Friday, February 18, 2011


Today, as I was driving home from clinicals, I cried on and off. It sucked. This is the email that I was composing in my head, trying to sound appreciative, and not needy but ---- what's the word?? (Not desperate, but close...)

"thanks for your patience this week (and in general), this week in particular just was not impressive and i'm not sure why. the areas that i'm not 'getting' are frustrating to me - as an OB nurse not to mention as a SNM - and it is getting to that point that i feel like i'm losing ground. i know i need more confidence and to be more assertive, etc - but am not sure how to get there from here, if that makes sense. not being able to palpate fetal body parts/find FHT's, determine what a cervical exam is/isn't, how to tell if the anterior shoulder has delivered or not (is that just feel or is there another obvious sign -- does the anterior shoulder become slightly visible before you switch to the posterior?), etc.
i know that these are women and families that you have been working with for a long time and i appreciate that you are giving me the opportunity to learn with them; i also recognize that your reputation and license are ultimately on the line as well and i am grateful to you for that reason and for the advice/criticism/info that you share, because i need whatever i can get to keep going forward.

also, just as an FYI - i know we talked a little about it when A was here - i have been trying to work out another site to get another perspective for at least part of my remaining hours... if/when that happens, i will let you know (i don't know if it would be just for a month or so, or longer/shorter term, etc... do you have an opinion on that?)

thanks again, have a great weekend... ~m"

(Maybe I'll jump in here and say that all of this may be exaggerated by the fact that (a) I'm probably a bit hormonal... I think AF is going to rear her lovely head *any* day now... and/or (b) I've been outta my little happy pills for days and days - so hopefully for us all, the Warm One has picked some up for me and life can cheer up soon...)

Anyway. Back to the post.

And I've been tearing up randomly ever since getting home. I've blogged before about self-doubt and having low self-confidence, I think. I don't think this is a great thing, but may not be that uncommon, either, for a student going into this sort of field... in fact, part of me thinks that being less-than-100% confident may be a good thing. (Isn't some bit of humility, some sort of willingness to admit that one might not know everything, probably good for everyone?) Anyway, I keep getting off-track here.

Earlier this week, I had a rough night with The Midwife. (My own fault) We had an induction, and another labor patient had come in as well; at around 12:30 a.m. the Midwife called me to let me know that the induction was going to be AROM'ed due to some concerns with the baby's heart rate (rather than "slept" and induced in the morning, as was the original plan...). I unfortunately was out like a light when the Midwife called and talked a lot of mumbo-jumbo, making little to no sense about needing a floor to sleep in if I came in and some sort of lighthouse or something --- totally looneyness, until my brain caught up with my mouth. Eventually, I made it in --- I live about an hour from the hospital --- checked in on both moms and caught up on their labors, and then laid down. Suddenly, it was four hours later when the nurses called to let me know that Mom A was about to deliver. Fast forward a bit, Mom A delivers, all ends up well, blah blah blah.... but it just wasn't my best delivery. At all. Mom A froze during pushing, head delivered, and I froze as well; baby was of course delivered and did wonderfully, but Mom A did get a tear and needed stitches, and the question comes up as to how much of her tear might have been avoided. Mom B delivers later, all is well... yadda yadda...

But, the crux of that night/morning was the Midwife's comment (at the nurse's station) that I need "a lot" of work in L&D. That stung... "a lot". Like many things, of course, that sting, it was important and necessary to hear. I do need a lot of work in L&D.

Of course, now, as the week has progressed, those words have been eating at me more and more. I've been walking on eggshells, slightly anxious about doing or saying the wrong thing... and a teensy bit scared to death about going back to L&D with the Midwife. (The irony is that what I was afraid of happened at work - away from clinicals - and went perfectly, without a hitch, in the meantime...) Not so, though, at clinicals... Our next go-round with L&D was tense again; my cervical checks seemed to be off (I don't get how I'm feeling a rim of cervix all around, and the Midwife can only feel an anterior lip when she checks right after me... I swear I have been checking cervices for years. I can, I can!) The delivery - same thing. Head delivers - mom tenses, fights pushing; I have a hard time "catching" when the anterior shoulder delivers... has it? Hasn't it? Time to go for the posterior shoulder now, or keep with the down and out pressure? I can tell the Midwife is not happy with my indecision (easily) but I JUST DON'T KNOW.

Again, baby delivers, all is well in the end... but the vibe, again, is not so hot. I want to talk with the Midwife before leaving, but it's 5 p.m., Friday, my babysitters at home wanted to leave by 5 (and I still have an hour drive...), and the Midwife is at the desk yet. I change, stop to say something on my way out, and she mentions that she will email me with "a few things"...

