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. 

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>

The blank screen

Hmm.  I have this awful feeling in the pit of my stomach, and a peculiar craving for a very large chocolate bar.  I'm staring at a blank screen, pressing the refresh button every minute or so. 


Yep, must be the day that the placement choices are going to be posted!   

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.

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.

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. 

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.