The Dream

School has started...and it aint all roses. But first my dream:

I was driving a car, a very nice car - which is drastically different than the car we currently drive...of which the driver's side window fell out and into my hands today... I was driving this nice car down a Dr. Seuss looking road. The road was pink, and the road going the other direction was purple. They were long and narrow, and traveled over the ocean like massive bridges...except they were so low that they actually skimmed the water...and they had no guardrails. There was nothing to keep a car out of the water except careful driving. I was the only car on the road. No cars were coming from the other direction either. I could not see where the road was headed...it was like looking out into the ocean, I couldn't see the end...just a drop off the edge of the earth. All of a sudden the road I was on ended and my car crashed into the ocean. I got out of the car and climbed onto the road and started walking back where I came from. Soaking wet, I told someone what happened and they seemed confused. I kept asking for help, and then I woke up.

At the time that I was dreaming, I wasn't at all afraid or freaked out or panicked...but now, now that I remember my dream, I'm a little freaked.

1. I don't know how to swim. At all. It freaks me out that I would drive down a road in the middle of the ocean that had no guardrails and was resting on the surface of the water. It's like I'm risking death to get somewhere...

2. And I don't even know where...the bridge was to nowhere. Yes I got to drive a fancy car there, but what did that matter when it dropped off the edge of the road into the ocean? I was walking again...and back to where I came from...was the drive worth it?

3. Did I realize on my way to wherever I was going that it was no longer a place I wanted to go...and because I refused to turn around, it was made so that I had no choice? Why was the road I was traveling a Dr Seuss looking joke?

4. I was calm when I climbed out the ocean back onto the road. I was so calm on the walk back...soaking wet, but calm. I only became frantic when I kept asking for help but other people insisted on asking me questions before they gave it me.

So that was my dream. Now onto my conscious life.

School started and I had to hit the ground running. I had almost 40 hours of clinical in a 7 day stretch, plus classes, and an advanced midwifery presentation to write and present to my class, and working on my research project. We only have one clinically based course this semester, but it's tough (to me anyway) and I the break I thought I'd get from how my schedule is set up and how many fewer credits I have this semester compared to last year never really materialized. Maybe this is how all midwifery students feel...but I am entirely overwhelmed.

And I feel like I'm learning everything but how to be with women...which is really frustrating. Over dinner with friends we talked about our expectations for midwifery school before it started and how our thoughts about what midwifery was/is are different now that we're here and hopefully almost done. One of my friends thought of midwifery school as a shorter, better alternative to medical school. I don't think she's far off in her description now that I'm here. I think there are many similarities, but also major differences that are quite obvious (ie surgery, management of high risk patients, etc) So, she's getting what she expected... I, and others, on the other hand, are not. I was not looking for an alternative to medical school. I did not expect so much pathology. I expected the technology...obviously there's going to be a great deal of that in a research institution with massive funding...but I did not expect so much of what we learned in midwifery school to be based on this technology or testing, period. I think I go to a good school. They consistently rank very highly for midwifery (for those who believe in the validity of these things) and I don't doubt that the graduates they turn out are ready to practice. In fact I've heard as much from the graduates of the program. I think that CNMs continually add more and more primary care to their practice as they fulfill the "with women for a lifetime" slogan of the ACNM. But as we remind women that we can provide their primary care from puberty to death...I can't help but wonder how I got here. I really was never interested in this part of midwifery...nor did I know the full extent of how expanded the scope of practice for midwives was and what would be required of me to become a midwife. How does this ever expanding role affect our care of women during preconception planning, pregnancy, labor, birth, and postpartum? Are we spread too thin as we try to manage depression, asthma, irritable bowels, hypertension, menopause and everything in between? I believe schools of midwifery are in a tough spot... I bet they'd love to spend more time on the "art" of midwifery, and less on the technology, charting, and hospital navigation portions involved in nurse-midwifery. I'm sure they'd love to show us how to do intermittent auscultation (IA) and let us practice it often, instead of hours of electronic fetal monitoring strip interpretations...but how can you justify spending a lot time on intermittent auscultation when nine times out of ten we're going to be interpreting strips instead? In a very cramped midwifery program all the fat is trimmed...you will read and know the evidence about IA but that's about it. The problem is that IA is treated as fat in the first place. That herbal treatments are also fat. That spiritual, psychological, and mental aspects of midwifery also seem to be fat. That when we get down to the details of the curriculum, everything unique to midwifery...most things that separate midwifery from medicine...has become fat to be trimmed from midwifery education in order fit in all the new information and technology and primary care that we are responsible for. I can't argue that we should be spending time learning all of these things... I think you'd be hard pressed to find any student who plans to be a CNM catching babies in a hospital that thinks she/he shouldn't have to learn it... but it makes me wonder if I still want to do it. Is the new midwifery I've encountered now that I'm knee deep into it something I want to be a part of?

I do. I don't know how, or even why, but I still want to be a midwife. Sometimes I feel like I'm on a road to nowhere... and that maybe I should stop and turn around. Sometimes I feel like this is all a big joke... and at any moment someone or something is going to pull the road from under me and laugh. You thought you were going to be a midwife? Ha ha ha. You thought you were going to provide a drastically different model for caring for women in childbearing? Ha ha ha. You thought you'd spend more time with your patients than docs get to? Double ha ha ha.

I've been assured that the way midwifery is practiced in school is definitely not the way midwifery is practiced in the "real world" and that the way it's practiced in some of the places that I've had clinical rotations is not the way it's practiced elsewhere. I been reminded that how I feel about midwifery will change when I'm back in my (or my husband's) home community because my reason for becoming a midwife started there, and I just have to get back to my roots. I hope these people are right. I so want to believe that what we do is different. I want to believe that midwifery school is it's own microcosm of life and not at all the real thing. I so desperately want to fall in love with midwifery again.

I try to think of things I can do to reconnect with midwifery so that it's not all about the book stuff. But it's hard because I don't even have a strong grasp of the book stuff. I feel like I am right with my colleagues as far competency and book smarts - none of us know everything. But when it becomes apparent that the woman's life could very well be in your hands, it seems silly to spend time on anything other than all of the million things that can go wrong in prenatal care and birth. I keep trying to remember all the test we do and why, and when they should be done, and the risks and benefits of the tests...plus the same info for all the meds we prescribe, and the interventions we do in labor... not to mention all the stuff I actually expected to learn in midwifery school like the pathophysiology of the female body and labor and birth. And our professors are unhappy with our disinterest in politics and advocacy... but I can't help but wonder when they expect us to do all of this? The information we have to know has increased by leaps and bounds, but the lengths of the programs have stayed the same. A glass can only hold so much water before it overflows. What if what pours out on the other side is our compassion for women and our passion for the profession?

How can midwifery students rejuvenate ourselves?

How can midwifery students and midwifery educators bridge the gap that seems to exist between us now (at least in my institution)? Among ourselves, students say we don't feel nurtured at all by veteran midwives. Maybe it's time to sit together and figure it out.

In the meantime, I'm hatching a plan to fall in love with midwifery again.

And starting a countdown to my last final of the semester!