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

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.

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.

Wednesday, 21 November 2012

To shadow an OB/GYN for a month

To shadow an OB/GYN for a month

This month has been very different for me.  Well, every month has been, but this one in particular has challenged me and amazed me in ways I hadn't thought possible.

My OB placement has so far been WAY different than I expected it to be.  I'd heard from other students about 24 hour OB shifts at larger hospitals, where a student could expect to go to 7-15 births in a shift.  The advantage of this is a large volume of experiences put closely together.  It can rapidly increase skill in things like suturing that us midwifery students worry so much about developing.

Apparently, an OB placement at a small Level 1 hospital is not at all like that.  In fact, although I'm on call a couple of days a week, I have yet to go to a birth with my OB preceptor in three weeks.  And frankly, part of me is terrified.  I had really looked forward to this placement as an opportunity to gain skill in suturing, and I'm just over a week until the end of my placement and it's likely there won't be a single opportunity at all. When I realized that, I  had a major feeling of let down.  I'm thankful at times like these that my Normal Childbearing placement was so busy and full of these types of opportunities.  Hopefully this means that I won't be too far behind my classmates who enjoyed the benefits of repeated births in the same night to hone their skills. I'm also super thankful for one of the lovely midwives in this community who took me under her wing one night and brought me to her client's birth.

 The great thing about this placement is how much gynecology I'm being involved in.  I'm going to all of my preceptors gynecology clinic and surgeries, and there is SUCH a wide variety of experiences that I think it's amazing.  I've heard from other students that many OB preceptors don't allow involvement with the gynecological patients but mine does and I am so greatful for it.  The way my preceptor sees it, although our scope is limited right now, perhaps eventually we will become more similar to the Nurse-Midwife model in the U.S. where the midwives provide well-woman care throughout life, rather than just the childbearing year. 

What has thrown me off, is how alone I feel.  Opinions and management choices come up sometimes in OB clinic that I really struggle with. Sometimes it's because I'd prefer to present them differently (prenatal screening like ultrasounds or group B strep), and sometimes because I simply have a really strong bias that I haven't gotten over (like topics such as VBAC and circumcision).  It's hard to hear the medical perspective when you've walked on the wild side your whole adult life.  Sometimes, I'll have a typical day, but I'll end up crying all the way home and I can't even figure out why (and no, this isn't something that usually happens for me, only the odd day since I've started here).  I think it's an internal battle.  I believe in midwifery care, I would fight for it to the very end, and I made pretty radical choices as a client of midwifery care myself.  So I think I'm fighting with myself because sometimes the explanations that my preceptor makes for the way that she practices make total sense. But it still goes against the way that I do things.  It's hard to sit with that feeling - I like to know what is right.  But it seems like maybe there isn't always one right answer.  I should have already known that! 


Anyway, the whole experience is pretty humbling.  These doctors do not always deal with the same people that midwives deal with.  When I have a day in clinic in midwifery care, I am usually very happy and feeling confident.  I walk into a room with a client who is also usually very happy, have a great discussion full of respect and choice, give her good prenatal care, and am on my way.  In this scenario, we have some of that, but we are also seeing those women who are not lucky enough to be in midwives care - those who are suffering from infertility.  Those who are recovering from a miscarriage or abortion. Older women undergoing hysterectomies.  Women who have lost their husbands and are now facing other health issues. Not a day goes by that someone doesn't cry in a clinic visit (or ten), because an OB/GYN, just like most doctors, are not always the bearer of good news.  Sometimes these women are being called in to find out that they have cancer, or that they'll never be able to have the baby that they've so desperately wanted.  Certainly midwives aren't always the bearers of good news either, but we definitely see it a LOT LESS.  And in the midst of this, I see my preceptor as an amazing doctor.  A little while ago, I looked into the window of the operating room to see her with a patient who was about to undergo emergency surgery.... and she was holding the woman's hand as she waited to fall asleep.  How many doctors take the time to comfort their clients?  I don't know, because this is the only one I've spent a lot of time with.  But I hope she's among many like her. 

Friday, 9 November 2012

Ping pong

Well, I've done it again.  Things got all busy and all of my good intentions to post went out the window.  I marvel at how much I used to post in first year.  I felt like I was so strapped for time.  I know I was very busy then, but I think at that point I hadn't really learned too much about prioritizing. 

So, third year, you ask - how is it?  Different!  Dynamic, unpredictable, and exciting - combined with boring, predictable, and sometimes troubling.  I've been bounced back and forth between so many different places and each one puts me into a new learning environment with new responsibilities and expectations.  I love it!

