Prenatals or Client Meetings

(Semantics)

Quick: What pops into your mind when you see the word “Prenatal?” Maybe prenatal vitamin? Prenatal care? Prenatal appointment?

Okay, so, what is a prenatal appointment? A prenatal appointment is a set apart time where you receive care from your care provider such as an obstetrician or midwife. If a pregnant person is using a midwife, this care will be personalized to their specific health needs and desires for birth. If they are seeing an obstetrician, this care will be personalized to the OB’s practice. Whichever care provider they choose, they will have monthly, bi-weekly, and eventually weekly prenatal care throughout thier pregnancy.

In my role as a doula, I cannot provide any clinical care at all. My doula services are limited to educational, informational, emotional, and physical support. This means that I provide education and evidence based information on pregnancy, labor, birth, and breastfeeding. This comes in the form of private classes, answering questions, and providing evidence based websites for parents to do their own research. Emotional and physical support is provided through labor in the form of gentle, caring speech, rubbing the back, arms, legs, or hands, offering sips of water, offering ideas on different positions to find comfort, support the partner, the use of a rebozo, and many other comfort-level methods. None of these methods are clinical in any form.

In my doula role, I provide two client meetings before birth to help familiarize myself with my client’s birth wishes and to create a birth plan. These meetings are informational and educational.

Now to the nitty-gritty that may upset some doulas. This is not a slight on any doula. Please stay with me, because the purpose of this post will be evident in the final few paragraphs: I have never called my doula meetings “prenatals” “prenatal appointments” or anything closely related to “prenatal.” I call them “client meetings.” I could never get into the habit of calling what I provide as a doula, a “prenatal,” because I am not providing any prenatal, ie. clinical, care whatsoever. Prenatal appointments imply, to ME, an appointment with a care provider such as an obstetrician or midwife for the purpose of clinical care. What I am providing, as a doula, is education, information, and a 2-hour class on labor comfort measures. That to me does not equal a prenatal. It equals an informational/educational meeting.

I say all of the above, because this is an area where the change of roles is considerably different to me. As a student midwife, I am now, officially, attending prenatal appointments with a licensed midwife. Because as a doula I always called them “client meetings,” it was a huge deal when I switched to calling clinical appointments a prenatal. As a student midwife, the prenatal consists of all things clinical, as they usually do with a care provider. There’s the urinalysis, weight check, blood pressure, pulse, externally checking baby’s position, listening to heart tones, and discussion of any symptoms and/or concerns regarding the health of the pregnant woman. I can do none of these procedures during client meetings in the doula role, but I can do all these things during prentals as a student midwife under the supervision of a licensed midwife.

Using these two terms for what they are intended is a huge significance for me, now, as I switch between the doula role and the student midwife role. When I’m hired as a doula, they are client meetings. When I attend an appointment with a licensed midwife, they are called prenatals. I’m ecstatic that I have the privilege of attending prenatal appointments with a licensed midwife, and that I have the opportunity to perform all the clinical tasks which are part of a prenatal.

To some people it may be a matter of semantics, and that’s ok. To this writer it is a sign of a vastly different role:  student midwife/ midwife apprentice.

 

Apprenticing

(Any and all clinical work is done under the direct supervision of a licensed midwife.)

Being a midwife apprentice/student midwife is such an amazing experience. As an apprentice in the assist phase of clinical work, I am able to perform the tasks of a midwife assistant while under a licensed midwife’s supervision. Because of this, I have already been able to check for fetal heart tones using a Doppler during prenatals and during labor. I have checked blood pressure, measured fundal height, and checked for baby’s position externally. I have handed the midwife anything she needs during labor and birth, and I have charted during prenatals and labor.

The newest thing I’ve done is catch a placenta and perform a newborn exam! Catching the placenta is right there next on the level of awesomeness as that of catching the baby.

This is completely new territory for me, because, as a doula, my scope of practice was only that of providing education and comfort measures. I explicitly state on my doula website that I cannot perform any clinical work, whatsoever; I cannot even perform a simple temperature reading. As my role has now switched to an apprentice, I am in awe at what I can do under the direction of my preceptor (or any licensed midwife). Yes, even that simple temperature, I can now perform as an student midwife. It feels completely different, but I am enjoying every minute of it!

This weekend I had the opportunity to perform a newborn exam with my preceptor’s instruction. To have the opportunity to weigh and measure a newborn and perform other exams on the baby, is such wonderful experience! The baby’s skin, freshly born, is the softest feeling ever. I was ever so careful with the baby, and spoke to the baby as I performed the exam. This baby was so peaceful, and allowed me to perform all tasks.

As I go along my journey, I plan on learning from a variety of licensed midwives. Each one will be able to teach me from their vast knowledge and expertise. Gaining lots of experience from different midwives is the best way for me to know how my future practice will function. My current preceptor is so patient and calm while she teaches me. She instructs me with such kindness. I’m honored to be learning under her tutelage and gaining knowledge from her years of experience.

Please enjoy these pictures of my first newborn exam which were taken by the family’s doula. They are shared with permission.

Left photo: I am using a student stethoscope to listen to heart rate and respirations while my preceptor also listens. She is able to verify that my count is accurate.

