Prepping for Call Shifts: Part II

Welcome back for Part II of Prepping for Call Shifts. My first post explored the nuts and bolts of how I prepare externally—sleep, stuff I bring, pre-call routines etc. This post is more about how I get ready emotionally and mentally for 12 hours of being a midwifery student on call. It’s also a window into how I communicate my learning needs and goals to the preceptor I’ll be working with. My experience so far is that this communication piece is critical for a successful call shift.

This is not a cut and dry “routine” with concrete steps, per se…but I have found over the past term and a half that there is a bit of a process that seems to be evolving and I’d love to both share and also hear from other students and practicing midwives about what they do to prepare emotionally and mentally for being on call.

Making Peace with the Trepidation

Let’s be perfectly frank. I often find myself at some point in the few hours before my next shift feeling both excited and nervous/jittery at the same time. “Maybe another birth today!” is the first thought. But there’s no getting around it…the responsibility of stepping into the midwife role feels daunting. I never really feel prepared enough, even though I’m constantly reviewing protocols for the high-stakes complications.

That’s just an element of midwifery that is inherently part of the work: labor and birth are unpredictable, often flowing without complication, but that can quickly change. I would add that triage calls are a whole other category of unpredictable. You just never know what’s on the other line. I have yet to experience a true shoulder dystocia or postpartum hemorrhage or severe preeclamptic patient…but I know it’s only a matter of time. So, before each shift, I try to take some time to sit for a few minutes quietly and just breathe. This is after the bags and food are packed, coffee is made, scrubs are on. Just a minute or two to be still and breathe in some calm energy.

Clarifying and Articulating Clinical Goals

After that initial sinking feeling of “Oh, gosh, am I ever going to feel competent?” has had a chance to bubble up, make itself known, and then settle again, I try to spend a little bit of time before the shift thinking about my clinical goals. I have a running list of things I want to be working on, informed partly by our course objectives and partly by my own level of confidence in certain skills or aspects of clinical judgment. Of course, I never know what’s going to come in, but I review the things I’ve highlighted as priorities and then think about how I want to present those priorities to the midwife on call for that shift.

The midwife will often ask, “So, where are you and what do you want to focus on today?” That’s an invitation for me to be as clear and honest as possible about what I feel comfortable with and what I still find slightly terrifying. I find that just naming it helps.

Key current example: For whatever reason, I’ve mostly attended multip births so far, so I haven’t had the opportunity yet to do a lot of laceration repairs. Of course, I’m thrilled for those folks—easier recovery for them! But it means that I still sweat bullets at the thought of getting started with a repair and often feel like even figuring out how to approximate tissue is a challenge. I will just come right out and say so, letting my preceptor know what I think I might need to feel supported in the event that I need to do a repair. I also quickly review with her what I’ve been doing on my own in the meantime to try to keep my hand-skills fresh.

I also try to give a quick run down of the things I feel pretty comfortable with now—getting a good history, doing an initial assessment, management of an uncomplicated early labor, giving SBAR to an OB if we need to consult on a patient’s care or possibly co-manage, informed consent conversations for various scenarios, for example. This helps my preceptor know how involved she should be and how much space she should give me in doing these things on my own. Knowing that we’ve set this foundation up in the beginning of a shift helps the whole shift run more smoothly.

Chart Review in Advance

One of the nice things about having EHR access from home is I can keep tabs on how many midwifery patients are on the unit throughout the preceding shift. Especially if it looks like things are going to be busy, I try to prep as much as possible before I go in, knowing I may not provide direct care for all of them. However, having quick notes jotted down on my brain before I go makes report go a little faster, often saving precious time if there’s an imminent birth or change of plan at shift change.

I personally like to do this prep regardless—sometimes we’re short on time and I don’t get as much time as I would like to review the course of prenatal care…but there are often lots of pearls to be found if I take the time to read through that history. In addition to all the usual labs and other medical things, I try to make note of at least a few small personal detail that will help me make a connection with each person I work with, particularly when I haven’t met them in clinic before. It takes some time at home, usually no more than a half hour or 45 minutes, but I generally find it’s worth the peace of mind of coming in feeling a little more prepared. Perhaps as a practicing midwife, this need will feel less pressing…but for now, it’s become a part of my routine.

Cultivating Flexibility

The way our call shifts work this term, we’re not assigned to one single preceptor for the entire term. The benefit of this model is that we get to see lots of different approaches among our clinical faculty practice. The downside is there is less consistency and it can be frustrating to be told one thing by one preceptor only to have another preceptor tell you something different on your next shift! This is a more ongoing thing, but I find that before each call shift I have to consciously remind myself to not go in with expectations if I’m working with someone less familiar and to just ask her what her preferences are around certain things (pushing comes to mind: hands on or hands off? Or placenta delivery…to twist or not to twist—I’ve seen lots of variation!). Being open to new perspectives, even when working with a familiar preceptor, is important—no two labors are the same!

***

These are the core things I find helpful before a shift…some days feel more organized than others. But I’m trying to establish the habits I want to have as a practicing midwife now, as a student, weaving in threads of practice that I observe from my preceptors as well. What are the things you find most helpful in the mental and emotional preparation as either a student or practicing midwife on call? Share them here or on Facebook, I’d love to hear from you!

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