbled upon <a href="http://thetravelingmidwife.wordpress.com/2014/01/" target="_blank">the blog of a wonderful midwife</a> today, local to an area that I once called home, today, whose words were one of those messages that helped things fall into place for my brain space today. Highly recommended reading!Melissa Nhttp://www.blogger.com/profile/08471361326091236891noreply@blogger.com0tag:blogger.com,1999:blog-965482003517153191.post-67167155425163090072014-04-17T11:16:00.000-07:002014-04-17T11:22:25.044-07:00Finished and moving forwardDone. I'm done. <br />
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It feels so, so good to be able to declare that to the world. I'm DONE!!! <br />
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Placement finished a few weeks ago. The most gruelling exam I've ever written followed shortly after. And a few days ago I got the notice that I passed it. Which means I'm done. <br />
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On a more challenging note, my grandfather has been ill with esophageal cancer, a particularly invasive and awful cancer, since the winter. He's undergone some really difficult chemo and radiation, and last week he had some very invasive surgery to remove his esophagus, with the hopeful end result of kicking it in the bucket. So please, think of him and wish him a speedy recovery. He's been very much a father to me for my whole life and it is hard to see him suffering. <br />
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What's next? <br />
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Well, there's the job interviews. That harrowing process where you have to put your heart and soul on the table and await judgement. There was a very difficult decision about where to start working because I was lucky enough to receive multiple offers. Problem is I got the offers before I attended the interview in Orangeville, the town that my kids grew up in, that we spent ten years in. And the people giving me the offers needed answers before that interview. Sadly, staying here in Guelph is also not an option, because even though there are two practices here, neither of them are taking a new registrant. So we (our whole family) made the decision to accept one of the offers. What a hard decision this was! So many things to balance out! I do feel like we've made the right decision though. The interview went really well, I got along great with them, and the practice seems like an excellent model that I'm frankly very excited to try out. It's also only 30 minutes from my home right now - which is probably too far away to commute but its also close enough that I have enough flexibility that I won't have to move immediately, we can let the kids finish school, maybe play out the summer with the childcare resources we already have in place, before moving. <br />
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What else is next? <br />
A long line of paperwork. Registering with the College of Midwives (lots of money). And the Association of Ontario Midwives (also lots of money). Getting ready to order my equipment (lots of money that luckily will be reimbursed). Getting ready for the national exam whicih allows us to practice in all provinces (also lots of money). And starting to put my ducks together to get hospital privileges in my new community. I'm still working at this a couple of days a week. And in the meantime, my partner gets to work as many hours as he wants and not worry about childcare, or logistics, or overtired mommy. I get to hold the fort down for a while - which feels weird! I've missed the kids a lot, but in that time I also forgot how hard it is to keep the house and family functioning. <br />
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Best of all, despite how burnt out I felt by the end of my very very busy final semester, I miss it already. I actually went to the Newman Breastfeeding Clinic and Institute yesterday for a day of observation to pick up some extra tips for breastfeeding challenges and it really made me miss taking care of women and babies. And its been less than a month since I finished! <br />
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I figure that's a pretty good sign ;) <br />
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"Captain Midwife", as Jamie has called me since the day I received that most</div>
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wonderful phone call telling me I was accepted into the midwifery program.</div>
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<br />Melissa Nhttp://www.blogger.com/profile/08471361326091236891noreply@blogger.com0tag:blogger.com,1999:blog-965482003517153191.post-75459011773531336272013-12-31T12:53:00.001-08:002013-12-31T12:53:23.514-08:00The real home stretch.So, winter break blew by in a heartbeat, as always. Tomorrow is New Years Day, and the following day I go back for my last 12 weeks of student life (at least, as long as things go well it'll be my last 12 weeks!). <br />
<br />
I've had a lot of people noticing how little time there is until the end, and many folks already offering congratulations and comments of wonder of how amazing it must feel to be so close to the end. <br />
<br />
Being at this point in my education is like a mixed bag. Every minute I feel differently about it. So how am I really feeling about this?<br />
<br />
<br />
<strong>Afraid</strong>. There are so many things to be afraid of. I keep courting this strange feeling that there is some very deep inadequacy in me that nobody has yet spotted. That maybe I'm actually a total bumbling idiot, and that when I get out on my own and am not having my every move being shadowed and mentored, I might make a fatal mistake. <br />
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<strong>Overwhelmed</strong>. The thought of walking back into a clinic has changed over this time. I went from an excited Normal Childbearing student, where every birth was an adventure and every client a pleasure to meet - to where I am now - and don't get me wrong, every birth is still an adventure, and every client is still a pleasure to meet. But the level of responsibility that I see is so much more than I had realized it to be before. It can be overwhelming. Couple that with the idea that there's a high likelihood I may need to scoop up the family and move to a new community again in order to work, and Melissa tries not to think about how overwhelming this is. <br />
<br />
<strong></strong><br />
<strong>Introspective: </strong>I chose certain placements over the course of my education because I wanted to be shaped into the type of midwife that I dreamed I would become before I came into this. I understood right from the outset that the placements students are in drastically affect the type of midwife they will become. And yet, not all of these experiences were of my choice, or done in my style. And now I am left to question - am I still becoming the type of midwife that I imagined I would be five years ago? Will I really even make a good midwife? Should I even be focused on that, when my main objective is just getting through this year?<br />
<br />
<strong>Relieved</strong> - I'm relieved that I've made it this far; I know that I have enough resolve and determination left in me to make it to the end. I have always felt like I have a strong sense of determination and commitment, but many points over the last six months have brought me to my knees and caused me to question whether or not I'm making the right career choices. But now, although I know the learning curve of the first few weeks back will be steep, because I always seem to forget most of what I learned when I have a vacation, I know Im on the TRUE home stretch now, and with that comes an immense sense of relief. I will live to see the spring, and all being well graduation will follow shortly after that. Melissa Nhttp://www.blogger.com/profile/08471361326091236891noreply@blogger.com0tag:blogger.com,1999:blog-965482003517153191.post-54853040382320288042013-10-29T07:19:00.003-07:002013-10-29T07:24:22.972-07:00TransitionI can't believe I'm sitting here writing a blog entry right now. It's my first day off in almost an entire month, and for some reason it was my first instinct today. Probably because I've gotten some subtle comments from people who are curious about how my life is going since I dropped off the planet. Probably also because this is my own little journalling exercise and a little bit of therapeutic relief for me as well. <br />
<br />
So, where the course is at: this term, the course we are in is called Maternal Newborn Pathology. The course component, much like the other placement terms, consists of learning objectives that each student has to independently research each week and create study notes, and the class teaches one another by using what we learned through our research by enacting a scenario. The emphasis now has shifted slightly from learning about conditions to learning how to manage them (although there's definitely still learning about the conditions too). And as you might guess by the name of the course, the theme is mortality and morbidity - serious conditions that are way outside of midwifery scope, but that may happen to our clients so we need to be able to identify them and initiate care. It's heavy. But really, what part of this degree hasn't been heavy?<br />
<br />
The great part about it is that it's the last academic semester. Clerkship, the final semester, does not involve assignments and no new objectives (as far as I know) will be introduced. I have a paper due November 11. It's my last paper for this degree. This is very exciting. Watch me dance. Oh wait, I'm too tired. <br />
<br />
I looked back on my older posts about my early placements describing what we do in those placements and chuckle that I had the impression that in normal childbearing we do "everything that a midwife does". Clearly we are sheltered (probably on purpose, so as not to scare us off) from many of the extra responsibilities that midwives have. In Normal Childbearing we learn to conduct prenatal appointments and births, and we learn basic clinical skills. But the senior year expects that those skills are concreted (which they often are not) and focuses more on <strong>management</strong> - consults, writing letters, making hard decisions and having to be accountable for them, and learning gradually to do this job without someone telling you what it is that you are supposed to do next. It's intense. The number of births is about the same as all of the other placements, although of course that ebbs and flows as births always do. Sometimes it feels really unbalanced, and sometimes you're so worried about your numbers that you're afraid you won't be able to graduate on time. The responsibility burden is high and a bit of a shock sometimes.<br />
<br />
There's the practical part of it. In living this, it's been a real emotional challenge. I'm thinking of this point in my education as "transition" in labour - the hardest part, the part where I feel like I'm drowning and I don't know if I will make it out the other side. It can be isolating sometimes - all of my blogging about work life balance sometimes just does not account for the fact that when the pager rings, you still have to go. Even if you just stepped out the door to go for ice cream with your kids after not seeing them for a week. Even if your family just arrived at your house after driving two and a half hours to come and see you. The reality of it is really hard. <br />
<br />
I know I sound like I'm complaining a lot. I am. Even half way through 4th year, I still feel like I am adjusting to this lifestyle, tweaking the challenges of meeting my needs (food, exercise, social interaction) with those of my family (quality time, housework, food preparation) and my placement which basically has to take priority over everything. <br />
<br />
