Another Year Another Move Another State

We have finally, finally, moved.

Almost a week later than we planned.

After an unexpected trip to the ER for the man.

After much stress.

We are at our new destination.

And now, now, I'm on vacation.

Starting Over

This is our FIFTH across-states move in the eight years we've been married. That's a lot of starting over. And over. And over. It's one thing to move a lot (which we also do) but to move hundreds of miles away is a beast of a different kind. We moved here by airplane, so you can imagine how very little we came with. I mailed my books before we left, but that was about it. We accumulated an apartment's worth of stuff over the last two years and now I am faced with sitting a small fortune's worth of stuff out near a dumpster. This includes a 27inch tv that the pawn shop wont take because all the TVs are being switched to the digital thing in couple months. A tv, a kitchen full of appliances that I actually like, a table and four chairs, a sofa bed, a sofa chair, and everything else a house takes to function like dishes and lamps and electronics... all outside, in the snow, wasted. Some of the items I think we will try to take to a local good will, but we have so little time and so, so much to do I don't know if it's gonna happen. I should make a commitment to make it happen. sigh.

I'm tired of starting over. I want a house, to sit in, to stay in, to live in for the next decade. No more moving. No more cramped studio apartments. No more packing my life into two suitcases and a box. No more buying furniture and then giving it away or selling it for dirt cheap. When we moved in we said we weren't going to get a lot of stuff because we knew this day would come. But still, there's a lot here. Where did it all come from?

Anyway, back to packing.

Sigh.

It's Happening So Fast, Part 3

Our wonderful friends/neighbors came over on Thursday late afternoon and dropped off dinner they cooked for us. I had spent another few hours at the health center getting two of the million things checked off my list that now reaches the entire length of the Brooklyn bridge. It had also snowed like a million inches and I had to walk home... uphill... because the buses had stopped running to my house because I live on top of the hill. Luckily, I ran into a classmate while leaving the health plan who was also about to tackle said hill, so we did it together. I won't say which of us fell, lol. It was cold, and snowy, and my face burned from the little ice pellets flying by. By the time I got home the man had caught a fire under his azz and had actually gotten a lot done in our basement, which of course put me in a better mood. So, right after my last post things turned around a little. And then, yesterday, a friend came and helped the man move the couches down to the dumpster. Those couches (together forming a sectional) were very heavy because they were also a sleeper sofa. They did this while me and my friends (one of whom is the wife of the man who was helping move the sofa) went to eat sushi for in celebration of the end of the semester. And, yes this couple is also the couple who brought us the dinner on Thursday! (all of that to say, they're wonderful and we're going to miss them)

So me and the girls had sushi last night at a beautiful place with bad service but cheap and good sushi. I'm going to miss them and our pow wows. I just kept thinking "this is happening so fast." Not school... that was really, painfully, slow. But now that the semester is over, and my to do list is getting longer and longer and the countdown to when we leave is getting shorter and shorter, it all feels like it's happening very, very fast. I've been getting messages about integration- what to bring, who to meet with when, and tasks that should be completed before I start. This of course adds to the mega to do list (I feel like I should name my to do list something jazzy at this point, lol) but is also exciting because I remember being stressed about whether or not this was even going to happen. My friends talk about how they didn't want the stress of setting up their own site and moving over break and meeting new people in a new setting as their integration experience. I can understand that because this was definitely more stressful than just letting the school stick me in boston or south dakota or something. But the reality is that we all couldn't stay in the area, there were only a few spots here and some of those were taken by people who had been at the same place the whole time they've been here. So I wasn't going to take any chances getting sent off to some unknown place where I still would have had to meet new people in a new office and sub lease my apartment and be away from the man at one of the most stressful (I'm assuming) times of my midwifery education. Um, no thank you. I'll take responsibility for my experiences, even with the added stress that it has definitely caused. This is certainly not the ideal, doing all of this in a short period of time. But being home with family and not having to pay my own way for a while, that's fabulous. The chance of learning my clinical skills alongside a midwife of color- which both of my friends have had the opportunity to do, but I don't know if they really understand how much of a blessing that is, and how much different it is when you never have that as minority student- is going to be fabulous. Not yelling at an interpreter phone all day, fabulous. Being in the city and building connections where I actually want to work, fabulous. I think I need this in order to see myself as a midwife, and when I'm finally there, and can finally breathe and not worry about all that has to be done before I can get there, the stress will no longer matter. Oh and the bonus: not having to move over graduation or while studying for the certification exam. So, yeah I'm stressed, and I've cried about this whole integration madness, and I'm having to pack up fast so that I'm not stuck here for Christmas, but still... I'm leaving and you know? I'm happy. I mean really happy. Happy that I finished this looong leg of midwifery school. Happy that my friends made it through, too. Happy that the man is still here by my side. Happy that I have so many people rooting for me. Happy that my family is coming up for graduation, but really we could all just as easily go on a cruise with all the money it will take :o)

We also talked about graduation plans, but that's like a whole 'nother post.

The Bliss Before the Breakdown

First, I'm done. I actually finished the semester. I don't know how successfully, but finished nonetheless. There was a moment during the exam, at the second to last page, where I didn't know the answer to one single question. 10 questions. All on one page. I just laughed. And laughed. And laughed, sometimes even out loud, but I don't think every one is in their own mental hell and didn't really pay attention or care. I just had this feeling of... bliss. Like, you know? There aint nuthin I can do about the fact that I forget to study hepatitis in pregnancy. I mean I didn't study one ounce of it. The questions were over hep B and C, comparisons of which is more dangerous, ect, whether you get hep c from contaminated water (yes) etc. I knew none of those answers. The other questions on the page were about asthma. ugh. and bronchitis. random. So, I laughed as I looked at that page full of guesses.

And then I turned the page.

Last night I drank something that tasted like a cross between champagne and white wine... it was a German Riesling and it was great. Over the semesters I have developed a tradition for how I handle the night before a big exam. I study all day, then, I stop at a decent hour, somewhere between 9 and 11. Then I usually take a shower and get something ready to wear for the next day. Then I have a drink. A good one. More than one. And I relaaaaaaaaaaax. Then the next morning I look at my one most important sheet... it's titled "I will not go into this exam not knowing:" And has the things that I feel are most important or that I've been running from/skipping over while studying. It also includes lab values, etc that I feel are basic and should be able to answer off the top of my head. I only allow myself one page, and no tricks like writing really tiny. It give me something to say "ok, if I don't know anything else, I know this." This whole ritual has really helped me keep myself in check in that time the night before and the morning before an exam. Of course not much on my list was actually on the exam this time, lol, but I still felt really calm going into it.

Then I got home... and hit a low.

Isn't it weird how one thing in your life can be going so well... or least be done... big cheesy grin here... but the rest be a big mess? Home is a mess. Everything about it.

We have a million things to do before we roll out of here on Tuesday.

And I feel like I don't have any help to do them.

Let me go back a few months. We had this grand plan. The man would stop working on an agreed upon date, and then collect unemployment and pack us up so that when the time came we wouldn't be stressed. There were also some career-related things he wanted to work on while he was off. Well, unemployment never came. Long story short, in this crazy state that we hate, you aren't owed unemployment simply by virtue of working for a few years. You have to seriously be granted it, like by a trial and hearing. After many weeks of BS, a fake azz "trial" wherein he was denied but told to reapply (no kidding) he was not granted any unemployment. So, ok, whatever. I still work, per usual, and we can live off of what I make. BUT this also means that for anything that is not a budgeted item, we are using savings. Ugh. Ok whatever, that's the way it turned out. That's ok. What's not ok is that we're leaving in a matter of days and my house isn't packed. What's not cool is that there was a very short list of things we decided he would be responsible for... over the last three months... and none of those things got done. (If this were his blog, he would say "yet") So I've been standing back because I hate that 'mama' role thing that happens between us when I keep trying to ask about the progress of things, it's like asking "is your homework done" everyday. I also don't like when women ask their partners to do something and then proceed to do it themselves because they don't like how the other person's doing it, so I tried not to do that either. My point is I was very purposefully standing back to let him do it his way, on his time. But, some of the things were time sensitive.

