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.
Thursday, October 9, 2008
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.
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.
Monday, October 6, 2008
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.
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.
Saturday, September 27, 2008
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
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
Monday, September 22, 2008
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
[::] I caught a baby on Saturday morning
Tuesday, September 16, 2008
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.
Sunday, September 14, 2008
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!
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!
Sunday, August 31, 2008
Because Something Always Keeps Me Up an Night
I'm one of those thinking people who lay in bed for hours trying to fall asleep unsuccessfully because of the ridiculously extreme future planning swirling around in my head. I'm also a planner. Organizer. Goal setter and writer-downer. A budgeter.
A worrier.
So, something is always keeping me up at night, and for the last several months the reigning question at 2 am has been: When should I get a Phd?
I am SO SICK of having this conversation with myself. But I also think that maybe there are others out there having with themselves as well?!? Or probably some folks out there trying to decide whether they should work for an RN for a year (or another year) before going back to nursing school for their masters degree. I ask people around me questions like "how did you decide when to get your PhD?" or "generally, how many years of full time clinical nursing is considered to be optimal when you're interviewing people for faculty positions?" I've also talked to people about raising children while in doctoral programs, and having children in their first few years of practice. I guess I do field research, lol. It's funny when I think about it, but also necessary, I think. One of the best things about nursing is that it's dominated by women. Sure, there are drawbacks to this, but how cool to be a part of a profession that is mostly made up of women and therefore has women in every leadership role available. This provides the perfect opportunity to explore the intersection of working and personal life for women...
Thursday, August 21, 2008
How to Pay for This
I've been thinking a lot about the debt I've accumulated while in nursing/midwifery. (What's new?) As I finished my last financial aid documents for this 3 year stretch of school I felt incredibly tense. As I looked at the totals, an instant prayer for loan repayment formulated in my head. I will probably chant this prayer for the next two years as I attempt to secure it. I have always reminded myself that loan repayment is a very viable option for me because working in the types of communities that they offer the repayment for has always been my goal. But as I look more closely at these programs - the timing of the applications, their rate of award vs the number of applicants, and just how long it's going to actually take to repay these loans - I am, again, tense. I keep trying to put the possible ways this can pan out onto paper (this is how my mind works) and there are indeed many ways to make it all work, but nonetheless, the debt load is mind boggling. The reason why I am focusing myself to have some semblance of a plan now is because the first payment on half of my loans become due in June 2009 - the month following graduation! For others who may not have thought about it (but should) or those who have thought about it and happened to find themselves stressed and teary-eyed over how it's going to work, here's the best scenario I have so far:
May: Graduate...with June and July's loan payment in the bank.
June: Take the midwifery certification exam and start looking for a job
July: Secure a midwifery job...if not secure a temp placement in order to continue with loan payments
December: loan payments increase due to the 6 month grace period on federal loans ending
February: Apply for the NELRP and NHSC loan repayment programs
Even if I am awarded loan repayment under one of these programs, I will have to make payments for at least one year before the payments are taken over. Therefore it may be a good idea to use the "graduated" method of paying back one's loans so that I pay as little as possible during that year. So far, I am settled on working for 3 years straight (I pay my own loans the first year, someone else pays them the next 2) and taking a few classes a year toward a doctoral degree during this time. After three years of this, I should be able to move into a full time doctoral program with only one more year of classes remaining + dissertation. All loans would be deferred while I am in school full time. Then I would apply for research-based loan repayment through the NIH (or a faculty loan repayment program) for the remaining loan balances. The only thing I don't like about this plan is that taking a few classes here and there means that I have to pay for them myself. Not what I envisioned! Also, some of the schools I'm interested in don't have a distance option for their PhD program, and schools are picky about transferring in credits at this level.
I could also work for one year, then enter a doctoral program full time (thereby going into loan deferrment for 4-5 years) and then apply directly to the aforementioned research and faculty loan repayment programs... which was what I initially intended to do before I started waking up in night sweats about my loan totals. LMAO
Just a couple of the many ideas I have about "how to pay for this."
Today I start reviewing notes in preparation for the start of class next week... wish me luck.
Ugh.
May: Graduate...with June and July's loan payment in the bank.
