A Guide to the Difference Between a Certified Professional, Licensed Midwife and a Certified Doula

Not every service that a CPM, LM offers was able to fit under the CPM section, so only the main topics were included. It’s not an exhaustive list but a starting point for families to understand some of the differences. The Spanish version is available here.
La versión en español está disponible aquí.

Midwives-Doulas Handout ENGLISH

Una guía de las diferencias entre una partera profesional certificada con licencia y una doula certificada

No todos los servicios que ofrece un CPM, LM pudieren caber en la sección de CPM, LM, asi que solo se incluyeron los temas principales. No es una lista exhaustiva, sino un punto de partida para que las familias entiendan algunas de las diferencias. La versión en inglés está disponible aquí. (The English version is available here.)

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Clinical Placement: Maternidad La Luz

March 1st – December 2nd 2018…..Student-midwife at Maternidad La Luz, El Paso, Texas.
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The last nine months of my life have been a whirlwind of learning. Grasping and gaining so much knowledge has transformed me into a new person, both as a human, but as a future midwife. How can such a short time create a new person? How symbolic that my time at Maternidad La Luz (MLL), to create me into the midwife I need to be for future clients, is the same time it takes to create a new human!

I didn’t get to where I am by myself! My husband and my children have been my greatest supporters. We missed each other immensely, but somehow, we made it! We survived. I missed a lot of important life events while I was gone. Those can never be replaced. But, we will make many more memories.

While at MLL, I had NINE preceptors, total. Each one of them so unique, and so special in their own ways. Each preceptor with differing views and methods. Each one with different likes and dislikes. Each one ever so willing to teach and guide. I love everyone of you. You have created someone who is hungry to learn, and who will always be willing to accept when I don’t know something. I will always remember your “look it up in the protocol book” saying, and I will always be looking things up!!!

Patti and Fina, who have been at MLL for many years, are some of the most amazing people, also! While they are not preceptors, without them, MLL would fall to pieces. ¡Ustedes dos son unas de las más bellas en el mundo, y como las quiero y las extraño mucho! ¡Nunca me voy a olvidar de ustedes!

There is no other place in the world like MLL. MLL not only is a clinical site, but it is an academic site as well. Because the academic director knows all about what NARM requires, she has all the paperwork needed to complete the documentation. She knows every detail that needs to be documented for our logs. This translates into our preceptors knowing that they need to sign us off on our logs.

Now, here is the tricky part, that is difficult to describe…Because I am already enrolled at MCU, a MEAC accredited school, I only needed a clinical placement. So, while I was at MLL, I was there only for the clinical portion of the program. I still attended several MLL classes, especially the skills classes, but the most classes were not a requirement, neither was the homework, because of my enrollment at MCU. This is the reason why I “only” was there for nine months. I was there for clinical work. My academic work is still through MCU of which I still have one semester to complete. All my logs go through MCU, and are verified by MCU. BUT, I couldn’t have completed my clinical work in such a quick manner if it were not for MLL.

Because I had both MLL and MCU logs to get signed off, it was double signatures for my preceptors, but they never once denied me a signature. They understood the importance of getting everything signed-off and signed-off in a timely manner. I have heard of preceptors denying signatures to their students, or making students wait weeks and months before signing logs, but this never happened to us at MLL! After every single shift, I would ask for their initial on logs. At MLL, falling behind even one week on initials, is like falling behind one month in “real-time life.”

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My binder for logs

Many have called MLL “bootcamp for midwives”, and it is so true! We learn quick, and get in there and begin doing prenatals, attending births, and doing postpartum appointments on the first day in the clinic. Additionally, time is so different at MLL. One day in the life of MLL is equivalent to one week in “real-time” life. So, after 9 months of MLL life, it was the equivalent of about 2 years in “real-time” life.

What makes MLL the most unique? The clients do. Without the clients, MLL would cease to exist. The clients trust MLL to provide them with quality care. They trust their pregnancy to MLL! Being in the border city of El Paso, Texas, the majority of clients were from Mexico. So, all their care must be done in Spanish. Since Spanish was my first language, picking up the midwifery Spanish was easy. Learning Spanish midwifery was/is so extremely important to me, because I want to be able to provide midwifery to the Spanish speaking community in my city.

I was able to complete 6 full continuity of care clients (FCOC), all my partial continuity of care clients (PCOC), and my “other” births. I gave care to more pregnant people than that, but several of them transferred for various reasons. I gave each one of them individualized care. Each one was unique in their needs, and each one received the care they needed (of course always under the supervision of the preceptor). In all, I attended 73 births, with many more labor sits than I kept track of, and I completed all my clinical requirements and skills at MLL!!
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Once going “on-call” began, life took a turn for me. I no longer had a life. My life was the clients and being on shift. When I first began in the clinic, I requested 12-hr shifts. But the way it worked out, I was at the clinic all the time. I was there for shifts, and then for citas (prenatal appointments). There was never a day I wasn’t in clinic, because citas needed to be programmed on our days off, if possible. I then requested to be on 24-hr shifts, to see if that would help me not be in the clinic so much. It did! I felt like I had a bit more time to myself and wasn’t in the clinic all. the. time. But then I was on 24-hours shifts, which was so exhausting. Sleeping on days off was essential!

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Sleeping area upstairs in the clinic 

MLL is not for the weak. It’s a place where one WILL learn and get the skills needed or go home. When I first started in the clinic, I called my husband after every shift crying my eyes out, telling him, “I just want to go home. I can’t do this anymore.” I was exhausted beyond what I have ever been in my life. I cried and cried and cried. I was in pain physically, and the only way to be able to sleep was to take 800 mg ibuprophen. I was also in pain mentally and emotionally. I missed my family SO much. I cried myself to sleep every night. Eventually, I acclimated to my new normal, and I no longer needed ibuprophen every night. I eventually stopped crying every night, also. I always missed my family, though.

The two illness I got while at MLL was laryngitis and a terrible kink in my back. I still was in clinic with both, though!! With the laryngitis, I used a mask, and whispered to clients. The funniest part was when people (clients, midwives, other students) would whisper back to me!! With the kink in my back, I just “toughed” it out, and waited until the kink resolved, about a two weeks! It eventually got better, and I was back to “normal.” I still went to clinic.

I arrived at MLL ready to learn and jump into doing all things midwifery. I left MLL knowing how to attend to low risk pregnancies and births, knowing when something is out of range, and knowing how to handle emergencies. I learned to do blood draws, and am very good at them. I also learned how to place IV’s. While IV placing took me a bit longer to master, I can now place IV’s! I’m thankful for an outside source who was willing to help me and my friend Angela practice on him, and become proficient in IV placements.

I couldn’t have survived MLL without the support of my husband and children, but also without the support of my wonderful friend Angela! We had known each other only online, through our school (MCU). We ended up becoming roommates, and supported each other by debriefing the difficult births, and celebrating the easy births. We brought each other food during long labor sits. We had each other’s back!
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My family support while in El Paso, was my cousin, with whom I stayed when I first arrived in El Paso. She and I got along so well. When I moved out to be closer to the clinic, we still hung out together and went swimming and out to eat. I love her so much and am so eternally grateful for her love and care of me!
Food Gift (1)My cousin made caldo, and she left me a little note saying there was  some soup for me!

I, also, learned that allowing ourselves to take time off to grieve, mourn, pour ourselves out completely, to be able to return and begin giving again, is essential to healing from traumatic events in midwifery.