For example, our car broke down like a month ago. This became one of the things on his list of stuff to take care of. I wiped my hands of it because we decided he, who was home all day and not packing, nor working on his own projects, could handle it. Well, he didn't. I started to nag. I said do something. Get it fixed, or get it towed, or donate it to charity (it's not worth anything) just do something. I don't want the city to tow it. I don't want a ticket on it. I don't want to end up paying some stupid fee for something that can be totally avoided right before Christmas... right before we move. What does he do? Nothing. I am running around like a chicken with my head cut off trying to pass my full time school load, my call shifts, and my clinic days, and do my job, and the other random house stuff that is my responsibility- like making sure all the bills get paid to who they're supposed to, and can not/will not deal with this car. Packing and the car = the man's job. Do you see where this is going? Yeah.

So, about two weeks ago, apparently, someone hit our broke down, parked on a residential street, car so bad that they totaled it... smashing the trunk into the midsection of the car. How did I find this out?

Well, on Monday night I opened my mailbox and had a letter from the state. Before I could read past "state vs..." I panicked and thought, "how can I be sued when I'm still a student?" and was all freaked out... until I read the rest and saw that it was state vs some other girl. Phew. So I call the investigator at the bottom of the page. He tells me this woman has hit my car and do I want to add my damages to the other damages in the case. I say, I dont know, let me talk the man and get back to you. I now start yelling about the situation cause I am pissed because I have been asking him to handle this for weeks. The next day he goes to where the car is and, of course, there's no car because the city police have towed it. He is clueless as to what to do next. And this brings me to an ultimate frustration of mine. Why in the hell can't you figure anything out?!?!? So I'm thinking, ok... he's not going to figure it out how to process through these kinds of things unless you leave it up to him to figure it out.

But he didn't take any initiative to figure things out.

So as moving day nears, I'm getting even more frustrated, and of course am looking at the days ahead, and them impending 4-8 inches of snow forecasted for tomorrow and am thinking, I gotta do this myself. He isn't going to do it. And that's when I break down. Right here in the house.

I think of all the shit I have to put up with on a daily basis. And I'm angry that there were two tasks that he had to do and he did not one of them. I have to call multiple police stations because there are a million little cities in this little azz area and I have to find exactly which one towed the car. I have to figure out how to go about paying for all the days that have accumulated from the car sitting there for soooo long as he sat here on his azz. I'm left trying to add these tasks: go to the police station to get the police report to see if this woman had any insurance, call said insurance company if it exists to file a claim, if not, get some money to pay the tow and storage fees, then go find this place and the car (this is after I've called the guy to set up some kind of deal to sign over the car to him so I can get the plates back), return the plates to the DMV- required in this dumb azz state when you cancel your car insurance policy to prove that you aren't driving an unregistered car and to prove to the tax folks that you don't owe them any money because here you must also pay property taxes on your car! I'm adding these things to a list that is already incredibly long and filled with things like: get that second physical, follow up appointment for shingles that cursed me a few weeks ago, stop by student health and get this SECOND PPD read because when I took the time to go get my immunization record yesterday they realized they had LOST the results of the one I had done in August, so "come back on Friday for an accurate set of records," a three hour meeting with my thesis advisor, a meeting with my academic advisor to check out for the semester, pick up a rental car, and on and on and on. And while you're at it, do it all on public transportation. And pack up the house cause not ONE box is really packed. And do it all in, oh, 5 days or so. And while you're at it:

"Can you make me some pancakes?"
"Are you serious?"
"Is that a no?"

Here's the thing. I'm tired. And he's sleeping... all day... most days. I know he's depressed. I know it sucks to be him, according to him, I get that. I understand how he got to this place. I watched it. I know his history. I know how far he's come. But today, right now, I don't give a shit. I'm tired.

I'm tired.

I'm tired.

And I need help. And I'm disappointed that someone who loves me is watching me, or snoring through, me work my azz off and it doesn't at all compel him to get up off his own azz. I'm teary, but they won't come. I think it will come after the move. I think it won't come because I know I have a lot to do between now and Tuesday. I am not at all confused about the fact that it will all work out. Afterall, I know me. I know I will do what needs to be done. But I'm not supposed to have to do it by myself. I swore I wasn't going to do it by myself. But what else am I going to do? There is not time to

Breakdown

Breakdown

Breakdown.

The Liver is NOT on the Left

Yeah. I've reached a new low. While trying to understand the right upper quadrant pain that is associated with HELLP syndrome, I just could not figure out why this pain would be on the right... is it referred pain? No. Of course not. FYI: your liver is on the right side of your body. Now, of course I knew this at some point. But right now my brain is mussssssssssssh.

To top it off I had a so-called annual this morning with a CNM who did nothing but give me a pap and refer me to a physician for the rest. She refused to give me documentation for a physical (understood, because she didn't give me a physical!) but neither did she listen to my heart, my lungs, or feel my thyroid- all of which I have been taught for the last 2.5 years is part of an annual well woman exam??? Ummm. ok. She then preceeds to ask me who is seeing me for primary care. A midwife!! Hello!! It's in my chart that XYZ, CNM is my "primary care provider," yes she does my routine health management, she does all my screenings, she does all my exams, including the GYN stuff.

Now. If I had known that YOU weren't going to give me a full exam, I would have NEVER made an appointment with you in the first place. I would have begged to put into a slot with my midwife. And I do not think it's fair that you will be billing for a well woman check up when all you did was a pap and half hearted breast exam. But I digress.

Where does this leave me? Having to go to the doctor's office yet AGAIN next week to get the annual exam I was expecting to get today. And I have to wait until 2:20 in the afternoon to get it... I was hoping to leave in the wee hours of the morning on Tuesday so that I didn't have to drive 6 hours in the dark for this move. Ugh.

Off to a Good Start

I woke up at exactly 8am without an alarm clock. Isn't it funny how you can mentally tell yourself what time you want to get up and have that happen? I am such a better person in the morning when I get to wake up naturally. This is my last study day, and I'm determined to make it a good one. I cooked a bit pot of ziti last night, got some coffee and tea ready, printed everything I need to study today, and I woke up happy. Within the next 15 minutes I will be fully dressed and walking out the door to the library.

I think I'm off to a good start.

This Is It

The final exam is in about 24 hours. Nothing is sticking and I am of course freaking out. I got a call from my lil sib today who was of course freaking out, and I was so calm and so sure of her impending success, but I can't seem to find the same place of peace for myself. I know I don't know a lot, and it's bugging me. I feel like a fraud. I look at a lab panel and try to pick out the abnormal values and I can't always do it. I ask myself what goes into calculating a BPP and what number am I looking for? And I draw a serious blank. I mean a real... blank. I'm sitting reading the details of multiple gestation and getting irritated at how much I'm supposed to know about stuff midwives barely touch, and how very little I know about "normal." I'm trying to remember the labs I order to diagnose HELLP, and right when I think I know, I ask myself ok, now when the labs come back how will you know if they're normal or not? Yep, back to picking out abnormal lab values.

I don't know what the hell I'm doing.

And no matter how many times I tell people that, they reassure me that I know exactly what I'm supposed to at this point.

I don't buy it.

Maybe I'll learn it at integration when I'm learning it all through real life scenarios, in real time, almost full time for 3 months straight?

It's Happening So Fast, Part 2

We're moving.

A week from tomorrow, to be exact. I can't believe it. The man is packing up the apartment while I study for finals and write my final papers. We're moving home, and couldn't be more thrilled. It was very, very shaky for a minute- turned out that we all of a sudden didn't have everything needed for me to go to integration in January, but just last week it all came together (thank you universe) and I here we are... getting ready to move. This has been such a grueling experience. We've been lonely, away from our families. We've been stressed, dealing with the privilege we've encountered and become a part of. Yes, we've adapted to, and recognize our participation in the privileges that come with being in an ivy league environment. The resources are incredible. I will miss that about this experience. I will miss the buildings, their mahogany and marble and stone beauty and solidness. I will miss the opportunities to go to talks, presentations, receptions and luncheons about a very wide variety of topics. I will miss access to a massive network of information- miss clicking on links that automatically take me to articles instead of pages requesting payments for the right to view. I will miss the 24hour access to a quiet place to study and the door to door transportation that takes me there. I will miss being able to check out books for months at a time... more books than will ever be available at a public library. Yes, I'm going to miss this place. Honestly, what I just described is one of the reasons that I'd love to work at an institution like this. But surprisingly... I've put my PhD aspirations on hold for a minute...

