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.