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Grief in midwifery is real and takes a toll.

Yes, MLL’s program is difficult and extremely challenging, but if I can get through MLL, I can get through anything. Yes, plenty of times, I just wanted to quit…During a difficult birth outcome, I thought there was no way I could be a midwife. But with the support of all of MLL’s staff, my interns (I missed you all after you graduated!!), my classmates, and my husband, they helped me move forward, and not get stuck in the tragedy, which could have been so easy to do.

This picture was me after participating in a sweat lodge ceremony, where I was invited to attend by the abuelita to work through my grief and pain with my preceptor who was also going through her own grief.

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Angela and I were able to take off for an afternoon to the not-so-nearby-nearby hot springs. We were only there a couple hours, but it was so good for my body to be in the hot water filled with amazing minerals, to help in the healing process.

 

I kept a journal of my experience at MLL. I don’t think I’ll ever write it all out electronically, but my experiences are recorded, both the high points, and the low points. I’m so thankful that I recorded my experiences. This was a time in my life that I don’t want to ever forget, and I have not only my memories, but a written account of my time at MLL.

It’s been almost two weeks since I have been home, and I am still in recovery-mode. My body is the worst hit by the clinical placement. I am still sleeping a lot, and just laying around a lot at home. I am spending time with my children, just being home with them. I might just need a few months to fully recover. I have heard from many other students who have said it took at least three months to get back to “normal.” I feel like this will be true for me as well.

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When I got home!

I will incorporate many things I learned at MLL into my own future practice. When I am qualified to be a preceptor, I will incorporate a lot of MLL’s methods into my future apprenticeship program. I appreciate everything I learned at MLL. I appreciate every staff member, my preceptors, resident staff, my classmates, and the clients. I am forever grateful for everything I was taught. I am, also, extremely grateful to my husband and children who supported me.

I have one semester left at MCU, then I can apply to take the national exam. I look forward to completing the academic work!

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Estudiante de Partería

Mi nombre es Marivette Torres. Estoy casada, y he dado a luz a ocho de mis bebes, de los cuáles cinco nacieron en casa con la ayuda de una partera. Mis hijos varían en edad desde 9 hasta 28 años. Para mí, pasar el trabajo de parto, y dar a luz en hogar ¡fue una experiencia maravillosa!

He acompañado personas en sus trabajos de partos como doula por 20 años. Una doula da apoyo durante el trabajo de parto, pero no da asistencia médica.

Los servicios de partería incluyen cuidado prenatal, escuchar los latidos del corazón fetal, medir la presión arterial materna, asesorías en nutrición y salud y mucho más. También, la partera presta cuidados durante el trabajo de parto y cuidados post parto y examina él bebe cuando nace. Está entrenada en situaciones de emergencia, y está certificada en RCP para adultos y RCP neonatal.

En California, las parteras con licencia pueden obtener y cargar con ciertos medicamentos para el cuidado de lestreptococo tipo B durante el trabajo de parto, y medicamentos para hemorragias en el post parto inmediato. Está disponible para los partos domiliciarios de embarazos de bajo riesgo.

Cabe resaltar que aún, en el 2014, nuestra comunidad de bakersfield y condado de kern contaba con ninguna partera hispanohablante. Es casi una injusticia que la gente hispanohablante no tengan oportunidad de obtener los servicios de una partera acreditada y licenciada. Así que en enero del 2015, me matriculé en el colegio de parteras de Utah y actualmente curso tercer año, para así suplir esa necesidad en el mercado y brindar un mejor servicio a estas comunidades.

Mis metas son de graduarme del colegio de parteras y tomar el examen nacional. Habré de realizar y empesar la parteria con titulo en el 2019.

Cómo una latina e hispanohablante, mi meta es proveerle a mi comunidad cuidados de partería a las personas hispanohablantes. Mi deseo es ayudar y asistir a las personas con un embarazo de bajo riesgo que quieran dar a luz en sus casas. Como muchas de las americanas cuentan con una partera que habla su lenguaje natal, las personas hispanohablantes puedan tener acceso a una partera hispanohablante. Sobre todo, aquellas que actualmente no tienen acceso a una partera con la que puedan comunicarse libremente. No falta mucho que este sueño será realizado en nuestra ciudad y condadao de Kern.

Mientras tanto, sigue me en este blog para detalles de mi progreso, y para obtener información de los servicios que da una partera.

Voy abrir una página en el Facebook, y colocare la página aquí lo más pronto posible.

 

 

Bullying in Midwifery: An exploration of the power imbalance in the student/preceptor relationship

Today, I am featuring a final project done by Tracy Cuneo on 4/26/2016 while she was a student at MCU, “The project was part of a qualitative research project for an Advanced Midwifery Studies class at Midwives College of Utah.”

Bullying in Midwifery:
An exploration of the power imbalance in the student/preceptor relationship
By Tracey Cuneo

Bullying from precepting midwives to student midwives is a problem globally.  In the United States, it is a widespread problem affecting Certified Professional Midwives. This paper looks at the problem of power imbalances in the student preceptor relationship and the effects of bullying on student midwives physically, emotionally, and psychologically. It includes research conversations with student midwives, practicing midwives and national midwifery leaders.  Lastly, it provides recommendations for changes to eliminate bullying in midwifery on the Certified Professional Midwife path.

Bullying in midwifery has become a wide spread problem in the United States in the Certified Professional Midwife model. While being under reported, bullying is clearly an issue that needs further action in the midwifery community.

Introduction

Research occurring since 1996 struggles to define bullying in midwifery, and a true consensus on the definition has been yet to be made. The definitions describe intimidation; undervaluing of skills; humiliation; belittling of work; undervaluing effort; questioning of professional competence and excessive criticism.  Case studies by Hadikin and O’Driscoll (2000) further illustrate the culture of bullying with midwives recalling occasions when they had been, “undermined, belittled, controlled, victimized, had work devalued and been passed over for promotion” (Gillen, Sinclair, & Kerhohan, 2008). While workplace bullying definitions apply to midwifery, there are distinctly unique problems in the midwifery model and there is an obvious need for a well-rounded, universal definition.

Definition
A good definition of bullying at work is provided by author and psychologist Gary Namie:

Bullying is repeated, health harming mistreatment of a person by one or more workers that takes the form of verbal abuse; conduct or behaviors that are threatening, intimidating, or humiliating; sabotage that prevents work from getting done; or some combination of the three. It is psychological violence—sublethal and nonphysical—a mix of verbal and strategic assaults to prevent the target (the victim) from performing work well (Namie, 2009).

Focus

Bullying in the workforce has been a significant global subject of research, discussion, education, and policy-making over the last twenty years. It’s gained more attention in the last ten years as bullying awareness campaigns have gathered momentum in the school atmosphere (Namie, 2011). Currently, there are no U.S. laws against workplace bullying but groups are beginning to lobby for legislation in many states (Namie, 2009). Many corporations have begun to design anti-bullying policies and grievance policies for employees dealing with bullying issues.

Bullying has a high price tag at the level of the individual and to the institution in which it occurs. Bullying affects worker’s health and productivity (Liddle, 2015; Stagg, Sheridan, Jones, & Speroni, 2013; Stutzer, 2014). The financial consequences of bullying behaviors manifest in a loss of profit for companies, high turnover rates, and employee burn out (Stagg et al., 2013).