I had wanted a PhD in nursing, but lately I feel like I want it in anything but nursing. I still haven't fell in love with the profession, and I don't think I ever will. After fighting for respect as a midwife (which is a given and something one pretty much expects and accepts as part of joining the profession) I do not want to do the same in nursing. It's too much. While I appreciate the idea that multiple paths/entries into nursing and midwifery allows a larger cross section of women access to the profession, I do not like how much that negatively impacts the way other people and profession view us. I also don't want to spend my entire life in a position or profession where I am & for always will be a "midlevel" citizen. I already feel that... that... smallness... in other areas of my life. It's odd... I thought it'd be different because these are woman-dominated professions. I thought I'd feel more empowered by belonging to them. I thought I'd find the challenges of working within these communities negated by a sense of sisterhood. But that hasn't happened. I find myself wanting to study something different, but similar. Something like public health, or reproductive biology, or health sociology- with a focus on women for all of them. I don't really know.

All I know is that because I am unsure, I can not simply go straight into a nursing PhD program. All I keep thinking is... yes there's a shortage of nursing faculty, yes that shortage is only going to get more and more drastic... but at the same time, we know why there's a shortage, and we aren't that close to solving it... the salaries are not going to reach those of other postgraduate educated professions, despite the fact that we're still paying the same tuition as everyone else... as long as it is a field dominated by women, and women are undervalued in society, the pay is going to continue to be measly... and I deserve better. I've worked too hard. Sacrificed too much. Have waaaaay too much debt. Am simply... unwilling... to give my entire life to a profession that can not give me what I need. But, what I can do, and am planning to do, is define what kind of midwife I want to be with careful thought and investigation about combining midwifery and something else to make the perfect career for myself.

I must put in the effort to create a career that is personalized, fulfilling, and sustaining.

It's Happening So Fast, Part 1

Well.

I had my last class of midwifery school. Ever.

It's surreal. My final is this week, and it's going to be hard, as it should be. But I'm done with classes... like, there are no more... like, I never have to sit through a midwifery class again. Meaning I've almost, actually, done this thing that I set out to do. True, I have all of integration to go... a lot can happen in 3 months (integration is from mid January to mid April) and I have the comprehensive exit exam at the end of it, but that's its own challenge. And of course I have to finish my thesis. But the challenge of sitting through classes every week, both midwifery and nursing classes, is over.

I've been here for two and a half years. I've sat through a few interesting lectures and discussions, and that's much appreciated. I've had people say one small thing that sends my mind into overdrive, excited about going home and reading up on it, intrigued. I've witnessed some very strong midwives juggle research, clinical practice, family commitments, and call shifts all at the same time. I am so grateful to have witnessed this juggle up close so that I can make a better decision about where I want to go from here. I have met talented, bright people who I would not have ever known, and even if we don't keep in touch, I am glad to have met them. I have studied at tables in rooms of buildings where I was never supposed to step foot- with other students who get what that means. I've met the people who conduct the research I respect... people who I would have never met if I had not left home. I've seen artwork other people read about in books. I've been taught by women who are historically respected in this profession- even if I choose to think a little more critically about who they are what they've done. I've had more opportunities than I ever thought I'd have access to. I've been inspired to write about my own life, and the other brown faces that have contributed so much to this profession without much recognition. I LEARNED A LOT ABOUT MYSELF THAT I COULD NOT HAVE LEARNED IN ANY OTHER SETTING.

But I've spent the last 2.5 years in windowless classrooms, sometimes bored out of my mind. I've had a lot people say some of the most racist, non-checked bullshit I've ever heard in a classroom, which left me angry, distracted, and near tears. I won't miss that. I won't miss those disparity statistics being presented without context, that left me feeling less than on so many days in class. I won't miss the blatant disrespect people have for poor people that they don't think twice about sharing because they have no idea that the people they speak of are sitting right there in the room with them. No, I won't miss that at all. I will not miss the assault on my sense of self-worth... the feeling of impending loss of sanity... the acute sense of being distinctly outside of community. No, I'm not going to miss that at all.

Several people said that they got a little sad when they realized we were all together (whole nursing class of nearly 100) for the last time in our last class of the day. I didn't feel that. I felt intense joy. Giddiness. My friend emailed me in class and said she couldn't believe it was almost over! I emailed back "OMG OMG OMG!!!!!" and that's exactly how I felt. So. friggin. excited. So happy that I did not, ever, have to sit through another nursing class. I felt like I could breathe again. After that we had a reception at school. A classmate made some smart ass comment about what was available to me to eat per her usual entitled, judgmental self. Then I let everything I had been wanting to say to her about her comments in the classroom indirectly directed at me and her blatant disrespect come tumbling right on out. Since the moment she looked me in my face and verified that she didn't care whether I graduated with the class or not, I've kept myself a safe distance from her. Everyone had been tiptoeing around this girl, upset at her disregard for the rest of the people in our class- talking over people, answering questions posed to the teacher, and more. Well, I knew it would happen; I knew I was going to blow soon but I never thought I could be so civil... musta been the champagne- I was in a happy mood, lol. So, I drank good stuff, ate lots of chocolate, said what I had needed to say for so long, and enjoyed every minute of it.

Now I'm working on a final paper for a nursing class.

...

I'm exhausted.

On Writing a Thesis, Part 3

Yesterday I spent all day working on chapter 2 (methods) of my thesis, and I still have one more section (data analysis methods) to finish the chapter.

Today I work up to the sound of a metal shovel on concrete outside my window- too early in the morning- got up, looked out and saw snow. I crawled back into bed and haven't moved since. The first complete draft of my thesis is due tomorrow.

I still have the literature review section + results, and discussion to write (or as much of them as I can, considering I'm not really done collecting data yet) by midnight tomorrow. I have a good argument for why the results and discussion won't be done... but there will be no excuse for the literature review, so I guess I can start on that first thing in the AM if I can't pull myself out of bed tonight... this is so sad, and I know it.

But I'm writing this post because it's part of the process. I'm starting to dread writing. It wasn't always like this. I feel like my thesis is crap (the writing- not the data... interviewing midwifery students has been the best part of my semester) and like when it's over I'll want to bury this thing under a rock somewhere far, far away.

I heard it would be like this. I'm glad that I had fair warning. But there really isn't anyway to prepare for the frustration.

In other news, I caught two babies in the last 6 days, and will putting up HIPPA-compliant birth stories soon.

I really appreciate the comments you guys leave! Since I haven't managed to put newer folks in my sidebar, everyone please pay Giyen at baconismyenemy a visit- I am a dedicated reader of hers now.

On Writing a Thesis in Midwifery School, part 2

I've been away cause I haven't much to say. It seems like all my thoughts lately are about how tired of school I am and about how much I have to do and I fear those are very boring things to hear to most folks. But then I remember the purpose of this blog is to tell the truth of midwifery school, so I really should write more...

Today, and tomorrow... and the next day, and the next... and the next... I will be working on my thesis. Specifically, working on finishing a complete draft, which is due by Monday. I have exactly one chapter... and three or four (depending) to go. I hate school right now. Today so far I have typed out a transcript of an interview (like 10 pages single spaced) which is a kind of torture I don't wish on anyone who isn't getting paid a handsome sum, and tried desperately to finish the methods section (chapter 2) which is close to being done, but isn't there yet. I keep staring at the pages like they're going to write themselves. Wishing they would write themselves. If I had this to do over again, I think I would do a survey monkey and call it a day... but then again, the live interviewing was the best thing ever. I still have a couple interviews to do... so my analysis section is going to be the roughest of all as I haven't collected all the data yet.

I spent the first several hours in a beautiful library, but now I'm in the grad school cafe... but it's getting noisy so I'm considering a move to a library... but I'm hungry because although I've had like 6 cups of coffee and a croissant and a muffin and a nutragrain bar, I haven't had any food. I think I may have to go home and regroup. But I know that if I do, I won't get anything else done tonight... not that I'm getting anything done write now...

UGH.

I hate school right now.

Yesterday I caught a baby girl... oh crap I need to turn in an eval for that birth... sigh.

I need to find time to study for my advanced midwifery final... and do a case analysis that's worth 50% of my grade... and a take home professional midwifery exam that looks like it will be at least 10 pages before it's over... and create a portfolio for the same class...

slooooooow dowwwwwwwwwn minority midwifery student

one thing at a time...

THESIS.

Oh yeah, that's it.

That's what's due first.

How many hours left? Oh about 500 hours of writing but only 125 or so to do it in.... and 8 of those will be spent in class tomorrow.

What was I thinking when I signed up for this?

SOS

I get to go to clinical today. Woo friggin Hoo. It is supposed to be my last day of prenatal/gyn clinical, and I so truly hope this is the case. (She has the option of having my come another day in a few weeks in December) I could really use any extra days in December to take call for labor patients.