Center photo: I am measuring the baby’s chest. My preceptor is next to me verifying that I measured correctly. I was actually measuring too low, so she let me know that I needed to measure at the baby’s nipples.

Right photo: I am weighing the baby using my preceptor’s scale and sling. Dad is standing right next to me reading off the weight.

Winter 2016 Update

There is so much to update, and not enough time to update!

First, before there is more written, I didn’t realize how little time I would have to keep this blog updated. I thought I would at least have a couple hours a week to write about my experiences throughout the trimester, but that did not happen. Instead, my days were full of school work (6-8 hours per day), house work (unending), cooking, church, and other student midwife related duties. So, this post comes between trimesters. I finished two weeks before the trimester ends which gives me about a four week break! Next trimester begins May 2, 2016.

A quick, condensed (not so quick/not so condensed) version of this winter trimester goes as follows:

I was able to complete all the observation births needed, and I qualified to move to the assist phase. This means I can now log all home birth/birth centers prenatal and births I attend with an approved Midwives College of Utah (MCU) preceptor.  I can also log things like doing vaginal exams, heart tones, catches, placenta exams, postpartum, newborn exams and well-woman care. Of course, there are many more things I will have to learn as I have different skills signed off.

I was certified in neonatal resuscitation (NRP) and basic lifesaving (BLS) using an AED (automated external defibrillator). These certifications were needed as part of the requirements to enter the clinical program at (MCU).

I reached out to three local midwives by sending them an email seeking a clinical placement. One of them let me know they would like to meet with me. Long story short, this midwife agreed to be my preceptor, and we spent a couple hours one mid-morning filling out the appropriate MCU forms. I sent them off, and waited for them to be approved. At the same time, I also applied to the clinical program. About 10 days later, my preceptor was approved by the Clinical Dean, and I was accepted into the clinical program! I have already logged a birth and some prenatals!

A benefit to being a midwifery student is that I can attend births and/or prenatals with other licensed midwives. They do not need to be my approved preceptor for me to assist them. However, because they aren’t an approved preceptor, the births and/or prenatals I attend with other licensed midwives will not count towards my numbers needed (more about in another post). But, I am eager to learn so I will assist at births with other licensed midwives so I can gain more experience!

The Midwife Assistant Orientation class I took this trimester with MCU prepared me for much of what my responsibilities as an apprentice will be. I was also required to prepare a midwife’s assistant bag, and this is what it looks like:

MidwifeInProgress Assist Bag

I collected several pieces of equipment, and I slowly plan on adding to this bag.

Watermarked MidwifeInProgress

The bag I purchased is here. I know I will eventually need a bigger bag, but this will do for now for prenatal appointments with my preceptor.

I also purchased and received my Practical Skills Guide for Midwifery from MorningStar Publishing Company. This is a skills book in which it has all the midwifery skills I need to learn. As I master each skill, my preceptor signs off the skill. There are skills from basic general skills like proper hand washing technique, using a stethoscope, and reading a blood pressure to more advanced skills like drawing medications, administering IV fluid, and suturing. These are only a few of the skills listed in the guide.

Oh, and I was honored with being called for jury duty where I spent 7 hours doing my school work before being called to a courtroom. I had to return for a second day to see about getting picked for the jury. Thankfully, they selected 12 jurors, and I wasn’t one of them!

School while on Jury Duty Water Marked

I created my clinical binder, which is a beauty!

 

I went to an IV class in Ventura, Ca, and I started my first ever IV. I still need a lot of practice, though! Hopefully, I can get some people to agree to being my practice models. But, I feel as if I might be able to start on IV in an emergency situation (doesn’t sound very confident, I know, but it’s a start!)

I am well supported by so many people, including my church family. My pastor knows that I have school so when he asked me if I would be able to be a driver and hotel chaperon for the fine arts competition for our school students, he said, that I would still be able to do my school work. So that’s exactly what I did. I drove the students there, dropped them off, and did my school work in my vehicle. I stayed at the hotel after I dropped them off the next two days, and I did my school work. I was able to complete ALL of my assignments for the semester! It means so much to me that people in my life understand this season in my life, and understand that I have to make adjustments to get through it.

School is demanding, to say the least, and this is my life for the next four years until become licensed as a midwife. I am thankful for the people in my life that understand this: my husband, my children, my family, my friends, my church family. It won’t be forever. In 3-4 years, I’ll be done with the first phase of this academic pressure/demand. I plan on continuing to the Bachelors of Science in Midwifery, and eventually to the Masters of Science in Midwifery, so that will add more academics. Hopefully, I still continue to have the same support as I do now. Lots of people dedicate their entire lives to their academic success, and I am trying to only dedicate the next few years. The next 5-7 years compared to the next 30 years or so of being a midwife is well worth the short-lived sacrifice.

Currently, I have allowed my life to revolve around my college career. I want to finish this season, and finish strong. I do need to find a balance, though. For now, that balance manifests itself in a break for a few weeks between trimesters.

I will update when I get my final grade for my last class, but currently this is how all my classes ended for Winter Semester, 2016:

COMM 114:  A+

MDWF 146 (Midwife Assistant Orientation): A+

MATH 212: A+ (this was a very hard class for me and many other students. I’m quite surprised that I was able to be successful and pass this class with an A. It took a lot of work and determination!! This class had 11 tests!)

BIO 202: A+