In the nursing profession, in the United States, bullying is recognized as a significant problem, with anti-bullying education and task forces creating resources for both bullies and victims (Australian Nursing Federation, 2011; Craine et al., 2015; Nurse Uncut, 2014).

In midwifery, bullying is a pervasive problem that many students, new practicing midwives, and experienced midwives are familiar with (Farrell, 2006; Gillen, Sinclair, & Kernohan, 2009). In a recent survey of 119 student and practicing midwives in the United States, primarily Certified Professional Midwives, over 90% of respondents said they experienced bullying by another midwife.

The Survey

Bullying can occur from preceptor to student or in the form of a group to an individual. “Another form of bullying in the workplace is known as ‘horizontal violence’ or ‘oppressed group behavior’ where there is bullying and aggression by an individual or by group members towards another individual or group of members within a larger group. There is evidence to show that student midwives routinely experience this during placements” (Curtis, Bowen, & Reed, 2007).

The Bullying in Midwifery Survey was an anonymous national survey that students and practicing midwives responded to in February of 2016. The project was part of a qualitative research project for an Advanced Midwifery Studies class at Midwives College of Utah. The survey consisted of 26 open response questions that 62 students and 57 practicing midwives responded to. Additionally, the research project involved interviews with national midwifery leaders and educators. Interviews were held with Marinah Farrell, President of the Midwives Alliance of North America (MANA), Treesa Mc Lean, Director of Public Affairs (MANA), Ellie Daniels, President of National Association of Certified Professional Midwives (NACPM), Kristi Ridd-Young, Vice President of the Midwifery Education Accreditation Council (MEAC) and President of Midwives College of Utah, and Sarah Carter, Clinical Dean at Midwives College of Utah.

Participants of the Bullying in Midwifery survey identified bullying behaviors they experienced as verbal assault, physical assault, behaviors with others, acts of power/abuse of authority, acts of non-support, and unclear/changing expectations. Respondents reported verbal attacks as being the most common, with name calling, threats, and verbal abuse. Physical assault consisted of being slapped, hit, or pushed; having objects thrown at them, or being forced to submit to internal exams and venipuncture.

Responses that were common to behaviors with others consisted of embarrassing or bullying behavior that was done in front of clients or other student midwives. The most common responses were gossip, rumors, negative comments about the student, and being black listed from midwifery groups/associations. Participants responded about acts of power and abuse of authority writing they were required to do non midwifery related things (childcare, clean preceptor’s home, wash preceptor’s personal laundry, personal shopping, clean her yard, etc.); manipulation; and a refusal to sign off on births or skills after performed that,  “paperwork was held as hostage.” Intimidation and being denied clinical experience as punishment for personal disagreement was prominent.

Another common response was feeling that preceptors ignored personal boundaries and the student’s personal life. One participant reported that her preceptor, “Told me how to run my house, how to discipline my children, insisted on what birth control I use and what extracurricular activities my children could do— I was not allowed to move ahead unless I complied.”

Participants listed acts of non-support as being significant factors. “I was told if this bothers you or makes you cry, you should just give up now, because you can’t handle midwifery!” This included unclear expectations to move ahead and avoiding set times for evaluations. Some reported preceptors demanding money for sign offs that was not previously agreed to and one participant recalled her preceptor demanding $6,000 at the time of sign offs for births. Participants felt forced to choose midwifery over family emergencies/sick children. Several reported being told, “You must abandon family to be a real midwife!” and, “You don’t want it enough!” Discrimination due to religious beliefs, age, or motherhood status was also reported by participants.

The final category for multiple responses was unclear/changing expectations. This involved poor communications or no communication of what the preceptor wanted done to reach needed benchmarks on the CPM path.

One large difference in the Certified Professional Midwife route of training compared to the Certified Nurse midwifery route is that it requires students to spend two to four years in a daily apprenticeship, working for free or very little pay, with experienced midwives in exchange to learn essential skills, gain experience, and receive skills sign offs. Often the power imbalance in these relationships along with the limited accountability and oversight of preceptors makes these relationships vulnerable (Wiley, 2013). Additionally, the student’s collective financial burden (paying for tuition, expenses incurred with apprenticeship, and inability to maintain other full time employment), along with the limited selection of preceptors in some areas, and the private nature of the CPM work in homes and birth centers, can make the situation ripe for abuses of authority.

An expectation of bullying came up repeatedly in the survey. “This is just what midwives do to each other!”  Several others shared the response of, “I just put my head down and tried to get through it.” It was a prevalent belief among students that some bullying behaviors would occur.  Marinah Farrell, President of MANA, responded to this idea of cultural acceptance of bulling in midwifery, “We need to eliminate the student expectation that bullying will occur. The bullying culture needs to be unacceptable.” Even though this may have been acceptable practice in the past, eliminating bullying is essential for a healthy midwifery work force.

Interviews

While hospital midwives do report bullying behaviors, the Bulling in Midwifery Survey of 2016 made it evident that these abuses are under-reported and rampant in the CPM community, with 97 of the 119 saying it was a, “huge, significant problem, happening often.” Student midwives are unlikely to report incidents of bullying, the survey found, due to fear of losing the clinical position or being shunned professionally in their community (Wiley, 2013).

National midwifery leaders who were interviewed responded with personal stories of how they were bullied, with one accounting a story about her preceptor who always demanded they do four-handed catches, and another responding that her local birth community became angry when she published an article about bullying in midwifery. Their stories were similar to what students report. “I wasn’t nurtured,” one leader said.

As to why they think this problem still exists today, Ellie Daniels, NACPM president explained, “Oppressed people oppress others around them. As midwives, we have been oppressed by the medical society around us, and we take that out by oppressing our students.” She continued to say, “As midwifery becomes less marginalized this issue will go away.”

Over time the move to professionalize midwifery will distinctly change with midwives feeling less oppressed by the medical community.  It is doubtful though that those who choose to use their power and authority negatively in the preceptor relationship will recognize the disparity and change how they speak and interact with their students by their own initiative. Preceptors have no authority they must answer to, and they are left to formulate “how” they want their apprenticeships to go. While NARM supports the autonomy of preceptors, this privilege can, at times, lead to a crippling abuse of the student.

Another leader stated, “It’s the old-school mentality that says ‘this was hard for me and you will just have to suck it up and get through it.’  When the old-school finally retires, we will have a new generation of midwives who remember how unfairly they were treated and will not repeat these abuses.” Or will they? Our survey asked, “As a preceptor, do you ever find yourself justifying a behavior because, ‘that’s what was done to me?’” We found the overwhelming majority (74) felt that they would not repeat this behavior as a preceptor. Many stated that they actively evaluate their own behavior as a preceptor so as to not repeat the abusive behavior. One responded that she would not take students or ever precept because of what she had experienced, and two respondents replied that they felt their past negative experiences as a student made them “lenient” and “a pushover” as a preceptor, now.

Six participants did say they felt justification in their behavior as a preceptor, even though their experience as a student was negative, because, “that was done to me.” Marinah Farrell, president of MANA, said, “Trauma affects us all.  Those who bully are usually those who have been traumatized and have not processed that trauma. Instead they return it to others.” The individuals who were subjected to the greatest amounts of abuse must take time after their student experience to heal from the ordeal and process their pain, lest they go on to become callous to the experience and later pass on those same behaviors to their students in the future.