For those who don't know the nitty gritty, third year consists of inter-professional placements - for me this semester, that means 4 weeks with a nurse in labor and delivery, 2 weeks in a breastfeeding clinic, 2 weeks in the neonatal intensive care unit, and 4 weeks under an obstetrician.  Next term will be some elective placements and a virtual online placement.  I can't emphasize how greatful I am for having the opportunity to see into the world of these other professionals.  I wish that all of these disciplines had this amazing opportunity to witness the lives of their colleagues.  I'd bet that it would breed a lot more compassion and respect between disciplines.

What all of these placements play out in reality is so complex.  Sometimes, I'm observing.  Sometimes, I'm thrown into the midst of things when I don't expect it.  Mostly I'm somewhere in between.    I have both loved and hated going from place to place so often.  The great thing is that its helping my social skills - I'm meeting new people every day and needing to quickly establish rapport with them, which is an interesting skill that I have definitely NOT mastered.  The other great thing is that I've gotten a taste of every hospital that I'd consider working in.  Each one operates so differently!  The social infrastructure is also very interesting to navigate sometimes.  We're really in this unique place in these placements where we're following nurses and OB's, and observing conversation that sometimes involves slogging midwives.  I've never explained what my scope of practice is so many times in my life - nor have I had to defend homebirth so much.  (And after a few interesting conversations, I've decided to just not mention my birth history for fear of being judged too harshly). 

But as challenging as that aspect of it has been, I find it such a privilege to be able to do these placements.  I feel like I've developed a much better understanding of what sort of follow up care our babies that go to the NICU get.  My NICU placement what such a pleasure.  Although I saw more bottles and formula than I would have liked, shift work and predictable hours are lovely things and the staff at the NICU in Brampton have such a lovely working relationship with one another. I was also able to follow one of the nurses into the high risk births that occurred while I was on shift, which helped me to feel more comfortable observing cesareans and instrumental births.

My labor and delivery nursing placement was at the hospital closest to me, which was great for driving.  The midwives here are newly implemented so it was interesting to observe the dynamic as they became established in a hospital that has never had midwives before.  It was especially interesting to hear the nurses' side of the conversation, since I am (obviously) used to hearing any conversation about hospital relationships from the perspective of the midwives.  Working as a labor and delivery nurse at a birth was also very interesting - there is much less freedom to manage the birth as I might choose to do it because the nurse is not the woman's primary caregiver.  I found that very frustrating, not because I didn't respect the decisions the doctor was making, but because of the fragmented care that the woman was receiving, which was being split between a number of different people. 

My breastfeeding placement was definitely the highlight of my year so far.  I was enormously lucky enough to be placed at the Newman  Breastfeeding Clinic and Institute.  The doctors and lactation consultants at that clinic are amazing.  I like to think of them as "breastfeeding midwives".  Each woman that enters their clinic leaves there having received the combined recommendation of two lactation consultants and a pediatrician (and usually a student or two).  I'd been aware of mixed opinions about the clinic before I came there, but truly, their approach is amazing.  I am so grateful for the opportunity to immerse myself in their environment for as long as I did, and those of you who are entering third year - even if its not close to you, this placement is *so* worth the drive. I think it's made an enormous difference in how I'll be managing breastfeeding issues.

I've just begun my OB placement this week.  I'm still new to it, and I'm quite certain it's going to deserve a post all on its own, so that one will wait for another day.

Monday, 17 September 2012

Tired, bewildered, stressed, and happy

Can I feel all of these things at once?  Sure.

Third year started with a (loud) bang for me.  We started off the first week of September with a 6-day intensive that I was totally looking forward to.  It was definitely nice to see classmates again, but I hadn't really thought too hard about the level of content that was going to be covered in those 6 days - they mean it when they say intense!  What struck me most about it, though, was the switch from "Normal" (our first two years) to "abnormal".  It jarred me a bit, to go from figuring out how to get my hands to do the right things when I'm catching a baby, to managing obstetrical emergencies, just like that.

After that, we began our interprofessional placements - a series of 2-4 week placements with other professionals in the field learning clinical skills from them and discovering their role and the unique benefits and demands of being a part of their profession.  What a unique opportunity this really is.  Its a great chance to learn clinical skills more quickly than I would with midwives.  Its also a great chance for me to see how really happy I am to be in midwifery.  I'm placed with a labor and delivery nurse first, and although I've only had a couple of shifts, I'm noticing quite a few differences that make me very thankful that we as midwives have such a wide scope and flexibility so we can maximize continuity of care.  Just when you really get attached to a woman, your shift ends and you might never see her again.  But then again, your shift ends, and your family knows when you expect you - and if you've read any of my previous posts, you'll know how happy they are about that!

