New Beginnings

The dishes have been put away, lunch made for tomorrow…the baby (almost toddler?!) has nursed and is sleeping upstairs. B is off having a board game night with the guys, so all is quiet. Finally, I can put my feet up, take a deep breath…take a sip of my tea and breathe again.


It still doesn’t feel real. I have to pinch myself and sometimes even steal glances at the exam report that says I passed my certification board exam, or the diploma that says I graduated with a master of nursing. But it’s true. I have finally, at long last, accomplished these things. I am a certified nurse-midwife, just a few logistical details away from being licensed as an advanced practice nurse. And I’m three days into my new job. I’m currently working as a triage RN while I wait for my privileging and credentialing paperwork to go through, and then starting this winter, I’ll transition to a full-scope CNM within the same practice. Living the dream.

There are so many blog posts that I’ve been writing in my head and heart this summer as I moved through my integration experience. Because I was a quarter behind the rest of my cohort (see here for the adventures of an unplanned pregnancy in midwifery school), the summer left me feeling a bit lonely out there as I plugged along with a full-time schedule of one or two 24hr call shifts and 2-3 clinic shifts per week. I hardly had time to cook regular meals and be with my family, let alone think, reflect, write. There were so many moments that I wanted to share with you, my blog readers, about the emotional journey toward becoming a more independent provider, those triumphant births and clinic days when I was spot on in my diagnosis or treatment plan (or the days when I learned even more about my weak spots)…but it just didn’t happen.

And honestly, I feel like sometimes that’s just how it rolls. Being a parent has really driven home how key flexibility is as a life skill…we were rolling with the punches every day. Luckily, Tahini is a pretty easy-going kiddo…once our initial breastfeeding issues resolved, breastfeeding and pumping were uncomplicated. His transition to full-time childcare at 3 months went smoothly, and for the most part (dare I say it out loud?!), he’s been a great sleeper. Lucky, lucky, lucky.

The whole process of applying for this midwifery job was a whirlwind that happened right smack dab in the middle of the Annual ACNM meeting in Albuquerque and the week before I took my comps exams (in my program, we take our comps right before moving on to integration, as a way to demonstrate our competence in the didactic material). I honestly don’t remember much from that month at all, except that I quit my part-time RN job, which was a huge relief, because a 45 min commute one way 2-3x/week plus clinic and call and school work and parenting was killing me. I have never been so relieved to pass an exam and get started with a new job in my life…there was such a long gap between when I was offered the position and when I started, and it felt like it was never going to happen!

But, here I am, settling into this new career.

Which brings me to what feels like a natural closure to this blog. Since I started this blog in 2012, I have met countless individuals, both virtually and in real life, who have expressed their gratitude for sharing my journey to midwifery. Along with such wonderful fellow bloggers as Robin from Mindful Midwife, Stephanie from Feminist Midwife, and Michelle from Sage Femme, it has been such an honor and privilege to be a part of creating an online community of support for student midwives and recent grads. I can’t even begin to count the ways in which this online community has inspired and carried me through pre-reqs, nursing school, and midwifery school.

I’ve been mulling over what to do with this blog once I finish school. I’ve built up a bit of an identity as “Notes from a Student Midwife,” which has been wonderful and fun. But, I am no longer officially a student midwife…and I think that this blog has reached the end of its season. So, with much gratitude, fondness, and a touch of sadness, I will no longer be actively maintaining this blog or contributing new posts. It feels right to me to recognize that this blog has served its purpose, which was to offer a space for reflection on my journey to become a midwife.

I haven’t decided yet whether I will continue blogging about my evolving journey as a practicing midwife. To be honest, writing posts has felt more like a chore recently than a help, which was another sign to me that it was time to wind down. So, for now, I’ll still be active on the Notes from a Student Midwife Facebook page, where I’ll share updates on my transition to practice, as well as links to articles that I think every radical midwife should read. And if I decide to start blogging again, I’ll be sure to let you know on the Facebook page. I’ll keep all comments open so folks can reach out with any personal questions.

My deepest gratitude to you all for witnessing this journey and cheering me on through the toughest moments. And to all the aspiring midwives who have kids, are pregnant, or want to have kids but don’t know how to time things: know that it can be done! Best wishes to you all, and don’t hesitate to be in touch on Facebook!