In other news:

I got an SOS email from an underclassmen... I reposted two posts from December of '07 for her. (over in the archives) She thinks she's going crazy. I remember that feeling quite well. I don't feel that way as often as I used to, but sometimes, when things get crazy, that sense of "I must have been crazy to think I could do this" creeps in. As this semester narrows down, I feel it more often because I am in my last ever midwifery classes and I of course don't think I know anything. But I want her to know that she isn't crazy. She isn't losing her mind.

She's just in midwifery school.

And it aint no ways easy.

I Want to a Start a Petition...

that says NO MORE STUDENTS until you can comfortably educate the ones you have... NO MORE STUDENTS until you have clinical placements for them all. NO MORE STUDENTS if that means any less clinical experience... NO MORE STUDENTS without first really investing (and I don't mean just money) in new midwifery faculty. NO MORE STUDENTS UNTIL MIDWIFERY EDUCATION PROGRAMS CAN SUPPORT THEM FULLY.

The following is an excerpt from the current (until last week!) president of the ACNM who just resigned and sent the members a long email about her departure, and what lay ahead.

The ACNM strategic plan calls for midwives to be attending 20% of the women giving birth by the year 2020. I estimate that we will need 14,000 practicing midwives by then. Without a plan for producing these care givers, we are “sounding brass and tinkling cymbals”. Last week I spoke with the educators and the service directors as they met in Washington about this need. I asked them to think out of the box about developing a plan for doing this. Each and every one of us needs to think about how we can do it right now. Brainstorm ideas and communicate them to headquarters through your Chapter Chairs and Regional Representatives. Believe that all things are possible. When you talk with nurses, accentuate the positive and eliminate the negative about a career in midwifery. I know that every one of you would not have changed your choice to become a midwife. Use the Cochrane Review recently put up on the ACNM website and the cost-benefit study of midwifery education that will soon be released by ACNM. If 40 programs just admitted 25 students each we would have the potential for graduating 1000 students annually. We need to do this NOW. If nurses do not step up to the plate we need to look more at direct entry. There are young people wanting to be midwives and we need to open the opportunities for their education. Every practicing midwife needs to be involved in nursing education for nurses to understand the need and the career opportunities open to them in midwifery. This window of opportunity will not be open long.

Again:

NO MORE STUDENTS UNTIL MIDWIFERY EDUCATION PROGRAMS CAN SUPPORT THEM FULLY.

I agree that we should support direct entry programs, but not because nursing "isn't ready." We should support them because they are equally effective sister midwives, period. Honestly, I don't even know how it is possible to have this conversation, this email, a strategic plan, about educating more midwives that does not first seriously address our faculty shortage and inadequate clinical space for students. Maybe this isn't a problem in every state, but from my understanding several schools are facing the same issues.

There are 16 people in my cohort and we're struggling... 25? 25?!?

No thank you madam president, no thank you.

Now... loan repayment to encourage me to become an underpaid, overworked midwifery faculty so that we might one day be able to accept 25 students per program?

Yes please.

As soon as possible, thank you.

Pity Party

I am tired, overwhelmed and sick.

I have two presentations to give this week, one on ethics and the other on some topic in black midwifery. My ethics presentation is done. I'm working on my black midwifery project now.

All I want to do is crawl into bed and go to sleep.

I have clinic tomorrow and it's supposed to be my next-to-last day, but there is a potential extra day built in if she wants me to take it.

I also have what feels like a mountain of random paperwork to do over the next few days that I am dreading.

Our car broke down on my way to the grocery store to remedy my empty refrigerator... just in time for the last 6 weeks of school, after which we were dumping it in the nearest junk yard.

Countdown to 5PM, end of semester:

37 days

909 hours

54589 minutes

3275355 seconds

Not soon enough.

Every Time I See Them Together

...my heart swells and I unintentionally gasp... there are black people... loving each other... on national television.

...I think about this journey that me and the man are on... about the stuff we've seen... we've done... we've experienced... together.

...I am sure that there is no safer place for him to rest his head, his heart, his hopes.

Minority Midwifery Student...

is taking it all in.

November 4, 2008

I have to write this before I go to sleep. We woke up and I put on my Obama tshirt that I got from a skateboard shop. It was a beautiful morning for November. The sun was shining and it was warm outside. We voted by absentee ballot mailed overnight express to Omaha on Saturday, November 1st. We headed to the mall to find T an Obama shirt to wear tonight. We went to the summit of East Rock to take in the view. Then we came home. We stayed home for a few hours, eating nachos and drinking homemade mixed drinks. We played around with this map on CNN where you guess which states each candidate is going to win. We kept saying, "he's going to win... he's going to kill it, there's no way McCain will be able to do it." We watched each state... we saw him win Pennsylvania. We saw him win Ohio. We saw him win Virginia. We saw him win Florida. We saw his electoral votes rise and rise and rise. But we weren't sold. See, we would not, could not, allow ourselves to believe it until it was really over. We kept saying "how will they cheat us out of it? What are they going to do? They are not going to let this happen." But then we said, "this is happening and we gotta get out of here, out of the house."

We had to leave, had to get to our people. I talked to my daddy, and then on the bus on our way downtown, I talked to my mama. We went to a party at Hula Hank's that was sponsored by Hot 97.3 and the NAACP. They payed no attention to the fire hazard policy. They let black people in the doors until we spilled out the doors. We stepped on each other, over eachother, and around eachother, no problems, no worries, all love. It was the first time we had seen so many black people in one place, in one spot, on campus. It was beautiful. We got drinks. I screamed so much I almost lost my voice. Over and over again the dj kept saying "we have a black president, we have a black president" like he couldn't believe it, I couldn't... can't... believe it. He kept reminding us that this "is it" and that we are family and if there ever was a day when we needed to love each other it was today. Today we made history happen. We voted in droves. We waited in lines that wrapped around buildings- some people for hours. Hours. They played hip hop all night...2PAC, Nas, everything. And not just between punk and rock and techno. Black fists in the air to Marvin Gaye's "Wake Up," perfect, wonderful black people's music playing nonstop... then McCain came on the screen and the dj said "I think this is it ya'll, he's giving up!" They stopped all the music and we listened. We could not believe what we were seeing on the big screens in the bar. He gave up, graciously, saying "CLEARLY the people have spoken." YES WE HAVE. YES WE DID. Then he... Barack Obama... our president... OUR FUCKING PRESIDENT... came on the screen...and we went crazy. My God. Black people hugging eachother, being nice to eachother, loving eachother. I was and am so fucking happy to have seen this in my lifetime. We listened to him speak about the century of history the 107yr old woman voter saw in her lifetime, and were moved. The moment he acknowledged his wife... that was it for me. That was the moment. I don't know why that was the moment. I don't know why that meant more to me than anything else. All I know is when I heard him say it, and then when she and Sasha and Malia eventually came out I was so intensely, insanely, overwhelmingly happy and proud. I couldn't even cry, it was like a state of emotional overload... then he kissed her. OMG. My heart melted. I turned and kissed T. All was right with my world right then. I felt like there was nothing, NOTHING, that could get in the way of what we're trying to do. If they could make it up there on that stage, we can surely do whatever it is that we dream of. Together, who can stop us? After seeing that, I kept thinking who dare stop us? Bring it on.

Helen texted me to say there's going to be hair grease in the white house now. I giggled and stomped my feet. Grease! In the White House! We texted back and forth for about 10 texts each. I can't call my grandma because it's too late.

On November 4, 2008, we elected the first black president of the United States of America. I was there. I am here. I voted for this man. On November 4, 2008 I celebrated the most important moment in history while on the campus of Yale University where I am a student. I am a student at Yale University... I voted for Barack Obama... I saw him win. For my ancestors, who never had the chance... for myself because I wasn't supposed to have the chance either... I voted. And my vote counted. And T's vote counted. Our vote counted. And it wasn't even close. We fucking blew it out of the water and then, from New Haven to Kenya, we partied in the streets.

God willing, this is what I shall tell my children.

Overheard As I Walked into Walmart

"Oh! There's your midwife!"

It didn't register at first...

Eventually my eyes focused on the couple standing in front of me and I recognized a woman I did a prenatal visit for, and who I triaged a couple weeks ago. She ended up delivering two days later. Her partner was excited to tell me that she waited until the very end to come in and she "didn't even get an epidural." She was so proud of her, and so was I.

I am still smiling (and shocked) that tonight, for the first time in public, somebody called me "their midwife." I don't know if that's weird, but I didn't really expect to have this experience. It makes me wonder how much better it will be when I have continuity with patients in a community that I call my own...