I am close enough to the end, though, that I can see the light at the end of the tunnel. Sometimes I reflect on the privilege it will be to finally be able to offer midwifery care in my own style, after having learned the styles of many other midwives along the way. I am still continually amazed by the hard work that birthing women and new mothers are willing to put into their experience, and that inspires me. Its incredible how similar the process of becoming a midwife is to becoming a mother. And these women do it, over and over again they show me that they can surpass what they thought they were capable of and come through on top of it. And if they can do it, so can I. Melissa Nhttp://www.blogger.com/profile/08471361326091236891noreply@blogger.com0tag:blogger.com,1999:blog-965482003517153191.post-15750178317957978082013-07-29T13:00:00.000-07:002013-07-29T13:04:41.883-07:00On being a learner and making mistakesThere are many points in my life where I have found myself in the position of being a learner. Some times are easier to step into this position than others. Of late, I have found that the majority of my time awake is spent in the role of the learner. Much of this, of course, is because I am a student, but I'm also a student of drumming and would be a much more diligent student of yoga and dance as well - if midwifery and drumming did not occupy so much of my time and head space. And above all of these, I have my children - likely the greatest learning adventure of all, and often the area that I feel I have the most that I still need to learn. In all of these things I consider myself fully a learner - not only am I not an expert, but most of my time practicing these is still spent struggling with self-doubt or actively learning a new skill - with a small amount of this time being spent consolidating skills that have already been learned.<br />
<br />
Being a learner comes with its own unique privileges and challenges. Since I truly feel that I spend almost all of my time in life currently as a learner, I thought I would reflect on these today.<br />
<br />
<strong>Making Mistakes</strong><br />
The learner has the immense privilege of being allowed to make mistakes without severe repercussion. A patient teacher expects the learner to make mistakes because very little in life comes naturally without practice. A patient student expects this of themselves as well; this is a concept that I understand theoretically. Practically, however, swallowing your embarassment when making mistakes is not an easy thing to do - especially when it involves the bodies of the people you are trying to help. Or the perception (whether it is true or false) that people are depending on you to do the right thing. Some how, we as learners have to find our own personal way of carrying on after a mistake has made. The client still needs to receive care. The music must continue. I've also learned lately that I blush very deeply when I've made a mistake that I'm embarassed about. Sometimes I get flustered or anxious - especially when the people around me expect me to continue my efforts despite the fact that I messed up the first (or tenth) time. I'm happy to learn this about myself. Overcoming it is a lifetime ambition :)<br />
<br />
I wanted to write about humility as well, but I'm really not sure where its place is. You have to humble yourself to learn from another person. You have to step down from the things you think you know, and the things you think you are good at, in order to really hear what a teacher is saying to you. That being said, I am also afraid of losing the things that I felt like I knew; the values that I held so dear. I don't want the act of learning to also be accompanied by the act of forgetting what I knew before. There must be a balance somewhere. <br />
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<strong>Empowerment in GETTING IT RIGHT!</strong><br />
Fortunately I have gotten far enough into my education that I'm getting some things right. I was happy when I looked back on my learning objectives for the beginning of the term to see that some skills, like vaginal exams, catheterizing, IVs, and catching babies in fantastic and interesting positions have become things that I actually feel very confident about now. Doing these things without making so many mistakes is empowering. Leaving a postpartum visit that I've done completely by myself, and reflecting on it thinking "Yup; I covered every base. I feel like I really helped those people!" and hearing similar praise when I check in with my preceptor is so satisfying. <br />
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<br />
<br />
Even though I'm now in my fourth year of midwifery education, the learning curve this semester has been the steepest yet (if that is actually, physically, possible). That's because this term, we had to shift from acting like "a learner" to acting like "the midwife" - making the decisions and plans, and most importantly, understanding the heavy repercussions that those decisions can have. This came with *many* challenges that I had no idea were coming until I stumbled upon them. It was *not* easy. But this term, folks, is DONE. And I'm still alive. Now, for a month, I can focus my learning more on things that I find recreational (but for which I have just as much learning to do). <br />
<br />
I have spent *so* much time learning this term, that part of me craves to be an expert about something. I want to be able to answer a question with certainty, without turning to one teacher or another for reassurance. And the other part of me is terrified that I will actually have to reach a point where there *is* no teacher to look to for reassurance (at least, in midwifery anyway). But learning, of course, is a lifelong journey. No one is ever really finished with it until they are finished with life. <br />
<br />
<br />Melissa Nhttp://www.blogger.com/profile/08471361326091236891noreply@blogger.com0tag:blogger.com,1999:blog-965482003517153191.post-58451729823893782962013-06-12T19:31:00.002-07:002013-06-12T19:41:19.503-07:00It is a good day in the lifeIt feels so good to be writing what I'm writing tonight. Midterms are the day after tomorrow, and I'm starting to feel ready for them. Placement is going extremely well. Actually, this week it has been a bit on the slow side, but if you've read my other blog posts you'll know I don't exactly have a problem with that! <br />
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Now that I think about it this has probably been my first post since the senior year placements have begun. What a story to tell! I'm feeling good and settled into this new clinic.<br />
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By gosh there was one hell of a learning curve to move through before I got to this place of somewhat "balance". Hard enough that I even started to daydream about what my life would be like if I just quit school right now and became a stay at home mom again. (HA!). But no really, I guess that's just indicative of how big of an adjustment it is to move into a new role and back into a challenging lifestyle. Finding childcare in a brand new community was not easy. I think when all was said and done, we interviewed over 20 people. Right now, we are juggling 3 different childcare providers to make sure all times that my partner is away are covered. I also chopped my dreadlocks off right before I started, because I was so darn worried about being judged by clients and preceptors and dripping wet hair on someone if I got paged right after a long shower. I do have to say I miss them (I always do when I don't have them, I've cycled through this a couple of times now) but this is my first time with short(ish) hair and I'm enjoying it all right. But really now that I'm here, I realize the dreds would have been just. fine. <br />
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Also, although my third year was spent in many dynamic roles, what it wasn't strong in was clinical opportunities. I learned a lot of things, more at some placements than others, and many of those things do inform how I'm learning right now, for sure. But being a midwife felt like it was completely brand spanking new to me again. It had been a year since I had given an informed choice discussion. A year since I had taken blood. Almost a year since I had even caught a baby! It was a bit unnerving. <br />
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Thankfully the clinic I'm placed in has been fabulously supportive. I'm in an environment of tremendously friendly and supportive people who know what kind of feedback helps me to learn and empowers me at the same time. So, despite the challenging first couple of weeks where I felt like an idiot making a thousand mistakes on things that I used to be *SO GOOD* at, they got me through it and over the course of some of our busier points, had me feeling pretty darn good about things.<br />
<br />
So I guess that's a pretty good way to end the note on things. I almost wish that I could move back in time a month or two and read this so I could have worried less.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiP92qgrGd989I6gPedduTAxwLE7AZwtGULbQDmMif_wveBmeklAMVBB-0ac2XyFlUkPDOIvuVApcQi9qrMJ-pUi4rOmbuN20qNXiiF_HIvLbJU5y2xBg3vGXHljt1eF2O1hHAd5t_BrHY/s1600/dreads.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiP92qgrGd989I6gPedduTAxwLE7AZwtGULbQDmMif_wveBmeklAMVBB-0ac2XyFlUkPDOIvuVApcQi9qrMJ-pUi4rOmbuN20qNXiiF_HIvLbJU5y2xBg3vGXHljt1eF2O1hHAd5t_BrHY/s320/dreads.jpg" width="320" /></a></div>
In memory of the departed dreadlocks. May they rest in peace. <br />
And also in memory of that awesome retreat. May I never forget the joy that rhythm and dance bring to me.<br />
Melissa Nhttp://www.blogger.com/profile/08471361326091236891noreply@blogger.com1tag:blogger.com,1999:blog-965482003517153191.post-7271884731338878722013-04-20T21:09:00.003-07:002013-04-20T21:09:21.874-07:00Work life balance has been the story of my life. <br />
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It started when school started and I needed to "balance" my "I'm so sick of being home with my kids and not feeling productive" with the workaholic that emerged learning about something I love so much as midwifery. Then it intensified when I started clinical placement and had to risk my kids forgetting what my face looked like because I was gone so much. <br />
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Work life balance is a challenging concept for many people, in many kinds of careers. But in a caring profession like midwifery, it can be more like a daily challenge. How do I balance the needs of my clinical duties, with the needs of my school, with the needs of my children, with the needs of my partner....and, do I deserve needs at the end of this as well? Having kids and being in this program is REALLY HARD. There. I said it! Sometimes, when I've been out for hours and hours (or days) and all I want (need) is a shower and a sleep, but instead I find myself again cooking dinner and reading bedtime stories, I find myself wondering if I have a right to have needs when so many other people need from me. <br />
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You know what the answer is? You are damn right that I deserve to have my needs met. In fact, I'm not going to make it through the program (or as a midwife) if I do not. The lesson is how to convey this to family and preceptors without sacrificing the family or a passing grade. This, I have yet to master in practice - but I'm working on it. <br />
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I deserve to dance!</div>
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(and do yoga! And shower! And sleep! and eat (*every time I'm hungry*!)</div>
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And you do, too!</div>
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<br />
SO - I'm reciting such a mantra, and I haven't even started senior year yet. I've been blessed with a month off between placements - which is a bit of a joke, since we moved right in the middle of that month, and searching for daycare in a brand new city in which I have no established connections is a nightmare and a half (we have interviewed 10 daycare providers so far - I guess I'm really picky...but it is my *kids*, after all). I will be lucky if I'm able to *start* my pre-readings for next week's intensive on the train down to Toronto, which is completely unlike me. In all honesty, folks, I've become cynical recently. I've learned that part of what I love the most about midwifery was missing this entire last year (of non-midwifery related placements) and I've missed it terribly. That being said, this new city that our family has dropped everything to move to is turning out to be very cool and I'm already dreaming about a future here. But who knows about that, since I haven't even set foot in the clinic yet!<br />
<br />
Anyway - the reason for my blog post is an essay that I wrote for third year. Its' long, so I'm actually going to include it as a link here. But there has been an immense amount of talk in the midwifery student community about work life balance and I actually wrote my third year paper on it. SO - it hasn't been graded yet (so bear with me), but I thought it to be an appropriate time to post my own contribution to the discussion. Happy reading! <br />
