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 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.

Friday, October 31, 2008

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.


doctorjen said...

Huh. And in general when you finish your program you are ready to practice? Or is some additional training usually taken?
Since continuity is such a mainstay of the midwifery model of care it seems weird to miss out on that in training.
Also, it's just so different to care for your own clients - I'm sad for you that you don't get that chance. In FP residency we had our own continuity clinics from the start and I had some clients for 3 full years by the time I finished. I know it's different in CNM training which is more similar to med school than residency, but still - to have so few continuity opportunities and so little birthing experience just seems weird to me.

On rupturing membranes, I think most docs are taught that it's okay to rupture if the head is well applied to the cervix - and to be cautious if the head is not engaged and not well applied.

Loving Pecola said...

Hmm, actually integration is not at all like medical school... you don't take any classes- you work full time as if you were getting paid.

Also, the learning curve in midwifery school has been a little steeper than medical school. For example, at our medical school, students don't touch patients for the first 2 YEARS of their program... we see our first patients (physical exams, labs, testing, etc) in the first two WEEKS of school!

This continuity of care issue is not a midwifery-wide issue. There are always a few students who get "lucky" and get placed at practices where they remain for their entire education. I (and half my class) just don't fall into that group. And faculty members have told me/us that what we're experiencing is not the ideal... and not the way they're used to practicing midwifery or want to practice... but they're stuck between a rock and a hard place. Some schools staff their own entire clinic, and all students practice in that clinic/birth center (or so I've heard) and therefore they probably have continuity of care. My school is in the process of setting up something similar (it's own midwife-staffed birth center) But as for now, the school is short on faculty and clinical midwives in the midwife practice... sad, stressful situation... but one that is plaguing a lot of schools right now as the nursing faculty are aging out of the profession! It's going to get worse, unfortunately.

Yes, according to graduates of the program they are indeed ready for practice when they graduate. (And honestly, I feel like I'll be ready, too- remember that we refer out the complicated cases) But like all professions, a good mentorship and orientation is great way to bolster skills and confidence in your first job. In my opinion, the safest midwife is one who knows her limitations...knows when to refer... when to ask for help... and I think I will be great at that in my first job.

So much going on drjen, so much!

. said...

Hi there,

Thanks SOOOO much for the posting! I couldn't believe you went out of your way to write such a helpful post(and in such a timely fashion!). I found your response really helpful and inspiring (just like your blog). I've tried to email you a few times, but gmail tells me your address doesn't work - maybe I typed something wrong.

Again, thanks very much with all of your help. I recommend your blog to midwifery-interested gals all the time (have yet to run into a boy who wants to be a midwife)!

Bye for now,


Ciarin said...

I awlays laugh when I see those numbers from ACNM - Frontier requires double in some areas. I had to have 40 births...couldn't imagine only doing 20 and then graduating to be honest. But then Frontier students can often times find clinical sites all over the country which makes it easier to get these numbers. Also, the program is structured very differently.

Morag said...

So, question for you. Are any of your primary birth numbers required to occur outside of the hospital setting?

Worth noting also, that while NARM numbers represent a baseline, several states which license (direct entry) midwives require additional numbers. in Washington State we must have observed 50 births ('observed' but may have participated in some way), participated actively in a further 20 (involved), and managed 20 (at least 10 of which must occur in OOH settings). Or thereabouts... I think it ends up totaling 100 births in all before we may sit the licensing examination.

We also have a continuity of care requirement(~20 - at least 4 prenatals, birth at involved or primary level and at least 3pp). It's unclear to me if that's a state requirement or my school's. Our Canadian students must have 30 or so and that is a CMBC rule.

I envy the CNM's ability to provide well woman care outside the childbearing cycle...sigh.

You're so close!! :)