June: Take the midwifery certification exam and start looking for a job
July: Secure a midwifery job...if not secure a temp placement in order to continue with loan payments
December: loan payments increase due to the 6 month grace period on federal loans ending
February: Apply for the NELRP and NHSC loan repayment programs
Even if I am awarded loan repayment under one of these programs, I will have to make payments for at least one year before the payments are taken over. Therefore it may be a good idea to use the "graduated" method of paying back one's loans so that I pay as little as possible during that year. So far, I am settled on working for 3 years straight (I pay my own loans the first year, someone else pays them the next 2) and taking a few classes a year toward a doctoral degree during this time. After three years of this, I should be able to move into a full time doctoral program with only one more year of classes remaining + dissertation. All loans would be deferred while I am in school full time. Then I would apply for research-based loan repayment through the NIH (or a faculty loan repayment program) for the remaining loan balances. The only thing I don't like about this plan is that taking a few classes here and there means that I have to pay for them myself. Not what I envisioned! Also, some of the schools I'm interested in don't have a distance option for their PhD program, and schools are picky about transferring in credits at this level.
I could also work for one year, then enter a doctoral program full time (thereby going into loan deferrment for 4-5 years) and then apply directly to the aforementioned research and faculty loan repayment programs... which was what I initially intended to do before I started waking up in night sweats about my loan totals. LMAO
Just a couple of the many ideas I have about "how to pay for this."
Today I start reviewing notes in preparation for the start of class next week... wish me luck.
Ugh.
Wednesday, August 20, 2008
Getting Back into the Groove of Things
This will be my last semester of classes in midwifery school!
And it's the lightest load we've ever had. When I look at my schedule, I am in awe. I only have three classes and by some miracle they're all on the same day! I'm expecting for someone to say "oops, we saw how incredibly wonderful your schedule looked for this semester, and realized we forgot to tell you about a class..." on the first day of school. The rest of the week will be dedicated to clinical rotations (both antepartum and intrapartum) and working on my thesis. Of course I'll go into detail about these courses and the schedule when school actually starts. In the meantime, I had a ridiculous amount of fun shopping for school supplies and a new bag!
A lot happened over the few months that I didn't blog regularly:
[::] I became an RN! That's right, I took the NCLEX on May 20th and found out I passed 2 days later. It was monumental in terms of reaching a major checkpoint in this path of becoming a midwife and finally getting some closure for at least the first half of all the work I've done. Otherwise... I don't know. I didn't run out and get an RN job... and I feel no desire to do so even now, 3 months later. Most of the people around me have gotten jobs though and I feel like an outcast for not being the least bit interested. But in my defense, most people are doing it to make money, not for the love of nursing. I found another way to make money that's much more in line with who I am and my future goals:
[::] I worked all summer as a research assistant for midwives who were working on an application for a NIH research grant. It was such a great learning experience, and I got paid just as well as my RN working classmates. I then parlayed that into another position as a graduate assistant for a diversity program on campus that involved mentoring minority undergraduate nursing students through their own research projects. That job has been extended and I now have a job for the whole fall semester. These jobs were/are much more in line with my specific talents and goals. So why do I feel like I'm supposed to be working as a nurse? Or, more importantly to me, why can't I find more of the non-clinically working new RNs who are willing to talk about why they have chosen not to take RN positions? Where can I find mentors who think it's fabulous that I'm following my own dreams/paths to success in nursing - or at least get those who have been great mentors to really stand up and say "look, it works the way you're doing it too, we respect the decisions you've made and will make, even if they aren't in line with the traditional way of doing things in this centuries-old profession." LOL I won't hold my breath for that last one. ;o) It reminds me of something I wrote earlier about embracing all kinds of midwives, not just those who love clinical practice. The same goes for nursing. I have embraced nursing, just a different aspect of the profession. I hope I continue to find the treasured, less treaded pathways so that I am not only giving to the profession, but giving to myself as well. Good luck to all of you new clinically practicing RNs... but also to the new RNs still trying to find their niche in nursing!
