Sunday, January 16, 2011

I'm scared to death.

Period. End of story.

I thought maybe if I said it (typed it?), it would make me feel better, or at least feel something different - but I am still scared sh*tless, to be perfectly frank. Within six short months (god willing), I'm going to complete my clinicals, work on passing comps, and take my boards. And then, I'll officially be able to call myself a midwife in front of clients - something I've been feeling for months now (or even longer).

And that, dear anyone-who-may-or-may-not-be... almost paralyzes me some days. I am a terrible, awful student. I procrastinate, I get distracted, I prioritize poorly. I don't know when exactly this happened - I used to rock in high school - but at some point over the past few years (maybe once my brain cells started being killed off by motherhood?), my attention span has decreased. Somehow my remaining brain cells get overloaded, and everything I have studied flies out the window - things that I know, that I can explain frontwards, backwards, and upside down. But when it comes to spitting them out for an exam, or off the top of my head for a professor, spur-of-the-moment? Hello, pee-in-my-pants-because-I-got-nothin'! Not. Good.

Don't get me wrong - I'm working on this. (I like to think that I'm smart enough to realize that I can't be successful and still have this HUGE crater in my path). I've talked to other students, I've had study groups. I've gone to counseling. I've got awesome support from the Warm One. Some of my family recognizes how hard this is (full time grad school + working 20ish hours a week + family), others don't... but that's all right. And, I've got the Bears. (More about the Bears later on)

So, most days, I can work through the fear, and I'm good. But. There are other days.

Like, the days when I realize that, holy shit, I need to basically learn (or at least very, very deeply review every SINGLE thing I have learned since starting grad school - not to mention a very good portion of what I learned in my associate's nursing program) in the next few months. Some days - when the Bears are closing in, and I've forgotten to avoid the crater in my path - I let myself get anxious and (again) horrified, realizing that I never really learned even the basics of anatomy and physiology. Autonomic nervous system? What's that do again? Tell me more about the parasympathetic stuff, again... Oh, f*@#!

And then there's meds - I learned them enough, for long enough, to get through at the time. (Or at least - again - that's what it feels like). What's a beta blocker for, again? Double f*@#.

The basis for EVERYTHING I have learned, and need to know, is built on an awful shaky foundation (at least in my own mind). I have been flying by the seat of my pants for the past five years, milking the "fake it till you make it" mantra for all it's worth... but something tells me that as a provider, that won't cut it.

Or, the days where I remember deliveries I've seen as a nurse: moms who come in, with no risk factors whatever. Spontaneous labor, or just something "not feeling right". Baby hasn't been moving as much as usual, a little bit of unusual discharge or bleeding, sharp pains... whatever it may be, or nothing at all. Perfectly normal pregnancies - and then, when the fetal heart tones are doppled or monitored --- a "bad baby" is seen immediately, a crash c-section is called, and a little boy or girl, pulled out a thick, dark meconium is worked on in a curtained nursery for a long, long time by nurses, doctors, respiratory therapists, and finally the NICU team that has flown in. Or, maybe it's a baby that looked fine throughout labor - a nice, normal, happy vaginal birth - and then with no warning, baby just doesn't transition after birth, needs help breathing, and help is an on-call doctor or an ambulance ride away (which, of course, seems like days and days with a baby that isn't breathing).

Or, the days when a baby is suddenly no longer there. Or is found to have an abnormality non-compatible with life. Or anything that will be very, very difficult to share with the parents. I am terrified that I won't have the words or the grace to share these moments with the families that need me to, the most...

Please, please, if anyone is out there and has been in this place (specifically or not), please tell me it passes...!


On "The Bears"

This is a technique that was shared with me during a counseling session when I was struggling especially hard with stress and anxiety (thanks, Dave - I hope you don't mind!). I am most certainly paraphrasing the technique, since I don't really remember how it was explained to me... so please 'bear' with me (groan!).

Setting: Wooded area surrounding a small clearing (perhaps a campsite?) with a campfire, simple block bench, etc
The Players: A handful of the Bears (these symbolize Stress/Anxiety/Fear - any negative or bothersome issues - I always picture them as cartoon characters similar to, maybe, "The Far Side" or something?) and You
(We enter the scene with You sitting on the crude bench near the campfire, maybe toasting marshmallows or a hot dog. Something's troubling you - fear? stress? anxiety? - and you realize that the shadows creeping up behind you are actually several large - albeit cartoonish - bears)

Don't Fight the bears - this will only encourage them to come back (and release adrenaline - the 'fight or flight' hormone - in you... leading to more bears --- and more stress/fear/anxiety) and... Don't feed the bears! (I.e. don't let yourself dwell on the anxiety/fear/stress/whatever's bugging you - that will also keep them coming - it also releases adrenaline) Just look 'em in the eye, say, "Hey bears, I see you there, you're right, I am stressed/freaked out/pissed/etc, and it's okay. I'm not going to feed you, and I'm not going to fight you. I'm just going to be."

