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!).
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.
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?
Afraid. 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.
Overwhelmed. 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.
Introspective: 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?
Relieved - 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.
Tuesday, 31 December 2013
Tuesday, 29 October 2013
Transition
I 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.
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?
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.
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 management - 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.
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.
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.
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.
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?
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.
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 management - 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.
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.
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.
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.
Monday, 29 July 2013
On being a learner and making mistakes
There 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.
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.
Making Mistakes
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 :)
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.
Empowerment in GETTING IT RIGHT!
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.
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).
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.
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.
Making Mistakes
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 :)
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.
Empowerment in GETTING IT RIGHT!
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.
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).
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.
Wednesday, 12 June 2013
It is a good day in the life
It 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!
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.
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.
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.
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.
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.
In memory of the departed dreadlocks. May they rest in peace.
And also in memory of that awesome retreat. May I never forget the joy that rhythm and dance bring to me.
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.
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.
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.
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.
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.
And also in memory of that awesome retreat. May I never forget the joy that rhythm and dance bring to me.
Saturday, 20 April 2013
Work life balance has been the story of my life.
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.
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.
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.
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!
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!
Life in Midwifery: Managing Work-Life Balance Through Alternative Call Models
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.
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.
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.
I deserve to dance!
(and do yoga! And shower! And sleep! and eat (*every time I'm hungry*!)
And you do, too!
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!
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!
Life in Midwifery: Managing Work-Life Balance Through Alternative Call Models
Paper: Life in Midwifery: Managing Work-Life Balance Through Alternative Call Models
The
benefits of midwifery care are well known.
Women enjoy the relationship that they develop with their midwife, and report
greater satisfaction compared to other models of care. (1:901, 2:12-13). Clinical benefits have also been documented
for women receiving midwifery care, including lower rates of labor
interventions such as induction of labor and epidurals. (3:6) Midwives
enjoy their professional autonomy and the relationships that they are able to
develop with their clients. (4:436, 5:5, 6:10, 7:36)
Midwifery
itself is often a calling, something that had been dreamed of for years before pursuit. It can be described as more of a lifestyle
than a job, something that becomes entwined with one’s sense of identity. (8:24, 7:36) The nature
of midwifery work is selfless, yet its demands can cause an upset of work-life
balance that can be problematic. (4:439, 6:10,7:30, 8:26) 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. (7:38, 6:10) The passion
that midwives have for their work fuels them through many of these challenges.(8:25, 7:36-40) 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. (6:10, 7:38) Without
careful attention, this can easily lead to burnout, which is the main reason that
midwives discontinue practice.(8:26, 6:13) This burnout
is reflected in the attrition rate for Ontario midwives, which was found to be
21% between 1994 and 2008. (8:23) 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. (7:30, 7:42, 9:314-315) Such a
high attrition rate is unacceptable in a profession that seeks to grow to match
maternity care needs.
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.(10:3) 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.(11:1) This plan has included a thorough literature
review with extensive client and member surveys and interviews in order to
represent midwifery in Ontario. Their
review of client feedback has revealed a client base that continues to value
continuity of care.(12) 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.(12) 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. (11:1) Other
studies with similar objectives have indicated an “overwhelming” support to
increase flexibility in the current model of care. (7:39) The most prominent suggestions from Ontario
midwives have included revising the requirement that two midwives attend every
birth, and modifying continuity of care requirements.(7:39) 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. (13:2-6) 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. (14:2, 13:2-3-6)
Alternate approaches to care
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. (8:26, 7:40) 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. (15:13) 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.(15:6) 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.(15:12) Differences
in philosophy of care, which can come up during routine care or emergency
situations, can also create tension.
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.(15:13) 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.(15:12)
Another
approach to interprofessional collaboration is sharing clients between
physicians and midwives. 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. (16:8) 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. (1:905-907, 17:221, 5:5) 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. (18:332) 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.
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.
Continuity of care is one issue that could get severely compromised if midwives
are working shifts in any setting. 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. (18:329) 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. (7:41) 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. (12) 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.
Practice Considerations
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. We also, however, need to learn from the
voices of midwives who were not able to achieve this balance and subsequently
left practice.