[::] I went to the ACNM conference! It was held in Boston this year and we had a blast. I petitioned one of the deans for some conference funding on behalf of myself and the other midwifery students of color, and to my great surprise was granted funding (after a lot of paperwork - also a great learning experience) So we all cramped into a very small, very expensive hotel room in Boston and enjoyed the opportunity to meet midwives and student midwives from all over the country. There were of course moments where I was irritated with people for minor offenses (case in point: someone we had breakfast with randomly turned and asked me if my parents were "healthy" without it being the topic and without asking anyone else at the table... ugh ... just file it under "fat in nursing school" and keep moving I thought to myself) and the expected moments of disagreements while in conversation. Nonetheless, I had an good time. However, I will not be attending this conference every year unless it is paid for by my employer. There are good opportunities available, such as becoming certified in things like vacuum extraction and of course getting your CEU credits in one swoop. There were also good seminars, but being a student meant that we had just had lectures and read the research on a lot of the topics like hypertension, etc. It was more worthwhile to go to sessions that we will not get like those on herbal remedies, or working with residents, etc. But mostly the conference seems like one great big reunion... and I don't know that I need that every year... especially not $1,000 worth. Something occurred to us students over the course of the conference though... the ACNM is a very white haired white lady organization right now...or, probably more accurate, the younger midwives aren't very involved. We think that one reason may be that those in charge seem to be hanging on for dear life. Somehow we must make rom for the next generation... but the "next generation" is actually also quite older... so that means we should be making room for my generation. I think there is room to grow in the ACNM, but I think it is plagued with the same issues as the nursing profession is - the "requirement" that one work for a significant amount of time before moving "up" in ranks and education adds a considerable amount of years to the average age of those in leadership positions. It will be interesting to see where this goes, and to see how I choose to become involved...
[::] Random. In other not-so-significant news, I lost a few pounds, attempting to prep this plush, soft, fatty body for pregnancy in the near future. I started planning for graduation, which is seriously no small feat.
And it's the lightest load we've ever had. When I look at my schedule, I am in awe. I only have three classes and by some miracle they're all on the same day! I'm expecting for someone to say "oops, we saw how incredibly wonderful your schedule looked for this semester, and realized we forgot to tell you about a class..." on the first day of school. The rest of the week will be dedicated to clinical rotations (both antepartum and intrapartum) and working on my thesis. Of course I'll go into detail about these courses and the schedule when school actually starts. In the meantime, I had a ridiculous amount of fun shopping for school supplies and a new bag!
A lot happened over the few months that I didn't blog regularly:
[::] I became an RN! That's right, I took the NCLEX on May 20th and found out I passed 2 days later. It was monumental in terms of reaching a major checkpoint in this path of becoming a midwife and finally getting some closure for at least the first half of all the work I've done. Otherwise... I don't know. I didn't run out and get an RN job... and I feel no desire to do so even now, 3 months later. Most of the people around me have gotten jobs though and I feel like an outcast for not being the least bit interested. But in my defense, most people are doing it to make money, not for the love of nursing. I found another way to make money that's much more in line with who I am and my future goals:
[::] I worked all summer as a research assistant for midwives who were working on an application for a NIH research grant. It was such a great learning experience, and I got paid just as well as my RN working classmates. I then parlayed that into another position as a graduate assistant for a diversity program on campus that involved mentoring minority undergraduate nursing students through their own research projects. That job has been extended and I now have a job for the whole fall semester. These jobs were/are much more in line with my specific talents and goals. So why do I feel like I'm supposed to be working as a nurse? Or, more importantly to me, why can't I find more of the non-clinically working new RNs who are willing to talk about why they have chosen not to take RN positions? Where can I find mentors who think it's fabulous that I'm following my own dreams/paths to success in nursing - or at least get those who have been great mentors to really stand up and say "look, it works the way you're doing it too, we respect the decisions you've made and will make, even if they aren't in line with the traditional way of doing things in this centuries-old profession." LOL I won't hold my breath for that last one. ;o) It reminds me of something I wrote earlier about embracing all kinds of midwives, not just those who love clinical practice. The same goes for nursing. I have embraced nursing, just a different aspect of the profession. I hope I continue to find the treasured, less treaded pathways so that I am not only giving to the profession, but giving to myself as well. Good luck to all of you new clinically practicing RNs... but also to the new RNs still trying to find their niche in nursing!
[::] I went to the ACNM conference! It was held in Boston this year and we had a blast. I petitioned one of the deans for some conference funding on behalf of myself and the other midwifery students of color, and to my great surprise was granted funding (after a lot of paperwork - also a great learning experience) So we all cramped into a very small, very expensive hotel room in Boston and enjoyed the opportunity to meet midwives and student midwives from all over the country. There were of course moments where I was irritated with people for minor offenses (case in point: someone we had breakfast with randomly turned and asked me if my parents were "healthy" without it being the topic and without asking anyone else at the table... ugh ... just file it under "fat in nursing school" and keep moving I thought to myself) and the expected moments of disagreements while in conversation. Nonetheless, I had an good time. However, I will not be attending this conference every year unless it is paid for by my employer. There are good opportunities available, such as becoming certified in things like vacuum extraction and of course getting your CEU credits in one swoop. There were also good seminars, but being a student meant that we had just had lectures and read the research on a lot of the topics like hypertension, etc. It was more worthwhile to go to sessions that we will not get like those on herbal remedies, or working with residents, etc. But mostly the conference seems like one great big reunion... and I don't know that I need that every year... especially not $1,000 worth. Something occurred to us students over the course of the conference though... the ACNM is a very white haired white lady organization right now...or, probably more accurate, the younger midwives aren't very involved. We think that one reason may be that those in charge seem to be hanging on for dear life. Somehow we must make rom for the next generation... but the "next generation" is actually also quite older... so that means we should be making room for my generation. I think there is room to grow in the ACNM, but I think it is plagued with the same issues as the nursing profession is - the "requirement" that one work for a significant amount of time before moving "up" in ranks and education adds a considerable amount of years to the average age of those in leadership positions. It will be interesting to see where this goes, and to see how I choose to become involved...
