Complete

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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!

 

 

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!).

But.

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!]

 

Harvesting

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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.

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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?

As always, feel free to share here or on Facebook!

Catching Up

Whew! Not sure how it’s already the middle of July…anyone else feel like June just kinda disappeared?

There are still, oh, about five posts in my head about my experience at the ACNM meeting in DC at the end of June…suffice to say, it was an amazing experience and I promise, I’ll be writing more soon.

For now, a few photos and little tidbits of my summer term (only 7 credits, my friends, I feel so…FREEEEEEEE!!!!)

Açai bowl summer yumminess...

Açai bowl summer yumminess…

 

Hey Green Journal, what up? I actually had to tab all the articles I wanted to read!

Hey Green Journal, what up? I actually had to tab all the articles I wanted to read!

 

Squish babies. That's what I get to do all summer! For credit!

Squish babies. That’s what I get to do all summer! For credit!

 

Knots. There is yarn. Everywhere. In. My House. And. Car.

Knots. There is yarn. Everywhere. In. My House. And. Car.

 

Hey, you again! My brain! It continues to evolve...there's now a phone triage cheat sheet on back!

Hey, you again! My brain! It continues to evolve…there’s now a phone triage cheat sheet on back!

 

For those who have been following the thread about my note-taking sheet that I use on the unit…I’ve made a few changes, including moving the birth details so that the full front half of each page can be used for one patient, rather than having to flip back and forth. The back side now has space for two triage call notes. You can download a .pdf here: Lena’s IP Brain_Summer2015.

What are you all up to this summer? Do share, either here in the comments or on Facebook!

Fast & Furious: Catch #2

No, it’s not about cars.

It’s about a labor, and the magnificent mama overrun with the power of her uterus, on the edge of her ability to cope.

Contractions started with a bang. Her partner called soon after, asking whether they should come in.

We hemmed and hawed, concerned about the dwindling number of beds, asked to her wait a little while longer at home.

Not long after, partner calls back: Things are hot and heavy over here, she really wants to come in.

We manage to find a room, not the largest on the unit, but it will do.

They arrive, we check her, our fingers barely making it in before reaching a baby’s head.

Baby’s coming, just breathe, you can do this, you’re almost done, stay with us, mama, you’re so strong!

She glistens with sweat and power and the primal smell of birth. Uncontrollable, unstoppable, unbelievably strong. My breath catches in my throat with awe.

Hands poised, trembling, ready for the moment when inside meets outside.

My heart is racing, but then, hands steady as I breathe again and remember what I’m here to do.

Catch.

Baby’s here, beautiful, healthy baby’s here, up to mama, right where they belong.

From start to finish, two hours.

I can’t stop grinning all day long. Really. Really?! Really?!! I can’t believe I get to do this.

Catch!

This past week has been a flurry of firsts: first time practicing knot-tying and suturing, first time doing postpartum rounds, and first catch! Yes, that’s right, I had the incredible honor of catching my first baby as a student nurse-midwife this past week.

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I was processing the experience with a friend of mine who’s also a midwife and all I could really say was how struck I was by the simultaneous extraordinariness and ordinariness of the experience at the same time. It was a smooth, uncomplicated delivery, perfect for a first catch. As always, I caught my breath at that moment when the baby crowned and we got to see her face for the first time…and yet…there was no feeling of overwhelm for me afterwards. There was just a feeling of inner stillness and calm.

For a brief moment, I wondered if I had become immune to the magic of birth already: was I already getting bored? But no, what I realized was that I have been to enough births that I can sit in that space of calmness about it…and that I can rest 100% assured that I am called to this work. Even though my hands felt a bit awkward, and I wasn’t really sure how much cord traction was necessary, and I struggled to come up with a wild guess on the EBL, there was no doubt in my mind that I was supposed to be there in that moment, catching that baby.

This is what I am meant to do with my life, and the feeling of “ordinariness” was feeling that sense of alignment that I have been waiting for my entire life.

I know that there are more complicated, challenging experiences for me coming down the pike, experiences that will make me question my skill, my clinical judgment, whether I am called to this work. I hope that I can remember the feeling from that first catch, and from my week of doing postpartum rounds. It’s a feeling of deep satisfaction. I love that I get to talk about birth and families and contraception and transitions and transformation and healing…all in a day’s work.

Can’t wait to get back on the unit tomorrow for another 12 hour call shift. Who knows that tomorrow will bring?