As many of you wonderful readers know, I’m nearing the completion of my midwifery program. We midwives love metaphors, and on my plane ride home last night from the ACNM Annual Meeting in New Mexico, I was thinking about how I am at that point in my midwifery education journey of complete dilation: I have done the incredibly hard work of learning how to catch babies, do clinical appointments, flexing and stretching those muscles over and over, actively laboring to get into the rhythm of having those cervical exams, IUD insertions, Leopold’s maneuvers become second nature.

On June 6th I’ll sit for my comprehensive exam, which our program requires we take before we start integration (our final practicum). This exam is a test of all the knowledge we need to know to be safe, entry-level midwives. It’s a reassurance that if we pass, we at least have the knowledge foundation to get the most out of our final clinical practicum and do well on our certifying board exam.

One week later, I’ll start integration! I get lots of questions about what this entails: basically, it’s a 10-week final practicum, precepted by one midwife (although, I’ll probably work with 2-3 midwives fairly regularly). I’ll be essentially working full-time with my preceptor, seeing all her patients in clinic and on call-shifts. While my preceptor is there for support and in cases of emergencies, I will be largely responsible for patient care and charting, making management decisions as independently as possible. It’s my chance to truly integrate all the clinical and didactic learning of the past 6 quarters of midwifery school and really hone my own voice as a midwife.

How do I feel about moving from active labor into the pushing phase of my midwifery education journey, you ask?

I’d say about 60% thrilled and excited and about 40% terrified. Not because I don’t think I’ll do a good job, but because the gravity of the responsibility is heavy. I came to midwifery with some pretty lofty goals about my future practice and how I want to serve my community. Every day, I have questioned whether I’m on track to meet those goals and enact that vision. It is an incredible honor and privilege to walk with my patients on their individual journeys to health and well-being throughout their life, and not one I take lightly.

Like most laboring patients about to enter the pushing stage, I know intellectually that I am about to be asked to work harder than I have ever worked in my life…and getting to complete is usually no walk in the park. It’s one thing to know this intellectually and another to actually experience it. I tell my laboring patients when they get close to hitting that wall of despair that they will find wells of strength within themselves they they didn’t know existed. I know the same will be true for my experience in integration: I will have moments of doubt, but also will deepen my confidence as a midwife.

To follow this metaphor a bit further, the pushing phase of labor is engages different muscles and a different mental space. Suddenly the vision clears and the end-goal becomes clear again: I am thisclose to moving across that threshold from student to practicing midwife. While I will always be a student at heart (future PhD, cough, cough), it won’t be the same and it will come with a different set of responsibilities.

So…here’s to that little lull that sometimes happens at complete dilation before active pushing. I have a few weeks to rest, prepare, re-evaluate my clinical goals and priorities, before diving deep for the last effort before graduating as a midwife. I’m about as ready as I’ll ever be, so let’s bring it!



Zero to Sixty in 4 Years

I recently received a request to chronicle my journey from “pre-nursing to CNM”–what classes I took, etc. Carolyn, sorry it’s taken so long to reply. Life as a second year student nurse-midwife is a whirlwind. Add in having a baby, and you have a perfect recipe for letting some emails slip through the cracks. Also, I realized that I simply cannot remember which classes I took when…and somehow, I seem to have lost the folder on my computer that had all my pre-nursing planning docs. Probably in a moment of “must organize everything! now!” I deleted it, thinking I wouldn’t need it again.

I chose to do my pre-reqs part-time, as I was working as a doula at the time and also busy volunteering at Planned Parenthood and with Backline.

Also: I would avoid applying to programs that require an entrance exam. Sheesh! That just sounds like more work! But I was lucky, the program I wanted to go to didn’t require one.