<a href="http://learningthemidwiferyway.blogspot.ca/2013/04/paper-life-in-midwifery-managing-work.html" target="_blank">Life in Midwifery: Managing Work-Life Balance Through Alternative Call Models</a>Melissa Nhttp://www.blogger.com/profile/08471361326091236891noreply@blogger.com0tag:blogger.com,1999:blog-965482003517153191.post-48169557667071946752013-04-20T21:08:00.000-07:002013-04-20T21:08:03.409-07:00Paper: Life in Midwifery: Managing Work-Life Balance Through Alternative Call Models
<br />
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 10pt; text-indent: 36pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">The
benefits of midwifery care are well known.<span style="mso-spacerun: yes;">
</span>Women enjoy the relationship that they develop with their midwife, and report
greater satisfaction compared to other models of care. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">(1</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:901, </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">2</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:12-13).<span style="mso-spacerun: yes;"> </span>Clinical benefits have also been documented
for women receiving midwifery care, including lower rates of labor
interventions such as induction of labor and epidurals. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">(3</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:6) Midwives
enjoy their professional autonomy and the relationships that they are able to
develop with their clients. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">(4</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:436, </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">5</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:5, </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">6</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:10, </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">7</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:36) <span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 10pt; text-indent: 36pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Midwifery
itself is often a calling, something that had been dreamed of for years before pursuit.<span style="mso-spacerun: yes;"> </span>It can be described as more of a lifestyle
than a job, something that becomes entwined with one’s sense of identity. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">(8</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:24, </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">7</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:36) The nature
of midwifery work is selfless, yet its demands can cause an upset of work-life
balance that can be problematic. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">(4</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:439, </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">6</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:10,</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">7</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:30, </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">8</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:26) Working on
call as a midwife often means sustaining very long hours, sometimes with no
breaks for meals or rest. It also means being in a constant state of
anticipation, having to leave at a moment’s notice without knowing when you
will be returning. The demands of being on-call can disrupt midwives abilities
to meet their most fundamental needs, such as nutrition, sleep, and interaction
with family and friends. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">(7</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:38, </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">6</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:10) The passion
that midwives have for their work fuels them through many of these challenges.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">(8</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:25, </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">7</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:36-40) Yet many
midwives still struggle to balance their lives. Their struggles can continue to
mount, resulting in feelings of social isolation or declining mental health. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">(6</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:10, </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">7</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:38) Without
careful attention, this can easily lead to burnout, which is the main reason that
midwives discontinue practice.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">(8</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:26, </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">6</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:13) This burnout
is reflected in the attrition rate for Ontario midwives, which was found to be
21% between 1994 and 2008. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">(8</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:23)<span style="mso-spacerun: yes;"> </span>Midwives approaching retirement, and those
with young children, are at particular risk of suffering from burnout, yet
these women make up the bulk of the workforce in midwifery. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">(7</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:30, 7:42, </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">9</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:314-315) Such a
high attrition rate is unacceptable in a profession that seeks to grow to match
maternity care needs.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 10pt; text-indent: 36pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">There
is no lack of evidence to justify the fact that midwives need a more realistic
workload. Some Ontario midwives may work in excess of 80 hours per week, which
can only lead to exhaustion and questionable safety of care delivery.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">(10</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:3)<span style="mso-spacerun: yes;"> </span>There is a clear need for revision of policy to
enable midwives to find solutions, which is best undertaken at a regulatory
level. The College of Midwives of Ontario (CMO) has responded to this need by
creating a policy review plan that is currently in execution.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">(11</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:1)<span style="mso-spacerun: yes;"> </span>This plan has included a thorough literature
review with extensive client and member surveys and interviews in order to
represent midwifery in Ontario.<span style="mso-spacerun: yes;"> </span>Their
review of client feedback has revealed a client base that continues to value
continuity of care.</span><span style="color: #222222; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%; mso-fareast-font-family: "Times New Roman";">(12</span><span style="color: #222222; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%; mso-fareast-font-family: "Times New Roman";">)<span style="mso-spacerun: yes;"> </span>Clients
in all Ontario call models report equal levels of satisfaction, and while they
persistently express the desire to know anyone who will be at their birth, the
nature of birth itself makes this an issue that may never be universally
resolved.</span><span style="color: #222222; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%; mso-fareast-font-family: "Times New Roman";">(12</span><span style="color: #222222; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%; mso-fareast-font-family: "Times New Roman";">) </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Consultations with CMO
members have been undertaken to determine how regulations are currently being
interpreted and practiced, and the degree of member support for change. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">(11</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:1) Other
studies with similar objectives have indicated an “overwhelming” support to
increase flexibility in the current model of care. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">(7</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:39)<span style="mso-spacerun: yes;"> </span>The most prominent suggestions from Ontario
midwives have included revising the requirement that two midwives attend every
birth, and modifying continuity of care requirements.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">(7</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:39) The CMO has
echoed their members’ support for increasing flexibility, while also responding
to concerns from other members about the risk of change that could compromise
the quality of care that women are currently receiving. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">(13</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:2-6)<span style="mso-spacerun: yes;"> </span>The CMO’s goal is to allow for more opportunities
to prevent burnout by increasing flexibility, while strongly maintaining all of
the existing tenets of Ontario midwifery care. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">(14</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:2, </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">13</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:2-3-6)<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<br />
<h1 style="margin: 24pt 0cm 0pt;">
<span style="color: #365f91; font-family: Cambria; font-size: large;">Alternate approaches to care</span></h1>
<br />
<div class="MsoNormal" style="margin: 0cm 0cm 10pt;">
<o:p> </o:p></div>
<br />
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 10pt; text-indent: 36pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">One
such approach is enlisting the help of nursing staff to act as second birth
attendants, rather than requiring a second midwife to attend every birth. This
has the potential to alleviate midwifery resources and save costs on the
healthcare system by utilizing the services of a nurse who is already being
paid. It may also facilitate closer relationships with hospital staff, an issue
that has been identified by a number of midwives. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">(8</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:26, </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">7</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:40) A rural
hospital in British Columbia implemented such a model, whereby nurses provide
second attendant care and assistance through the first stage of labour as
needed. The nurses in this setting were interviewed after the integration
process was considered complete, and the arrangement appeared to be working
well for everyone. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">(15</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:13) Such an
arrangement may provide additional support for midwives to take meal or sleep
breaks during long labours. This type of integration can, however, result in
role confusion because the nurse assumes a much different role in a
midwifery-led birth than she does in a physician-led birth.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">(15</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:6) Obstetric
consultation and transfer of care are already challenging situations in many
settings, as each discipline attempts to determine what role to play, and this
certainly has the potential to be compounded when there are two sets of
expectations depending on whether the most responsible provider has changed in
labour.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">(15</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:12) Differences
in philosophy of care, which can come up during routine care or emergency
situations, can also create tension.<span style="mso-spacerun: yes;">
</span>This can be anticipated and alleviated by identifying and explaining
differences in practice styles. The most significant advice gleaned from the British
Columbia example of collaborative care was to facilitate clear, frequent and
direct communication about client care, and the roles and scope of each player
on the team.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">(15</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:13)<span style="mso-spacerun: yes;"> </span>Nurses and midwives can grow to respect one
another a great deal when given time and the opportunity to work together and
observe each other in practice.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">(15</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:12) <o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 10pt; text-indent: 36pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Another
approach to interprofessional collaboration is sharing clients between