Sarah Carter, Clinical Dean at Midwives College of Utah brought in another perspective.  “Preceptors are dealing with their own problems. Maybe they have relationship or marriage stresses. Maybe they are dealing with practice stress and poor relationships with the medical community or other midwives. They have not had any training in how to be a preceptor and how to successfully teach a young student.  They are dealing with a ton of stress and it comes out on their students.” Busy preceptors have very little available time to spend on additional training and meetings, and yet the need for support in their unique role is crucial.

Preceptors need training in how to precept. The North American Registry for Midwives (NARM), the certifying body for Certified Professional Midwives, does not require any specific training on how to precept a student. MEAC schools also do not require preceptor training and Sarah Carter expressed that it might further deplete the already limited pool of preceptors if mandatory training was required.

Can we expect preceptors to just know how to be good preceptors? If bullying is occurring at such a high degree, how will new midwives know how to be excellent preceptors later when they have no true model to recall? “By actively addressing this problem as a profession, we have the opportunity to stop this destructive cycle,” said Nicole Croft, Academic Dean at Midwives College of Utah. Organizations like the Association of Midwifery Educators (AME) are working to change this, but with no absolute requirement for preceptor training, it’s unclear if busy midwives will take the time to attend these trainings.

Several participants in the Bullying in Midwifery survey denied they were bullied, yet went on to describe bullying behaviors that occurred to them. These responses matched what has been found in previous studies on the effects of bullying in midwifery (Gillen, Sinclair, Kerhohan, 2008).  One young midwife even became so enraged by the survey link for the Bullying in Midwifery survey being posted on social media she responded with, “What about the students who bully preceptors? This survey is a form of abuse and bullying!” Another very experienced midwife posted, “If you can’t deal with bullying midwives, then there’s no way you will be able to handle doctors! Stop being such wimps!” These statements serve as great examples of how women, who have internalized trauma within the profession, continue to perpetuate it.

Preceptor Training

When asked what training preceptors receive, most midwifery leaders recognized the lack of programs in this area. AME is trying to tackle this issue head on with training videos, webinars, and resources for preceptors. Accredited schools have taken multiple directions to try and entice preceptors to attend these trainings.  Many have offered CEUs, free classes at their schools, and even rewarded preceptors financially but are still finding a very high rate of non-compliance by preceptors. “We just can’t force them to do it,”  Sarah Carter remarked. Preceptors receive tangible assets by having students involved in their work; especially advanced students as they negate the need to pay a birth assistant fee, and the advanced student attracts clients to the practice. It seems unlikely that the greater majority of practicing midwives who choose to take on a precepting role would no longer take this position if they had training requirements

Preceptors must be recognized and valued for the skill they bring to training future midwives. Treesa Mclean, CPM and MANA board member, who has been a preceptor for four different midwifery schools, said that preceptors, in a large part, feel undervalued for their part in teaching.  She reported that schools have very few, if any, optional trainings available and that personal connection and oversight with each school was very limited. Since MEAC views these preceptors as field faculty, training these preceptors on how to precept should be expected.

The Effects of Bullying

Previous research on bullying in midwifery (Clews, 2009; Gillen et al., 2008; Gillen et al., 2009), and the experiences of participants in the 2016 survey found almost identical health and emotional outcomes resulting from experiencing bullying behaviors. Targets are more likely to have nausea, digestive issues, panic attacks, crying spells, depression, and suicidal thoughts (Namie, 2015). The Bullying in Midwifery survey found participants having physical symptoms of sleep problems, nausea, adrenal stress, weight gain, heart palpitations, migraines/headaches, high blood pressure, miscarriage, low back/neck pain, menstrual periods altered or stopped, excessive crying, and panic attacks. Emotional symptoms included depression, feelings of excessive stress and worry, feelings of self-doubt, lack of confidence, disillusionment, disappointment, and embarrassment.

This left students feeling afraid to practice, having an inability to trust anyone, and with feelings of being worthless, inferior, “beaten down,” or a failure. Many responses included feelings of intense anger/hatred; feelings of isolation (i.e. trying to avoid preceptor, isolated from midwifery community); that the behaviors brought up feelings of past abuse (childhood/marriage); feelings of lack of control/desperation to finish/worry, and feeling of confusion and emotional numbness. Suicidal thoughts were recorded by several participants in the survey.

Family life was greatly impacted because of bullying with many (49 participants) responding their relationship with their husband or primary partner and children suffering. The greatest response was a changed sex life and that primary relationships were “put into survival mode.” Many women reported seeking professional counseling during their apprenticeships because of bullying victim experiences. Six participants wrote that their primary relationship was destroyed because of the bullying they were dealing with.

Many targets of bullying feel driven to leave their jobs (Green & Baird, 2009; Stagg & Sheridan, 2010; Stutzer, 2014; ). Along with the physical, emotional, psychological and social effects of bullying, targets often have felt an overwhelming desire to quit midwifery school or leave the profession as a new midwife because of the bullying they received (Gillen et al., 2009). The response in our survey was quite the same, with 45 participants responding that they considered quitting, nine of the participants quitting, and four returning a year or two later.

Bullying impacts the kind of care midwives offer their clients.  Many students responded that clients witnessed the bullying behaviors and that senior midwives often corrected and belittled them in front of clients. Several described being blamed for the senior midwives mistakes. One even noted that she was told to lie to clients and was denied clinical experience if she refused. Students reported clients asking questions, clients being confused about the perceived tensions and feeling, “uncomfortable with how she treats you.” Many students recounted preceptors being angered when clients asked for the student’s phone number or arguing about minor issues in front of the client. One student told of her preceptor regularly yelling at her in client’s driveways before clinical visits while another reported being hit at a birth by an enraged preceptor. Clearly, pregnant women are noticing how students are being treated.  Bullying not only impacts the student, but it affects the level of care the pregnant woman and her family receives, and also may cause women to have distrust in their care providers.

Solutions

What can we do to diminish bullying? The Royal College of Midwifery in the U.K., and the Australian College of Midwives in Australia, has done extensive research in this area and has successfully put programs into place. Research points to naming the problem, educating and creating awareness about what bullying is, adopting anti-bullying policies and resources, offering support for the target, and training for the bully are essential first steps to eliminating bullying in midwifery (Clews, 2009; Craine et al., 2015; Farrell, 2007; Nurse Uncut, 2014; Gillen et al., 2008; Stagg et al., 2010; Stagg et al., 2013).

The U.K. successfully created a bullying tool kit which is available online to help both students dealing with bullying and midwives accused of bullying (Royal College of Midwives, 2014). In the U.K., written anti-bullying policies were adopted, but the real effectiveness was found with staff training (Georgiou, 2007).

In Australia, they have taken it a step further with adopting laws that make it illegal to participate in workplace bullying, along with national midwifery organizations taking an anti-bullying stance (Australian Nursing Federation, 2011). Australian nurses reported a larger impact by attending trainings that raised awareness about bullying (Nurse Uncut, 2014).

In the U.S., the nursing profession has created the Stop Bullying Toolkit (Pacers Committee, 2015; Nurse Uncut, 2014) and some professional direction from the Center for Disease Control (Craine et al., 2015). When U.S. midwifery leaders were asked what could be done to diminish bullying in the preceptor/student relationship, Ellie Daniels responded, “Students need to look for another opportunity. They need a guide to help them find good preceptors….and they need to complain to their schools when they experience bullying.” The majority of participants in the survey did not report their bullying incidents to their schools for fear of losing the only perceived opportunity for clinical work in their area. While leaders would like to be made more aware of these incidents there lacks an anonymous way for the student to make a report and get the help she most needs. Schools need to create safe avenues for students to get professional assessment and counsel if they feel they might be in a bullying situation.