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. (4:438-439, 7:36) 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. (18:332, 9:314)
Yet
many midwives have reported a sense of “expectation” or “pressure” to work
beyond their capacities in order to pull their own weight. (6:13, 7:39) In some
instances this can be the result of peer “bullying”.(7:39) 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.
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.(9:316) 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. (7:40) Priority should also be given to meeting
often to facilitate clear communication about client cases and individual
needs. (14:1)
Some
midwives may be unable to maintain working on call for certain periods of their
lives. 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. (7:42) 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. (14:1-2) 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.
Practices need
to evaluate the effectiveness of their call model regularly to ensure that it is working well for everyone. (10:4) 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. (8:26) This
mentality, while perhaps common in midwifery, does not foster a sense of
balance or longevity. Practices need to
employ mechanisms for midwives to obtain adequate time off call to sleep and
nurture their non-working selves.
The
CMO recommends that practices structure protocols to prevent midwives from
working more than 24 continuous hours, despite the fact that this many hours awake impairs an individual’s cognitive
abilities to a similar degree to alcohol impairment.(10:3-4) 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. (6:13, 10:3) 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. 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.
In this model, each midwife is required
to have two days per week completely free of all work-related responsibilities.
(9:313) Midwives
in this model are also required to
call in a backup and discontinue working after 12 continuous hours of client
contact. (9:313) Policies such as these provide a baseline for
accountability toward one another. 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. (9:316) 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. (9:316)
Models
such as Fereday and Oster’s show that midwives who can feel confident that they
will not be overworked and will 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. 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. 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.
References
(1) Walsh D, Devane D. A metasynthesis of midwife-led care. Qual Health Res 2012 Jul;22(7):897-910.
(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.
(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.
(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.
(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.
(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.
(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.
(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.
(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.
(10) College of Midwives of Ontario. CMO discussion paper: conditions for safe practice. 2006 November:1-4.
(11) College of Midwives of Ontario. UPDATE August 2012. 2012; Available at: http://www.cmo.on.ca/documents/RD_PolicyReview_AUG282012.pdf. Accessed March 2013, Aug.
(12) Rapaport Beck R. Personal communication. 2013 25 February;Policy Analyst for the College of Midwives of Ontario.
(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.
(14) College of Midwives of Ontario. Flexibility within the model of care. Member Communique 2011 Winter;5(1):1-2.
(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.
(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: 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. Accessed Feb 27, 2013.
(17) Todd CJ, Farquhar MC, Camilleri-Ferrante C. Team midwifery: the views and job satisfaction of midwives. Midwifery 1998 Dec;14(4):214-224.
(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.
Wednesday, 27 February 2013
Winter Placements
I'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.
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.
Our soon-to-be new house in Guelph. We move in April 15!
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!
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!
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.
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) build up his website, and organize a Drum Dance, and Yoga 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
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.
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.
Our soon-to-be new house in Guelph. We move in April 15!
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!
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!
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.
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) build up his website, and organize a Drum Dance, and Yoga 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
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.
Tuesday, 19 February 2013
Our family begins a new journey
The senior placement lottery has been the bane of my existence since the minute I started considering the Midwifery Education Program.
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.
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.
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 born here. And as much as our family was growing out of our little cabin in the forest, it was in the forest (what better place?) and we've been surrounded by a loving and supportive community.
But then I got the list of placement choices, and it did not 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).
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?).
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 business as a professional jembe player and teacher from scratch. I don't know anything about the midwives there. I don't want to leave the forest!
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.
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.
And after all, the forest isn't going anywhere. I'll make sure to come back and visit it often. <sniff>
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.
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.
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 born here. And as much as our family was growing out of our little cabin in the forest, it was in the forest (what better place?) and we've been surrounded by a loving and supportive community.
But then I got the list of placement choices, and it did not 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).
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?).
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 business as a professional jembe player and teacher from scratch. I don't know anything about the midwives there. I don't want to leave the forest!
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.
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.
Tuesday, 22 January 2013
The blank screen
Hmm. 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.
Yep, must be the day that the placement choices are going to be posted!
Yep, must be the day that the placement choices are going to be posted!
Tuesday, 8 January 2013
That damn placement lottery
Have 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...?
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?
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.
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.
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?
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.
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.
Tuesday, 1 January 2013
The honeymoon is over
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).
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!)
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.
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!
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.
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.
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.
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