Can my preceptor dump me via email?!


  1. Aw, Mandi. Honestly, that comment would have been in my brain way too much as well. I would have thought it to death. This midwife has YEARS of training though. I'm sure she started off just as everyone else does. Take charge in the rooms. Prove her wrong. Show that you are more than capable of doing things.. maybe you just need a pep talk once in a while. Everyone does. It's how we get by in life with all of the stress. <3 you and hope for the best. Remember - CONFIDENCE! Walk into that place like you own it. Compliment yourself as well. Don't focus on the negatives, but focus on the positives. <3 you!

  2. I was feeling so indecisive and having NO CONFIDENCE with one of my preceptors. I found that once I forced confidence, took a little initiative, faked sounding confident...she seemed more confident in me. I have a lot to learn, we are just starting this amazing journey, but have been a midwife in everything but the actual degree or letters after your name for some time. Perhaps her personal approach is not what will be comfortable for you with your clients.

    It has to be different learning her personality at the same time learning all of this stuff. I am lucky to not have to "learn their personalities."

    Does she allow you or are you at the bedside during their labors. I feel like once I am at their bedside bonding with them and supporting them while they are in active labor, then the patients become confident in me which carries over to how I feel and then to the midwife.

    I want to say take the step to "control" the situation/room/plan of care...but does she allow you to do that?

    When did A visit? How did that go? Do you have to get another site or what's up with that?

    You can send me an email if you don't want to say it all here, but I believe in you. I love that you are quietly confident. I love that you take the time to listen to the whole story and appear to totally be listening to me and then respond. I think you have so much to offer to women and if you aren't able to exude all of that in the clinical setting yet-you will.

  3. OK, my response might be longish...
    I have 2 preceptors. They are both great, but are very different personalities.
    The one, "B" admits that she has a hard time "giving up control" and keeping quiet to allow her student to do things. The other, "A", is laid back and allows me to run things, while keeping a low profile, other than for some assistance when needed. She will give me tips or feedback after the visit, birth, whatever, IN PRIVATE. "B" has said a few things in front of patients about me not knowing this or that because I'm just a student. That is inappropriate, I think, but happens. I know it definitely made me feel about an inch tall and cut my confidence level about 90%. After an incident like that, it can be very difficult to function well with that preceptor in attendance. You're so nervous, that you can do nothing right!
    If I only had "B" as a preceptor, and never "A", I don't know if I could've made it through! There were plenty of difficult days, where I would do a few visits (well, I thought) independently with "A", then go in to do a visit with "B" and she would not introduce me at all, not let me get a word in edgewise, and I was pretty much wall paper. Very frustrating!
    But, I kept telling myself that it is just their different personalities and I could get through it. Eventually, "B" did give me a little more independence and actually praised me at times. She always tended to have more "critiques" for me than the other preceptor, though. She tended to prefer things to be done the way SHE did them, whereas "A" was open to the fact that there are many ways to skin a cat. (Not that I would ever skin a cat. I like cats.)

    As for the whole anterior shoulder thing, I have also had some trouble figuring that out! I think it's something that will come for us in time. We are STUDENT midwives! Basically, I think that when you feel some "give" with that anterior shoulder, you can start working on the posterior, but it's different each time.

    And I, too, especially having finished my clinical hours, have a truck load of self doubt and apprehension!! My thoughts go something like, "I can not do this by MYSELF! What if I can't figure out how to sew up a lac? What if she starts to bleed PP and it won't stop??? What if there is a shoulder dystocia that I can't relieve??! What if the FHT drops to nothing and she won't push?????!!! What if I see a wierd looking thing on a cervix in the office? How will I know what it is? What to do with it? What if, what if, what if, what if???????!!!!"

    I try to turn this off by reminding myself that I had many of these same worries as I was graduating nursing school and the responsibilies I would have as a RN terrified me. Eventually I got more confident in that role and I will get there this time, too!
    In the mean time, maybe it wouldn't hurt to do a little time with another preceptor... One a little more like my "A"!

  4. Glad you're back! I check everyday for a new post. I wont give you along detailed comment like everyone else, just the two things that stuck out to me because I've had this discussion with my preceptor recently...

    It's ok to not know! You're learning, and it takes maturity to say you don't know. Guessing or "faking it" (and not talking confidence here, but knowledge) wont help in this situation, you're there to learn and will make mistakes. Take them in stride and try to do better next time!

    And, listen to your hands when you're palpating. Crazy, but they know what is there. Just listen to them :)