physicians and midwives. <span style="mso-spacerun: yes;"> </span>This is especially
beneficial in rural and remote areas where care can be shared between
physicians and midwives to enhance back-up coverage. This form of maternity
care has been endorsed by a number of Canadian health care organizations. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">(16</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:8) It should be
considered with caution, however, for the urban Ontario population. The United
Kingdom has a vastly different system from that in Canada, and midwives there
often work within such a context. Many midwives in the UK have become employed
by the centres in which they work, sometimes providing only clinic or hospital
care to women of all levels of risk. For this reason, their care styles and
philosophy of midwifery, including continuity and low intervention birth, are different
than Ontario’s midwives. Many who work in these settings claim a lack of
professional autonomy due to the institutional nature of their hospital-based
job. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">(1</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:905-907, </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">17</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:221, </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">5</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:5) Further
study has hinted that these models only produce high levels of job satisfaction
when the institution subscribes to similar values as the midwives working
within it. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">(18</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:332) Physicians
and midwives also have different scopes of practice and legal responsibilities.
This means that if both disciplines are regularly sharing the same client base,
liability issues have the potential to alter care and interprofessional
relationships. It must be stressed, then, that any jurisdiction considering
interprofessional models consider the ramifications it may have on practitioner
autonomy and satisfaction. <o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 10pt; text-indent: 36pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Hospital
or birth centre-based midwifery that revolves around shift work has also been
suggested as a solution to the stresses of on-call work. Predictable shift work
could bring a number of benefits to midwives as well as the benefit of
eliminating the chance of midwife exhaustion for the client. This practice,
however, comes with a number of drawbacks.<span style="mso-spacerun: yes;">
</span>Continuity of care is one issue that could get severely compromised if midwives
are working shifts in any setting.<span style="mso-spacerun: yes;"> </span>This
system may also require midwifery management teams, which leaves the potential
for a hierarchical system of division between midwives with greater seniority
and authority than others. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">(18</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:329) It will
most likely also require employment within the institution, which could have an
impact on practitioner autonomy, an aspect of care that midwives in Ontario
value a great deal. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">(7</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:41) </span><span style="color: #222222; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%; mso-fareast-font-family: "Times New Roman";">Some midwives that the
CMO has consulted with have warned of the potential for conflict between
midwives if the college were to adopt a more flexible guideline for models of
care such as this one, highlighting the potential for two different “kinds” of
midwives to emerge. </span><span style="color: #222222; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%; mso-fareast-font-family: "Times New Roman";">(12</span><span style="color: #222222; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%; mso-fareast-font-family: "Times New Roman";">) </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">For these reasons,
consideration of this option must be very detailed before it is determined that
continuity and autonomy can be preserved before proceeding with a model that
could significantly alter the tents of care received by clients. <o:p></o:p></span></div>
<br />
<h1 style="margin: 24pt 0cm 0pt;">
<span style="color: #365f91; font-family: Cambria; font-size: large;">Practice Considerations</span></h1>
<br />
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 10pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"><span style="mso-tab-count: 1;"> </span>Regardless of the transferability of these options to
current settings, it is imperative that midwives find ways to practice that
promote the longevity of their career and the continued satisfaction of their
clients. Certainly work-life balance is not upset for all working midwives, and
so we can take lessons from those who have found a positive work-life balance.<span style="mso-spacerun: yes;"> </span>We also, however, need to learn from the
voices of midwives who were not able to achieve this balance and subsequently
left practice.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 10pt; text-indent: 36pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">The
first step to happy and fulfilled midwives is an environment of positivity in
the clinic. Midwives within a practice are interdependent upon one another –
for call coverage, advice, and consultation, but also for emotional support. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">(4</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:438-439, </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">7</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:36) Because
midwives depend on one another in so many ways, each member of the team has a responsibility
to maintain respectful and empathetic relationships. Their sense of support has
a strong influence on midwives’ job satisfaction, and their abilities to handle
challenging or busy periods of work. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">(18</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:332, </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">9</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:314) <o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 10pt; text-indent: 36pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Yet
many midwives have reported a sense of “expectation” or “pressure” to work
beyond their capacities in order to pull their own weight. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">(6</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:13, </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">7</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:39) In some
instances this can be the result of peer “bullying”.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">(7</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:39) In others,
these expectations may never actually be spoken but are anticipated by midwives
who know how hard the job already is and do not want to burden their
colleagues. Regardless of the reason, this can lead to a sense of obligation to
continue working, sometimes to the detriment of physical or mental health, or
even to the detriment of client safety. Flexibility and a non-hierarchical
nature within the practice for midwives to express themselves and influence the
structure of the practice can facilitate the sentiment that everyone is working
together, rather than against one another.<span style="mso-spacerun: yes;">
</span>Taking even small steps such as matching clients geographically to their
midwives can make a big difference in lightening a workload and feeling as
though you have been considered as members of a team.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">(9</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:316) For those
practices who are still striving toward this type of environment, conflict
resolution interventions can be an effective way of retaining midwives and
facilitating a team mentality. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">(7</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:40)<span style="mso-spacerun: yes;"> </span>Priority should also be given to meeting
often to facilitate clear communication about client cases and individual
needs. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">(14</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:1)<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 10pt; text-indent: 36pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Some
midwives may be unable to maintain working on call for certain periods of their
lives.<span style="mso-spacerun: yes;"> </span>Midwives who have young families
or who encounter health complications may still wish to be involved in work but
unable to maintain on-call responsibilities. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">(7</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:42)<span style="mso-spacerun: yes;"> </span>These midwives can still be of immense value
to the team, through alternate work arrangements. Examples of this include
providing clinic care only, or acting as “non-call practice managers”,
maintaining aspects of practice such as call schedules and caseload
arrangements for the group. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">(14</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:1-2) This can work
beneficially for everyone in the practice as it lightens the workload for those
midwives who continue call work, and provides a continuing means of meaningful
paid work for those who are not able to maintain on-call duties.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 10pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"><span style="mso-tab-count: 1;"> </span></span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Practices need
to evaluate the effectiveness of their call model <i style="mso-bidi-font-style: normal;">regularly</i> to ensure that it is working well for everyone. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">(10</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:4) <span style="mso-spacerun: yes;"> </span>Midwives who have left the profession have
reported losing their sense of self in lieu of the priorities that
they felt obligated to place on their work. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">(8</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:26) This
mentality, while perhaps common in midwifery, does not foster a sense of
balance or longevity.<span style="mso-spacerun: yes;"> </span>Practices need to
employ mechanisms for midwives to obtain adequate time off call to sleep and
nurture their non-working selves. <o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 10pt; text-indent: 36pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">The
CMO recommends that practices structure protocols to prevent midwives from
working more than 24 continuous hours, despite the fact that this many hours <i style="mso-bidi-font-style: normal;">awake</i> impairs an individual’s cognitive
abilities to a similar degree to alcohol impairment.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">(10</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:3-4) One could
speculate how few careers require such long hours, particularly in such a
litigious field. Care providers who are not adequately rested are at a greater
risk of providing suboptimal care, making mistakes, and encountering conflict
with their peers. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">(6</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:13, </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">10</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:3) The 24 hour
rule ignores the possibility that work may commence at a time of day when the
midwife has already been awake for a number of hours. Clearly a delineation of
less than 24 hours would be beneficial for both the client who deserves safe
and effective care, and the midwife who has physical needs to be met. Further,
the interdependence between midwives can sometimes result in being paged back
into work before sleep has adequately been recovered.<span style="mso-spacerun: yes;"> </span>Fereday and Oster examine a model of
midwifery at a clinic in Australia that provides an exemplary template for
practices that are looking for suggestions.<span style="mso-spacerun: yes;">
</span>In this model, each midwife is <b style="mso-bidi-font-weight: normal;">required</b>
to have two days per week completely free of all work-related responsibilities.
