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.

Rambling, part 2

Yes, the life of a homebirth midwife is very different than the life most of my peers are headed for!

What comes to mind when reading the comments of this post... which I am so grateful for, it feels good to try blogging consistently again... is, these are like two very different careers. A CNM working full time in a private office asking for her own office space is not over the top. Nor is requiring a substantial salary. She's seeing the same number of patients a day as her peers... she's providing the same basic care... she requires the same equipment... she deserves a place to hang her degrees, consult her patients, and eat her lunch in peace just like the other providers... and she deserves to be compensated equally for equal work. I am not a midwifery martyr. Working for years without payment is unacceptable to me. But good luck to those who can afford it. It reminds me of a conversation we had one day about how midwifery is a" rich white woman's hobby." I bucked at that comment because, as always, I was thinking about the granny midwives, and I never seem to meet any wealthy midwives. But now I can see how people came up with that, and after being in this environment for a while I have learned that many wealthy people do whatever they can to look otherwise. That doesn't mean that I buy into this definition of midwifery, but I get it. It gets at a subgroup of women who might be able to afford to work for free for several years and still pay bills and have partners who are home 24-7 raising babies and supporting them in their life journey. But I think the more likely scenario is struggle. I'm done strugglin. Spend most of my life strugglin. Don't intend to spend the rest of it doing the same.

There's such a huge difference between a provider who sees maybe 10 patients a month and one who sees 20 a day. It's one thing to have a rough patch of 24-48hrs of active call time for one or two patients at various times during the month, but it's another thing entirely to be at the hospital for 24hours and then in clinic for 10hours directly following that, twice a week, continuously, every week. I think that's unsafe.

I believe in homebirth. But I don't want a homebirth practice. (not to mention it's illegal for CNMs in Nebraska anyway) I'd have my babies with a homebirth midwife in a minute (if I weren't risked out for this pesky, fluffy adipose ;o) and I wanna catch a baby or two in my lifetime, but otherwise, homebirth catchin is not in my future!

If I know one thing for sure, it is that midwifery does not come before me and my family. And I'm ok with that. I hope I can find a good balance though.

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.

I Feel Encouraged

I had to stop my life and write today because I feel, for the first time in a while, encouraged. I just finished another interview for my thesis. For those who don't know, I am interviewing black nurse-midwifery students across the country. I remember in the beginning I was looking for other brown midwives in cyberspace, and couldn't find many, if any at all. Well, there really aren't that many of us. I scouted each nurse-midwifery school looking for students to interview, and some schools sadly responded that they didn't have any, some even said they hadn't had any in years. That made me teary. But I have done several interviews now, and even though we are small in number, we are drowning in fortitude. They make me feel like I can do anything. It is a blessing unto my soul just to hear their voices. It has been a long journey, and most times I don't know if I'm coming or going. But today, if nothing else, I feel a little less alone in the journey. There are things that come up in interviews that make me want to cry, but there are other things that make me happy. Most of all, I'm just grateful that I had the conviction to take on this project. If not me, who? That is my mantra.

School is eerie this semester. I haven't had any exams, nor any papers due yet. I've mostly been studying haphazardly and working on my thesis... which is an experience all its own and maybe I'll write more about it here sometime. But at the very least I will say, it's hard to write... and even harder to have someone constantly critique it. I have not found a groove for studying this semester. My study group is all over the place, we haven't met once as a group yet. That will probably change as our first exam draws near, but so far, nothing.

I feel behind in my knowledge. I don't feel prepared for residency at all. I'm calling it residency, but that's not exactly what we call it at school. Most students just select a place off of a list provided by the school, but I worked very hard to set up my own site. This was important to me because I've spent all of my time working with the faculty of the school. For me, this has not been ideal, but it has been supportive in its own way. It means I've had a very limited exposure to other ways of midwifing. I've had very little to no chance at continuity of care with patients. I've had no clinical interaction with midwives of color. I think this last point is huge... I think it has negatively affected my assimilation into the profession. There are many, many days when I don't want to be a midwife anymore... where I can no longer imagine myself as a midwife... where I can't remember why I'm here... when I can't remember what this has to do with my own history. I think not being able to be precepted by someone who I identify with has something to do with it, and I wasn't clear about this until now.

But I said this post was about feeling encouraged. And it is. As I was saying, I wanted to set my own residency site... well months and months later, I have it! I started this process in June, and now I have a signed contract for residency with a black midwife far away from this institution! I met this midwife at the ACNM conference this past summer, and I asked her if she would have me. I laid it all out there... 1. what I'm looking for (a site in the city I would like to work in post-graduation, to be with family) 2. why I was asking her (she's black, yes, but also because she's accomplished and when I asked around at the conference, everyone told me to go find her - that she was who I was looking for) and 3. how badly I wanted it (badly...teary-eyed badly.) She said 'yes' on the spot, and when she randomly, fondly pointed out that the last student she had precepted for residency some years ago happened to be pregnant, I felt the universe hug me. I am not pregnant, but I hope to be by the end of the school year, so it's nice to know she won't have a problem with that. It matters that it's some distance from the school (hundreds of miles) because it means I have a greater opportunity to see a different way of practicing. The patient population is also different. Currently I spend more than 50% of my time providing care to patients who only speak Spanish... even though I don't speak any Spanish. This is incredibly frustrating and tiring and disheartening because I don't feel like I'm providing the best care. I'm having to shout at an interpreter phone all day, who then translates to the patient, the patient then screams back into the phone, etc. It's just... sad. The last two babies I caught were born to women I couldn't even speak to, and there are never interpreters on the labor floor. Usually the preceptors or nurses- who speak enough Spanish to get by, but that's it. I have not been able to take a Spanish class (but one is offered on another part of campus) and at this point I don't foresee it any time soon... especially after spending years learning French. So I am happy to be moving to a place where I will be more useful. Having this work out for me also means that the man and I are headed home. That's right, we get to go home to family. Technically, it's his home and family, but that's good enough for me... for now. If I can't have my own family, his is definitely good enough. Back to love, we go. The man, as you can imagine, is head-over-heels excited. He's already started planning the packing and moving, and then he'll head down before me to start his new job hunt.

This time I did actually cry when I got the news... I mean sobbed. I just feel like I need this so badly right now. I need this to fall in love with midwifery again.

So this news + talking to other midwifery students on the phone = encouraged.

I caught a baby a week ago. I forget if it was a boy or girl. It was my fourth. I couldn't speak to the woman because she had absolutely no English and I had absolutely no Spanish and the nurse assigned to her did not like me and would not let me know what she was saying in spanish to the patient all night.

This was my fourth catch. I have 2.5 months left to catch another four babies. In the meantime we have a serious, serious shortage of available midwives to staff the call shifts necessary for the number of students in my cohort. At first, I was very

Little Bits

[::] It feels like it's a windy day and I went out side and my purse fell open and all the little bits of paper flew out and all over the street. I need to collect all the papers back, but I have no idea which one to chase first...or even if they're worth the effort of chasing them down. There's a lot of paperwork this semester. In fact, I'm drowning in it. My planner is effective, but things need to be added so fast that I feel like it might be time for a PDA.

[::] I caught a baby on Saturday morning

Empty

I remember I used to write about feeling like I was losing my mind. I had gobs...egg white cervical mucous during ovulation type gobs... to say. Imagine, I have nothing left to say. Well, that's exactly what it feels like every time I sit down to write- and not just here on the blog, but everywhere now. I can't journal. I can't purge on a blank Word page. Nothing.

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!