North by North West...

That - is the question.

At the end of the last post, I alluded to some internal conflict between the two sites where I recently had interviews. The first site, dibbed "North", is located about 5-6 hours from where my family has always called home. It's got quite a few things going for it; the pay is nice (relatively - I don't know what the other nurse-midwives that graduated in my peer group are being paid, for the most part, but the rough starting pay I was quoted for this position is about what I was expecting based on my searches for this area). The site is also a HRSA (Health Resource Service Administration) designated site, and the position is eligible for loan reimbursement --- which means that by committing to work in the role for at least two years, I would say buh-bye to a nice chunk of my student loans (and by working a third year, one more of those big ole monkeys would also take a hike... leaving me just about free and clear on the loan front). My partner would be a midwife who developed the nurse-midwifery practice at the site ten years ago, and has worked to build a great relationship with the handful of family practice doctors who she works alongside (by the way, I LOVE family practice doctors - not such a fan of OB's --- most likely because I simply have worked with very few, but also what I have heard of them hasn't been so favorable...). The main clinic at this site is located in a rural area and is very full-service, offering clients a range of services from x-ray and lab to WIC and massage; the practice also has a secondary site in a large city about 30 minutes away, with limited services (but just as vital care for recipients in the urban area). Call would be shared, possibly 2-2.5 days a week and 1 weekend a month (with an estimated 50 births annually); clinic would be 4 days a week split between the two clinic sites. After visiting "North" --- I felt good, confident, ready to go. I had a strong feeling that I was going to be offered the position, and that I would probably take it.

But. (That "but" is always there, now, isn't it?) In the days that followed our return from our visit, a few things nagged at me. At the end of my visit with the midwife at "North", I asked a few questions (thankfully) regarding the specifics of her midwifery practice. Did she feel that she did a lot of inductions? (She felt like she actually probably did more than she should... red flag?! red flag!! Her rationale? She did take days off - understandable, since she was a solo midwife and had been for the past 10+ years; she stated that she did offer induction at times to her patients before she went on vacation. Hmmm. So - on one hand, this seemed OK. On the other... something to ponder.) What about continuous monitoring versus intermittent? (Answer: If a woman specifically wanted to be off the monitors, she was good with that - but if there was no preference either way, she didn't push for intermittent monitoring either... ???!!? Rationale for this one --- The nursing staff tended to be low, and this made IA difficult to impossible at times. The unit did have telemetry, so continuous monitoring didn't necessarily =/= a patient that was stuck in bed --- but then again, MY unit also has a telemetry unit... which sucks. As much as I'd like to say telemetry means a patient can labor while ambulating, or in the shower, or on the toilet or squatting or standing on her head --- not necessarily. Especially if she's on continuous EFM for nursing/provider convenience in the first place. S0 - another thing to ponder. While again I can understand the reasoning behind using EFM versus the additional time necessary to IA --- and am glad she had that explanation rather than that she needed the security blanket of the paper/electronic strip to ensure babe was doing all right --- I still get nervous at the idea of having hours and hours of paper strips staring at the nurse... and resident... and whoever looks at them and starts seeing oogie-boogie monsters in the shadows of innocent variability or the occasional benign decel.) Those were the two biggies on my "hmmm" list... From just a facility point of view, it would take a while to get used to LDRP's that are half the size of the ones at "my" rural critical access hospital, some of which have shared bathrooms. And residents (I've never worked with residents in my life - they seem like a whole different species!). And - while I won't say specifically which states, I will say that "North" is in a neighboring state which has a longstanding, sometimes vicious football rivalry with our NFL football team. And the Warm One is a diehard football fan.

So there are at least a handful of things that "stick", if that makes sense. Not that I'm not seriously considering things --- it's just not 100%, yet...