Fall 2011

I started taking pre-reqs in the fall of 2011. I had no background in the biological sciences, so I took an intro bio for health sciences, which was a pre-req for the A&P series as well as for microbiology

Medical Terminology (online)

Winter 2012

Anatomy and Physiology I

Human Development

Spring 2012

Anatomy and Physiology II


Summer 2012

Anatomy and Physiology III

Fall 2012


Submitted application in December of 2012

Winter/Spring 2013

Accepted to accelerated RN/CNM program

Continued working as doula, studying Spanish

Summer 2013: Began the 5-quarter Accelerated Nursing Program at OHSU

Health Promotion

Pharm I

Patho I

Fall 2013

Chronic Care: Clinical and Didactic

Pharm II

Patho II

Winter 2014



Population-Based Care: Clinical and Didactic

Spring 2014

Acute Care: Clinical and Didactic

Leadership II

Summer 2014

Integrated Practicum (on L&D/MBU)

September 2014

Studied for and took NCLEX

Started working part-time as abortion RN

Fall 2014: Began the 2 year midwifery program at OHSU

Health Assessment and Diagnosis for Advanced Practice Clinicians

Advanced Patho I

Reproductive Health Care Mgt

Concepts for Advanced Practice Nursing (online only)

Winter 2015

Advanced Patho II

Advanced Pharm I

Antepartum and Postpartum Care: Clinical/Seminar and Didactic

Spring 2015

Left RN job to focus on school

Advanced Pharm II

Intrapartum Care I: Clinical/Seminar, Didactic

Evaluating Evidence (online only)

Summer 2015

Intrapartum Care II: Clinical/Seminar

Newborn Care

Midwifery Foundations (reviewed history of midwifery, scope of practice, etc)

Fall 2015: Had a baby, so took time off from gyn clinical until 8 weeks PP and did not do any IP care

Started part-time RN job in an out-patient primary care clinic to fulfill RN hour requirement for APRN licensure in OR–OR APRN’s need 384 hrs of documented RN experience to qualify for licensure…but pretty sure we’re the only state with this requirement

Advanced Gyn: Clinical and Didactic

Intrapartum Care III: Seminar only, no clinical

Foundations of Teaching Midwifery (“How to Be a Preceptor 101”)

Concepts of Advanced Nursing Knowledge and Leadership (online only)

Winter 2016: made up gyn clinical hours, started IP clinical hours from Fall

Primary Care for Midwives: Clinical/Seminar and Didactic

Intrapartum Care IV: Clinical/Seminar

Spring 2016: made up IP clinical hours from Winter

Integration Seminar (resume writing, negotiating contracts, liability, etc)

Summer 2016

Final Integration: 8 weeks of working full-time as midwife with clinical preceptor

Fall 2016

Take board exams

Apply for state licensure as CNM/APRN

Apply for NPI and DEA license (to prescribe narcotics)

Find job, get privileged and credentialed, live happily ever after as a midwife!



The Beginning of the Home Stretch

Every year, the first year students of our program throw a send off party for the second years as they wrap up their didactic requirements and prepare to head off into integration (an 8 week final practicum very similar to a medical residency, in which we essentially live the life of a full-time nurse-midwife, working all clinical and call shifts with that midwife and taking on as much leadership in clinical care as one can without being fully licensed).

As an acc bacc student I attended this party and felt such awe and inspiration, watching how  confident (even though they said they weren’t) the first and second years seems as they shared advice about how to survive life as a student nurse-midwife. I simply couldn’t imagine how in a few short years, that would be me–catching babies, running prenatals, attending to patients’ every day health care needs. It was both wonderful and yet impossible to imagine.

Last year I ended up not going, because I was still in my first trimester of pregnancy and simply too fatigued to make it. I hadn’t started taking call yet and while I was starting to feel comfortable in the prenatal care setting, I still felt like a complete imposter.

Tonight, though, I attended the annual send off as a second year. It was such a surreal experience, and in many ways, isn’t quite as immediate for me because I’m a quarter behind the rest of my cohort (having a baby in the middle of midwifery school will make you adjust your timeline a bit!).


As impossible as it was to imagine a year ago, I am a different midwifery student now.

I’ve been a part of over 50 labors and 20 births. I’ve logged almost 450 hours of L&D call, with another 200 hours to go before integration. I’ve seen over 80 individuals for prenatal care. I’ve been involved in over 30 postpartum visits and over 60 gyn visits. I’ve placed 10 IUDs. And I have almost 400 hours of RN experience in a primary care clinic.