A majority of participants in the survey did not report abusive behaviors to their schools or midwifery program but did discuss it with someone in their birth community. “Students are afraid of losing their only perceived option for a preceptor,” stated Sarah Carter. Kristi Ridd Young, MEAC Vice President described students’ vulnerability by saying, “So many people think that by entering a MEAC school you will avoid this issue, but the truth is, it still continues.”

Participants commented that fear of being black-balled in their birth community, of not being believed, and of just making the experience worse for themselves by speaking out were not unfounded. Thirty-nine participants reported that discussing the issue with their preceptor resulted in continued or worsening negative behavior, punishment, termination, or they received no sign-offs.  However, for some, this did improve the apprenticeship.

Student midwives were asked if they tried to approach their preceptors about problems in the relationship, and many (46 participants) replied they did but were met with resistance and were mocked. “She said she is, ‘in the club, and if I would like to get in too I must comply and not complain or she will just drop me,” wrote one student. Thirty-seven reported they did not discuss the issues with their preceptor, with many who did attempt to discuss the issues reporting that it, “just made things worse”.

Ridd-Young told of how the Midwives College of Utah, has a grievance policy for students and preceptors. She stated that many students do not realize that preceptors are field faculty, and it is the responsibility of the College to respond to acts of bullying. In nine years, there have been two formal complaints filed at MCU involving preceptors. Informally, there are about “two to three a semester” that want to talk to administrators about their preceptor issues. We know from our survey that bullying is occurring at far greater numbers, but students are not coming forward.

The cycle of abuse in a bullying relationship disempowers the student to feel she has no voice, generates fear, and much like domestic abuse creates a sense of low self-worth that makes the woman feel she deserves the treatment on some level. The bullied student just feels if she can just endure it, then she can move on. Even students who recognize the repeated behavior as harming, find themselves paralyzed about how to change the situation.

Students who reached out to their schools did not find the support or advocacy they needed, with only a few stating they received support and listening from their school administrators. Students were met with a, “That’s just the way they are, put your head down and get through it!” response by faculty.  Or, “Don’t tell me anything else or I may have to disqualify her!” Only six received communications skills or classes, three received counseling, and two were offered a book with coping techniques. Two did report having mediation. Many reported personally paying for professional counseling. One student midwife reported that she was told, in writing, from NARM, that they would, “always take the side of the experienced preceptor.” Another recalled NARM’s response, “They responded by saying it is up to the preceptor to define her/my role in the apprenticeship, and they will not get involved.”  Many noted, that while NARM acknowledged their complaint, they offered no investigation or accountability.

Some PEP students had stories of years of work for one preceptor with no sign offs of skills and no available recourse when contacting NARM. Preceptors who choose not to follow through with their promised agreement have no consequences if they forgo their verbal or written contracts. One student wrote, “When I contacted NARM, they told me, in writing, that it is up to the preceptor to define the relationship. ‘We always take the side of the preceptor’.”

The power imbalance continues to exist even when the student pleas for intervention, often silencing the target for speaking out. This furthers the cycle of abuse and bullying. While there is a grievance policy in place with NARM, it appears to be met with resistance when students ask for help. Accountability for preceptors must take priority and rejecting of statements like, “We will always take the side of the preceptor,” must be discouraged.  Accountability of preceptors must be a high priority.

The effect of bullying lasts long after the apprenticeship is over. One participant in practice wrote, “It made me wonder if I was even worthy of becoming a midwife. It caused me to doubt myself on every level of ability as she went from saying I was great to saying the most horrific things to me that no person has ever said to me. It takes a toll on your confidence, and it takes a while to recover from that.” While the close working relationship between an apprentice and a midwife can create a lifelong sisterly bond, it’s clear that student midwives carry, for years, their preceptor’s voice in their head, and often struggle to silence the negative aspects.

Conclusion

Certified Professional Midwives need to adopt a standardized definition of what bullying is. “Bullying diminishes another person’s needs, concerns, or contributions. Bullying is behavior that is repetitive and creates communication gaps. Bullying involves escalation, power disparity, and attributed intent” (AACN, 2016). Bullying is not legitimate performance feedback, holding a student to a workplace standard, demonstration of necessary control and authority, or a disagreement/difference in style between a student and preceptor (Lieber, 2012). Bullying is not two powerful women just not getting long (Farrell, 2006); its repeated destructive behavior.

The nature of homebirth is that most of the work is done in private. The tradition of apprenticeship is an essential element to learning not only the skill but the art of midwifery.  Apprenticeships must evolve with professionalism, integrity, education, and high standards of practice. Preceptors ask for long commitments from their students, often lasting multiple years, along with most students sacrificing an income during those years and financing midwifery school tuition. Students are desperate to finish and preceptors rely heavily on their unpaid assistance. The lack of accountability for preceptors has created a power imbalance in the apprenticeship model that is ripe for abuse and exploitation.

As Certified Professional Midwives are overcoming obstacles and becoming professional peers in the maternal health care system, we must be honest and comprehensive in examining our training techniques. Abuses of power and authority are causing students, and new midwives, to leave the profession, thus reducing options for safe childbearing in many communities. The physical and emotional effects of bullying are not short-lived and do not cease when the student graduates; it impairs how these midwives later practice. It destroys their self-confidence and greatly affects personal relationships, leading to high burnout rates and midwives leaving the profession.

Midwives have created a survivor mentality; a false belief that, “if you want it enough, you will sacrifice everything or endure anything.” I would challenge that this surviving does not make better midwives; it just creates an impaired, fractionalized, damaged group. If we truly care about empowering women we will also care enough to look at the dysfunctional side of midwifery: bullying in apprenticeships and take steps to create a healthier, balanced process.

Recommendations

Based on what is identified as best practices in the literature and the experiences of students, midwives, and midwifery leaders, I am offering the following recommendations for CPMs to begin to address and end bullying in midwifery.

  • Midwifery organizations need to name the behavior and adopt anti-bullying statements
  • MEAC-accredited schools should adopt anti-bullying statements
  • MEAC-accredited schools should develop a course of action for student and preceptor education (classes and/or webinars to raise awareness and help find solutions), complaints (ways for students to report without fear of losing placement), support, counseling, and resources that comprehensively address and mitigate bullying
  • All preceptors need training. This can be in the form of webinars, classes, workshops, or forums. Preceptors should be trained in teaching techniques and have verbal check-in points with staff, preferably a mentoring, experienced teacher who will give individual oversight and written and verbal feedback to the preceptor
  • NARM, as the professional certifying organization, needs to offer a clear, legitimate way for students to report bullying behaviors and offer clearly defined contracts that all preceptors sign

About the author:
Tracy has twelve children, and has been married for 26+ years. She had her first ten babies in hospital, and her last two babies were born at home using midwifery care. After having attended over 100 births as a doula, she began pursing midwifery. She enrolled at the Midwives College of Utah in 2012 and received a Bachelor of Science in Midwifery after four years of dedicated didactic and clinical work. She graduated in May of 2016, and holds the title of Certified Professional midwife with a Bachelor of Science in Midwifery. She is offering midwifery services in the Metro Atlanta, Georgia area. Her website can be accessed here.