And then - there's "West". I flew out there last week and fell in love. I texted the Warm One immediately (or maybe it was after dinner with the midwives - either way, I hadn't been there long) and emphatically told him that I would cry if I didn't get the position. Throughout the course of my two days with the midwives at the "West" practice, my position on the area and their care philosophy didn't change. At all. I want to go there. The town where this practice is located? Beautiful. It's twice the size of the small town I live in; I'm a small town girl, so I can handle that. Their practice? Gorgeous. Clinic exam rooms that are spacious, with huge, full-sized "beds" (seriously, I have no other way to describe them) covered in pillows created for expectant mothers to lounge --- alongside big brothers and sisters, or dads-to-be as well --- and chat, listen to that precious heartbeat, and learn. Beautiful birth-inspired, earthy artwork everywhere. No sterile white walls or ugly, plain paintings meant to be aesthetically neutral. All of my questions - "Do you induce a lot?" "How do you feel about VBAC's?" "Are you open to a new grad?" - are met with just the right answers ... yes, inductions are necessary sometimes --- but not just 'because'! And they do VBAC's, and waterbirths, and LOVE students. It's amazing just to pick up the calm, reassuring vibes as they answer questions - to picture these two women as mentors is mindblowing. The call/clinic schedule is specifically geared to give each of the three midwives a rejuvenating period frequently; at least once every three weeks, each midwife gets a 5-day off stretch (that is, five STRAIGHT DAYS OFF in a row. Heaven. No clinic, no call, nothing, for five days.). Clinic and call are intermixed, often with stretches of 3 days off in a row as well. As one of the midwives stated, "When we are on-call, we usually work hard (the group of three midwives delivers between 250-300 babies annually) - but when we're off, we also 'rest hard'." I can dig that. To be able to serve my patients AND my family? Awesome-sauce. And the hospital is about 2-2.5 larger than 'my' OB unit --- so larger, but not as large as "North"; the nurses were great, and loved the midwives. Downfalls? Cost of living! To find a house under $200k may be impossible, and we would have to trade in one of our cars for an AWD or four-wheel drive; the pay "West" is also significantly ($10-$15k - ish) less than "North", with 2 weeks less vacation time and likely less benefits in other areas, particularly no loan forgiveness. Big things the Warm One is concerned about. And, of course, being a plane ride away from Home. Where the hearts are.

Speaking of home.... And hearts. It's a hard thought to think of leaving everyone that I/we love behind us. As much as I always suck at returning messages, emails, phone calls, etc --- it's even harder with all of this going on. Part of me wants to ignore that any of this is happening - that any changes are coming - but to do that it also means ignoring any references to change. Whether we go "North" or "West" ... or anywhere else ... it hurts. And it's scary. But it will be okay, too.

For the time being, I'm waiting for a phone call. A phone call from "West" could be making a decision that we go that way - throwing caution to the wind and hoping that the cost of living will balance out - or the other way. Or, perhaps, no call, but a "thank you, but no thank you" letter (as they did have two other candidates yet to interview...) leading us "North" ...

~*~*~*

In the meantime, I'm content to be back on the edge of that abyss, arms wide open, and leaning in, knowing that wherever the fall leads, I will land gently...

Will work for Food...

Seriously, I will... I certainly have a bit of a love affair with food. Especially this time of year, with the county fair in town: cream puffs, beer-battered cheese curds, funnel cakes.... Oh, my poor achin' arteries.

And summer. I love summer too. (Can it seriously be Labor Day already?! I want to cry! I do *not* do well with winter... sigh...) Anyway.... this blog has clearly been neglected for the past month or so. Oops.

I've been a little busy, to be fair. Since the last time we met, I scratched off each and every last clinical hour and visit I needed to meet the requirements of my program, as well as having a "declaration of safety" submitted by Dee (signifying that she feels I am a safe, beginning-level practitioner); one of my biggest feats was taking - and passing - the first of the last 3 big tests standing between myself and midwifery. I'm engaged, descended, and flexed - now on to finishing the rest of these cardinal movements, little by little...

(was that too corny?!)

From a personal standpoint, things have also been busy. Family life has been hectic as always, with ups and downs. My bigger-Mini started Kindergarten (!) last week, which seems incredible; I still remember the moment she was laid in my arms and the immense feelings of wonder and

awe I felt to be a mother to such a wondrous little being; my Mini-er is beginning preschool this week (and memories of her labor, and birth, are even more vivid; the moments in the shower, visualizing her path down to birth, and the moment when the Warm One proclaimed her as a "little girl"... so clear!). Harder to work through these past weeks have been the continuing struggles with my brother and his own battles (battles which he alone can fight, but that as a family we have been trying to find ways to support him in...), the diagnosis of Lyme's disease in my father, and acute, aggressive leukemia in my grandfather. It's painful and exhausting to see the toll, both physical and emotional, that's accumulated across the family lines in the past weeks and months; through hopes, prayers, and support (and communication), I'm waiting for a strengthening of the bonds that hold us together.

