Saturday, May 21, 2011

Thank God for Midwives

(And mama's, and babies, and supportive dads/aunties/grandmas/friends, and doulas...)

But, at least for me and at least for this week --- thank God for Midwives! If you've followed along at all, you might remember how intense (is that a good word??) things became at my last clinical site. I won't go into all of the details again - because frankly, it makes me feel pretty lousy and I also start to feel a little badly for the women who really want a midwife and don't realize (until it might be too late) when they've actually found a medwife - but it was rough.
Rough on me a student, as a person, and even as an OB nurse. That site caused me to question a lot of things both about myself and the way I have been prepared to practice as a CNM; the Midwife was motivated, she was popular, and she was good. But - she was also (either by choice or by necessity) very much a medwife. As a learning experience, it was good; the four months I spent with her allowed me to begin the hands-on learning I needed to grow as a new midwife, and the last few weeks (along with many, many weeks thereafter) gave me pause to reflect on ways that I myself need to grow my personality to better perform in that role, as well as on the pieces of the Midwife's practice that I did and did not want to take with me into my own practice.

It wasn't until today, though, that I realized how deeply I felt wronged in my previous site. My faculty advisor has been working hard to help me find a new clinical site; this process, which originally seemed as though it would be fairly quick (I had another preceptor in mind, who was happy to work with me) ended taking 2 and a half months. Obstacles with policy, administration changes, and just enough little roadblocks to keep things from progressing have kept my hands from officially (as a student nurse-midwife, that is) welcoming a baby into the world since March 1st. (And it has been kiiillllllllling me!) As things continued to stall, my advisor suggested I come to a site that has welcomed several of my classmates in the past; while at first I was hesitant (as this site is a 3.5 hr drive from home) eventually it got to the point where any site was perfect, and I jumped at the chance. The midwifery group agreed to work with me, the paperwork was approved, and plans were made for my arrival early this week.

And, it has been amazing. Amazing for the births I have attended - 9 so far since Tuesday (and I missed several others one day when I finally had to admit that my body and mind needed rest), including two glorious waterbirths, two VBAC's, and a handful of other triumphant displays of mama-power. Amazing in the fact that the midwives and nurses have welcomed me with open arms, eager to help me blossom as I work my way towards becoming a beginning-level midwife. I've had "scary" moments - a decel that wouldn't come up (while my precepting CNM and the OB on-call were in the midst of a c-section and completely unavailable), a shoulder dystocia that didn't resolve easily with McRobert's maneuver and suprapubic pressure - but made it through them. I've been allowed to be more independent in four days, with four different midwives, than I was in four long months with the Midwife: when our dystocia baby's shoulders didn't ease out shortly after his head, the CNM I was working with that day didn't push me aside to take over... instead, she stayed back (as hard as it must have been) and allowed me to identify the situation as a shoulder dystocia and to work to resolve it. When my efforts weren't quite doing it, and I looked to her for help - she was there. The trust that I've found from these midwives - each of whom I have met for the first time the morning that the call shift begins - literally brought me to tears as I finally took some time today to reflect on this first week. It takes a momentous amount of trust to stand back and allow a student to be in control of a situation - especially one that is as intense as a shoulder dystocia or prolonged decel. I can't even begin to fathom how difficult it is to stay back and just "be", while a student works to resolve something that can so quickly develop into disaster. And yet - the true mark of a good teacher is to understand that without allowing a student to take the next step towards independence, the student will ultimately never succeed, and both teacher and pupil end as failures. In labor and delivery, with the life and well-being of a longed-for baby on the line (as well as the mother's safety), the amount of trust and courage in takes to do this is multiplied ten-fold... with the rewards equally as impressive.

I'm not there yet - a part of me froze up in those tense situations, and it took longer than it should have for the little voice in me to say, "this is what you do... remember?". But the gift of being allowed to wake that little voice up, to do my best, and to know that I had a supportive preceptor right behind me --- rather than pushing me to the side immediately --- was worth more than anything else. Then, the bonus of constructive feedback and open communication - rather than quiet, tired frustration - after each incident: What should I have done? What might have been a better way to do that? And - what did I do right?