More importantly, I’ve started to find my own voice, however shaky and uncertain it may be, as my preceptors start asking me to sit in the driver’s sit and take the lead. They ask me what orders I want placed and they type it in the computer and click “sign.” Done. They ask me how I want to manage a labor and why, and then step back and let me see the outcomes of those decisions (within safe parameters of course). They ask me for my understanding of the evidence and then tell me to go in and direct the conversation with the patient about why we’re making the recommendation we’re making. That I’m making.

It is terrifying but also…I’m starting to remember why I’m here, finally starting to feel more at home in this role. There was a period where I kind of forgot, where the pattern became “just get through this term, survive in one piece, don’t ask for too many extensions from one class.” Having a baby cured me of any last vestiges of perfectionism in my work (oh, don’t worry, the impulse still lingers…but oh so faintly now). As my preceptors move back and encourage (read: push) me forward, I’m remembering that I was drawn to this work because I love talking about the things that matter most to people: how to feel good and safe in their bodies, minds, and spirits. There is nothing more satisfying than partnering with a patient to come up with a plan to help improve her quality of life.

As I sat around listening to my fellow cohort offer wisdom and advice, I was struck by just how much we have learned in this past year together and how much more at peace we are with how much there will still be to learn upon graduation (suturing workshops, anyone???).

There’s still a lot more to come before I can say I’m on the home stretch (this spring I’ll be cramming another quarter’s worth of call into 8 weeks so I can have enough of my integration done that I qualify to participate in Convocation with the rest of my cohort)…but it’s beginning to feel like it’s possible, which is more than I could have said a few months ago.

I wish I could say there will be time for more blog posts, but I’m not sure I can make that promise…so if it’s quiet here till August, know that I’m sending love and solidarity to all you midwifery students out there balancing school and family to pursue this wild journey of becoming a midwife.

[This is where, if I had not been busy wrangling a wiggly 5 month old, I would have inserted a picture of the freaking AWESOME uterus cake and uterus piñata that the first years made us for the party. Ah well…letting go of the perfectionism in action!]


The Fourth Trimester

Well, that flew by. Tahini has been with us for almost four months now.

Being a mama to an almost 4 month old, a full-time midwifery student and a .4 FTE RN doesn’t leave a lot of blogging time these days…but life is good right now. He’s growing like a weed, grabbing everything and putting it in his mouth, laughing, and trying desperately to roll over. Being his mama is amazing, frustrating, exhausting, exhilarating, mundane, tedious, profound, and so full of love.

But one thing is clear: I’m a mama…but I was called to be a midwife long before Tahini arrived and I have no regrets about continuing my program rather than taking time off to be home. It was not easy coming back to class 2 weeks postpartum, or starting gyn clinic at 8 weeks postpartum…but I don’t regret it for a single second, because I love my work so much.

I loved learning about gyn this fall, even though I wasn’t quite as sharp or organized as I would have liked to have been. I loved getting to work with menopausal patients and hear their stories and help reassure them that yes, they still deserve a rich and fulfilling sex life if they want one. I loved getting to explain pelvic exams and Pap smears to adolescents and young adults in for their first gyn exam and then perform gentle, thoughtful, empowering exams that helped patients understand their bodies. I adored getting to talk about contraception and family planning with patients of all ages and intentions about how they wanted their families to look. I loved getting to insert IUD’s for those that wanted them, and taking them out for those who didn’t.

I started taking call again two weeks ago. I’ve caught three babies so far this quarter and have been slowly finding my hands and voice again on L&D. I’m enjoying my primary care class and seminar, along with my last intrapartum seminar, and can’t wait for my primary care clinical rotation to start this weekend. This winter is my last quarter of course work as a midwifery student. In the spring, I’ll just be taking L&D call to catch up on the hours I missed from the fall…and then this summer, I will complete my final integration (practicum) as a nurse-midwifery student. If all goes as planned, I should be sitting for my certification exam in late summer/early fall, about a year after Tahini was born.

I’m so, so grateful for the amazing guide, Alex, at the Montessori infant community that Tahini attends full-time during the week. I rest easy knowing he’s in a safe, nurturing environment while I continue to pursue my life work. I firmly believe that Tahini will only benefit from seeing his mama doing work she loves, even if that means I’m not always home, or able to attend to him all the time while I am home. I cannot imagine not being a midwife, any more than I cannot imagine not being Tahini’s mama.