But, back to the "Work" thought that started this whole rambling... I'm starting to think more seriously about jobs again. (It's getting to be time, I suppose. I have one more "school" test - the competency/completion exam, after which I am officially a graduate nurse-midwife, and the final step is the national certification exam). I've realized, after doing a phone interview or two over the past few months - mind you I haven't interviewed in years! - that I need to brush up on my interviewing skills. I thought maybe I'd toss out a few random, jarbled thoughts on here, if nothing else, to help myself sort out a little more about myself (you know how they - "they" being interviewers, of course - always ask about your strengths/weaknesses, what you would like to improve on, etc...)

About Me...

* I'm not there yet, but I'll be there soon!

* I don't drink coffee... but I anticipate that I will start to do so soon...

* I run habitually late (not much, but just enough to be a few minutes late...)

* But - see above - I'm reliably late those few minutes!

* I learn by doing, not by reading/listening

* I'm quiet - but only for so long. I will open up (you may be sorry....)

* I do have a sarcastic streak... and a good sense of humor!

* I may hold back a bit at first - let my confidence build, and I will shine.

* I trust women, their bodies, their intuition, and their abilities.

* I am a very dedicated, motivated employee.

* I can't even come up with enough to write here! Man, I better hire myself out to a farm or

something instead....

Mama Needs a Time-Out

Seriously.

Whatever happened to TGIF?! So much for Friday, I guess... whatever optimism and good vibes I had going into the earlier part of this week somehow dissipated as the week rolled on. In the wee hours of Wednesday morning, while I was gearing up for the clinical week - I usually do clinicals with Dee Weds/Thurs/Fri - I woke up with a killer migraine. (I've had migraines since I was four or five ... nothing new there. They've probably been in the best control of my life for the past year or two, actually; I've found a daily preventative med that seems to help, and for the first time ever, I've found an abortive that seems to actually knock them down when they do kick in. Score. But - that being said - I do still get the occasional nasty f*@!er, but never, or rarely, has one ever woken me in the middle of the night before... so this one sucked!) I did my best to get through the day Wednesday with Dee, but even after taking my abortive, and all my usual knocker-outers, I had nothing and had to leave early ---- which I hated doing. After a few hours of solid rest and a combination of narcotic, another abortive, heat/ice, and some topical cream to my neck/shoulders/etc (which by the way was not a good idea - more on that later), I was somewhat coherent again.

Unfortunately, the arthritis cream that I picked up to rub onto my neck/shoulders/temple (similar to what I usually use, but a different brand... I can't even think of what I picked up that day) was awful. Whether it was the intended effect or not, it caused my skin to feel as though it was on fire - my palms, my shoulders, and my neck raged at me the entire afternoon, evening, and next day, even after scrubbing in an attempt to relieve the sensation. And, of course, smart cookie that I am, I slipped my contacts out (and then tried to replace them the next morning) with residue apparently still remaining. Good gracious golly. Not only was I living in the migraine hangover, I was also fairly certain I was close to blind...

Then, when I got out to my car --- I found it egged. What. The. ... Seriously. Of course, as usual, I didn't have any spare time (why would I?! Any of you who know me, know that I don't generally run with spare time...) to rinse the gook off, much less for a real car wash. Okay, so it was only one egg (or maybe two) on the driver's side door and window, but for the love of mud --- why?! I really, really was NOT in the mood and, as I'm sure you can imagine, would have had some not-so-pleasant things to say to whoever thought sharing their breakfast fare with my vehicle was a good idea.

The rest of the week has pretty much continued as such. Though I am sooooo close to the end of my necessary clinical hours - T-minus 66 and counting - I've hardly knocked any off this week, thanks to the lovely migraine and having to cut out of clinicals early yesterday (Thursday) as I was scheduled to work in Babyland.