Rather unfortunately, we had a major childcare crisis and a threat to my son's safety to deal with after my first day at the hospital when I came to pick him up.  I also was faced with the much-greater reality of relocating for my senior year placement - something that I've always been afraid of, despite being aware that it could be a real possibility, but it now seems to be a much greater one.  Couple that with some OSAP complications as well, and I had me a pretty emotional week.  Thankfully the childcare problem is all cleared up now and the summer-long quest to find a replacement for our much loved (but now far away) home daycare provider came to a close the other day when we met "the one".  Phew!  There's a load off.  I'm also working days this week and got to be part of some really great experiences today, so things are looking up!

Tuesday, 21 August 2012

Another summer day....

 has come and passed.  The breeze is cooling and the end of the summer is approaching.

In all honesty, I spent most of my time in school dreading this summer.  It is the only long period of time that I will have off throughout the entire program.  For someone like me, who has increasingly identified myself as a bit of a workaholic, this was terrifying.  I figured out a long time ago that I'm not cut out for stay-at-home parenting.  Four months of it felt like a bit of a nightmare.

And then April came along in placement.  In my last two weeks of placement, I attended 9 births.  What a way to go out with a bang!  And what a way to make me really appreciate the benefits of a long vacation.  By the end of it, despite the amazing variety of mostly positive birth experiences I got to witness in that long string of births, I was exhausted, drained, and desperate for sleep and a good meal (or ten!).  The day my summer vacation started, was the day I stopped dreading it.

We have made it work so far.  The kids have been in daycare part time, which gives me a chance to do a little bit of work and allow myself the space to get other things done that I had completely let go of last semester.  And here we are in August and I feel all caught up. Dare I say, I'm almost starting to feel an inkling of excitement for third year to begin.  But not before I get some more fun out.  Oh, and a few births, but that's beside the point.

This summer, I've had to very realistically reflect on how the midwifery lifestyle impacts my life.  When I was entering the program, I felt like I had a good handle on what it would be like - after all, I had been a doula for a number of years and was used to being on call and making backup childcare arrangements.  But the midwifery lifestyle is much more demanding than the one I led as a doula, and it is particularly demanding for students.  Students, who need as much experience as they can get, get very few days off and (if they're lucky) will be very busy on the days that they are on.  I know this, and I accept and eve love this, but it is much more difficult in practice than it is in theory. 

I have grown used to the unpredictability of birth and midwifery already.  It feels selfless, it feels purposeful. I know it is making a difference in people's lives. I've grown incredibly fond of it.  Although it has its dark moments, I look forward to hearing from clients.  I enjoy not knowing where I will be an hour from now.  I love surprises, the spontaneity of picking up and changing everything.

My family, however, does not.  Throughout the course of my studies last semester, I grew to learn that no amount of preparation I did could have prepared my family for what it was really like.  It wasn't my absence - they anticipated that.  They knew I would be away much more than I'd be home, and they knew I'd need to rest much of the time that I was home.  No, it wasn't how busy I was.  It was how unpredictable it was. 


I can't say how many times I arrived home just in time for dinner, only to get paged away 20 minutes later, kids on my lap.  Or right in the middle of the bedtime routine.  Or just as I'm preparing them for the morning.  People, I cannot stress it enough - prepare your family for this.  Make them read this if you want!  It is so important. 

Kids are so resilient, though.  They got used to Daddy doing just about everything for them - he cooked them dinner pretty much every day, put them to bed most nights, took them to school and daycare, made lunches. Everything that they were used to me doing, or at least used to us sharing.  My partner pulled through for me in so many ways, and I know (because I know him) that he will continue to do so, but it is not easy for him!  Many of us midwifey folk have discussed trying to band our men together so that they can form a support network of deserted midwife husbands. And while I was aware that he was struggling a great deal during my placement, it wasn't until I was off and had the time and energy to check in with him that I realized just how hard it had hit him.  Our relationship had become extremely fragile because amidst how busy I was, and my efforts to compensate for it by taking over household chores and childminding while I was home, I had nothing left at all to put into our relationship.  The result is that we found ourselves in a crisis.