Parenting was not meant to be a solo endeavor even if you choose not to work outside the home…but especially when you do, having your village around you is essential. I’m so glad Tahini is learning from Day 1 that he can get his needs met from his mama…and from his papa, and his Mike and Mo and Anne (our housemates and Mo’s mom) and his Alex…and most importantly, himself. I will not be there for him every second of every day. My greatest wish for Tahini is the same as for my patients: that he may thrill and delight in his own body, his own mind, and his own heart, feeling confident that he can accomplish anything he sets out to accomplish with his own power. I’m just the midwife here, here to help support and guide.

The Unexpected, Part IIb (Neil’s Birth Story)

Part I (On getting pregnant in midwifery school)

Part IIa (On the discovery at 39 weeks that our little Tahini was breech!)

We arrived to the labor and delivery unit at 7am. Out of habit, I used my ID badge to swipe in and walked up to the nursing station as if I were about to put my name and pager number on the board. B looked at me and smiled. “You’re cheating,” he said.

“What?” “You’re not the student midwife now, you’re the mama. Mama’s don’t let themselves onto the unit with their ID badges. They press the call button and wait to be buzzed in, like everyone else.” He squeezed my hand affectionately.

Oh. Right. Time to take that hat off and put on the mama hat.

Deep breath.

After getting settled in our room with labs drawn and IV placed, the third year OB resident came and chatted with us about the plan for the day. She also did another ultrasound and surprise, surprise, Tahini was still breech. Other surprise, my amniotic fluid level (AFI) was now reading 4.6, down from 7.0 yesterday.  Not sure how that happened, as I didn’t have any leakage of fluid…but sometimes there can be variation in calculation of this measure. In any case, 4.6 is low, technically considered oligohydramnios (Greek for too little water). As I mentioned in the last post, the risk with oligohydramnios and a version is that the cord doesn’t have as much cushioning, so risk of cord accidents and stillbirth increase quite a bit.

I wasn’t entirely convinced they would even do a version with such a low AFI, but the resident said to sit tight and she’d go consult with the attending, who would be overseeing the version. She had been recommended to me as a skilled and compassionate OB, one who would be happy to work with us to have as calm as possible a cesarean birth if that’s what needed to happen.

We waited around a while for lab results, for the OB’s to finish morning rounds, for the resident to consult. Being an “insider,” I wasn’t alarmed in the least that B and I had over two hours to work through two Tuesday crossword puzzles from our book and for me to take a little nap, along with a visit from the anesthesiology resident who would be performing my spinal/epidural.

The resident returned around 9:30 and sheepishly apologized, noting that three other little ones decided to make an entrance that morning. “No worries,” I smiled. “I know how it is around here.”

“Oh, right,” she said. “You’re a midwifery student. You totally get it. Well, thanks anyway for your patience.”

We then chatted about the plan, which was that the attending felt ok about attempting a version in the OR under spinal, but at the slightest indication of distress, we’d move straight to a cesarean. That felt completely reasonable to me.

And so it was that a little before 10am, I was being prepped for my spinal/epidural. B and I had just a few moments to ourselves to let it sink in that October 1st was the day we’d be meeting Tahini. In just under an hour, he’d be in our arms. We both laughed a little when I asked, “Does it feel real?”

“Nope,” he said. “It won’t feel real until he’s here. And even then…” I nodded. Yup. That was exactly how I was feeling.


In the Bair Hugger: a specially designed gown that can attach to a warm air tube in the OR to keep patients warm.

The placement of the spinal/epidural went smoothly. Having seen tons of them placed, I knew exactly what to expect: they first wash your back with a cold ChloraPrep solution and then inject you with lidocaine to numb the area. That was the worst part–it stings going in…but after that, all I felt was a strange tugging sensation in my spine. I tried not to think about what the anesthesiologist was doing and just focus on slowing my breath.