[::] Random. In other not-so-significant news, I lost a few pounds, attempting to prep this plush, soft, fatty body for pregnancy in the near future. I started planning for graduation, which is seriously no small feat.
Tuesday, August 19, 2008
Starting Anew
I'm starting fresh for the school year...without archives. I'm not going to attempt to weave all of the compartments of my life together here on this blog because, really, it's too much and I don't have the time, energy, or mental space to do that right now. I'm going back to the roots of my blog writing. I'm here to write about my experience in midwifery school, and anything that's relevant to that.
I am no longer a completely anonymous blogger but that's just the way it is. People around me will read this to get to know me instead of actually trying to get to know me through the work of interaction. People will use what I say here however they see fit. People will gain a slight advantage by knowing more about me than I do about them. People who know me in real time will continue to read me and not offer up a significant compartment of themselves in return, and that, too, is just the way it is. And my audacity to write about my own life - imagine that- will be seen as arrogance to a few people.
When I think about how I came to be ok with all of this, I have peace; and I only have to remember why I'm writing in the first place to reach that peace.
So, for the millioneth time, the blog is public again. But what does that mean when there is no archival history previous to this post?
I am no longer a completely anonymous blogger but that's just the way it is. People around me will read this to get to know me instead of actually trying to get to know me through the work of interaction. People will use what I say here however they see fit. People will gain a slight advantage by knowing more about me than I do about them. People who know me in real time will continue to read me and not offer up a significant compartment of themselves in return, and that, too, is just the way it is. And my audacity to write about my own life - imagine that- will be seen as arrogance to a few people.
When I think about how I came to be ok with all of this, I have peace; and I only have to remember why I'm writing in the first place to reach that peace.
So, for the millioneth time, the blog is public again. But what does that mean when there is no archival history previous to this post?
Friday, July 25, 2008
Digging Deep
I'm just living inside my own head right now.
Trying to nourish myself, my brain, my heart, my body.
Trying to hear my own voice again.
Trying to nourish myself, my brain, my heart, my body.
Trying to hear my own voice again.
Monday, July 7, 2008
July 4th, Home, and Hair
It's been a moody few days. The holiday came and I was miserably homesick. We stayed in the (dark) house the whole day and didn't venture out until 10pm to see a movie downtown. The man had bought me some sparklers, so when we came back from the movie we sat outside and I played with those and it was right at midnight by then. Back home the usual street-blocked-by-barricades-for-fireworks-family-BBQ was in full swing. New babies, old friends, and good food. We were supposed to go to a work BBQ, but didn't make it out the house. I just wasn't in the mood for random conversation. I miss...everything. I didn't cook either, but yesterday I cooked what I would have cooked (jerk chicken, kale and collard greens, and yams) Then I finally cut my dreads out on Friday night which was...emotionally painful. I was left with about 2 inches of hair (less than an inch in the back) which I promptly got braided up. The hair appointment turned out to be a a pretty good pick me up with a beautifully ghetto salon with not air for the first few hours I was there, filled with African women speaking french most of the time, and videos of african dance and drumming playing on the TV. 7 hours later, I was again homesick (albeit a different kind of home, but home nonetheless)
Tuesday, July 1, 2008
The Final Say
In one of the previous posts I was talking about having the final say in me and the man's relationship when it comes to child rearing...
Russell wants the world to know that the same goes for the mama of his babies, so back the hell up... why do ya'll care how much money a billionaire provides his family anyway?
LMAO.
Russell wants the world to know that the same goes for the mama of his babies, so back the hell up... why do ya'll care how much money a billionaire provides his family anyway?
LMAO.
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