Living life and figuring it out, one little piece at a time

Friday, 31 October 2014

To the midwives-to-be

Note:

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" :)

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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.

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).

And now here I am almost done, with a lot to say and very little capacity to actually say it.
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). 

#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. 

#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.  

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 *needs* 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.   

#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). 

Settling in

Well, 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.

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.

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. 

 And now it's the end of October - I've had the whole month off call to sit back and relax 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 favourite doula in the world 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. 

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 paying off debt  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. 

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...)

Friday, 11 July 2014

Reflections from a one week old midwife

The 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. 

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! 

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? 

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. 

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). 

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!

Tuesday, 3 June 2014

Feeling so good

Do 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.


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.

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. 

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. 



Wednesday, 23 April 2014

A turning point

Today 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.

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? 

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. 

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!



Like I was THERE. (Hillside 2012)



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. 

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. 



Also, for some extra motivational reading, I stumbled upon the blog of a wonderful midwife 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!

Thursday, 17 April 2014

Finished and moving forward

Done.  I'm done. 

It feels so, so good to be able to declare that to the world.  I'm DONE!!! 

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. 

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.

What's next? 

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. 

What else is next?
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. 

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! 

I figure that's a  pretty good sign ;) 


 
"Captain Midwife", as Jamie has called me since the day I received that most
wonderful phone call telling me I was accepted into the midwifery program.


Tuesday, 31 December 2013

The 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!). 

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, 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. 

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.


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.

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. 




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. 

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>