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Full Throttle…into the Fog

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The walk to class each morning from the parking lot down the hill…

We’ve been having some weird weather here lately…lots of dense, heavy fog in the mornings, grey, grey, and more grey…and then in the afternoons, it burns off into blindingly brilliant sunny blue skies. It’s a bit of whiplash, really, to go back and forth between the two, but as someone who thrives on every drop of sun possible in these dark winters, I don’t feel like I should complain too much.

Mostly, I find the current weather a fitting metaphor for my outlook on life in general these days. I vacillate between feeling confident and excited about what I’m learning, to feeling slightly terrified and (almost always) overwhelmed with the sheer amount of content we’re taking in. I knew what I was getting into with nurse-midwifery education…but on the long days, I wonder how effectively I’m actually learning all of this…and am I really becoming the midwife I want to be? The reality of 20 minute prenatal appointments is startling. I have yet to see through the fog of my self-doubt that I will ever be able to run an efficient 20 minute prenatal.

Perhaps even more unsettling to me is the question of whether I want 20 minute prenatals to be what my practice looks like. I know that I’m not really called to homebirth midwifery…but 20 minute prenatals feel impossibly short. I just don’t know. In an overburdened system, maybe this is the best we can hope for? Group prenatal care is a wonderful alternative, but it’s often an inaccessible alternative to many of the patients in the clinic where I’m working this term, as we expect participants to come without their older children, and for many, it’s impossible to find affordable child care for the 2+ hour group appointment.

Most evenings I come home unable to really engage in meaningful conversation with my partner or housemates, because I’m either too tired or too busy with homework, or both. I know eventually this will change…but in the meantime, it’s hard to trust that eventually the fog will lift and things will feel easier.  I know so many wonderful midwives who make the most of those precious 20 minute appointments, and I just have to trust that I will be able to do the same. More than ever now, I find myself reaching back for the reasons that propelled me here to midwifery school in the first place–they’re the things that will keep me going, one step at a time.

Scheming and Dreaming (and trying to keep up)

I just want to say thank you to all of the many readers who shared my recent blog post on being an abortion nurse. I have been blown away by all the responses, from other fellow nurses, fellow students, and folks who have been cared for by nurses. It’s been a reaffirming past few weeks.

As an update, I want to let you all know that I’m in the process of exploring creative ways that I can collaborate with others on creating and sustaining this community that we so deeply desire. If you are interested in getting involved or have specific ideas of what you’d like to see, please let me know.

In other news…this term is wild, friends! Patho and pharm are all-consuming, which would be fine, except I have two other classes in antepartum and postpartum care. I’m still trying to sort out how I want to keep all my notes organized, especially for my clinical days. Lab values, common STI’s and treatment protocols, week-by-week reminders on things to discuss in prenatals, new intake forms…there’s so much and it’s all so fascinating.

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I think the hard part right now is pacing. Every week feels like another deluge of information. I know it’s not realistically feasible to integrate it all at once…but when I’m in clinical, I find myself making tons of mental notes: look up that test, read up on this genetic condition, review those STI symptoms…a lifetime is not enough, really. I imagine (desperately hope!) at some point down the road I’ll look back fondly on this stage and how new everything feels.

What were some of the things you found most helpful when you were starting your first clinical rotations? Any and all tips are welcomed, in the comments below or on Facebook!

Midwifery School: Week 9

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I think the last time I posted a weekly post was back in week 3 or 4 of the term…I definitely did not go into this term thinking I’d realistically be able to blog about each week…but somehow weeks 4-8 disappeared into some Black Hole.

In any case…last night I had my last reproductive health lab (wet mounts), and today had our last real health assessment lab (a bit of a repeat on sexual health histories and exams). There’s only one more week of class and then finals…and then a much needed three-week break.

In all honesty, this term didn’t really feel much like midwifery school, which sometimes was really frustrating. Only one of our classes directly addressed reproductive health in any meaningful way. A friend and I were talking about it yesterday, and we realized that somehow between now and June of 2016, somehow we’re going to become midwives. It’s a bit disconcerting how quickly this term went by…ten less weeks that I have available to me to learn the basics of what I need to be a safe and competent clinician. Eek!

I think if there’s anything I’ve learned over the past year of nursing school, though, it’s that patience has its virtues. I know that my experience would be really, really different if I were in a direct-entry program right now. I would have been doing prenatal and intrapartum clinicals already, etc. I have to remind myself that I knew all this when I started this particular path to midwifery…and I do feel I’ve learned some useful assessment skills as part of my nursing education.