Almost immediately, I felt my legs go numb and become heavy. The nurse and anesthesiologist had to help me lie back down and then the team finished the rest of the prep for the version: a pulse oximeter was placed on my finger, a blood pressure cuff on my arm, a nasal cannula (which was super itchy the entire procedure and very distracting!) was placed to provide extra oxygen during the procedure. A foley catheter was placed, as I no longer had control of my bladder. I remember commenting that it felt so strange–I could tell my legs were still there, as the numbness was more tingling than complete lack of sensation…but I couldn’t move a thing.

Someone asked me what music I wanted…I was a bit flustered by the tingling sensation and nasal itching, so I said the first Pandora station I have that I could think of: Django Rheinhardt. It’s often what B and I will play on Saturday mornings while we make a slow, lazy brunch. I instantly breathed a little deeper, mindful that breathing already felt different with the anesthesia in place. I had been told that sometimes, patients have the sensation of being short of breath if the spinal anesthetic flows up the spine…but in general, I should not panic and that it’s a normal sensation. I remember slowing way down and just focusing on each breath.

Someone dimmed the lights. B and one of my midwives, Liz, came in and arranged themselves at my head. I kept my glasses on so I could see what was happening. Everyone paused to confirm we had the right patient, etc., then we got started on the version.

The first attempt lasted about two minutes. I could feel mild tugging and pressure as two residents, overseen by the attending, used their hands to try to move Tahini in a counter clockwise direction. They were able to get him to a transverse (horizontal) position before his heart rate started dropping. In medical terms, this is called a deceleration.

Using the ultrasound during the version to assess Tahini's position. The blanket on my arm was a warm pack, as my IV had been bugging me all morning.

Using the ultrasound during the version to assess Tahini’s position. The blanket on my arm was a warm pack, as my IV had been bugging me all morning.

Normally, baseline fetal heart rate varies between 110 and 160 beats per minute. A variable decel is a random, quick drop in rate with a quick return to baseline. An “early” decel often coincides with a contraction, and is usually a sign of head compression during the pushing stage of labor. And a “late” decel is a drop in heart rate after the contraction, usually a sign of chronic placental insufficiency. A variable decel can be caused by multiple things, but usually, it’s transient cord compression. You can also have a prolonged decel, which is longer than 2 minutes but less than 10.

Tahini’s heart rate dropped down to 80 beats per minute. It wasn’t quite technically a prolonged decel, as it only last one minute, but I vaguely remember the room getting quiet as the residents focused on the screen showing the heart rate.  As a student midwife, I can assure you that one minute of heart rate at 80 can feel like an eternity. B remembers the whole room was completely focused on listening to the heart rate on the monitor. It wasn’t tense, yet, just very, very focused.

At some point, the attending came over and looked into my eyes and said, “We’re just having a decel here…we’re going to give your baby about five minutes to recover before we try again.” I remember thinking, “Five minutes…that must have been some decel.” I didn’t know at the time exactly how low it had been, which was probably a good thing.

After five minutes, the attending was honest: “I’m okay attempting one more time, but your baby didn’t particularly like that first attempt…so if his heart rate dips down again, I’d like to move directly to a section.” That was fine with me. Another dip would confirm that for whatever reason, Tahini wasn’t going to tolerate further attempts, and that potentially, there was an issue with his cord that was impeding the version.

I didn’t have a strong sense of time,  but it seemed like the second attempt was shorter, maybe only 30 seconds. Both residents and the attending had hands on my belly, trying to move Tahini’s head down. B says they were putting quite a bit of force into it, but Tahini wasn’t budging…and his heart rate dipped again. “Doesn’t look like he wants to move further…and he’s really not happy here.” As they spoke, apparently Tahini just slipped back into his former breech position.

The decision was clear: Tahini would be born via a cesarean section..and it was going to happen very soon.

Part IIc to follow

The Unexpected, Part IIa (Neil’s Birth Story)

A week ago today, B and I were repacking our bags. We had already been packed with the bags in the car since week 37, with plans to be at the birth center for a few days postpartum.

But, to continue the theme of the unexpected, on Wednesday night, we dragged those bags back in and made some adjustments.

I should back up.

Earlier that morning I had my 39 week prenatal. I went in alone, as B was meeting with our general contractor about ADU stuff. It was uneventful, as I didn’t have much to report. I’d been having Braxton Hicks for a while, but nothing to write home about. No discomfort, no cramping, no little leaks, not a drop of bloody show. Just lots of belly and swollen hands and aching feet and ready to be done with pregnancy-ness.