It may sound silly -- but to me, it was very, very helpful. (And, in fact, as I typed this I realized how very little I've 'practiced' it lately - which can't be helping the topic of this posting.) On a side note, the ringer of my cell for a while was Mini #1 saying "Don' feed tha' bear!" - from the Adventures of Winnie the Pooh - for a year or so, which made this technique feel even more 'right' for me... every time I was getting myself worked up, her sweet little voice reminded me not to.


  1. So, I hear ya... I have one preceptor, that is really good and really nice, that I cannot for ANYTHING answer a question right. CAN'T! I pisses me off to no end. With my other preceptors I am a confident SNM that can do wonderful history taking, good differential DX, have wonderful assessments and plans. I am praised often. I do make some mistakes or don't know something here and there (that is the learning process) but I am what clients see as a "midwife".

    Then...I am with the other one. She asks me a question "What are the three P's that OB docs worry about?" The F&@$ing three P's???? I think to myself. OH OH, "position, position, position." Did I really say this? YES! So, it is Power, position, and passenger. Oh yeah, I know about all that. KILL ME NOW!!!!!!!!!!!

    I wrote about this is my student self eval and my RCC said..." When you are with this preceptor don't be the student you are with her, pretend you are the student you are with the others. Remember you know this stuff, be confident and it will come.

    The next delivery with her I still had some wrong answers, but I did notice I was more confident. I also noticed she stepped back a little more and allowed me to be the "midwife" just a little bit more.

    You are right, you know this, you can do this, you have been a midwife at heart for a long long time. The more we do this, the more confident we will become. We will begin to trust ourselves like we hope our patients trust us.

    You are not alone. You are not alone.

  2. After leaving the nursing field 8 years ago for silly reasons (not so silly to me at the time, but with wisdom I see how much I was trying to take on the burdens of the world), I have decided to return to nursing and to start work on my masters to be a midwife...
    I'm one of those people who once I get an idea in my head it consumes me and I have to get as much of it as I can (which is how I found your blog, googling for midwives to read their stories). So after choosing to start classes to renew my license I went down to my basement, dug around for a while, and pulled out a few of my old text books from college.
    I picked up the pharm book and flipped to the quiz at the back of chapter one. And failed it. Miserably. Chapter two, same results.
    Ok, on to the A&P book. On this I did better, but only because I was obsessed with A&P in highschool, took honors courses for it, and then had the 2 courses in college- so that stuff had plenty of time to really fix itself in my mind.
    But nursing care plans, path reports, drug cards- all those things from nursing school seem like some whispery cloudy memory, like the "conversational spanish" from freshman year of high school. Sure, I learned it, but I cannot pull it up in my mind now!

    Unfortunately, or fortunately, I live in Nebraska. This state is ridiculous in their renewal of a nursing license that is expired 5yrs or more. At first I was cursing myself for leaving Iowa where $200 and a random 2ceu online class gets your license back no matter how long you've been gone from the field. But now, after looking through those text books, I'm kinda glad I have to take 40 credit hours online to renew my license. Its likely to jog my memories and show me where I need to study better... its going to suck, but at least I won't feel like a complete idiot on the floor when I go back to work my way through my masters classes!

    sorry so long- just wanted to let you know you are so not alone, mommy memory is my excuse and I use it to the point of exhaustion! :)

  3. I am nearing the end of my CNEP clinicals myself and I am SOO glad to hear that I am not alone in feeling panicked at the thought that soon women are going to look at me and assume I know what I'm talking about!! I've decided I'd just rather remain a student midwife (except for that pesky little detail of "no pay checks"). I feel like it is acceptable for me to not know everything because I'm a student. I also love having my preceptors with me all the time, not only for the back-up, but because it's fun! Makes me kind of sad to think I'll be running to births alone soon.

  4. thank you all for sharing my misery! we are *not* alone and i think this is normal --- and i think some degree of worry/fear is probably good (overconfidence would be a bad thing, no?) no matter how experienced we are.

    breathe, breathe, breathe...