That said…I’m already looking ahead to winter term. I’m registered for four classes: Advanced Patho II, Pharm I, and Antepartum and Postpartum Management, which has both a lecture component and a seminar component, in addition to a full clinical day. I’m also helping coordinate a reproductive health elective with folks from the medical school.

Some second years have told us that in the beginning of the winter it will feel like we’re just getting in the way, but by the end of the term, we’ll be able to hold our own pretty well in clinical, mostly running a prenatal visit ourselves. Finally! I’m ready to start feeling more like a midwifery student. There’s only so much of putting speculums in plastic vaginas that feels useful…at some point, we just have to dive in. Just have to wait till January…

Monthly Chai 7: November 2014

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Oh, November. It always creeps up so fast. Somehow, September and October just fly by, with their gorgeous colors and crisp air…and then it’s November, which feels like the Month That Lasts Forever. I must be honest, my friends, this past month has been a challenging one…and while I love Thanksgiving, November is not on my List of Favorite Months. School itself is fine, and work (work! have I even had time to write about that yet?!) is also fine, I just can’t avoid the November Doldrums that come around when the sun slips behind the grey.

So in the spirit of openness and vulnerability, I’ll invite you in to my new office to catch up on the past month, yours and mine. I’ll crank up the heat and put my indoor Uggs on. Tea kettle bubbling, I’ll pour us each a Good Earth Sweet and Spicy tea, brewing it extra dark. I’ll pull up my Miles Davis Pandora station and let you get settled in the new comfy chair.

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After asking you about your month and hearing all the latest news from your corner, I’ll share that it’s hard sometimes, knowing how honest to be about the ups and downs of life. Each person’s journey is so different. I don’t want to make anyone feel like there’s a right or wrong way to go through midwifery school. I will say, though, everyone warned me that being in midwifery school can be challenging not just for us as students, but also for our partners.

Between being super busy with assignments and clinical, never having time to cook dinner or do laundry, and always talking about vaginas at every opportunity, being the partner of a midwifery student is not for the faint of heart. I like to think that B and I figured some things out while I was in nursing school (ie, take-out is a perfectly reasonable dinner option and not just during finals week)…but the truth is, it’s hard work for both of us to make sure that we’re making enough time for each other. Midwifery school demands a lot of energy, and not always just academic. It can be hard to summon the energy to be fully present to the other aspects of our lives and relationships.

I share this not to scare people, but because I think strong relationships, of all kinds, are vital to surviving midwifery school. In that vein, I’m always reminding myself that nurturing those relationships is just as important as the papers and labs and loads of reading…the trick is learning how to balance work and home with awareness and sensitivity. Let’s just say some weeks are better than others. Just when I think I have some kind of routine down, the quarter ends and then we’re back to the beginning again.

Taking another sip of chai and casting a dubious look out the rain-covered window, I’d ask you how you find motivation on the days when it feels easier just to snuggle down under the covers. My regular care routine includes a sun lamp (essential in Oregon!), lots of Vitamin D and adrenal support herbs. I’m also much more gentle with myself in terms of the number of social engagements I commit to attending. November is my month for holing up with a book and some tea most nights per week. Or, let’s be real: just going to bed really early.

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I’d also share how grateful I am to have this new office of mine. After nine years of sharing office space with B, I decided it was time for a room of my own. B works from home and is on the computer/phone all the time, which makes studying at home a challenge. So, with the bit of extra income from my new job, I’m renting a little 8×8 room near work. Most of November has been spent slowly making it my own space. I didn’t realize how much I needed this space until I had it…but now I can’t imagine my life without it. I know it’s such a luxury, especially as a student…but it has been such a gift during this dark, cold weeks. Having such a warm cozy space outside my house makes it a little easier to drum up motivation to get going on the days I’d rather hide under the blankets. 

Pausing to refill with some fresh hot water, I’d share that despite moving a bit more slowly these days, I’ve still got some exciting projects on the burners…between planning our annual Roe v. Wade anniversary event on campus with local medical and law students, stepping into a board position with Nursing Students for Choice, and settling into my own with my job (more soon, I promise!), life is feeling full. It will be interesting to see how this all flows next term when I add prenatal clinic to my schedule (can’t. wait!!!).

Before we wrap up, I’ll share the start of my winter break fun list…and invite you to share what’s on yours!

  1. Christmas Snowshoeing at Mt. Adams
  2. Knitting!!!
  3. Making lots of soups and dishes with potatoes…
  4. Reading, of course! This, and this, and this…to start.

Wishing you a nourishing November, that flows at just the right speed for you. See you in December, post-finals!