</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">(9</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:313) Midwives
in this model are also <b style="mso-bidi-font-weight: normal;">required</b> to
call in a backup and discontinue working after 12 continuous hours of client
contact. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">(9</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:313)<span style="mso-spacerun: yes;"> </span>Policies such as these provide a baseline for
accountability toward one another.<span style="mso-spacerun: yes;"> </span>All
midwives have to work together to ensure that these requirements are met. In
order to implement these, each midwife on this team was on call only 3-4 days
per week. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">(9</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:316)<span style="mso-spacerun: yes;"> </span>While this model may not facilitate the same
degree of continuity that Ontario midwives strive toward, a modification of
these practices is worth consideration. The midwives who worked in Fereday and
Oster’s model had high levels of job satisfaction, and indicated that they did
not wish to return to hospital shift work. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">(9</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">:316)<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 10pt; text-indent: 36pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Models
such as Fereday and Oster’s show that midwives who can feel confident that they
will <b style="mso-bidi-font-weight: normal;">not</b> be overworked and <b style="mso-bidi-font-weight: normal;">will</b> have adequate time to rest and
restore themselves can find good balance. The considerations listed here are an
introduction into approaches that can be used within current or future models
that may be able to maintain principles of autonomy and continuity while still
allowing for self-care and growth.<span style="mso-spacerun: yes;"> </span>Each
midwife will meet her own challenges to managing work-life balance, and each
practice needs to find a flexible way to accommodate the midwives within
it.<span style="mso-spacerun: yes;"> </span>Ontario midwives need to continue
the discussion together about what works, and what does not, so that all
midwives can foster happiness and positivity both within themselves and in
their work. </span></div>
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References<br />
<br />
(1) Walsh D,
Devane D. A metasynthesis of midwife-led care. Qual Health Res 2012
Jul;22(7):897-910. <br />
<br />
(2) Fereday J, Collins C, Turnbull D, Pincombe J, Oster C. An evaluation of
midwifery group practice, part II: women's satisfaction. Women Birth 2009
Mar;22(1):11-16. <br />
<br />
(3) Turnbull D, Baghurst P, Collins C, Cornwell C, Nixon A,
Donnelan-Fernandez R, et al. An evaluation of Midwifery Group Practice, Part 1:
Clinical effectiveness. Women Birth 2009 Mar;22(1):3-9. <br />
<br />
(4) Collins CT, Fereday J, Pincombe J, Oster C, Turnbull D. An evaluation of
the satisfaction of midwives' working in midwifery group practice. Midwifery
2010 Aug;26(4):435-441. <br />
<br />
(5) Yoshida Y, Sandall J. Occupational burnout and work factors in community
and hospital midwives: A survey analysis. Midwifery 2013
Feb;SO266-6138(12):1-6. <br />
<br />
(6) Wakelin K, Skinner J. Staying or leaving: a telephone survey of
midwives, exploring the sustainability of practice as lead maternity carers in
one urban region of New Zealand. New Zealand College of Midwives Journal 2007
October;37:10-14. <br />
<br />
(7) Versaevel N. Why do midwives stay? A descriptive study of retention in
Ontario midwives. Can J Midw Res Practice 2011 Summer;10(2):29-30, 36-44. <br />
<br />
(8) Cameron C. Becoming and being a midwife: a theoretical analysis of why
midwives leave the profession. Can J Midw Res Practice 2011 Summer;10(2):22-28.
<br />
<br />
(9) Fereday J, Oster C. Managing a work-life balance: the experiences of
midwives working in a group-practice setting. Midwifery 2010 Jun;26(3):311-318.
<br />
<br />
(10) College of Midwives of Ontario. CMO discussion paper: conditions for
safe practice. 2006 November:1-4. <br />
<br />
(11) College of Midwives of Ontario. UPDATE August 2012. 2012; Available at:
<a href="http://www.cmo.on.ca/documents/RD_PolicyReview_AUG282012.pdf" target="_blank"><span style="color: blue;">http://www.cmo.on.ca/documents/RD_PolicyReview_AUG282012.pdf</span></a>.
Accessed March 2013, Aug. <br />
<br />
(12) Rapaport Beck R. Personal communication. 2013 25 February;Policy
Analyst for the College of Midwives of Ontario. <br />
<br />
(13) College of Midwives of Ontario. Policy review: midwifery model of care.
The college of midwives of Ontario member consultation forums. Summary report.
2009 September. <br />
<br />
(14) College of Midwives of Ontario. Flexibility within the model of care.
Member Communique 2011 Winter;5(1):1-2. <br />
<br />
(15) Bell I. Maternity nurses and midwives in a British Columbia rurall
community: evolving relationships. Can J Midw Res Practice 2010 Summer;9(2):7-16.
<br />
<br />
(16) Society of Obstetricians and Gynecologists of Canada. A national
birthing initiative for Canada: An inclusive, integrated and comprehensive
pan-Canadian framework for sustainable family-centered maternity and newborn
care. 2008 Jan; Available at: <a href="http://www.google.ca/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&ved=0CDwQFjAB&url=http%3A%2F%2Fwww.sogc.org%2Fprojects%2Fpdf%2FBirthingStrategyVersioncJan2008.pdf&ei=fFYuUd3MPOimyQGflYHQAw&usg=AFQjCNFeQt4luDet2wtFY7buiBP4XVXcDA&bvm=bv.42965579,d.aWc" target="_blank"><span style="color: blue;">http://www.google.ca/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&ved=0CDwQFjAB&url=http%3A%2F%2Fwww.sogc.org%2Fprojects%2Fpdf%2FBirthingStrategyVersioncJan2008.pdf&ei=fFYuUd3MPOimyQGflYHQAw&usg=AFQjCNFeQt4luDet2wtFY7buiBP4XVXcDA&bvm=bv.42965579,d.aWc</span></a>.
