Level 4: I wanna be like you, midwife

When I arrive at a birth, I try my best to think of the major things I need to do before I get there. Immediate needs:

  1. Fetal heart rate, contraction timing
  2. Maternal vitals
  3. Set up equipment and document
  4. Offer vaginal exam (VE)

Generally, as I’m washing my hands after arrival all I’m thinking about is how am I going to do this vaginal exam, steps to finding a cervix, and what different centimetres feel like. Oh ya, and where is the piece of paper that I need to write it down on?

Meanwhile the midwife has already washed her hands, is doing a blood pressure, counting contractions, setting up equipment, explaining the plan to the client, assessing the heart rate … wait, how did she end up sitting on the couch with her hands poised, handing me a piece of paper, waiting patiently for me … who only had one job?

She even has enough time to tell the client to position herself in the position I need to do the VE … damnit, I barely have one glove on … and I forgot to open the gel before I put gloves on so my preceptor has to do that for me … I was getting there I swear!

Is that going to be me someday? I wanna be like her, someday (in 9 months, to be exact). Right now that seems unlikely …

Slowly, slowly, catchy monkey …

Level 4: Rough start, rough feels

Fourth year is intense. I promise to update with new stories of what’s happened and things I’ve experienced, but for now, I will give you the inside scoop of how I’m feeling.

The first three weeks or so of this placement were a bit of a fucking disaster. I say that carefully, because I naturally expected the first month to be challenging given I have not done much of anything midwifery-related in a long time and the level of student responsibility leaps up 1000 fold. On Day 1, I was given a key to the clinic and on Day 2, I was taking pages from clients. I also had the added stresses of unpacking my house, (I didn’t get a couch until May 22) getting to know a new city, and a having been allocated a preceptor that was on the brink of a stress leave.

It was a lot to deal with.

I felt confused, guilty, and stupid every moment of every day. There were no good moments, and I questioned hard what I was even doing in this job that asks so much of midwives’ emotional and physical selves.

My preceptor situation was sorted out at the very end of May, after which I was paired with a new preceptor midwife. Things have been more clear since, partially due to the preceptor situation but mostly due to me getting a feel for expectations and my role.

I am behind, though. While my classmates were getting orientated and learning community standards, hospital protocols, paperwork, and other basics, I was barely floating.

Now that it’s into June, I still feel stupid most of the time, but now I feel stupid with structure. The basics are forming. I have some good days, whereas in the beginning I really had none. I’m still tired as fuck every day, but I’m able to keep my dishes clean, my groceries stocked, my cat fed, and my homework done now.

I feel more hopeful than I did in May and early June. I feel my confidence creeping back, and I feel less horrified at the idea of going to a birth. I’m trying to get my midwifery mojo back. It is, after all, the whole reason I started this journey to begin with.

One day at a time, they say.

 

 

Level 3: L&D

Labour and delivery has been my favourite Level 3 placement thus far. It was one month with a nurse who supports women through labour and birth, and it was a great month!


Introductions

I was a little weary on the first day because typically the nurses don’t know that you’re coming and that is always an awkward conversation:

“Hi, I’m with XX nurse this month.”

Everyone stares. My new nurse preceptor responds:

“Oh, I didn’t know I had a student.”

Always a weird start, but I’ve become brave in this midwifery education of mine, and have learned there is nothing like a little patient smiling and nodding until they do something about my presence. Eventually my nurse preceptor remembered me from last year working with the midwives (I got lucky and got the same community).

Getting started

My lovely preceptor showed me around, asked me what I wanted to learn most, and then put me to work! At first it was a bit disorienting, especially after not having done very much of anything hands-on during OB, but I found a groove eventually. The nurses would quiz me, answer my questions, and make opportunities for me to help them. I got to do several IVs (missed most of them), fetal heart monitoring, a bit of suturing, and of course, delivered 4 babies when the student-friendly OBs were on. I even got to go on my very first ambulance transfer, and see how that whole part of labour is managed.

Building bonds

At night, we would do all of the above but also have lovely little social chats about different life lessons. Some were about having families. Some were about delicious recipes. Some were about the “dangers” of home birth (can’t go anywhere without this one!). For those 4am chats, I would wrap myself in a warm blanket from the warmer, settle in, and take a listen. Crack a joke or two, maybe, and pretend that I worked there. It felt almost like I was a junior member of the team being newly orientated to the ward, and I found myself wondering if maybe I should’ve been an L&D nurse. Even my friend L. spent some time at the same hospital in the post-partum ward, making the long nights go by much more quickly and making this placement my favourite one yet.

Transitioning to care management

From this placement forward, I need to start shifting my brain to learn to care management decision-making, but it’s really still a long way off. I get parts of it but miss others and need gentle reminding. My nursing preceptor was excellent at telling me what I could’ve done better, or at encouraging me to go into a room, look at the heart monitoring strip, and come out with what I thought would be the best management approach. She would then agree, or disagree, and eventually I started to see patterns and decision-making points that I hadn’t been able to identify before.

I really hope my 4th year preceptor is like that; pushes me but is still friendly. I really hope for good things this year, as I start to cement certain skills and build my clinical confidence.

Wish me luck, 4th year starts in May in Ottawa!