Tonight, without even having caught her baby, someone considers me her midwife.

I feel good.

A Productive Monday

I have a lot to do today (as I do every day)... It's a good day to provide a list of tasks that exemplify what midwifery school is like...

• Renew my CPR certification (past due, got a "turn it in NOW" email!)
• Put the finishing touches on a paper for class about health care policy and leadership (due now)
• Turn in a mock letter to the editor (due this week)
• Start my midwifery professional issues presentation (due next week)
• Start my midwifery ethics project (also due next week)
• Email the new participants of my study to schedule interviews (a week behind because I dropped everything to study for midterms)
• Complete an eval for my last clinical session and email it to the preceptor
• Turn in a copy of my exam to prove I competed the required online fetal heart tracing review course

It seems like it never ends, but I swear the end is in sight. There are only 7 weeks left in the semester, and that includes the week I'm taking off for Thanksgiving!

I'm almost there.

I'm almost there.

I'm almost there.

Sometimes you just gotta encourage yourself. (link)

Voting, Hip Hop, & Partying (Surface Only)

I am Panera, writing a paper. Trying to, anyway. This is a distraction. Hopefully when I finish this, I can get back to my paper... I'm just not in the mood to write about nursing leadership.

I mailed our absentee ballots by overnight express mail this morning. They'll get there Monday, one day before they're due. It was so cool to review politics with the man. Looking up every candidate, reviewing their histories, where they live, and what they're claiming to be passionate about. Calling people who work with these people and asking them what they think (things like who's going to lead the power companies and community colleges, etc) I don't talk politics on this blog. Basically because I'm not all that interested.

I understand the smoke and mirrors of this so called democracy that has really been running like a dictatorship. But I vote anyway, especially this year. Because you gotta have hope. Like love, there is nothing left without it. After you find truth, and are all but mentally squashed by the negativity of what’s really happening in our world, you must find hope. Otherwise, you just close the shades, stay in the house, and die a long miserable life in the dark… in truth… in pain. Nah, I chose Hope. Between the two, what the hell do I have to lose? Rhetorical.

We’re debating whether we’re going to a brown folks party on campus on Tuesday. It would be so, so nice to go to a party where we aren’t one of a few in the place… so, so nice to hear hip hop on full blast, all night, instead of sprinkled between techno (which I hate) and rock (which I tolerate) and pop (which is ok). The hip hop they play between those songs is always the radio kind. Right now, I’m loving some radio hip hop, too, specifically the new T.I. album (yes I mean I love it, as I did another of his albums... you'd have to understand how confident it makes me feel to hear rap music- how invincible... "no one has a swagger like mine"and I'm gonna "live my life" wait a minute, you know what... I'm going to compile some lyrics that have been getting me through my last weeks here... yes I know, rap is so bad, please don't lecture me about sexism, I get it... we have a love-hate relationship) But Tuesday there’s a greater chance that I might actually get to hear some Blackstar, or Outkast or something. These are popular hip hop artists, too, but they don’t make the radio very often. So, we’d love to experience that before leaving this place, but there’s also some racist crap going on in the city involving another university around the road and of course our university has it’s own history of issues. So we’re thinking… do we really wanna deal with all this on Tuesday, or do we want to stay in and watch it unfold on TV? (The party has the potential to be easily targeted because it’s being thrown by the NAACP at a popular club downtown, on campus) I’m in the mood to party, but I currently have such a low tolerance for any drama.

Talk Back & Clinical Guidelines

In response to comments from previous post...

[::] I think I learned to never rupture before zero station, for fear of cord prolapse, except in emergencies.

[::] No, we don't have continuity of care. We technically can have it with 1 patient I think, but because there are really very, very few call shifts in any given month, it never happens. (For example, I have two, yes, two, call shifts for the entire month of November.) So I gave up on even trying to have my 1 possible continuity patient.

The ACNM has provided the following clinical guidelines as an educational program resource, and they make sure to point out that these are not the requirements for individual students to achieve competency. In other words, achieving these milestones do not guarantee you graduation, nor does not reaching them prevent you from graduating. Nonetheless, I compare my notes to these nonrecommendations to see where I stand. Already, I know that I am lacking in the number of births I should have by now, mostly because of the clinical crisis? lull? we're experiencing. Here's the breakdown (the ones I've completed already are bolded)

a. 10 Preconception care visits
b. 15 New antepartum visits
c. 70 Return antepartum visits
d. 20 Labor management experiences (maybe... need to check)
e. 20 Births (6/20)
f. 20 Newborn assessments
g. 10 Breastfeeding support visits
h. 20 Postpartum visits (0-7 days) More than halfway there...
i. 15 Postpartum visits (1-8 weeks) I think I'm close...
j. Primary care visits:
-40 common health problems
-20 family planning visits
-40 gynecologic visits including perimenopausal and postmenopausal visits

All of this to say, I really need to catch some babies... (as does the majority of my class) and if it doesn't happen in the next month and a half, I have a whole lot of catchin' up to do at integration... Happily, I've reached the other milestones before even leaving for integration.

For those interested, the NARM requirements are below:

Experience Requirements

I. As an active participant, you must attend a minimum of 20 births.
II. Functioning in the role of primary midwife* under supervision, you must attend a minimum of an additional 20 births:

A. A minimum of 10 of the 20 births attended as primary under supervision must be in homes or other out-of-hospital settings; and
B. A minimum of 3 of the 20 births attended as primary under supervision must be with women for whom you have provided primary care during at least 4 prenatal visits, birth, newborn exam and 1 postpartum exam.
C. At least 10 of the 20 primary births must have occurred within three years of application submission.

III. Functioning in the role of primary midwife* under supervision, you must document:

A. 75 prenatal exams, including 20 initial exams;
B. 20 newborn exams; and
C. 40 postpartum exams.

*The primary midwife has full responsibility for provision of all aspects of midwifery care (prenatal, intrapartal and postpartal) without the need for supervisory personnel.

Talk Back

In response to comments from previous post...

I think I learned to never rupture before 0 station for fear of cord prolapse

Yay!

Bellytales is back!

I'm so friggin happy to see her return.

The hemorrhage post is a great read for midwifery students.

I Never Talk About Births... What Kind of Midwifery Blog is This?

I hardly ever talk about my catches/ clinical experiences...

LadyA: Young, obese (actually she had my BMI which really bothered me), having baby #1 with family (mom, older sister who raised her while single-parent mom worked outside the home, and equally young father of baby) LadyA was on the unit when I arrived. She was induced for "post dates" at 41 weeks... and I highly suspect that she had an unfavorable cervix when they did it. In the beginning of my shift she was coping well with the contractions (she also wasn't really feeling them) She had been counseled during prenatal care about pain management and she wanted to try to avoid medications. Our unofficial policy is to explain all the pain med options with side effects, risks, and benefits on admission to labor and delivery so that the woman doesn't have to understand the risks/make these decisions in the middle of intense contractions, and then if they don't want anything we put everyone on alert to not offer anything unless the woman herself brings it up first. So she decided at admission that she wanted to try non-epidural medications first if it came to that. and she would let us know (rather than us asking her) So when the contractions got a little more intense, she started asking for an epidural but we reminded her of what she said she wanted initially. She said she changed her mind, so an epidural was placed.

So it's around 11am and she's 3cm/85% effaced/-1 station... unchanged from when she was induced early that morning. She has pitocin running at 4mU/min. Baby's heart tones start to get funky... a prolonged decel occurs, which leads to the midwife breaking her water to place an internal fetal scalp electrode, especially because it's harder to keep the baby and contractions on the monitor on fatty girls. This becomes more important when there are decelerations of the baby's heart rate because you need to determine whether they are variable (ok) or late (bad). Otherwise, it's not a good idea to break someone's bag of water at 3cm and definitely not at a -1 station.

Hours go by... still having funky decels, another one is prolonged x 4 1/2 minutes. The pit is turned off (it was at 8 by then), o2 is given again, she turns on her side... throughout the day, she has two boluses of epidural because she has a "window" of pain on her right side above the thigh that she rates between a 6 and 8. Eventually an IUPC is placed, and after that we try amniotic infusion- the 30 minutes after that gave us her most beautiful tracings of the night. But it was soon over, and back to her normal funky tracings.

The dilemma: Her contractions were not effective... MVUs of about 120... usually the pit is increased when this happens... but her baby did not like pit AT ALL... and then even with the pit off, the tracing took a long time to resume a more reassuring status.

