Level 4: Bite sized chunks of learning

As I said in my last post, the expectations in senior year are a giant leap up, but I’m grappling with it. They need to be a step up because you are now the most responsible person in charge of the lives of two beings, but boy, it makes things hard to learn in a systematic way.

What do I do when things are abnormal?

The main difference I’ve found between this year and my previous midwifery placements is that we are expected to manage abnormal. I’ve been so conditioned to what is normal that when abnormal hits I am a deer in the headlights.

Baby shoulders stuck but the head is out? I’ve only ever done that on a doll. 

Fetal heart rate tanking? What’s your plan?

Mom bleeding out after delivery? Vocalize next steps. Command the room.

This is the time to learn to ACT in bad situations, and it’s challenging. The only way to learn is to do, with guidance.

How am I going to do this?

My new preceptor has me working on one small, new thing at every birth. Last time it was documenting. The time before that it was being on top of labour support and fetal heart rates, and making position suggestions to rotate the baby and encourage descent.

Next time it will be anticipating the next steps before my preceptor does. That’s the hardest part, especially when things are abnormal. She wants me to vocalize and instruct everyone, including her. That feels weird.

My preceptor told me I have a great handle on managing normal. When things aren’t going normally, though, I’m no where near running any sort of anything. If feels like I never will be, even though I know I have a year to get it.

Here are some things that have helped me start to build my capacity, but have also made me feel fucking dumb:

  • Post-epidural, a mom’s blood pressure tanks to 60/40 (normal is 120/60). I throw up the IV bag and get the IV equipment ready, thinking she will likely need a second one. Then I stand there like a log trying to get my brain to think of what to do next.
  • Baby being delivered by forceps. Many nurses and physicians enter the room, but my preceptor advocates for me to keep documenting. So I do, I document the abnormal fetal heart rate patterns. When in doubt, always document.
  • A mom is bleeding more than I’ve ever seen, and I look up pleadingly at my preceptor, demonstrating that I know that its too much bleeding. I suggest another shot of oxytocin – then my preceptor nods and takes over while I rub her uterus as hard as I can to expel any clots. Poor mama.
  • A baby’s heart rate is dipping while I listen with a Doppler. I notice and vocalize that the fetal heart rate is abnormal. I document. Then I need my preceptor to initiate the next steps because though my mind has read about what to do 1000x in this situation, my body has never actually done it before and the slow thudding of a decreasing, prolonged fetal heart rate is agonizing.

It’ll get better, right?

Everyone in my class agrees, this is hard. Even the most optimistic and skilled of us are working through our own issues. As we adjust to midwifery life again, and build stronger, trusting relationships with our preceptors, we will naturally gain confidence and skills. This is a job that takes time to learn and just plain old experience. It also means doing things wrong 1000 times. No new person in health care ever managed a post partum hemorrhage after reading about it once, so I just need to see how one is run and get in there as best I can every time.

For now, I move forward one day at a time, learning what I can, and napping when I’m overwhelmed.


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