And so, this summer, our partnership has been the real focus.  Sure, I've caught up on chores and fun with the kids.  But most of my transformative energy has been put into building steel bonds with the man who has proven himself to be the backbone that holds me (and our entire family) up when I feel I might crumble to the ground.  The crisis that we found ourselves in allowed us to realize that we don't just need eachother, but we want to be there for eachother and understand one another better, always.




Saturday, 19 May 2012

Reflecting on second year

Ahh...the summer.  The breeze, the warmth, the kicking and screaming children.  I had almost forgotten this part of life existed!  

Normal Childbearing is done - all 16 weeks, assignments, and exams.  We're done!  I am officially halfway through the program - although, given how much of a challenge the program was and knowing the rest of school is placements - I kind of still feel like I just finished the introduction.

I fully intended to have a new blog post out the second I finished placement.  But just before I finished placement, I had a string of 8 days where I went to ....oh gosh... I cant even remember now, something like 10 births?!  Needless to say, once I finished my last day of placement (and some very interesting detours getting home thanks to my GPS), I fell into recovery mode, and 3-4 weeks later I'm starting to get my head back on straight. That being said, I'm out of midwife mode for the next little while and totally forget what questions most people have been dying to know about the placement, even though I know there are many.  So please dont hesitate to ask away!  

There is so much to share about what these last four months have been like for my classmates and I.  All of us have had such diverse experiences from one another, though, that I can only really speak for my own experience.    I'll probably make a number of posts over the summer in little bits and pieces.  I'm also planning to post a couple of the papers I wrote, as they're in pretty understandable language and I think they're pretty darn interesting (I try not to write a paper about boring things, generally).

For today's post, I wanted to follow up on where my learning is at now, compared to where it was when I was only two weeks into my first midwifery placement.  At that point, I was already being directly involved in all aspects of almost all clients care, from prenatal visits, to birth and postpartum visits.  I felt awkward, didn't know what to say often, fumbled, made lots of mistakes. I also was undergoing a humongous adjustment to the midwifery lifestyle.  The scale of change for me was so big - easily as big of a change in life as the birth of my first child.  And for anyone who's got kids, you might imagine that means every aspect of your entire life is different.  My family had a major adjustment to go through as well, especially my partner, who had to give up a great deal of his work and identity to be only Dad.  For a man as passionate about his music as I am about midwifery, this was a huge challenge for him.  Musicians often get gigs at night. (no childcare) Midwives often go to births at night. (no way to predict which night)  You get the picture.


Amazingly, when you do it every single day, you start to get better at things quickly. We managed to figure out how to get through it at home with a lot of practice.  As for teh clinic, because I was the only student at the practice I was placed in, I had an open door to participate in basically anything and everything that I wanted to.  This meant that the only births I missed out of all that occurred in a practice of 6 midwives were the ones that happened on my days off (or when I was already at one).  In this way, being placed at a rural practice was a huge advantage.  While many of the students who were placed in busy Toronto practices were struggling to meet their minimums for birth numbers (18), I was grappling with the idea soon before the end of my placement that I was going to surpass the maximum (30) - - - which I did.  This meant tremendous learning for me.  All of these experiences meant that by my last two weeks of placement (two of the busiest and funnest of the whole term), I was *doing* almost all of what I had been timidly watching my preceptors do in the beginning: leading clinic discussions (oftentimes by myself with no other midwife in the room for the first part of the appointment); responding directly to client pages about pregnancy, labour, and postpartum concerns; doing all labour and immediate postpartum assessments and procedures within the scope of midwifery care including catching the baby (hopefully with minimal assistance from our preceptors)....the list could go on for 10 pages (it does in our course outline, actually).  

Everything that we are learning and capable of handling with minimal assistance is within the scope of Normal Childbearing - normal, common, or variations of normal.  Obviously, though, we can't always predict when that'll be, so most of us were exposed to a hearty share of not-so-normal situations as well.  I mentioned in my last post that my faith in the process had gotten seriously put to the test in my first few weeks of placement after a string of situations that I had never viewed from the care providers perspective before.  Thank goodness (for myself and my future clients!) that faith got restored with many, many positive, straightforward beautiful strong women and their births to show me that birth is a normal life event.  

Of course, the focus of our later courses will be on managing and consulting for some of the various complications that came up over the course of our learning.  By the end of the term, I found myself REALLY curious about those complications.  This, to me, is a sign that I'm comfortable with the "normal" stuff.  

Seriously, I feel like I've said absolutely nothing.  But there's so much more to say!  Since I got into recovery mode, my writing hasn't been as strong as usual!  Please post unanswered questions in the comments.  I just might make another post about it!