Breathe Easy, You've Found Me ((HUGS))

People will wonder why this blog is needed, why minority midwifery student? It's very simple actually; I was looking for this blog...but I couldn't find it...so I created it. We all have unique experiences, and every experience, every story, can help someone else. I am a black girl from the hood at an ivy league professional school. That, alone, is reason enough to write. Somebody was looking for this blog. Someone wanted proof that what I'm doing can be done - even when you come from where we come from.

To that person especially, WELCOME.

Tuesday, October 7, 2008

Rambling

We are experiencing what seems to be an extreme shortage of clinical space and preceptors in our program, and probably programs around the country. Students spend a massive amount of time complaining about the lack of clinical sites, especially after dishing out six figures worth of tuition, fees, and living expenses for their midwifery education. I have been somewhat silent about all of this in my program because I feel like I have about as much clinical time as I can handle. It is true that I wish(ed) for my diverse clinical experiences, but at this point, just having a clinical site is about all I expect. I was talking to a professor about the challenges of recruiting clinical faculty to a program. Most of it made pretty good sense... 1) The pay isn't the greatest- you can make much more in private practice, which makes it hard to compete. 2) Academic faculty who have spent the last several years earning a PhD don't want to spend all their time in the clinical setting (duh, they got the degree to conduct research)

But the one that has me thinking is 3) We younger generation of midwives simply refuse to give our lives over to midwifery anymore, and she cited this as a major issue. I think this is interesting. She said her generation of midwives basically lived midwifery, it was very much a part of their identity. She spoke of how husbands would bring babies to midwives on site to be breastfed, and how it was possible because midwifery was the kind of profession that was woman/family friendly.

Times have changed.

My classmates and I often talk about balance as a pivotal part of life. Not one peer that I know of intends to give their life over to midwifery. Basically this means to be on call 24/7... to provide real continuity of care... to embody what I think many people think of when they think of midwives. In a recent conference day we had about malpractice, work environments, credentialing, privileging, etc we, as a group, made a list of the things we wanted/expected as working nurse-midwives. Most of us want dedicated call and clinical times... meaning you're not on call at the same time you're working in the clinic (many midwives do not have this- if someone goes into labor while they're working in the clinic, the must leave the clinic to catch the baby, and then come back to finish up... the patients are either re-scheduled or covered by another provider) We want something like 2 days of clinic and 2 days of call... and would be nice to not have clinic the day you come off call (ie- be on call from 7pm-7am on Thursday, going straight to clinic at 8am Friday) We want malpractice insurance to be covered by our employers (in most cases it is) We want good salaries... specifically, salaries that enable us to repay these massive loans. We want good benefits. The list went on and on. I kept looking at thinking, yeah this is a good dream list, but of course you have to give a little bit of something up, your first job isn't going to be perfect. Nonetheless, it's good to see it written on paper. The discussion moved to how practices are set up to ensure that midwives can have lives outside of work. Basically, in order for you to be on call only twice per week you need 3 other people in the practice who also take 2 days a week, or similar. This means that you won't ever really have real continuity of care because the patients you may see on a regular basis still only have about a 1 in 4 chance of actually having you present at their birth. Now, following the "it isn't about you, it's about them" logic, this might be ok... the woman meets each provider once, but sticks with you for prenatal care, but she understands that you may not be the one attending her delivery. This is how it's been done many, many places for quite a while and it's working out fine I guess. But what about the women you'd like to be present for, or who really, really are choosing midwives for continued care including the birth? Well, we call them "special" patients... meaning you either gave them your home number, or you made a note on the chart that you are to be called if they present to the labor floor. (At my institution, students call these patients their "continuity" patient - meaning it's one of the few, few patients they will get to see regularly in the clinic, and then be called when the woman goes into labor, no matter which student is actually on call that day. As far as I know, we're only allowed one... I haven't had one yet. AND if she goes in at a time when no midwifery faculty are on the clock- which is rather often, you still lose the opportunity) So when speaking to a newer midwife (graduated 2006) she was telling me that she used to "special" a lot of patients at first, when she was new, but now she hardly ever does. Why? because she doesn't want to be on call all the time. Which was precisely my professor's point.

I'm rambling, but it's just what's been on my mind as I contemplate what kind of midwife I want to be. I meeting with a new midwife tonight for coffee to discuss some of this stuff, maybe I'll walk away with even more perspective.

4 comments:

Navelgazing Midwife said...

And reading this from a homebirth midwife's perspective, that list sounds amazingly selfish and even arrogant! I could never imagine midwifery in the way you all envision it/wish for it.

When I am telling a dreamy-eyed midwife-wanna-be about being a midwife, I tell her about the massive amounts of money it costs and how little she will make. I tell her there are YEARS that, as an apprentice, she will not make any money at all (any money made will be as a doula or breastfeeding counselor or childbirth educator). I explain that family is secondary to midwifery... she will miss birthdays, holidays, dates and sleep.

Her partner MUST send her off lovingly and welcome her back with food, a foot rub and the sheets pulled down. If her partner and children aren't 1000% supportive, she will never make it. Women who listen to this and are still drooling to be a midwife begin the process. Still, only 25% will make it to the end of the apprenticeship and schooling process.