Accessed Feb 27, 2013. <br />
<br />
(17) Todd CJ, Farquhar MC, Camilleri-Ferrante C. Team midwifery: the views
and job satisfaction of midwives. Midwifery 1998 Dec;14(4):214-224. <br />
<br />
(18) Lavender T, Chapple J. An exploration of midwives' views of the current
system of maternity care in England. Midwifery. 2004 Dec;20(4):324-334. <br />
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Melissa Nhttp://www.blogger.com/profile/08471361326091236891noreply@blogger.com2tag:blogger.com,1999:blog-965482003517153191.post-61088451394347759192013-02-27T10:36:00.004-08:002013-02-27T10:44:18.597-08:00Winter PlacementsI'm finished 2 out of 3 of my winter placements. The last of my third year is coming up in the next 6 weeks, and then we go through the summer into our senior year. Senior year. Me? Senior midwifery student? Do I actually know enough to be able to call myself that? I sure hope so. <br />
<br />
I'm looking forward to being back in midwifery placements. Now that I'm feeling better about the move that we're facing, I'm letting myself look forward to what I'm looking forward to: easy access to babysitters and daycare, an elementary school that's walking distance from our house, a CLINIC that's walking distance from our house!~ And the opportunity to start giving good midwifery care again, after a full year away from it, having been in so many different kinds of settings.<br />
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<br />
Our soon-to-be new house in Guelph. We move in April 15!<br />
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<br />
This semester has, though, been a very nice chance to breathe. In January, as I mentioned before, I spent the month doing research for the policy committee at the College of Midwives. I almost wish that this placement was a required placement, and I think you (you! midwifery student!) should do a placement there too. It was very good learning, and very good writing practice. I learned more in this placement than I did in most of my other midwifery courses, and helped the College with some really important admin work at the same time!<br />
<br />
This month, I've been doing "Virtual Placement". This means that the first two weeks of the month, we're studying pharmacology modules, and the second month, we are in a pseudo Midwifery video game world where we pick our own adventure to see the outcomes from various challenging scenarios. It's pretty neat. It's kind of weird. Mostly I like that I pulled 4 twelve hour days in my first week, finished it all, and now have this week free of placement duties!<br />
<br />
Next month I'll be placed at a naturopathic clinic, where I'll also get to work with a registered massage therapist and an osteopath. I'm looking forward to seeing how these different modalities work and gleaning some tips that I can take into my midwifery placement.<br />
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<br />
And admist all of this, I've been spending a LOT of my time on completely non-school related things (such as writing this blog post). Most importantly, I've been helping my partner Jamie (a professional West African drumming performer and teacher) <a href="http://www.jembesolutions.com/" target="_blank">build up his website</a>, and organize a <a href="http://www.jembesolutions.com/workshops-and-retreats.html" target="_blank">Drum Dance, and Yoga</a> retreat that's sure to blow even our own minds. People, you have NO IDEA how much work it takes to organize a retreat! I think I've put 20 hours a week into this thing since the New Year! But its really paying off now, we're a month away from the date of the retreat and its looking super. Mostly, I'm just excited that with all the work I've put into organizing this retreat, I'm going to be able to sit back and enjoy the fun while Jamie and our other instructors work their magic. Self care, people! For me, comes at the cost of 20 hours a week for three months in exchange for one weekend! :D<br />
So there's my little plug about that. I highly recommend checking it out (I'm not biased or anything) and registering before March 1st to get a $50 discount. <br />
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Melissa Nhttp://www.blogger.com/profile/08471361326091236891noreply@blogger.com3tag:blogger.com,1999:blog-965482003517153191.post-39269451296548905572013-02-19T19:57:00.002-08:002013-02-19T19:57:51.830-08:00Our family begins a new journeyThe senior placement lottery has been the bane of my existence since the minute I started considering the Midwifery Education Program.<br />
<br />
There is a lot of unpredictability in this program. We relinquish a lot of control of our lives to the greater purpose of our schooling and the future that it will hold for us. In second year, we awaited results from our first placement lottery with bated breaths. But that placement only lasted 16 weeks. 16 weeks is do-able anywhere, really, given the necessity. <br />
<br />
This one, though, is the whammy. The senior placement lottery is a placement that we're in for a whole year. And for many of us with families, the idea of not being placed in our home community is absolutely terrifying. <br />
<br />
For at least a month before we found out our placement choices I had become obsessed with the "what if's". I've lived in the same town, on the same property, since I was 19. The entire history of our family is in this place. Its the only home my kids have ever known. My son was <strong><em>born</em></strong> here. And as much as our family was growing out of our little cabin in the forest, it was <strong><em>in the forest</em></strong> (what better place?) and we've been surrounded by a loving and supportive community. <br />
<br />
But then I got the list of placement choices, and it did <strong><em>not</em></strong> include any options that would allow us to stay living here. I knew it was going to be a possibility because I'd talked with the midwives here in the last few months, but I was still clinging beyond hope that something would change. In a way, finding that out then was a good thing. We had the opportunity to pull out the map and really think about what community we wanted to move to (with a lot of restrictions, of course, since many practices in many communities don't always take students). <br />
<br />
And so, after debate and deliberation, we put in the "Top 4" choices, and I got my first one. Of course, it wasn't my first choice, because my first choice didn't even make it on the list. But it was my first choice, and so I can't complain too much. Our family will be starting a brand new adventure in Guelph, Ontario for a year (or permanently....at this point, who knows?). <br />
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At first, I was terrified. I don't want to leave the forest. Rent is easily double in Guelph what we're paying right now. I don't know hardly anyone that lives there. I really don't want to leave the forest. My husband is going to have to basically re-start his <a href="http://www.jembesolutions.com/" target="_blank">business as a professional jembe player and teacher</a> from scratch. I don't know anything about the midwives there. <strong><em>I don't want to leave the forest!</em></strong> <br />
<br />
Aaah but the ideas are settling in. A classmate emailed me the day after I found out where we were going about a friend's rental home and it is turning out to potentially be an absolute match made in heaven. The landlords seem like very cool people, the local school is one of the best in the area, the house is absolutely us and it is a 3 minute walk away from my new clinic! We're going on Thursday to have a "real live" look at it and sign the lease. I have never, ever lived so close to my work before. It's going to be a real treat to entertain the notion of coming home on lunch breaks. I think it's going to free up a lot more time for me to be with the kids and do mom stuff that I felt like I could never do when my workday didn't end until the end of my long commute. <br />
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We'll definitely have some adjusting to do, being on a main street in a city when we're used to silence all around us, but I think the trade offs are going to be worth it. <br />
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And after all, the forest isn't going anywhere. I'll make sure to come back and visit it often. <sniff><br />
Melissa Nhttp://www.blogger.com/profile/08471361326091236891noreply@blogger.com1tag:blogger.com,1999:blog-965482003517153191.post-79661957626087818622013-01-22T08:10:00.002-08:002013-01-22T08:10:17.072-08:00The blank screenHmm. I have this awful feeling in the pit of my stomach, and a peculiar craving for a very large chocolate bar. I'm staring at a blank screen, pressing the refresh button every minute or so. <br />
<br />
<br />
Yep, must be the day that the placement choices are going to be posted! <br />
Melissa Nhttp://www.blogger.com/profile/08471361326091236891noreply@blogger.com0tag:blogger.com,1999:blog-965482003517153191.post-14010406013107846272013-01-08T11:41:00.000-08:002013-01-08T11:41:48.285-08:00That damn placement lotteryHave you ever wondered what it is like for your life to be entirely ruled by something that is completely out of your hands? To have little idea about any of the details of your life to come? To wonder how you're going to deal the uncertainty of moving to a new community (whether or not its one that your family is okay with), finding new daycare, finding a new school, a new home...?<br />
<br />
These thoughts consume me so much. The placement lottery. I thought I worried about it a lot in second year! Maybe the memory has just faded a bit. I got my first choice for that placement, so what is there to worry about, right? <br />
<br />
There's a lot, actually. That placement was incredibly valuable, but it was too far away and I know I can't do another placement at that distance again. Actually, there's only one midwifery practice within 20 minutes of my home, which means for us that our whole family moves if I don't get the placement. We move from the same space of land that my husband and I fell in love on. The same one that my son was born on. The same community that we've spent the last 10 years in. The same school that my daughter's been going to for four years now. I like change, and I could use a bigger home, but I really don't want to leave my home town. It hurts thinking about it. But I know the chances are big that we'll have to, since I dont even know if that one midwifery practice is going to be taking students at all, let alone that I'd land up as the lucky one to get it. <br />
<br />
And so, I sit and wait, and try not to think about it as much as possible. In about 6 weeks, we'll know. And I'll have a couple of months wokring out the details of how we'll move out of the only life we've ever known together. (Or a couple of months to celebrate!) Hopefully, though, I'll be celebrating anyway. After all, wherever we're going is clearly where we're meant to be.Melissa Nhttp://www.blogger.com/profile/08471361326091236891noreply@blogger.com2tag:blogger.com,1999:blog-965482003517153191.post-5091341833883662372013-01-01T19:15:00.000-08:002013-01-01T19:18:59.131-08:00The honeymoon is over<br />
