Thursday, August 19, 2010

Disappearing midwifery students

Posted by Tatiana

Did we all get sucked into our studies?  Just to liven things up, I'm making a more casual post.

A few lessons my childbearing and childrearing is giving me to take along into midwifery work:

  • When a mother says she'd like to throw her baby out the window and nervously giggles, don't assume she's joking.
  • Same mama can have pain free and ecstatic birth, and a bitterly disappointing and painful birth in the same set of (controllable) conditions.  Lesson: Avoid drawing conclusions about a woman based on the way you see her birthing!
  • If I can remember that adults are like overgrown children and practice NVC and other presence-based communication with them half as willingly as I do with my kids, things are a lot more clear.
  • If I feel the well of my patience is absolutely dry and life presents me with yet another challenge, I must be wrong about that well being dry.
  • Vaginal exams during labor can be flippin' painful.
  • A birthing woman can pull back her own swollen cervical lip, thank you very much.
  • When giving nutritional counseling to a woman who already has children or is otherwise excessively busy, be very creative about how she can meet the nutritional needs of herself and her baby with minimal money and minimal time.

And just in case you also need a little extra oxytocin...


And yes, this baby came out of my vagina.

Wednesday, August 4, 2010

Standing on the Precipice...

Posted by D

This is it. The last big hurdle, outside of taking the NARM exam next year. This is what I have been waiting for and wanting, for many many months. I feel like I am standing on the precipice, waiting to jump off and either land on my face, or find out I can fly. Sure, I have 6 more weeks at Casa, but Casa right now feels easy and familiar, and much like a vacation to me now.

So, what is it that I am referring to with such trepidation? Last week the midwife I have been hoping to apprentice with called me and asked me if i was interested in working for her doing postpartums and birth assisting as a paid "nurse." Apparently, her most recent nurse quit after 2 months. She was hired when the previous nurse quit after 3 months, and she was hired when the previous quit after... Yes, I've heard stories. Stories about being yelled at, stories about how wonderful she is, stories from doctors about the "crazy" things this midwife does. And it all intrigued me until recently. Until she asked me to come work for her until she is able to hire a "real" nurse. So, today I went and met her and spoke at length with her one long term nurse. We talked aboutthe schedule and expectations and we also talked about the practical side of surviving working with this midwife. I've been warned. It will be rough. She will yell. But...she is also a great teacher and I will learn a lot.

Aside from the anxiety of workign with this midwife, I also have questions in my mind as to how this will actually work since I will actually be working with TWO midwives. This new one and the one who I've been going with for the last two months. I've logged a good 30 births in the last two months with the other one. She's VERY laid back and is so easy to get along with. She trusts me (for as much as she knows me) and she is very open to a student finding their way and figuring out what works for them. In other words, she's easy and comfortable for me now.

So, we worked on the schedule, which will be four days with one and probably two to 3 days with the other. There is some flexiblity in that, but it will be a lot of time on call. And though I remind myself that it is temporary, it is pretty clear that for the next year, or at least a good six months, my entire life will revolve around birth. It basically has been for some time, but it hasn't been with the commitment that it comes with now. Scheduled=paid=commitment.

The other thing that gives me pause is the fact that this population (Plain- Amish and Mennonite) is so different from the typical homebirth population that I would generally plan on serving. The general population is basically healthy, well-educated about health and hygeine, and they have doctors and the Internet readily at their fingertips. They take a huge responsibility to know their options and exercise choices in decision making. Many people (myself included) refer to these families as higher maintenance with their birth plans and ideas for the perfect experience. but at the same time the level of responsiblity they take on themselves is freeing to their care provider. The Plain population is easy in terms of birthing and choices, but they also rely on their midwives for information and care outside of the general scope of practice of a midwife. For example, this new midwife typically gives the MMR vaccine to the babies. Already I have seen families call the midwife when the baby is in the car seat and is pushed off the woodstove (cold woodstove) by the older sibling. Or a 2 year old who falls 8 ft from a barn ledge and hits her head, fracturing her skull. They call the midwife (who tells them to go to the ER). And I know of midwives who suture children after accidents that require repair. All of this makes me so nervous. In this practice that sees 18-20 babies a month...so much can and WILL happen. And will I miss something that I should have found. Will I miss a blood clot or a heart murmur? Genetic anomalies are common...will I miss a clue to a lethal something that could have been prevented. I've already been told that they typically attend 2 to 3 funerals a year. WHAT??? That definitely is not your typical homebirth population. And just as I had to rephrase my assumption that babies will choose breathing over eating , I am going to have to remember that much of the assumptions that we take for granted aobut birth being safe, really need to be balanced with the idea that things can and sometimes will go wrong.

