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!