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.

Hot Springs
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!

More pictures just for fun:  Community  (3).pngPictures  (5).png

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.

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.