My midwife Katherine and I chatted a bit about my plan for school this fall quarter (class on Tuesday afternoons, no call shifts, starting gyn clinic at week 8 or 9 of the term), which had just started up again on the 28th. We talked about my Mega Naps, and then she did Leopold’s (external palpation of the uterus). “Hmm…I know we’ve been calling him head down for a while, but I’m having a hard time finding my landmarks. Mind if I do an internal exam?”

Normally, she and I both wouldn’t bother for a first-time pregnancy at 39 weeks…but to be honest, I was curious. To my complete and utter surprise, I was 2cm dilated, with a soft cervix at midline and about 50% effaced (thinned out). Seriously?! But I hadn’t felt ANYTHING!

However, she couldn’t confirm a head down presentation. Normally, if the head is engaged at this stage of pregnancy, you can actually feel the bone sutures through the lower uterine segment. She couldn’t feel them, so asked for my permission to have another experienced midwife, Laura, do Leopold’s. Sure, why not?

She came in and almost immediately after placing hands on my belly, her face softened, and she sighed. “Yeah…I’m pretty sure your little one is breech,” she said. I nodded. I had a feeling. She asked if she could do another internal exam to confirm, which was fine with me. The first exam wasn’t as bad as I was expecting. The first words out of her mouth were, “Well, you’re 4cm…”

Katherine and I looked at each other in disbelief. “Uh, she was 2 when I checked her three minutes ago!” she said. “Yeah,” Laura said. “She was 2. Now she’s definitely a 4.”

Holy sheeeeeeeet. I still felt nothing. This is freaking crazy! I thought to myself. My life is about to explode
We talked about my options and the information I needed to move forward. First order of business: an ultrasound to confirm the breech presentation and to check the level of amniotic fluid around the baby. If the fluid levels were good, I’d be a candidate for an external version, where the provider uses their hands on the belly to try and turn the baby from the outside. If it was low, the risk of a cord accident is higher, and it wouldn’t really be safe. I’d then be facing the decision of whether to schedule a cesarean or attempt a vaginal breech birth…which very few OB’s offer.

Everyone has their own opinions about vaginal breech birth. My own thoughts can be summed up as: I wish we could see more of it, but it’s hard when so few OB’s and midwives actually have adequate training on how to manage breech birth. So much of the increased risk is simply due to the fact that people don’t know how to safely attend these births. OHSU offers a vaginal breech birth program, but they have strict protocols about who qualifies and the requirements are pretty narrow. I wasn’t sure I would meet the parameters, and so in the instant I discovered Tahini was breech, I immediately started thinking about the potential that this baby would be birthed via a cesarean section.

The ultrasound appointment confirmed what we all suspected–a breech presentation, with an amniotic fluid level of 7.0, which is on the lower end, but not dangerously low. I was a candidate for a version. The question was where to do it. In the end, I opted to do it in the hospital, at OHSU, where I am a student and where I know many of the OB’s. It felt like I had the best chance to work with a provider who would be accommodating of my wishes…and with the expertise of an academic clinical setting, I’d have the best chance of a successful external version.**

So, Wednesday night, B and I went out to dinner at our favorite restaurant. We talked through what was likely to happen the next morning when we arrived on the L&D unit. They would do another ultrasound, on the off-chance that Tahini verted himself overnight (unlikely, but it’s been known to happen). I’d have my labs drawn and a urine sample tested. I’d get an IV put in and they’d give me a bolus of fluid before placing a combined spinal/epidural.

Some places do versions without medication, others with a drug called terbutaline, which relaxes the uterine muscles…and other providers point to evidence that a spinal offers the best chance at a relaxed uterus and successful version. Our plan was that if the version was unsuccessful, we’d just move directly to a cesarean birth rather than attempting another version a few days later.

After the spinal was placed (in the OR), they’d attempt the version with ultrasound guidance, stopping every two minutes to check heart rate and make sure Tahini was tolerating the procedure. As we ate dinner we talked through potential scenarios…and commented on how unreal this whole thing felt. It’s entirely possible, we told ourselves, that in 24 hours, we could have a baby. On the outside. WHAT?!?