As I wrote what was supposed to be a quick update to my advisor, letting her know how incredible of a learning experience this has been so far, I found myself reflecting back to the days with the Midwife and comparing the feelings I had at the end of that rotation (inadequacy, doubt, fear, shame) and the ones that have emerged in just a few days here (confidence, readiness, calmness). Sitting on the back porch of the midwife who so graciously invited me into her home, smelling the lilacs with songbirds for a soundtrack, tears rolled down my cheeks as I typed on and on. Where my hands were rarely able to catch without the Midwife's covering them before, they now have eased 9 new lives into the world with very little guidance; when I reluctantly began to perform certain skills in the way that I had been taught from the Midwife (but had never been comfortable with), I was reassured that there was another way, and that the way I learned was not necessarily the best practice; what had been frustrating in the past (lack of expectations, absence of any real rapport) was nowhere to be found among these midwives.

So, thank God for midwives... the midwives I've worked with this week, who took my hesitant, injured confidence and allowed it to begin to heal; the midwife who opened her home to me, with its peaceful quietness (no television, no cell phone reception) and country beauty; the midwife (my advisor) who spent so much time working with me to find this happy place again. And even the Midwife, who started me on this journey and puts this all into perspective.



6 comments:

  1. Tears of joy for you, Mandi!!! Reading this warmed my heart :)

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  2. Thank you so much for sharing that story with me, for I witnessed your last birth with the previous medwife back on 3/1. My heart ached for you at the time for the way you were treated as well as my client (I'm a doula). I am so happy to hear that your new site and midwives are such great educators, friends and mentors. I can now shed happy tears and put the sad tears behind me from the one and only birth I witnessed with you. Blessings to you.........

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  3. I am soooo happy that you've found YOUR site! This sounds very much like the clinical experience I had and it was such an amazing learning experience. I had a couple of mild shoulder dystocia's (at least, the preceptor thought they were mild - I thought they were terrifying!) and when I started to let go and back away so she could take over, she calmly said, "No, put your hands back on the head." I did, and she placed her hands on top of mine and assisted the birth of the head so I could feel how much pressure she used. It was perfect! I wasn't "pulling" nearly as strongly as she showed me, and the baby came right away when she assisted me. That is the kind of teaching that student midwives need! Invaluable!

    You are right and very wise to realize that your first clinical experience was very much a learning experience, also. You may have gotten more from that negative experience than you will get from all the rest of your remaining positive ones. It's great that you can take that perspective now.

    So, so wonderful that you are finally doing what you were meant to do, the way you were meant to do it! Hugs!!

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  4. thanks ladies!

    @kathy, the way the couple worked together for that last birth was beautiful, and the new family itself... but there were certainly things that just weren't quite 'right'. it really opened my eyes (at the time) that a complete stranger could pick up on the tension/etc that was coming out during those last few weeks with the Midwife.

    @Mommy - the way your preceptor helped you realize how much traction to use in the dystocia is exactly how you describe... invaluable! i'm a hands-on learner, and having someone try to guide me through how to do something doesn't always work (like i can picture how i should be doing it, but my hands/whatever just don't always seem to get it right until i catch on from actually *doing* it). having a preceptor behind me telling me to "pull harder" isn't going to help at all - at least not until i realize how much traction really is needed (aren't we all always afraid of hurting the babe??). Whether I 'learn' that from trying over and over, or from the hands of an experienced teacher guiding me into it --- it's just something that I need to *do* to know.

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  5. Mandi, I'm so happy to hear that you have found your clinical "home". I sensed that things were becoming difficult for you and it is wonderful that you are getting such a fantastic experience! I am so worried that when I go to do my hopsital experience that I too will find a "medwife" Keep having those great experiences! You're going to be an awesome midwife.

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  6. I am so excited and my heart is "warm" because you have found that place to grow and flourish. I always knew you were going to be a good midwife and hated that perhaps you were doubting yourself.

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