So it's been a non-productive, miserable-feeling, blah kind of week. Oh, and that "other" position that I was excited about? I had a phone interview Wednesday evening, post-migraine... I thought it went all right, even though it didn't sound like my "dream" position by any means; while I didn't expect to get hired as they disclosed on the phone that they were doing a second interview for a previous applicant the next day, it still stung today when I received an email telling me that my "career goals didn't appear to be a fit" for the position, and thanking me anyway. Ouch. I guess it just is a downer, all around, even though I had more or less decided that I wasn't all that interested... *sigh*

To top it off, I'm finally home, getting to spend some time with my family --- and my lovely young ladies are not listening to me, I'm incredibly crabby and cranky with them, and I just don't have any patience for them, for myself, or for anything. I don't like how I feel, how I'm reacting to them, or anything at all. In desperation, after too much hollering after too much whining, I sent them to separate rooms for extended time-outs --- but really, deep down, I'm the one who needs the time-out.

Our Strength

I've been thinking about strength today. Mainly, because I am feeling wiped out - emotionally, physically, mentally, financially... you name it. And yet - a part of me truly believes that I just need to give in and accept that this is truly part of the process. I'm all right with this; it's just kind of, well, a drag.

Plus side: I started at my new site, officially, today. LOVE it. Everyone, so far, is amazing. Very welcoming. My new preceptor, "Dee", is introducing me to everyone (docs, nursing staff, random folks walking through the hallway...) as "the student midwife who we're trying to convince to stay here with us as a second midwife with our doctors & I". I so want to be that midwife, and am trying not to get my hopes up, but if there was a wishing well in front of me right now, and I had a penny to toss in, do you think you could guess what my wish would be?? (I won't tell, of course... but if you guessed, well, anyway...)

Not so plus side: I'm exhausted. I think I already alluded to that above. I started trying to type this post almost an hour ago, and keep getting distracted. Like, for example, I wanted a cute little pic to post with this (because honestly, doesn't a sweet picture make everything easier to read??) -- that took forever. Stupid picnik.com and it's stupidness. Also, we stayed overnight at this hunting cabin my grandparents have (I actually love it - it's very remote, quiet, and peaceful --- and a *tad* closer to my new clinical site as well --- but, there's always a but, right?) I got NO sleep. Like, very, very little sleep. A combination of woodtick paranoia (if you live anywhere that ticks are prevalent, you know what I'm talking about - nasty little creepy crawly vampire things - I had the heebie-jeebies ALL NIGHT LONG thinking they were stuck on me), not having the migraine-preventative med that I usually take at bedtime (which has a convenient side effect of zonking me out nicely), a less-than comfy air mattress, and first-day jitters (will my alarm go off? will I make it in on time? etc), all added up for a loooong night and weird dreams. I dreamt that I was living in a strange apartment building --- I think it was early 20th century, yet there was an odd open-air elevator to get up to the upper floors; very odd, in fact, in that you wrapped yourself around what was basically a fireman's pole and held on for dear life as you shot up it. If you let go ---- not good. I was doing okay until, all of a sudden, I was almost at the top and realized my arms were very tired, slippery, and I just didn't think I could hold on; plus, I realized I also had another "tier" to go (apparently, somehow, to get to my "level" I had to switch poles?! Very ... odd...). So that was one unsettling dream. Another involved the cottage we were at; we were apparently taking turns sleeping (in the dream) and someone - my older brother, I think, looked out the door all of a sudden and someone had jumped in one of our vehicles and taken off out of the blue. (There was much more to this dream, when I woke up --- at the time, it was very vivid and I meant to share it with the Warm One... but being that it was 0530, I decided to let him sleep, and know the details have faded. Anyway, it was another disturbingly vivid dream, I guess.)

I think, what this all boils down to, is that I need a good night's sleep. But,instead of going to bed at a reasonable hour (10 p.m. or so) as I had planned, it's almost midnight and I'm just deciding to call this blog post a night. It's nowhere near what I had planned to write (is there anything about nurse-midwifery, really?? Not much!!), but it's good enough. Suffice it to say - I feel stressed; I need to work more so that I can pay my bills, yet I need to get through clinicals so I can graduate. I also need to study more so I feel less anxiety about upcoming boards, comps, etc. I also need to work on family stuff - or maybe let it go; a close family member is dealing with heavy stuff (addiction) and I don't know how to help him. And yet.... I think it's all going to be okay....

(and, big cheers to my CKC'ers --- one just got married, one just passed comps, and one is on her way to CB!! Jaeger all around!!)

Hello, my name is {hebamme}, and I am a blog-a-holic... (and other confessions)

There.