We came home and repacked our bags, preparing now for a potential hospital stay of 3-4 days. And then we tried to sleep. I was asked to not eat or drink anything after midnight, and plan to arrive on the unit the next morning between 6 and 6:30am. We didn’t really fall asleep till close to 1am, I think. And even then, sleep was hard to come by. How do you sleep the night before your life could possibly be changed forever?

Part IIb to follow…

**I should clarify: most of the time, I feel that the out of hospital is a safe place for most aspects of perinatal care. However, I do think in the scenario of breech and versions, there is a lot to consider. Sometimes versions can cause cord issues, which can lead to hypoxia for the baby…and the best way to avoid that is to be able to do a version with ultrasound guidance and immediate access to an operating room. While I fully respect the choice to attempt a version out of the hospital if someone is fully informed of the potential risks, I personally didn’t feel comfortable taking that risk and opted for an in-hospital version with a spinal/epidural in place so that in the event of an emergency, my team could move directly to a cesarean birth and minimize the length of time my baby might experience hypoxia.

I also think there’s something to be said for the academic clinical setting and the ability of providers there to gain LOTS of experience because they see a higher volume of breech babies than in a birth center. For me, when considering my options, I definitely wanted to know how experienced my provider was in versions, her success rate, and what her threshold of comfort was in continuing the version vs. transitioning to cesarean. These are all factors that anyone considering a version should be able to freely discuss with their care team.

In sum: I adore my midwifery team and would not have had my prenatal care done any other way. I still believe and practice under the premise that midwives can and do provide evidence-based, safe, compassionate care and are the ideal care provider for a low-risk pregnancy. I just don’t happen to believe that breech presentation is an entirely low-risk condition.



September! The air is turning crisp, with that unmistakable smell of autumn…folks are bringing out their scarves and boots and this past weekend at the farmer’s market, apples were the new big thing. It’s hard to believe that I’m on the cusp of beginning my second and final year as a midwifery student. When I started this blog in 2012, this moment felt light years away, something I could only imagine in the most abstract and vague of terms: a much-anticipated “someday.”

Somehow, in the three intervening years, I finished my nursing pre-reqs, applied to and was accepted into an accelerated nursing/midwifery program, and survived the first two years of said program. Now, I have one more call shift left of my first midwifery year and then there will be a bit of a hiatus from L&D call between now and January as B and I prepare to welcome our surprise baby in early October.

If you had told me in 2012 that not only would I get into midwifery school, but that I would get pregnant during midwifery school, I would not have believed you, not for one second. But that’s the funny thing about life–it twists and turns and suddenly you find yourself in the present moment of your life right now and you can’t really imagine it any other way.

These past few weeks have very much felt like a harvesting time for me. There are lots of changes in our home as we continue construction on a small house out back for our housemates and as we prepare our home for a new little one.


There’s been unexpected time with family as we mourned the sudden loss of a dear relative, and there’s been lots and lots of trips to Goodwill as we continue to pare down and make space for things like diaper pails and co-sleepers. It’s been a lot of change all at once, but it feels good to pause and take stock: Do we need this? Is it meaningfully contributing to our lives? What is the life we want to create for ourselves as we expand our family? What are the traditions that are most important to us?

As I wind down my first year of midwifery school and reflect on what I’ve learned and where I need to focus for the coming year, it’s been helpful to remind myself just how far I’ve come. I’ve been a part of 34 labors and attended 14 births as a student midwife. Combined with the births I was involved with as a doula, that means I’ve been to over 60 labors and nearly 50 births. I’ve been involved in over 80 prenatal care visits and more than 20 postpartum visits. Numbers aren’t everything, to be sure…but it’s been good for me to just sit with the fact that I’m no longer a novice…that it’s ok to step into that role of second year midwifery student, with all the opportunity and responsibility it entails. Most importantly, I can see the big picture and catch glimpses of an emerging midwife who is growing more confident in her skills with each passing day.

What are you all harvesting these days, literally or metaphorically? What are the growing skills that maybe you haven’t let yourself fully acknowledge as yours yet, even if others around you are saying they’re blooming? What are the fruits of your labor that you are enjoying in these lingering autumn afternoons?

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