And then, the family/nurse issues. We have a very specific guest policy concerning # of guests allowed on labor and delivery. And it's non-negotiable, unless you appeal in writing prior to arrival to the hospital. And once you select the people, you can not change them (so no taking turns) This patient had another sister who was denied entrance to the floor. It was not a pretty situation. Patient's family is arguing with the nurse, nurse is arguing back (and honestly being very rude and non-understanding about the situation which just made everything worse) and eventually the nurse is switched to another patient. The nurse was in the right, she was enforcing a policy, but her attitude was terrible. She complained to us that the patients were speaking Spanish to their family on the phone and she couldn't understand what they were saying but she just knew it was about her and her insistence that the sister couldn't come in. That was probably true as this family was very upset, even after I explained the policy to them again after the nurse left. But, come on, don't stoop to the angry person's level- you're the professional.

So anyway, after 12 hours our shift was up and we transferred care to the oncoming shift... of OBs only, no midwives on after us. When we introduced them to the patient it was obvious that a section was imminent.

LadyB came into triage a few times before being admitted. First time I sent her walking (multip with stretchy 3cm cervix looking very uncomfortable. She came back a couple hours later- no change, contractions still hovering at 7-10 minutes. I sent her home because she lived close and said she had a ride (who was there with her when I asked) and told her to eat, drink plenty of water, take a shower and a nap, etc. Told her it would probably be soon. Well she returned about 6 hours later, in active labor (6cm, contracting every 3-4mins, not able to talk through contractions) The nurses were irritated because she arrived by ambulance and obviously birth wasn't imminent. Well her ride ended up backing out and she didn't think she could walk to the hospital (her partner and children walked over) But such is life. So I admitted her, and the nurse gave her a nubain/vistaril combo (what she asked for and had with all of her previous deliveries) and she slept very peacefully between contractions and barely woke up during them. It worked great for her. She got an IV because she was GBS positive. When it was time for change of shift she was 8cm with a bulging bag and saying it was time. That's when we left.

I hate this about being a student. When the preceptor leaves, you gotta leave. I wanted to stay. She was sad we were leaving. I was shocked... well maybe not... that we were leaving when she was this close. Midwifery educators are so overworked though, so I get why they aren't as apt to put in over time. I'm hanging my hopes on the idea that real life won't be like this...

So, 12 hours, 2 patients, no catches, but a whole lotta learnin... my life as a midwifery student.

Talk Back

I love that I allow anonymous comments, I think it allows people to speak freely.

This comment was left on the last post about privilege at the library.

Why make it into a male/female thing? Maybe he was just asking to see if your smaller party could move. Or maybe he's just dumb. But don't get all feminist on him....and this is coming from a girl. We've got enough real issues to be mad about the sexist divide without drowning them out with somewhat over the top assumptions...

Here is my response...

I actually didn't think it was one kind of privilege more than another kind. It could of have been male privilege, it could have been white privilege, it could have been class privilege, it could have been all of three combined. It could have been none at all. I didn't "go" anything on him, because I didn't say any of that (male/female commentary) to him. And while I only listed the gender commentary at the time, believe me there was also racial commentary going on in my head! (And I'm sure if I would have wrote that down someone would have said "why does it have to be about race? lol)

I only said that they couldn't have the room. And, real talk, he was not entitled to it anymore than we were... and, after being here for nearly three years, I am very aware of the sense of entitlement of many of the students here. It's rude to walk into a private study session and expect people to leave so that *you* can study. I'm not going to pretend that I don't think race or gender plays into these situations. The real/bigger issues of feminism are only smaller issues working on macro levels. That is, the same sense of entitlement that makes you think we should move for you (the smaller issue) is what eventually leads to you behaving as though you have more rights than me (the larger issue.) I believe that changes in personal thought patterns lead to larger social change.

Is it daunting to you that I would think all of this from a seemingly simple interaction? Would you have responded differently? Do you tend to give people the benefit of the doubt in most situations? If so, why do you think you do that?

Rhetorical really, just thinkin...

Thanks for stopping by.

Privilege at the Library

I made it to the library... two hours after I had planned to arrive. My study partner and I were in a study room, when in walks a guy and his friends asking if they could have the room for their group. Ummm. Well...

My study partner: "mmm"

Me: "Do you have the room reserved?" (It is possible, though not common, to actually reserve the study rooms for your group)

Him: "No, we just have a lot of people and need a room."

Oh, in that case...

Me: "we are actually studying here, so no that won't be possible."

Hello!?! My study partner graciously told them where she had saw another available room before we settled on this one. Do you think they went to see if that empty room was still available? No, of course not (unless they went later)

Not today, brutha, not today.

My girl self is not required to give up study space for your boy self... I am equally allowed space in this place.

Blogging Through a Headache in Procrastination

I have a lot to do school-wise today. I have papers to write, thesis stuff, and at least a micro study before clinical in the morning. I was not anticipating going to clinical in the morning, so studying for that was not something I planned for until today, unfortunately. I always wonder if other students feel this drowning, sinking feeling I do about how much there is to do, and how very little I actually know about women's health, labor and birth and beyond. One of my struggle points is the patho/physiology of all of it. I can read it over and over again, but it doesn't stick. I really, really do have a memory problem, but there's no explanation for it. My daddy has a terrible memory as well... but I guess he's allowed because he's getting older... and he isn't responsible for anyone's life. Last time I had blood testing, my thyroid was fine and my vit B12 level was normal. But still I am always tired and I can't remember crap. But I have never been able to remember things like this, even as a child, so maybe this is just me. I wonder if my residency preceptor is kind?

Anyway, my point is I need to update/improve my black book for school/clinical because if I can't remember this stuff I at least need to be able to find it quickly. So add that to the list of things to get done today. And to top it off I have a massive headache that just wont quit.

Afternoon Plan (maybe writing it here will help me stick to it)

• 12:30 Paper (very short) for Professional Issues class
• 2: Data Analysis section of my thesis
• 5: Organize the binders of two classes causing me grief
• 5:30 Pick a nursing leader to analyze for a paper I'm writing later in the week
• 6: Head home to review for clinical in a comfy spot on the couch with something warm and possibly spiked

In other news, this weather is really taking a toll on the walking regimen that I so successfully started this summer. I'm also drinking a lot more coffee and cocoa, which isn't a good thing, as more coffee and cocoa equals more sugar- especially since I tend to drink them with a donut, muffin, or bagel in the other hand. Sigh. I also cook less and less now that school's back in, and the food prices are so freakin high. Me and the man can eat out for less than we can cook... unless we're cooking with a lot of rice or pasta, which is really not the ideal situation. I've also taken a play outta the man's playbook and been eating frozen meals, which I HATE. But they're so quick. Midwifery school this semester + increasing frequency of bad habits = expanded waistline sure to follow. And what's worse? I crave smoking. isn't that odd? I'm not really a smoker, but I do smoke every now and again from the man's stash. But lately I've been really wanting to. Ugh.

Post-Midterm Exhale

The midterm was tough. But of course it would be. I'm glad it's over. I actually ended up going to sleep the night before for about 6 hours, instead of studying through the night, and I am so glad that I did. We still had class after the exam and I had class the rest of the day, too. I needed those hours to be able to function.

Today I went to the bookstore to browse and have a treasured marshmallow mocha latte. I browsed a book on taking risks by Ben Carson, and was so grateful to have found it. He talks about where and how he grew up, and how going to college at ivy1 was one of biggest risks he would ever take in life, among others. He talked about how at first it was just a big deal to actually get to the ivy league schools, but in his first semester he realized that the real challenge was going to be staying there. He realized he wasn't as smart as he thought he was... that the ivy kids were much smarter... that the SAT scores that he once thought were stellar- because they were record breaking for the public school district in his city- were below average... were the lowest of anyone at that table that day...

I remember that realization, too. It wasn't exactly the same because I was never under the impression that my scores were stellar, but I do remember being very shocked. Sad. Frustrated. Down right teary at the fact that I was... am... so far behind everyone else based on the drastically different educations between me and most of those who are able to attend this institution.

Then he talked about being at the bottom of his class, and how he wasn't an auditory learner, and how he had encountered an advisor who suggested that he wasn't cut out for medical school. No one has said this to me at school, but I have received my share of "you're failing and maybe you should leave" letters. Same premise, but much more cowardly in my opinion.

Anyway, all of this to say, it was great to get all of that from like 10 pages of a book... the feeling of familiarity... the encouragement from seeing that someone who has faced even more than you have, has been exactly where you are standing and came out on the other side... and not just made it, but turned out be Ben Carson... is so useful.