For the last number of years, I have spent almost every waking moment eating and breathing midwifery and school. Not only since I've been in school the last two and a half years, but for a couple of years before that while I was collecting my prerequisites, doula-ing, and generally obsessing about midwifery. Birth was seeping out of my pores at every moment. I wanted to soak up absolutely everything I possibly could about anything that remotely had something to do with pregnancy or childbirth. My idea of a great night was one where I was by myself writing an essay or reading a book by Ina May Gaskin. It was the only thing I was able to talk about with anyone, ever. (Okay, maybe that last point sometimes still holds true). <br />
<br />
I can honestly say now, that the honeymoon is over. I'm still hungry for knowledge. I still love midwifery with every fibre of my being, and I'm still willing to walk to the ends of the earth for its sake and its mission. But I've finally accepted that I can't be a balanced person if I eat, drink, sleep, and breathe midwifery. (As if! it took me this long to figure out!) <br />
<br />
I realized at the end of my OB placement how much that semester had worn me out. Really, looking back on the content and the placements, the responsibilities were much lighter than what came before it. But being immersed in foreign environments and brand new learning material all the time can be stressful, and the social interactions that accompany it can be very draining. I felt like I was constantly explaining midwives, their scope, and of course defending homebirth. It gets really tiring after a whole semester of doing this. I gave my studies less attention than I usually do because I could feel the need for balance. Placement got so intense by the end that I felt the rumblings of depression - a face I hadn't looked at for over 10 years. It wasn't pretty and its made me remember that I absolutely MUST care for myself! Having a shower, going to bed early, going to the gym, or going out for a date are NOT luxuries. They are necessities! And they should happen as often as possible so you can remain a happy person. Even if that means getting a B instead of an A. Even if that means missing your favourite client's birth sometimes! Because nobody has any use for a burnt out midwife with no happiness left in her because she has overworked herself. <br />
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Seriously, I love vacation now. I'm rolling around in vacation and rubbing it all over my face and jumping up and down in it. I'm soaking in the greatness of my family and friends and not thinking...as much... about midwifery! And it feels good. We had a great Winter Solstice, a great Christmas, a great New Years, and my little bub is turning four on Friday, so we'll be having more fun to come before the semester starts back up. I'm so glad for these breaks now. I used to dread them. I used to hate them when they came! But now, I stopped the daycare for the winter holidays (oh my god! I haven't written ANY essays for the course that hasn't started yet! YES I used to do that!) and am trying to go with the flow around here as best as we can. Its super! <br />
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Next semester is going to be a breeze (comparatively speaking), I can just feel it. My first placement is an elective - working on policy documents with the College of Midwives (which I get to do virtually through the wonders of the internet), followed by a month-long "virtual placement", and then a month with a naturopath in my home town! The course for this semester weighs heavily on a 10 page paper that I'm already excited about writing, since I'll have more time to write it while I'm NOT! Commuting! At all!! Nor am I on call at all! Nor am I working nights at all! I may not get this much time off call again in my entire working life, so I am going to LOVE it while it's here. <br />
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So yes! My honeymoon with midwifery is over. I'm not obsessed with it (as much). It's not the only thing I can think about. And I can carry on perfectly normal conversations with people that don't involve vagina's or babies at LEAST half of the time (hahaha!). I still love it, but I'm learning, bit by bit, to balance my interests to protect all of the things that I love. <br />
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End note: Hopefully my obsession with midwifery doesn't weird everyone out. My main reason for writing about this is because I'm dealing with a work-family-play balance that many of us have difficulties with. It's scary to admit to these problems sometimes, but it feels good identifying them and getting over them, too.Melissa Nhttp://www.blogger.com/profile/08471361326091236891noreply@blogger.com0tag:blogger.com,1999:blog-965482003517153191.post-55048210972895333682012-11-21T20:41:00.000-08:002013-01-01T19:17:32.468-08:00To shadow an OB/GYN for a monthTo shadow an OB/GYN for a month<br />
<br />
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. <br />
<br />
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.<br />
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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. <br />
<br />
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. <br />
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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 <strong>what is right</strong>. But it seems like maybe there isn't always one right answer. I should have already known that! <br />
<br />
<br />
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. <br />
<br />Melissa Nhttp://www.blogger.com/profile/08471361326091236891noreply@blogger.com2tag:blogger.com,1999:blog-965482003517153191.post-63762506997642837102012-11-09T18:24:00.000-08:002013-01-01T19:18:59.132-08:00Ping pongWell, 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. <br />
<br />
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!<br />
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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.<br />
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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). <br />
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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.<br />
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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. <br />
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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.<br />
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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.Melissa Nhttp://www.blogger.com/profile/08471361326091236891noreply@blogger.com0tag:blogger.com,1999:blog-965482003517153191.post-37336821787387695962012-09-17T17:59:00.001-07:002013-01-01T19:17:32.464-08:00Tired, bewildered, stressed, and happyCan I feel all of these things at once? Sure.<br />
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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.<br />
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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!<br />
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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!Melissa Nhttp://www.blogger.com/profile/08471361326091236891noreply@blogger.com0tag:blogger.com,1999:blog-965482003517153191.post-67957869039248307122012-08-21T08:57:00.001-07:002013-01-01T19:17:32.471-08:00Another summer day.... has come and passed. The breeze is cooling and the end of the summer is approaching.<br />
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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.<br />
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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 <em>really</em> 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.<br />
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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.<br />
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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. <br />
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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.<br />
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My family, however, <strong>does not</strong>. 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. <br />
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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 - <strong>prepare your family for this. </strong>Make them read this if you want! It is so important. <br />
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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.<br />
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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.<br />
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<br />Melissa Nhttp://www.blogger.com/profile/08471361326091236891noreply@blogger.com4tag:blogger.com,1999:blog-965482003517153191.post-80027788544090160562012-05-19T20:37:00.002-07:002013-01-01T19:18:59.133-08:00Reflecting on second year<div style="font-family: "Trebuchet MS",sans-serif;">
Ahh...the summer. The breeze, the warmth, the kicking and screaming children. I had almost forgotten this part of life existed! </div>
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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.</div>
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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! </div>
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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).</div>
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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 <a href="http://learningthemidwiferyway.blogspot.ca/2012/01/what-my-first-two-weeks-of-normal.html" target="_blank">two weeks into my first midwifery placement</a>. 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.</div>
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<span style="font-family: "Trebuchet MS",sans-serif;">Amazingly, when you do it every single day, you start to get better at things quickly. We managed to figure out how to get through it at home with a lot of practice. As for teh clinic, because I was the only student at the practice I was placed in, I had an open door to participate in basically anything and everything that I wanted to. This meant that the only births I missed out of all that occurred in a practice of 6 midwives were the ones that happened on my days off (or when I was already at one). In this way, being placed at a rural practice was a huge advantage. While many of the students who were placed in busy Toronto practices were struggling to meet their minimums for birth numbers (18), I was grappling with the idea soon before the end of my placement that I was going to surpass the maximum (30) - - - which I did. This meant tremendous learning for me. All of these experiences meant that by my last two weeks of placement (two of the busiest and funnest of the whole term), I was *doing* almost all of what I had been timidly watching my preceptors do in the beginning: leading clinic discussions (oftentimes by myself with no other midwife in the room for the first part of the appointment); responding directly to client pages about pregnancy, labour, and postpartum concerns; doing all labour and immediate postpartum assessments and procedures within the scope of midwifery care including catching the baby (hopefully with minimal assistance from our preceptors)....the list could go on for 10 pages (it does in our course outline, actually). </span><br />
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<span style="font-family: "Trebuchet MS",sans-serif;">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. </span><br />
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<span style="font-family: "Trebuchet MS",sans-serif;">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. </span><br />