References:

Australian Nursing Federation. (2011, November). Bullying in the workplace ANF policy. Retrieved November 20, 2015, from Australian Nursing Federation:
http://anmf.org.au/documents/policies/P_Bullying.pdf

Clews, G. (2009, July). Midwifery must take steps to deal with professional bullying.
Retrieved November 4, 2015, from Nursing Times:
 http://www.nursingtimes.net/midwifery-must-take-steps-to-deal-with-
professional-bullying/5003959.fullarticle

Craine, J., Costa, B., Hartley, D., Ridenour, M., Bain, G., Cohen, G. I.,… & Vessey, A. J.
(2015). Workplace violence prevention for nurses. Retrieved December 2, 2015,
from Center for Disease Control:
http://www.cdc.gov/niosh/topics/violence/training_nurses.html

Curtis, Bowen, & Reed, (2007) You have no credibility; nursing students experience
of horizontal violence. Retrieved December 10, 2015, from  
http://www.nurseeducationinpractice.com/article/S1471-5953(06)00071-0/pdf

Farrell, M. V. (2006, Winter Issue 80). Bullying. Midwifery Today.

Farrell, M. V. (2007, Winter Issue 84). Finding a better solution to end bullying;what an
organization can do. Midwifery Today.

Georgiou, G. (2007). Anti-bullying tactics make a difference. Midwives Magazine–The
Royal College of Midwives
.

Gillen P., Sinclair, M., Kerhohan, G. (2008). The nature and manifestations of bullying in
midwifery. Royal College of Midwifery.

Gillen, P., Sinclair, M., Kernohan, G., Begley, C.(2009). Student midwives’ experience of
bullying. Evidenced based midwifery, 460-463.

Green, S., Baird, K. (2009). An exploratory comparative study investigating attrition and
retention of student midwives. Midwifery 25(1), 79-87.

Liddle, D. (2015, May 8). Tackling bullying at work–webinar. Retrieved October 2, 2015,
from Youtube: https://www.youtube.com/watch?v=BfF-bEYuX0U

Lieber, L. D. (2012, May 17). Workplace Bullying and Violence; What HR Needs to Know;
webinar
. Retrieved October 1, 2015, from Workplace Answers:
http://www.workplaceanswers.com/workplace-bullying-and-violence-
information-hr-needs-to-know-2/

Namie, G. (2009). The bully at work. Naperville, IL: Sourcebooks, Inc.

Namie, G. (2015). How bullying can affect your brain and body. Retrieved November 15,
2015, from Workplace Bullying and Trauma Institute:
http://www.workplacebullying.org/individuals/impact/physical-health-harm/

Namie, G. A. (2011, May 3). Bullying on the job, what it is, who is doing it and how to stop;
webinar
. Retrieved October 2, 2015, from You Tube:
https://www.youtube.com/watch?v=2M0LVhonHUQ

Nurse Uncut. (2014, August 15). Anti-bullying seminar strike a chord. Retrieved December
2, 2015, from Nurse Uncut Australia: http://www.nurseuncut.com.au/anti-
bullying-seminars-strike-a-chord/

Pacers Committee. (2015). Stop Bullying Toolkit. Retrieved November 15, 2015, from
Pacers; Passionate About Creating Environments of Respect and Civilities:
http://stopbullyingtoolkit.org/

Royal College of Midwives. (2014, November 28). New online toolkit to tackle bullying.
Retrieved November 20, 2015, from Royal College of Midwives:
https://www.rcm.org.uk/news-views-and-analysis/news/new-online-toolkit-to-
tackle-bullying

Stagg, S. J., Sheridan, D. (2010). Effectiveness of bullying and violence prevention
programs: A systematic review. AAOHN, 419-424.

Stagg, S. J., Sheridan, D. J., Jones, R. A., Speroni, K. G. (2013). Workplace bullying: The
effectiveness of a workplace program. Workplace Health and Safety, 333-8.

Stutzer, K. (2014, August 21). Bullying in the workplace: It harms more than the bullied
AACN critical care webinar series
. Retrieved October 1, 2015, from American
Association of Critical Care Nurses:
http://www.aacn.org/DM/Webinar/WebinarDetail.aspx?Category=WEBINAR-
SERIES&ProductCode=WB0015

Wiley, L. M. (2013). An exploration of power within the student-preceptor
relationship.
 ProQuest LLC (2014).

 

 

So You Want to be a Midwife?

Do you know how when a pregnant person is in labor, and you ask them, “How many more children do you want?” Or when they are done giving birth, and someone asks, “Do you want anymore children?” What is the typical response to that? “NO!! I never want to do this again!!” Or, “Are you kidding me? That was the hardest thing I’ve ever done, and I never want to go through it again!” Give it a few months, or a couple years, and she will have put away the hard work of labor, and will once again think about having another baby.

Well, I am currently the laboring person, and I am around 5 cm dilated, and it is a ton of work. I’m sweating, and wondering why I did this to myself? What I need is rest, sleep, nutrition, hydration, and a good support team which will help me while I dilate to 10 cm, and hopefully I can begin second stage of labor. However, there is still quite a bit of work left. I’m only half-way there, and the hardest part of labor is about to begin: transition.  I cannot wait for this to be over so I can hold my baby, but I don’t want to do it again!

Key:
Laboring person: the student midwife, ie ME
5 cm: Half way through didactic work
Support team: family, friends, doulas who offer support, and other midwives
Transition: Clinical work
Second stage of labor: prepping for NARM exam, and taking NARM exam
Baby: certification and license

I’ve had several people ask me about midwifery school. A few weeks ago, I met with someone who was interested in becoming a midwife. I cannot be anything but honest with anyone who wants to know what it’s like. So this post will detail what I said to this person. It’s real. It’s raw. It might not be what you want to hear. It may sound like I’m complaining, like I’m discouraging people from beginning this journey. However, my goal is to make sure that anyone who wants to begin this journey is well informed. Someone tried to tell me how difficult it would be way back when I first was considering becoming a midwife, and I didn’t quite pay attention to what they were trying to explain. Now I look back, and I honor their words, and I know they were only trying to prepare me for what lay ahead.

This is no cookie-cutter, gum ball machine degree. This is a four year, full-time, degree which includes at least 1.5 to 2 years of clinical work.  Sure, it can be accomplished a little sooner, but at what cost to the student? Going to midwifery school takes dedication, perseverance, and a lot of late night hours completing assignments. The didactic work isn’t much different from other didactic work. We have teachers, syllabi, assignments, exams, research papers, APA formatting, long hours, and deprivation of sleep and good nutrition. When completed, I will have an Associates of Science in Midwifery. When I pass the NARM exam, I will be a certified midwife. Then I will apply for licensing through the California State Medical Board, and become a licensed midwife. The point is to say, we work hard for our degree, same as any other associate’s degree.

Financially, it is not a low-cost expenditure. Midwifery schools range from $5,000 – $40,000, depending on the school. From what I understand, that low range number is about to go up considerably in June (will update when that happens). Since I’m in California, we cannot go the PEP route, and must attend a MEAC school.

Add to that books which are expensive, school supplies, and any equipment needed. When clinical work begins, add gas expenses, especially if travel needs to be made. I’m currently traveling 90 miles one way for my apprenticeship. Add also any conferences or student enrichment courses that may be needed, including NRP and CPR certifications. Some schools provide federal financial aid, which is a huge help to students. There are a few who provide scholarships. However, for the majority of people, it is an out-of-pocket expense.