It was exactly what I needed to give me the faith to push on for the second half of the semester. This is it folks. I have only 1/2 a semester of classes left in midwifery school. I just have to hang on, and finish strong. I can do this. I can do this.

The man and I had a special dinner tonight. We needed to reconnect. I'm glad we took the time to make it special, otherwise life gets old, right?

My next countdown is to our trip home to my family's place this time.

Midterm Madness

My midterm is tomorrow, so today is a non-stop study fest. (Yesterday was a failed non-stop study fest... I did manage several hours though!)

When I was relearning the shoulder dystocia material I was so completely shocked by the Zavanelli Maneuver... wherein you put the baby's head back into the vagina. I just kept re-reading it like no way... there's no way... just in awe, lol.

Now I'm relearning breech delivery and I am equally astounded by the maneuver wherein you allow a baby to simply hang from the vagina for a few seconds if you couldn't reach the chin of the baby to flex her head. Here is a great pictorial (with commentary) of a vaginal breech delivery... it's the first place I've seen good pictures of this step in vaginal breech delivery. I am freaked out by the pics of the baby hanging there!

I can not see myself doing vaginal breech deliveries on purpose, although I have absolutely no problem with referring a woman who wants one. But at the same time it reminds me of "without providers, there is no choice." I have a very clear stance on believing in woman's right to choose abortion- meaning I would provide abortions if in the position to do so... but what about breech birth? If there are no providers willing to do it, there really isn't choice (with a skilled professional available), right? We don't spend much, if any, time discussing these issues in midwifery school... we spend our time with the science and the skills... which, honestly, is overwhelming in and of itself, so I understand. But I can only hope (and, really, I think it's the case) that my peers are thinking about all of these things in their own time as well.

I am dreading/stalling on bleeding and infections... sigh... I need an outdoor break and pep talk, then maybe I'll be ready....

On Writing a Thesis in Midwifery School

I had another interview this morning. I was encouraged by hearing this student's experiences in her program. She has faced a lot during her midwifery education but continues to push forward... quite amazingly. I can't wait to transcribe this interview and see it in print.

I don't write much about the process of writing a thesis. I had initially intended to write about it regularly so that people could see what the process (or at least my process) looks like. But I guess because I'm writing it while also taking a full course load (unlike how it is normally done in the humanities wherein you usually set out to write it after all of your classes are done and you can give it your full attention) and because it seems like a boring process, I haven't been writing about it at all. Collecting the data (interviewing) isn't boring- that's the exciting part, but writing down the methods and analyzing the process is all a little dry to me right now. However, I think it's really important for people who are considering taking on the task to have an idea of how it works, so I will start to write about it a little bit here.

First, in the beginning...

At our school, no one has to do a thesis. Everyone has to do something, but it does not have to be a thesis. You can do a literature review... a term paper... an artistic piece, etc. Actually, few students actually do a real thesis. I decided to do a thesis because I'm going to get a PhD after this and I didn't want to apply for a program without a thesis under my belt... I think it proves something. And for the last few weeks, I have been thinking that another plus to doing a thesis is that it may be easier to convince a program to let me do a secondary analysis for my dissertation since I have already learned/been through the whole primary data collection scenario. Also, I simply couldn't imagine leaving this institution without a hardbound thesis... I mean this is a research institution! How dare I not take full advantage?!?

So, I'm writing a thesis. The topic was a no brainer for me... I never found much about the experiences of black midwifery students, and according to my own experience I knew we had a story that needed to be told. Now, if I were just one year later coming into this program, my thesis could not have been done... the new rule is that you can only do a thesis that is a branch of a faculty member's larger ongoing research project. I take issue with that, but it doesn't affect me, so whatever! I'll let the next class fight the battle for why they can only research the stuff that's important to their professors... with very few faculty of color, there are bound to be some things (ie my topic) that no one is currently researching! I hope they find some topics that are at least close enough.

So you pick a topic, and a project type (thesis), and then you look for a (thesis) advisor. At my school, there isn't a whole committee, only one advisor. This is great because the fewer people who read it while it's being written, the fewer people you have critiquing it = the fewer changes you have to compromise on making. I suggest you look for an advisor as soon as you have an inkling of a topic. Don't wait to the last minute... each faculty member can only advise so many students, and you don't want to be stuck with whoever happens to be left. You can pick an advisor based on on many things:

• 1) Topic match. You choose this person because they've researched something similar to your topic and will have a lot of info to share with you which will cut down on your leg work. They will be able to point you to seminal texts and authors which will save you precious time. You know they'll have passion for your topic because it is what they've decided to spend their career thinking/talking/writing about.
• 2) Methodology match. This person may not know anything about your topic, but they might know a whole lot about the methodology you're using. For example, I'm doing qualitative work, specifically, interviewing people. It doesn't matter what I'm interviewing them about, what matters is that my advisor has spent years working with this type of methodology. So she knows how to conduct it, how to analyze it, and how to write it up. In this case, it isn't about the topic, it's about the method. (This is what I chose... and I had to make sure that she believed in my topic... I have no time to convince people that our voices are worth hearing... not right now!)
• 3) Personality/needs match. This happens when the advisor is just a good advisor, period. It doesn't matter the topic or methodology, she knows how to get you through your project smoothly, and on time, based on her ability to motivate you and point you in the right direction. If you're a procrastinator you may choose someone who has very rigid deadlines who's going to push you to the finish line. If you're very hard on yourself/perfectionist, you may need little direction but choose someone who's a little more laid back and who encourages you that "yes, that chapter is complete, move on to the next one!"

The most important thing is that you finish the project. Yes, quality is important. But in a program where a thesis wasn't even required, and they make you write it with up to seven classes going on at the same time... quality is going to be subjective, ya know?

So the next step, for me, was a review of the literature. Go here to read all about that process. I suggest that you keep an annotated bib along the way, otherwise you'll be frustrated by not remembering if you've read stuff, or forgetting the point of what you read, or forgetting why you thought it was good in the first place!

So that's it for now. Next time I write about it, I'll be talking about the IRB process.

In other news, I've been studying for my midwifery midterm. It's a lot of information of course. I feel like I have a good handle on VBAC, shoulder dystocia, active management of labor, and antepartum bleeding. That leaves a lot left uncovered! I have study group from 6pm to midnight tonight... what a long night I'm in for.

I went to see The Secret Life of Bees yesterday. I was so distracted by the darkening makeup they used on Alicia Keys. Ugh. We come in maaaaaaany shades, why did they feel the need to darken her skin so much?!?

I'm going to see The Duchess today for my midday study break, hope I love it!

That Old Problem

I reposted three posts from last year that deal with being a fatty girl in nursing school and practicing skills, including pelvics, on your classmates. They're listed in the archives under 2007. I put these back up because a friend, a dear blog follower, is now going through the same things that I was going through when I wrote those posts last year, and I wanted her to be able to re-read what I wrote, and what you guys had to say, again. I have also been discussing this with those who I've been interviewing, and it's been interesting and sad at the same time. I want everyone to know that in some places there is no choice but to participate... that professors actually require, demand, coerce students to participate in these clinical didactics. I want it to be known that I find this appalling. Seriously. Not that we would practice on each other (that can be beautiful) but that we would not have a choice... in this profession, especially... to dictate what happens to/who touches our own damn bodies.

There is a new article in the latest Journal of Midwifery and Women's Health (Sept/Oct 2008, page 403) that discusses this phenomenon. The author calls for us to re-examine the practice of students practicing on each other. She brings up some very valid points surrounding informed consent... basically students have the same rights to informed consent for procedures performed on them... and that informed consent is not valid if it's under coercion or fear of the person consenting.

I totally agree with the author.

It's time to re-examine it, and NOW, before somebody sues, or worse, women are traumatized.

((HUGS)) to my friend who's dealing with this. You're beautiful. And Kind. And good people, period. Your body belongs to you and only you. You have a responsibility to yourself to protect your body (and mind and heart and soul) from gross violation. What happened to you in lab is not acceptable and you have every right to be angry and hurt.

More Fat Talk

*I wanted to highlight the last comment from Pamela because it says so much of what I was thinking in class... I wish I had had the clinical experience to say some of what is said here...

My favorite accusation is the one that blames overweight women for the increase in maternal morbidity.