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<span style="font-family: "Trebuchet MS",sans-serif;">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!</span>Melissa Nhttp://www.blogger.com/profile/08471361326091236891noreply@blogger.com1tag:blogger.com,1999:blog-965482003517153191.post-45201120279206696132012-01-19T19:01:00.000-08:002012-01-20T06:06:45.022-08:00What my first two weeks of Normal Childbearing looked likeOkay, 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"<br />
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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.<br />
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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 <strong>4 days per month</strong> and every Friday morning for tutorial. <br />
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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. <br />
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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.<br />
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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. <br />
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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.<br />
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My first weeks have been <strong>busy</strong>. 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, <em>I have had days where I've covered almost 600km.</em> And please, let me allow you to think about what it is like to drive the hour to get home, <em>and then get paged right back </em>(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 <strong>rock solid</strong> 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. <br />
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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. <br />
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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.<br />
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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. <br />
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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.<br />
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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.<br />
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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. <br />
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And now, its 10pm, and I'm probably committing suicide by staying up so late!Melissa Nhttp://www.blogger.com/profile/08471361326091236891noreply@blogger.com3tag:blogger.com,1999:blog-965482003517153191.post-16226349094255707552011-12-21T19:06:00.000-08:002013-01-01T19:18:59.129-08:00The final semester of academic-only learning <a href="http://www.facebook.com/#!/learningthemidwiferyway">Find this blog on Facebook</a><br />
Winter Break is finally upon us, and I have finally breathed. I think its been a couple of months since I've had a moment of guilt-free relaxation! Needless to say, this semester was very busy. Also needless to say, its going to get busier as I gear into placement first thing after New Years day. Between a demanding placement, the commuting issues that will accompany it, and my family, I don't anticipate many blogging opportunities during my placement. So perhaps I'll give it my best go and give you a big long one now that I have time to do it by summing up my third semester in school.<br />
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According to the Ryerson schedule, full-timers are to take Clinical Skills, Pharmacology, Reproduction & Physiology, and two elective social science courses. I've said it before, and I'll say it again - <em>this is <strong>impossible. </strong></em>Nobody in their right mind can handle this kind of a course load and do well at any of it (as far as I can see, anyway). If you can get those electives out of the way (or even Pharm or Repro) in first year, during the summer break, or before you enter the program, <strong><em>do it!!!</em></strong> You <strong><em>will</em></strong> thank yourself later! <br />
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To sum them up fairly briefly:<br />
<strong>Clinical Skills: </strong>Is a 3-credit course taught by two midwives with many guest instructors that come throughout the semester. Because its three credits, and there is an absolute TON of material to cover, class time is a full day plus a half day per week. This year it was Monday afternoons and all day Tuesdays - but sometimes we needed to do full days on Mondays as well. Assignments were simple and no stress. A few quizzes and a final exam - I didn't find any of the evaluations in this course to be a major challenge. The material, though, was overwhelming. This course covered just about everything that we will encounter in everyday clinic, home visits, and births.....<br />
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.... That's prenatal forms, breastfeeding, nutrition, physical assessment, prenatal screening, ultrasound, vitals, mechanisms of labor, telephone assessments, labor support, baby-catching, fetal monitoring, cervical exams, pap smears, <strong>suturing</strong>, newborn resusitation, newborn physical exam, IVs, administering meds, phlebotomy, infection control, and a million other things I can't think of off the top of my head.... <br />
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As you can imagine, thats a LOT to cover in one semester. And a ton of reading to go along with it. Most topics only got a 3-hour lecture or workshop. Its a real glossing over of the whole thing, which I think was scary to many of us who want to walk into our first placement as competent students, but it turns out they dont really expect us to be competent when we begin placement. They only expect that we've seen the equipment before and have an idea of how to use it. For me, having had the experience both as a client of midwifery care and as a doula who is familiar with much of what I listed above, I found the course to be enjoyable, but a bit of a repeat on things that I already knew. I didn't miss a class and I definitely leared at every class, but the lecture portions were often a review. I really found myself feeling for those who have less experience in the field coming into the program, as it was a <strong>lot</strong> to absorb at once. Pretty much nobody could actually do all of the assigned readings, as some weeks were upward of 300-400 pages (only a couple were like that though). My challenge with this course was the hands-on skills - particularly IVs and suturing. I've got lots of hands on experience at things like labor support, but hand me a needle and I'm a bumbling idiot. Luckily we got rubber arms for IVs and beautiful little plush vaginas to practice suturing on. There were definitely lots of good times in this class!<br />
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<strong>Pharmacotherapy: </strong>I found my arch nemesis in this class. Not the instructor, who's been teaching this class since its inception 14 some odd years ago, but my brain. This course introduced all of the drugs that midwives can administer and prescribe as well as all the drugs we may encounter our clients taking, and the concepts of how they actually work at the cellular level. Really, really fascinating stuff. But really, really hard for a concept-based kinesthetic learner like me to memorize a gazillion drug names that sound the same and know the subtle differences. I think I made a come-back at the final exam (grades aren't up yet though), but the midterm knocked me on my butt-hocks (as Willow says). <br />
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<strong>Reproduction and Physiology: </strong>A great and fascinating class. This class introduces us to the method of learning we'll be using for the rest of our career as students: situation-based learning. So, the instructor (a scientist who also has been teaching this course since its inception many moons ago) gives us a situation at the end of class and we decide what we need to learn from it. Then we go out for the week and research it, and come together at the next class and teach eachother. There's very little teaching that the instructor does, mostly just mediating - its us that do the teaching. Its really interesting. Preparingn for this class was definitely my biggest time commitment, I'd say easily a full day of research to prepare for this class each week, but it was fascinating. It covered the ovarian and uterine cycles, embryological genital differentiation, embryogenesis, fertilization, implantation, placentation, maternal adaptations to pregnancy, fetal adaptations to extrauterine life, and the initiation of labor (parturition). Overall a great course (in my humble opinion). <br />
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There you have it! My novel for the semester. Thanks for tuning in!<br />
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p.s. I've had questions from a few people about applications and interviews into the program - to those of you asking, and others wondering - I'm so sorry I haven't had the opportunity to respond as I would like. I've been grabbing life by the horns and trailing behind trying to make sure I'm holding on tight! In a nutshell, my friends, the wait is stressful but show your true colours and keep your heart pure and that is the best that anyone can do.Melissa Nhttp://www.blogger.com/profile/08471361326091236891noreply@blogger.com1tag:blogger.com,1999:blog-965482003517153191.post-35775970278218274812011-10-25T19:40:00.000-07:002011-10-25T19:40:25.128-07:00Wow, this semester is flying by! Midterms are done, and our placement notices came into our emails very shortly after we finished the last midterm (I have a feeling it was planned that way). I'm happy to report that I got my first choice! I'm excited to have the opportunity to work with the midwife group that took care of my own most recent pregnancy and birth. But, my head is swimming with the details. Placement feels very real now. The grand "you get four days a month off call" is hanging over my head and childcare details are far from being finalized. There are definitely drawbacks to following your dreams, when you have a partner whose schedule is almost as wacky and unpredictable as a midwife's *and* two children (he is a musician). The practice that I'll be going to is also quite a distance from my home - more than what is typically allowable by the school (50 minutes away) - and the catchment area is even larger. I am far from most midwifery practices, though, because I live rurally, and I don't intend to relocate for this placement. My mom lives well within their catchment area and I know I can fall back on being there if I know I need to be available on short notice sometimes (or know I can't drive home *afterwards!*) <br />
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But those are details that only my head should swim with! I really am SO excited to embark on the next stage of the journey, and can't wait for the "real" experiences. In the meantime, we're being prepped by our clinical skills classes in all sorts of skills that we'll be learning more about in placement - some of those experiences have been INCREDIBLE. <br />
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More to come when I have time to breathe! (So, maybe Christmas at this rate!?)Melissa Nhttp://www.blogger.com/profile/08471361326091236891noreply@blogger.com0