Clinical work is a must. Many students cannot find a preceptor in their own city, so they must travel long distances to complete clinical work. Some have had to go out of the country to meet the clinical requirements. Some students need to move to another state, or attend month long placements in another state to get some clinical requirements met. Finding a preceptor is a huge challenge and can be a huge obstacle. There are students who are nearing the end of their didactic work, and still have no preceptor.

The partner in the relationship cannot be over-looked. I really cannot emphasize this enough, and while there may be a few who don’t have to deal with this, the partner in the relationship goes through a lot, too, while the student is working on their didactic and clinical work. I don’t really care how supportive people tell me their partners are, there WILL be push back, I guarantee it. There will be times when home life is not perfect, or there is an important discussion being had, and the call comes in from the preceptor that a client is in active labor. You have to get up and go. There’s no time to finish the conversation. Everything gets put on hold, or you miss the birth. Missing the birth is traumatic for you, but also for the client who got to know you. There will be times when you are driving to that birth, and you have to clear  your thoughts of what you left behind, and you have to walk into the birthing space, and leave all your worries at the door.

So, make sure you discuss this with your partner, in detail. This is no easy road for both of you, and no easy road for your children…

Our children…sigh…this is by far the hardest part. Our children miss out so much when we are going through this journey. There are missed birthdays and holidays. There are cancelled or postponed trips. The T.V does become the prime babysitter. Healthy meals, well they don’t happen as much, or at all. Fast food is easiest when it’s the end of the semester, and you have to turn in all your assignments in order to complete the class. Oh, I can be all romantic and say, “but my children see how important this is to me, and they will remember that mom went to school while she had a family.” Yeah, I don’t know. I think they will say, “I missed mom a lot when she was going to school.” Tears…

For me, it helps that my children are older, and can drive themselves here and there, and that they don’t need a babysitter, and can fend for themselves when I’m not home. They don’t need help bathing, getting dressed, brushing their hair, etc….However, if your children are young, then you have to consider the need for an on-call babysitter. Realize that a lot will be missed when you are away on births, and while you are needing to complete your assignments. Your children will grow up while you are going through this journey, and are you prepared for what you will miss, and what they will miss out on?

Extra-curricular activities are no longer a part of your life when choosing this route. Be prepared to not be able to just take a weekend to the mountains or to the beach, because assignments need to be turned in, or a client is within dates. That research paper won’t get done while you are frolicking in the mountains. Sure, if you finish all your work on time, there might be time to enjoy a mini get-away, but I’m sure you’ll be catching up on the messy house, and cluttered corner!…or cluttered cornerS.

Responsibility to our clients. Going from doula to student midwife, and then eventually to midwife has given me much to ponder. As a doula,  I am not responsible for anyone’s well-being or life. The care provider is responsible to make sure the pregnant person is continuing down a low risk route. They are responsible for an unborn baby!! There are so many health issues to consider: How’s the pregnant person’s blood pressure? How is the fetus’ heart tones? How is fetal growth going? What do the lab results show? Is there GBS present? How about gestational diabetes? Is that pre-e developing? Let’s consider the possibility of shoulder dystocia and how we will manage that if it occurs. Fetal heart tones are not recovering well after a decel. We must always be prepared to resuscitate a newborn.

These are things I never had to think about as a doula, because as a doula, I offered education, emotional, and labor support. Midwifery is not just about offering support. Midwifery is about offering individualized, competent, prenatal, intrapartum, and postpartum CARE, meaning, it’s not simply about offering support. Midwives have to deal with life and death situations, and make sound judgement about when to continue at home or birth center, and when to transfer care to an OB or hospital. Midwives and doulas have such different roles, that the two can’t ever be compared. They are two different worlds in their roles, yet, can be the perfect team for a laboring person.

I didn’t even mention our personal well-being! A small note: It’s not easy performing self-care like eating healthy, drinking enough water, exercising, meditation, etc. I gained 20 pounds the first year of midwifery school, ugh!! I’ve been able to get a handle on that, and have lost those 20 pounds, plus another 27 pounds. I still have not been able to find time to exercise, though. Additionally, sleep deprivation is real: long hours on school work and then births.

There’s so much more I could write, but I’ll leave you with these few items to think on. Like I said, I’m not trying to discourage anyone from going into the midwifery profession. I’m also not going to romanticize this journey and make it all rainbows and unicorns, and skipping merrily through the woods. This road is H.A.R.D. Is it worth it? For me, it definitely is.  Ask me again in five years, and I’ll probably tell you, I’d do it all over again. Right now, I’m in labor, so be prepared to get the nitty-gritty of this extremely challenging, birthing experience. Who knows, I might even yell and moan a little as labor continues. We need MORE midwives! And now you are informed on the challenges and you can make an informed decision to go into midwifery work.

Pictures below:
Left picture is Winter semester, 2017 when I was doing research for practice guidelines.
Center picture were some of the books used for Winter semester, 2017
Right picture is self-explanatory

 

Here is some information on becoming a midwife.

New Clinical Placement

A bit of history: Back in 2012, I became friends with Tesa Kurin. Back then, she was a doula, and was studying to become a midwife. I watched Tesa as she moved along through midwifery school, being in a clinical placement, and even going to the Philippines for three months to do clinical work. She did this all while parenting six children. I have eight children, and was parenting six children when I began to wonder if I could become a midwife.

As I began to get the midwifery calling, I started asking Tesa questions about school, and asked her if she thought I could do it. She answered all my questions, and encouraged me to look further into midwifery. Although I had already received the calling to be a midwife, I had not fully listened to it. However, having seen someone with a boat load of children, such as myself, doing this, I knew it could be possible. Watching Tesa’s journey inspired me to move forward and to accept what God was calling me to do.

Fast forward to 2015: I began classes at Midwives College of Utah (MCU) in January 2015. I began my first clinical placement in March 2016. However, my preceptor retired, and my last birth with her was in November 2016. So, now I was in need of another clinical placement. While there are two other midwives serving my city, they are currently not taking any students.

Tesa filled out the preceptor application and is now an approved preceptor with MCU!!! A couple weeks ago, Tesa and I signed the clinical training agreement, and I now have my next clinical placement!!!!!!!!!!!!! (Still in the assist phase.)

One little thing, though: Tesa’s birth center is 93 miles, which is approximately 1 hour and 30-45 minutes depending on traffic, away from my home! Right now, distance is not a barrier! I’m ecstatic to begin this placement, and I’m excited to see what Tesa has in store for the future of her birth center. I do believe I’ll be able to move right into the primary phase by the end of this year!

Today (4/18/17), I began apprenticing at the Antelope Valley Birth Center in Lancaster, Ca. It has been a great day and I also get to apprentice along side another MCU, Rebeccah! She is the primary student, and I am the assist.

All those Practice Guidelines and Client Handouts

We are nearing the end of Winter Trimester, 2017. It was a great semester! I was able to complete the trimester way ahead of schedule which gave me a nice long break! I was not in a apprenticeship this trimester, so there was plenty of time to complete all assignments, and complete them well ahead of schedule. There was also time to take a one week break mid-trimester to visit my parents out-of-state.

This semester, I decided to create a schedule, in a notebook, for all classes and all assignments, including the required participations (no computer scheduling this time, because that has not worked in the past; I’m the pen and paper type!) I followed the schedule precisely, and it allowed me to submit assignments on time, and not fall behind, but to move far ahead in assignments.

This trimester was the trimester of practice guideline and client handouts: 42 total!! The three courses I took were Chemistry & Nutrition, Complications of the Prenatal Period, and Postpartum Care. Below is a list of the practice guidelines and handouts I created this trimester.