I tell you what, gestational diabetes is a joke as it is presented. the only "GD" I accept is women on the verge of type II diabetes before pregnancy and then, with natural decreased pancreas function in pregnancy, have blood sugar issues. Can we just get rid of the GTT? please? and why so many varying, and conflicting, lab values for "diagnoses"?

In my practice, the worst hypertensive and hyperglycemic cases have been from thin women. Especially blood sugar issues - usually related to women older than 40 who have poor diets.

I can't even get over how few providers know about using a larger cuff to measure BP on heavier women.

I just get sick of the "fat=big baby/hypertension/diabetes/cesarean section"

More and more plus-sized women are being set up for cesarean sections right from the start of care based on these biases. And guess what? Plus-sized women do not heal well from cesareans. So maybe the increase in complications with these women are based purely on fatphobia.

In my medical records, 14 years ago, I was labeled "obese" because I weighed 165 pounds at the start of my pregnancy.

I contacted a midwife in the city I'm moving too ask about their risk-out criteria for homebirth with their practice. I told her that I am obese, and still want a homebirth. She told me that they didn't automatically risk out for that, and explained that they'd have to decide after meeting me and seeing my personal habitus. She said their primary concern is not being able to do good fundal massage in the case of hemorrhage. I had never thought about this, but now of course I think about it often. lol. Every classroom session for me now is fear inducing. I always leave class thinking "should I really be trying to get pregnant?" I have so many damn risk factors that it has taken the joy and positivity out of even the idea of being pregnant. The worse days are the maternal mortality days. I have to spend ALL DAY reminding myself that birth is a natural process and that, yes, there can be complications, but there can also be low risk intervention free homebirth for fat women that doesn't end in death. Seriously I have to go through all that... not only for myself, but for the women I will see this week and the next and those in the following year who deserve not only evidenced based information, but also the right to hope and happiness. So much of how we process and experience birth is mental... how sad would it be to instill fear in a woman when she needs it least.

And thus we return to the balancing act... telling her risks without sounding all doom and gloom. Being realistic about what she can change and what she most likely cant or wont. Hmmm. What I can change (and already have) is what I eat and how much exercise I get... I can take a multi or prenatal vitamin everyday... I can refrain from large doses of alcohol and coffee... what I can't change is the risk factors I have associated with race, ethnicity, and genetics...

Navelgazing also writes a lot about fat.

I wrote about it a few times over the course of my education, but I think I've lost all patience and have so little energy to repeat myself in the classroom!

Fat & Communication

Today I've sat through a two-hour lecture on preeclamsia and a one-hour lecture on gestational diabetes. I feel like I've had these lectures several times... and I have... but still I don't feel like I know the information. I sometimes get distracted by the conversations that happen around the topic. Today I was distracted by the tone of fat bias in the classroom, especially during the gestational diabetes lecture. One comment was about an obese woman who had the nerve to continue to eat steak after her gestational diabetes diagnosis. Oh the nerve of this woman. Steak! Imagine. Now of course, steak- and meat in general- has come to symbolize all that people who eat differently than the majority of the folks enrolled do wrong. And of course we then get to sugar and refined carbs. And don't forget the dunkin donuts in the morning and the McDonalds for lunch and dinner that all of us fat people are eating every single day. (Seriously, this is what was said today about how overweight and fat women are eating... without any caveats, any "most" or "many" nomenclature, and with lots of classroom laughter) Lately I've begun to tune out the things that bother me in the classroom. I figure I don't have the energy to care about these things when I have so many more important things to learn in my 9 hour classroom day. But fat bias is one of those things that, as the only obese patient in my cohort, is hard to sit through. I think a great future research project would be to interview obese nursing/midwifery students about their experiences in the classrooms of the medical field. I think we'd get an earful. I rarely say anything in class about this because, come on, how predictable... the proud fat girl defending the other fat girls.

And, at this point, my relationship with my class has moved to a completely professional one. I no longer participate in weekly check-in, and I am so proud of myself for making this decision. It was important for my sanity, self-esteem, and overall happiness. After being called hostile multiple times by one student who then started crying per her usual emotional state and my supporting of her feelings about me- with an apology and a hug to calm her despite my disagreeing with her outburst, and feeling very attacked and unsupported myself- I realized that I sit through a lot of teary, "my cat is sick...my dog is dying" kind of check-ins. Check-ins that don't serve me at all because my brand of emotionality does not involve crying in front of strangers and lamenting in a "whatever am I going to do" kind of exasperation. I realized that unless I was crying about the kinds of things that matter to them, very little support was going to be offered, and very few of my cohort has the ability to respect different ways of communicating one's feelings. While I think that people who desire support have a responsibility to communicate that to those who might be able support her, I also think that people who would like to call themselves friends have a responsibility to at least consider observing when someone whose first instinct is not sobbing might be stressed herself.

The other day I wrote that we lost a student. The primary (and only as far as I witnessed) concern of many in my cohort was who would get her now-available call shifts. I was appalled. We lost someone. Someone who started this program with us is no longer with us. I feel like that deserved a moment of discussion about what we could/should/might do as a class to acknowledge this situation. I'm not talking about a sit-in to get her re-enrolled or anything dramatic like that. I'm talking about compassion... acknowledgment of the loss... reaching out to see if there's anything she wants to talk about... something. Something other than vying for her shifts.

The Current Happenings

We're back home finally. I did not manage to get my license because I lacked some official paperwork I needed. I knew this would happen, and I'm glad I did a dry run. I now know where the board of nursing is and what time I need to get there (an hour before the door opens) exactly what paperwork I need, and the process that I'm going to have to follow to get this done. While walking away without my license was very frustrating, I'm glad I drove the five hours to figure it out (I had been given incorrect info on the phone - which someone else told me was very likely) It was worth it to see family, too. On the downside, my hair sucks. I do not like the style I ended up with. I really, really miss my dreads. I came close to crying thinking about it.

I need to seriously buckle down for the rest of the semester... 8 weeks left... My midwifery midterm is next week and covers:

Bleeding (AP, IP, & PP)
Intrapartum infections
Abnormalities of labor
Abnormal presentations
Shoulder dystocia
Preterm labor
Post-term pregnancy
VBAC
Initiation of labor
Active management of labor

sigh...

...the best part about midterms is the extended hours of the libraries on campus and the studious vibe of the university... coffee, laptops, pajamas, good times.

Last week I caught my sixth baby, the first without a preceptors hands posed in case I needed them. She stood waaaay back, and I didn't realize it until it was over, a few days later. I felt good about that birth, despite the fact that it qualified as precipitous and one of my gloves was only halfway on... and the bag of waters broke on the perineum and sprayed me, barely missing my open mouth- I didn't have on birth gear(mask! and gown) because it happened so fast...

Oh the life of a midwifery student.

We Lost One

There is a discussion about a midwifery case that's currently in the news over at navelgazing's place. My small group decided to use this case for our ethics roundtable. We will discuss what supposedly happened in this case, and then embellished variations (which we will very clearly separate out from the actual case) to stimulate discussion. We have a very home-birth friendly cohort, so hopefully the discussion will be good.

As for the rest of the semester, I'm up to my ears in pregnancy complications and thesis writing... and I'm supposed to be up to my eyeballs in policy analysis, but I'm behind in the reading for that class... it's so dry. So, so, dry. I need to get my arse in gear. I have a lot due in the next few weeks, including a presentation in professional issues in midwifery. My topic is "black midwifery" but I don't know what I'm doing yet. I'm considering doing a talk on the history of the short-lived Tuskegee School of Nurse-Midwifery, but I don't know yet...

We lost a student from our cohort last week. She will be coming back next year, but is no longer a member of our class. It sucks to lose someone. This program is very, very difficult. Most days I feel like I'm barely here... like I'm waiting for the other shoe to drop... like someone is going to come and say I, too, am no longer in my class... that I will have to return next year... that 2009 is not my year after all. I look at all I'm learning and I think "there's no way I can do this." But then I remind myself that of course I can do this- everyone thinks they can't when they're at this point of the program, but then they all do it. But then I am reminded by situations like hers that making it is not a given. At any given point in time, you can drown instead of barely treading the water. There's such a fine line between having your mouth under the water and having your mouth and nose under the water... and I can't swim...

but I can hold my breath for a very long time

Hopefully I can hold it long enough to float my azz back to the shallow end.

We came down to our inlaws place for a few days to get some business in order. I need to go the state board of nursing to apply for a license in this state, and I needed to get my hair rebraided.
Unfortunately this all fell on an ovulation weekend, so yet another month is gone on the baby making front (and my temps/cycle got all messed up because I'm sick) But it was good to be home.