I've said it, and it's true. I realized yesterday - or maybe it was today, or the day before yesterday (does it really matter?) - that I am addicted to this blogging thing. It's sort of liberating, in a way... I can go on and on, without worrying about the words stumbling out of my mouth (something that they tend to do in real life --- I think I have a bit of a speech impediment!) or if anyone really cares. In the world of blogging, I don't need to wonder if anyone is reading or not.

Sure, sure... it's GREAT to get an email notifying me of a new comment on one of my posts, or to see that I have a new follower. But, I can still imagine that there are people reading my daily musings - or that no one is (sometimes that is just as soothing). I'm certain there is a way to figure out how many 'hits' my site has had over time - but (a) I don't know how to do this, and (b) I don't really want to know. Ignorance really is bliss, as they say!

So, this one is gonna be short and sweet, but a few confessions for you (whether you're out there or not) ...

__________________

1. Blogging is taking over my life - I'm starting to daydream about it, put off schoolwork, housework, you name it, in favor of it. Is this bad (especially since my ramblings really aren't that good?)

2. Deep down, I'm a very lazy person. Given a chance, I will stay in bed until 10 a.m.; I'll walk right by a pile of toys on the floor (they're just going to get dragged out again anyway) and - as I type this - there is a laundry basket of clothes half-folded on the couch across from me. The only reason they are there, clean, to begin with is because the Warm One loves me and does way more than his share of things... I heart him for this.

3. I eat way too much crap. I know I need to eat better, and I want to (mostly), but it's just so much easier to just eat crap - you know? Ugh. Like, I have had Fazoli's drive-thru for the past two days because it was fast and (kind of) on the way home. And, again, see #3. Lazy ass.

I hope these things don't make me a bad person. I hope that these things are mostly related to life as we know it, right now, since it seems like there's a lot going on... I have memories from the not-too-distant past of actually cleaning my house, of making meals and even sitting down to eat them with my family. Fingers crossed that these things will come to pass again, some day...

(P.S. Confession #4 - I struggled a teensy bit with putting this posting up, only because I kind of liked having Gerard Butler headlining my blog... mmmm...)

On Blogging

This is a little off-topic, but worth the keystrokes. In the past week or so, I have been amazed at the wealth of perspectives out there via blogs and sites dedicated to birth and women's reproductive rights! (If you hadn't noticed, I've lagged a bit on this whole networking thing - it's about time that I caught up, eh?!) The whole blog-roll thing, where you can "add" your favorite blogs and see when they add a new post, right on your own page? Genius! And - even better - the blog rolls on those blogs, which lets you peek (and piggyback onto) at other awesome, relevant blogs, since oftentimes you have similar interests.

Yesterday, I was fascinated reading about anterior lips (really, they aren't so bad at all!) on Midwife Thinking's blog (read it here... please! http://midwifethinking.com/ I'm so glad I did, especially since we had a persistent, stubborn one last night - long story, I couldn't "help" with it, but... I so wanted to after reading this blog!)

I also was sucked into Stand and Deliver's blog. (It started off innocently enough with a journey into some relief measures for sinus troubles - hello, Neti pot!) but then I clicked on an older post - "Birth Around the World, My Alien Baby" is a title that kind of grabs your eye, I guess" (http://rixarixa.blogspot.com/2011/01/birth-around-world-my-alien-baby.html) and was hooked. A great birth story shared by one of Stand and Deliver's blog readers, it was the reader's own birth (her mother birthed her in Azerbaijan) and then the story of her own daughter (which, of course, didn't go exactly as planned). Beautiful writing, and a poignant message. Today's posting (http://rixarixa.blogspot.com/2011/01/birth-around-world-vbac-in-tajikistan.html) was similarly heart-hitting - another in her "Birth Around the World" series... I'm loving them, and the perspective they provide those of us just starting out and feeling like we are sheltered in the "same old, same old."

And, of course, there are the "thank god for you!" bloggers -- the ones that I know are right there with me. The student-midwives (or students in general), or new nurse-midwives, who are starting to feel their way through the paths of being "with woman". When so much rests in your hands, it's so comforting to know that there are others out there feeling the same things (a little anxiety, a bit of fear, much joy, love, excitement, trepidation, confusion, and all of the other feelings in the spectrum from here to there) on a daily - and hourly - basis. Life of a Student-Nurse Midwife, With Woman The First Year, Rainbows and Pony Rides, At Your Cervix, and all of the others that I hope to find as time goes on... this ones for us!