Chemistry & Nutrition Client Handouts:

1. Glycemic Index and Low Glycemic Diet Handout
2. Hydration in Pregnancy Handout
3. Prenatal Vitamins Research
4. Nutrition During Pre-Conception, Pregnancy, & Postpartum Handout
5. Take Charge of your Home Handout

Complications of the Prenatal Period Practice Guidelines and Client Handouts:

1. Group B Strep Practice Guideline 1. Group B Strep Handout
2. Ectopic Pregnancy Practice Guideline 2. Bleeding in 1st, 2nd, and 3rd Trimesters Handout
3. IUGR Practice Guideline 3. Miscarriage Handout
4. Placenta Previa Practice Guideline 4.  Gestational Diabetes Client Handout
5.  Abruptio Placentae Guideline 5. HELLP Client Handout
6. Miscarriage Practice Guideline 6. How to Prevent Preeclampsia
7. Gestational Diabetes Practice Guideline
8. HELLP Practice Guideline
9. Gestational Hypertension, Preeclampsia, Eclampsia Practice Guideline

Postpartum Care Practice Guidelines, Forms, and Client Handouts:

1. Immediate Postpartum Checklist 1.  Preparing for a Healthy Postpartum Handout
2. Postpartum Midwife Chart (a checkoff list) 2.  Postpartum Information for Parents Handout
3. Rh-negative Informed Consent & Waiver 3.  Nutrition for Postpartum Handout
4. Healthy Attachment of the Newborn and Mother Practice Guideline 4. Toning Your Body in the First 6 Weeks Postpartum Handout
5. Postpartum Depression Practice Guideline 5. Postpartum Depression Handout
6. Postpartum Needs of Women in Diverse Ethnic Cultures Practice Guideline 6. Sexuality in Postpartum Handout
7. Sexuality in the Postpartum Practice Guideline 7.  Healthy Attachment & Bonding Handout
8. Postpartum Visit Care Schedule Form 24 hour 8. Midwife Resource for Postpartum Services
9. Postpartum Visit Care Schedule Form 72 hour 9. Special Help Postpartum Handout
10.  Postpartum Visit Care Schedule Form 7 Day
11.  Postpartum Visit Care Schedule Form 2 Week
12.  Postpartum Visit Care Schedule Form 6 Week
13. Postpartum Visit Care Record Form 24 hr, 72, hr, 7 day, 2 week, 6 week

Final grades for Winter Trimester, 2017:
Chemistry & Nutrition: 100% A+
Complications of the Prenatal Period: 98.67 A+
Postpartum Care: 99.47% A+

Last semester, I forgot to update with grades. So I’m adding those in this post as well.
Fall Trimester, 2016:
Principles of Evidence Informed Practice: 96.85% A+
Prenatal Care II: 98.09 A+
Labor, Birth, and Immediate Postpartum: 96.71 A+

Paper schedule:

Halfway Mark!

This is the halfway mark!! Today marks exactly TWO years since I began my journey with Midwives College of Utah (MCU). When I considered becoming a midwife, I was a bit unsure of which school to attend. Could I really do long distance learning? Would it be structured enough for me? Would I be able to be committed? Would I be smart enough? So many questions, and no way to figure it out unless I tried it out.

Thankfully, MCU  has a continuing education program. Students can enroll in a few classes, without any on-going obligation. Entering the continuing education program was my way of testing the waters before fully committing to distance learning. After the first semester, I was hooked! I took a second continuing education semester, and applied to become an enrolled student. In Aug of 2015, I became an official enrolled student.  However, my academic journey began earlier that year in Jan 2015 with the continuing education classes.

Today, I reflect on how frightened I was to go full force, still unsure of my calling. Unsure if I was fit for long distance learning as a student over 40 years of age. Still praying about moving forward and wondering if this was God’s will for my life. Wondering if I could hold it together while still raising five children, with six still living at home, and cooking, cleaning, grocery shopping, school runs, teaching P.E., helping my children with their homework, helping my husband with his business, continuing to be a doula, church activities, volunteering at church, yearly youth camp (week long) trips, periodic youth trips, my daughters school competition trip and then comes the preceptorship. What’s more, attending MCU is year round with a three week break between semesters to rest before the next semester begins. Their academic year is divided into trimesters: three-15 week trimesters with three week breaks. Thankfully, I have been able to continue the forward momentum.

This journey cannot be forged, though, without the support of many people. With the support of my husband, my daughters, my son and his finance who sometimes pick up the slack and will drive my school-aged children to school or pick them up after school if I’m at a birth, MCU students who have cheered me on and have been my study buddies and a listening ear, and my MCU house mother whom I can text or call anytime I need help, I am able to continue on this journey to becoming a midwife!!

Here is a small window into the support from my children:

testing-chair-watermarked
When I am taking an exam with an online proctor, there cannot be any interruptions. For this particular exam, I told all the children that they could not come in the room while I was taking the exam. When I was done with the exam, I found this chair they had put in front of the door to block entrance into the room. One of them wrote this note: Don’t go in. Mom is taking a test.

Completion of the didactic work should be somewhere at the end of Dec. 2018 (almost exactly two years from today). It does seem unreal to be two years into this work, it will be equally           unreal when it’s all completed!!

Second Year Student

The break was great! It was a much needed time of resting my mind. I had time to enjoy the last bit of summer break with my daughters. We went to the coast and beach for two separate day trips. We also got to go camping for four days in Shaver Lake with our good friends. If there’s one thing I love doing in summer, it is camping.  I was able to find two small campsites, next to each other the week before our camping trip. We loaded up a U-haul with all our gear, our friend’s gear, and we took off! We had lots of food, water fun for the children, and s’mores by the campfire. We also went to San Diego for a couple days. I took all six of my daughters, and my son and his girlfriend joined us, too. We went to Balboa Park and then the beach. We had a great time!

I tried to fit all of summer into three weeks and did a lot of activities with my children to make up for a summer vacation that was filled with school work for their mom. All six of them and I enjoyed every trip we made.

Morro Bay 8-2016 Watermarked

Morro Bay, August 10, 2016

 

Monterey Bay 8-2016 Watermark

Monterey Bay, August 12, 2016

 

Shaver Lake 8-2016 Watermarked

View from our campsite, August 16-20, 2016

 

Balboa park 8-2016 Watermarked

Balboa Park, August 23-24, 2016

And with that….

All good things must come to an end, and now, it’s time to get back to school. The 2016-2017 school year at Midwives College of Utah begins today, August 29, 2016.  It’s still so hard to believe that I am a second year student in midwifery college. This school  year will have me enrolled in 10 different classes throughout the trimesters.

Many of the books used in past classes are used multiple times. So for the fall trimester, I only needed to purchase two books, because I already had seven books from previous semesters! That was a huge savings.

Fall trimester classes:
Prenatal Care II
Labor, Birth and the Immediate Postpartum
Principles of Evidence Informed Practice
(It’s a relief to not have a biology class for fall semester!)

Winder trimester classes:
Postpartum Care
Complications of the Prenatal Period
Chemistry & Nutrition (BIO 404)

Summer trimester classes:
Well Woman Care
Obstetrical Pharmacology
Complications of Labor, Birth and Immediate Postpartum
Applied Microbiology (BIO 405)

I look forward to the challenges and the information I will learn. Let the second year commence!