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....

Just keep swimming, just keep swimming...

It's seriously 99 degrees outside, with a heat index (whatever that is) another 10-15 degrees hotter. Wooooohooo. Swimming sounds amazing, no!?

At least in a symbolic sense (or a Finding Nemo sense), that's what I'm doing. I'm not sinking, I'm not thrashing wildly trying to get through these last few weeks of clinicals, and I'm doing more - at least, I think so - than just treading water. The end is in sight! I've just crossed the 600 hr mark (out of 675 required hours) of clinical experience; most of my numbers are met or very close. "Dee" keeps throwing this hope-rope to me about submitting a proposal to her administrators to add another midwife to her practice; several of her doctors are on board and supportive. I am so comfortable working with Dee, and with the women she sees - I think we are both praying that things work out and they (administration, that is) agree that expanding her midwifery practice would be beneficial all around. I also just had a phone interview - or at least, a short chat - with a midwife from another midwifery practice about an hour and a half from my home... it was encouraging and again gave me hope for a job opportunity in the near future.

So, while I'm trying desperately not to get too excited about any of these possibilities - and trust me, I really want to get excited... how great would it be to stay within an hour or so of our families?? - it does allow me to drift into the occasional daydream. House hunting... comparing elementary schools... thinking about future vacations and scheduling considerations... and, oh yeah, maybe a paycheck! (This whole "9 months of clinicals and little working" thing has really, really hurt our finances... I think anyone who's been in this spot can commiserate!)

Two more weeks - give or take - of clinicals; one more assignment (a client journal that I should have had done long ago, but had to start all over after the abrupt change in clinical sites); several uber-important tests. It's not that much, especially considering how far I've come this far - but when I look at it that way, it can easily overwhelm me. So, instead --- I'll just keep swimming.

(And, on a side-note, I'll keep looking forward to the end of September, when I will hopefully be an official nurse-midwife, and celebrating in Punta Cana...)

When my mind wanders, this is where it goes...

Today I had lunch with a great friend. We don't do it often enough... and we really, really should do it more often. Hmmm... how to 'dub' this friend? She is full of awesomeness, a truly free spirit, a little bit flighty (like all free spirits should be), and just all-around fun, fun, fun. Let's call her, simply... Friend.

Friend and I have worked together for years... I was a new nurse, and she was the "seasoned" nurse (albeit, still a newer nurse --- but, she had a few years on me, so it all worked out!). She had a little guy who was a year or so older than my oldest Mini, and it seemed as we always had some common interests. Over the years - and many snacks, deliveries, and desserts - I like to think we've become pretty good friends.

(I'll interrupt myself here to say that I don't really have many close friends... or maybe I do. I don't know... what is a 'friend', really?? I think in the past year or two, this has changed a lot... I don't know. Anyway, where were we?!)

So, moving on. Friend and I are both moving towards the common goal of midwifery, but via different paths. While I am pursuing a degree in nurse-midwifery (CNM), Friend is going a slightly different route to earn a Certified Professional Midwife license. Basically - from my understanding (and I would love to be further educated, so please let me know if I have this wrong!) - Friend is learning from "the best", a very well-known and well-respected CPM or "lay" midwife in the area. This midwife has been doing births in our area for the past 30 years, and has welcomed hundreds (if not more) of healthy, beautiful lives into this world in the warmth and love of their own homes. She is active in the midwifery community and - I can only imagine - a wonderful source of perspective and learning for Friend. So while my education is coming from a variety of sources, primarily distance-based (online) until my clinical rotation finally started a few months ago... Friend has been immersed in midwifery since deciding to take the leap into apprenticeship.

There's pro's and con's, certainly, to each method. She's been able to attend births as a midwife - and get her hands (and her brain) - on those delicious, slippery babes from the beginning; I have had to wait until getting successfully past all of the theory behind the birthing. I've had a large community of support from fellow classmates and those who've come before me via my school's online forums; Friend has been cocooned in the intimate circle of the two CPMs that she has been apprenticing with. Friend's coursework is self-paced, whereas my program has traditional terms - with equally traditional (and stressful) deadlines, midterms, and headaches.

Our paths will also determine our future course (as is so often true). As a certified nurse-midwife, I will be - in theory - eligible to deliver clients in a hospital, birth center, or home setting; in my state, though, over 90% of CNMs attend patients in the hospital setting. Friend, however, will be limited to seeing clients in out-of-hospital settings (at least in our state).

This is where my mind starts to wander... I don't know that I am courageous enough to catch out-of-hospital births (that's a topic for another day) - but I like to think that someday I may be. When my mind wanders, though, I think about a modest clinic site offering prenatal and well-woman care, just outside of 'town' (our small town is around pop. 8500); a few exam rooms, a space for education, perhaps room to have a lovely display to sell some "nice" stuff that the kind of mamas that might seek out a midwife may be interested in - cloth diapers, breastfeeding supplies, etc. We could offer childbirth classes, breastfeeding support groups, and - possibly? - one or two birth suites adjacent to the main space; while (in my wandering self) I imagine most women opting for hospital births, Friend would also be available to attend home births, and the birth suites would be available for a birth center birth.

I don't know the logistics of any of this. I have no clue on the feasibility of it. In all honesty, it really is just a mind-fantasy, but such a sweet one. I don't know if Friend would seriously consider "joining the fun" - in the past, we have joked about starting such a venture... but how much was seriousness, and how much was jest is hard to say.

If nothing else... this all gives me a nice bit of something to start with for a lovely, 60-odd page paper that I need to write (and have yet to even start thinking about, by the way) this term, so that I can graduate this spring. Happy trails, on that happy note!