Once women are DOING the things I said they would be doing/missing, reality kicks in and the romanticization of birth wanes... off the go, back off-call and into their normal sleep patterns.

Even when we aren't technically on-call (not having a woman due or newly postpartum), we are always on-call because if a 28 week woman goes to the hospital for some reason, we go, too. We are there for any issues that might arise during the pregnancy... no matter how small. We are in solo practice, so there is rarely back-up unless we are deathly ill or have a serious family emergency... but we pay our back-up for taking call or the birth for us.

I'm not wanting to sound all martyr-ish... I willingly embrace my role as a homebirth midwife, but felt you might want a little perspective when making up your wishlists. :)

starchild said...

Hi! I haven't been around for awhile (had a blog, starchild, but don't have the time for upkeep so quit blogging)but just wanted to pass this conference info along if you're interested or don't already know about it: http://blackmidwives.org It's this weekend in Harlem and may not be at all practical but the schedule looks interesting.

also, it's great that you're getting good things out of your research. also, my midwife (I'm expecting in Dec.) is a black woman and homebirth midwife and what navelgazing midwife says seems very accurate for her life.

best of luck to you!

pamela said...

There seems to be this sense of martyrdom with the elder midwives regarding "commitment, time and money". I hear it ALL the time.

I have a fairly busy homebirth practice. I charge a particular fee because I know I deserve it and I know that I want to do births for women who don't have money without feeling resentful that my bills aren't getting paid. I make money. I make enough to support myself. I actually could do more marketing and gain more clients, but I'm happy currently.

I don't answer client's calls when they call. They call me two times in a row if it's urgent (all clients have a special ring on my phone so when I hear it twice I know!). I return calls at a particular time of night.

I'm working on having another midwife take call for me on the last weekend of every month. During this time I will leave my cell phone at home and do something that I can't do when I'm on call.

Burn-out is real. It's good that you all are thinking about what you want, rather than just taking what you can get. It's important to have a life as a midwife. Midwifery is a lifestyle, especially coming from a homebirth perspective. However, within a hospital-based practice I would assume that one could obtain even more protection from burn-out.

I hear elder midwives discuss things like this along with discussions of apprenticeship. It almost starts to sound like the "well, when I was YOUR age, I walked to school backwards with no shoes in three feet of snow, five miles!"

I always respond with, "Well, were you happy doing that?"

I had a midwife say to me, "I had to attend 60 births before my preceptor ever let me lay a hand on a client!" as a reason why her apprentices cannot get hands-on skills right away. I'm flabbergasted - "so, you were happy with that arrangement? it made you feel trusted and valued?"

It's easy for women to become martyrs. It's even easier for those of us attracted to caregiving to become martyrs. Mainly because so many of us have a desire to be needed and wanted and that's why we get into this work. Eventually, we evolve and we move to a healthier place. For those of us that start in that healthier place I have amazing respect.

Good for you for laying out what you want and what you deserve. Midwifery, just like mothering, isn't a contest of sacrifice. It's a skill that includes balance and boundaries. Without those two things we don't serve ourselves, our families and our clients.

Navelgazing Midwife said...

It's so interesting, re-reading what I wrote and then Pamela's comment afterwards. She asks, "Did you like the way you apprenticed?" And the answer is a resounding "NO!" which is why a segment of the newer midwives (myself included) don't do it that way.

In asking my apprentice what came first, family or midwifery, she didn't hesitate to say family. However, when I asked her what came first - her child's birthday party or midwifery, the answer was midwifery. Several other scenarios were played out and midwifery was the activity of choice/responsibility, too.

Exploring the topic has been good for Donna and I... and will be a great Peer Review topic as well. What seems to be a common feeling is that midwifery isn't a *job* as much as a calling and therefore it isn't difficult or a sacrifice to leave family to "do" it. I certainly don't feel like I sacrifice one thing with my family... well, perhaps a steady income (in this time and place of the economy)... but Sarah has really encouraged me to not worry about that, so I tend not to.

Perhaps if I were as busy as I wanted to be, I might feel differently, but where my practice is now, I could definitely do more.

Allllll that said, I have to say - if I had my drothers, I would be working in a birth center setting. I *love* the aspect of working all day in clinic and then having a place where the women come to birth their babies. I love doing prenatals and well-woman exams all day long - *and* having shifts that I know will start and stop. I loved having my own continuities that I would come in for, but also seeing a woman for the first time in labor. I *love* working in birth centers! So I can absolutely understand the description that MMS gives regarding her "perfect scenario" after graduation.

I winced thinking I really looked like a martyr - and tried not to, too! But I can see how it looked whiny - and I didn't mean that at all. The apprentices we have are not abused, but loved and nutured through the challenging, and difficult, times. No one is hollered at, treated less-than nor are they dis-allowed from personal time when they need it. Conversely, the apprentices are so willing and so judicious in their taking times off, it is easy to say, "Yes!" because they give so much of themselves.

I am the preceptor I wish I'd have had myself.