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.

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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!

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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!

 

 

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!

On Baltimore

Over the past year, each time another story emerges of police violence leading to the death of yet another black man, I’ve found myself at a loss for words. What can I possibly say that hasn’t already been said?

Partly out sheer anger, frustration, and overwhelm, I sat back quietly on this blog and social media, listening carefully and appreciating the voices of others who somehow seem to be able to give words to the outrage that I know many of us are feeling as a new name rolls across the ticker on the bottom of the news screen: Garner, Brown, Scott, Gray...

Watching the media coverage of the recent protests in Baltimore has once again brought back this feeling…and the questions I keep asking myself are, “What is it going to take to create a cultural change in this country? When will there be enough outrage over the unnecessary, violent deaths of black men and women in this country that it boils over not just into protests, but into policy, into research agendas, and into a universal understanding that it is unacceptable? When will people stop dying at the hands of the very people who are supposedly working to ‘keep us safe’?

This morning I happened across this incredible call to action within the medical community by pediatrician Rhea Boyd:

In the wake of Sandy Hook, the response from physicians, and pediatricians in particular, was astounding. The tragic deaths moved doctors to address gun violence and its health consequences.

But week after week, as black boys who could be my sons and black men who could be my father, are shot and killed by police, doctors remain silent. As a pediatrician, I’m appalled.

We are watching a public health problem unfold in front of us and we aren’t doing anything to stop it.

These words stopped me in my tracks.

We are watching a public health problem unfold in front of us and we aren’t doing anything to stop it.

Yes.

As a future midwife, I place my work in the context of reproductive justice: my role is to serve my community, to help ensure that women and their families are healthy, as individuals and as members of their community. My role is to help reduce the institutional barriers that prevent equitable access to healthy outcomes. Yet we know that rates of preterm birth are higher among African Americans, and that there have been links made between chronic stress and preterm birth.

As Boyd writes, “Like the trauma experienced by war veterans, living under the threat of unprovoked police violence triggers intense emotional and physical stress, even in moments of relative safety. The chronic stress that fear generates may place African-Americans at increased risk for health problems like heart and lung disease, and depression.”

I simply cannot fathom what it must be like right now, or ever in US history, to be an African American mother. I think about my own unborn child, who will come into this world with privileges they did not ask for. My child, for simple virtue of the appearance of their skin, will not have to fear driving in Portland, among the whitest of white cities in America, and being pulled over by the cops for no reason at all.

My child, by virtue of appearing “Asian” in heritage, will be assumed to be intelligent, well-spoken, “safe.” My child will not be unduly punished for minor infractions in school, nor will they face increased risk of being suspended or expelled simply because they cannot sit still and learn quietly.

My heart will only have to bear the average amount of anxiety as a parent when my child starts wandering around the city independently…but I will not have to fear that my child might “accidentally” be shot by police. Such an occurrence would be an outrage, it would be unthinkable.

And this only scratches the surface of privilege that my child will experience.

Yet it’s not what many parents in this country live with every day. As a future parent and a future midwife, I find myself unable to breathe sometimes, I am so angry at the injustice of it all.

What keeps me going is knowing that as a midwife, I will have an opportunity to connect with people during pivotal moments in their lives, especially during the child-bearing year. I hope that I can be a supportive presence for all the pregnant people I serve, no matter what stresses and injustices they are facing during their pregnancies. And beyond the level of individual care, I want to use my voice and skills as a midwife, researcher, teacher, and activist to help shape policy that improves the health of families and communities.

I believe that the midwifery profession can and should be doing more to speak out the public health consequences of race-based violence. I intend to do everything I can to ensure that my professional organization, the American College of Nurse-Midwives, plays a role in moving our country in a direction in which all families can raise their children in safe communities.

 

Let’s Start from the Very Beginning

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If you don’t know me well, here’s something you’d learn pretty quick in getting to know me: I actually really like school, and more broadly, learning new things in general. Back before nursing school started, B would snicker lovingly at the stacks of library books I’d bring home…literally a stack of books, on whatever topic had recently struck my fancy: Italian cooking, pottery, Korean history, permaculture, woodworking…the list goes on and on.

There’s just something addictive about being in that beginner’s mindset. While I love the fact that I’m delving deeper into midwifery (although, I wouldn’t go anywhere near the label “expert” yet!), I find myself wanting to turn to something new, something completely different, something that feels fresh.

Enter adult swimming lessons.

I didn’t grow up in a family that could afford swimming lessons or pool passes, so I learned the poor folks’ swim, which is to say, I can kinda sorta tread water. I can float, I’m not terrified of putting my face in the water…but I really can’t swim at all. After a certain age, it just becomes embarrassing that you don’t know how, especially when half your friends are on the high school swim team. So, yeah, the water and I, we haven’t been especially close.

But, I want Tahini (our nickname for the little bean in utero) to know how to swim…and honestly, the thought of being 7+ months pregnant in the summer and NOT really being able to enjoy a pool were both enough to push me over the edge and into the water. I had my first real swim lesson this afternoon, and people, it was so much fun!

It was refreshing to be taught by a couple of gangly teenage girls who know way more about something than I do. It was refreshing to have to relearn how to do something as basic as breathing (it’s harder than you think to overcome 30+ years of instinctual “in through the nose, out through the mouth”). It was refreshing to think about the possibilities of developing an entirely new skill set and new way of interacting with my environment. And, seriously? Who thought goggles might be such a life-changer? I think, after all these years, that I might actually like swimming!

So that’s what’s new here. Oh, and I went to the Thorn’s Game last night, my first time at a soccer game here in town. That was ridiculously fun, and a great way to release some steam from an intense first two weeks of the term. Self-care, my friends. It’s a good thing.

 

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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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!