For the time being, I am holding my anxiety in check. I know thiat this journey has been anything but boring to this point, and that there is a reason for everything. I'm confident that I can come out of this experience a better midwife and a better person, even if parts of it may be quite painful,

Friday, July 30, 2010

Dorky new additions to the free resource list

Posted by Tatiana

I've added the following free learning opportunities to the Free Resources for Midwifery Study post:

Pelvic Floor Muscle Trauma from Medscape.  You need to join the site (free) to access this one, and there's a free CEU for completing it.

Examination of the Newborn from the University of Oslo in Norway.

The Little Handbook of Statistical Practice from Gerard E. Dallal of Tufts University in Boston.  It is my opinion that with the amount of "studies show..." spouting that midwives do, we better well be equipped to coherently interpret studies.

The first two were posted to discussion groups by other folks, the last one I unearthed myself because I kept bumping up against "I really don't know enough about statistics to interpret studies."  I wish I didn't need to be reading for the doula training I'm doing next week so I could just read through that statistics handbook.  It's absolutely delicious because it answers so many questions I've had about statistics, plus it's math and that's just a good time on a Friday night as far as I'm concerned.  I really think that I need the ability to critically analyze research as a midwife, and doing that when I'm not even sure what p= actually means is problematic. 

Tuesday, July 27, 2010

Inspiration to be a Nurse Midwife

Posted by Laurel

If men flee the female, we will survive, but if women themselves treat femaleness as a disease we are lost indeed. ~Germaine Greer

10 thoughts on why I am inspired to be a nurse midwife...
1. Women are not socialized to celebrate their bodies, let alone live in them and own their power... I want to help bring in generations of beings that celebrate women and the female body. I love my body!
2. No matter where a woman is at in her life cycle, I believe that she deserves the option and opportunity for midwifery are. Whether a woman wants to have children, is pregnant, is pregnant and does not want to be, is unable to have children for one reason or another or choses not to... they can benefit from a midwifery philosophy of care. No matter age, sexual orientation, race, religion, ethnicity, SES, marital status, class, motherhood status, education, nationality, able-bodiedment - the option of midwifery care should be available.

Friday, July 23, 2010

I.am.exhausted.

Posted by D

I'm trying to figure out whether my exhaustion is a result of something with my health, or just my general state of circumstances at the moment. Several nights of disrupted sleep from a few births and also a 3 year old who is waking up at 3 Am and insisting that he wants to go play with his friend outside, does nothing to improve my sense of well-being.

It was an interesting week of births. Only 4...although I guess to some that sounds comical. Only? Four births with 3 different midwives. It both exhilarates me and exhausts me just thinking about it. I came away from all four births with lessons learned.

Thursday, July 22, 2010

In Celebration of Nursing

Posted by Katy
I just passed the NCLEX, which is the nursing licensure exam! It took me a humbling first attempt and much more confident successful attempt but now I am officially a New York RN! Som with that really good, relieving news I want to take some time to share some of the things I've enjoyed in this year of nursing school, several of which are quite surprising!

(1) I have enjoyed meeting all of the wonderful people with diverse backgrounds who completed the program with me. I learned so much meeting people from all over the country with interest and expertises including transgender health, dance, massage, art, and community organizing! I gained an enourmous amount of knowledge from and respect for my peers, they enriched the learning environment.

Monday, July 19, 2010

Naturopathic midwifery - Part 1

Posted by Tatiana

Naturopathic midwives make up a small minority among midwives. They are naturopathic doctors who practice midwifery either in conjunction with a larger practice, or as their primary practice. I was introduced to the existence of this subset of midwives recently and personally vacillate between being compelled by the notion and turned off by the notion. I want to know more. I'm investigating it further by interviewing some ND midwives, but I want to first provoke questions I haven't considered from the rest of you.  

Here's a breakdown of my current understanding and opinions of naturopathic midwifery: