Mad skills or mad at your skills?

jmacmidwife

            What new skill or information have you learned over the last few weeks?

            Let’s see, I have learned so much it isn’t funny and you know that I think everything is funny. Mostly, I am learning what to say or how to say it.  I have learned what herbs to give for varicose veins (horse chestnut) or PTL (Black Haw). However, I wish I could learn some of these other skills right now, like the newborn exam or something else helpful.  It just seems like some days I am following the midwife around like a puppy and not able to do much except lick her face and chase butterflies.

            Well, I have learned how to wet a diaper to make a heated booty for the baby before performing the pku.  Also, it appears that you have to really squeeze the baby’s foot to get all the blood out, if you use a small lancet. This makes so much sense! I am used to seeing the baby’s tortured in the hospital where it seems like a huge nick is placed on the babies heel. Poor babies. But the blood comes flowing like water.  I have seen a washcloth used to warm up babies heels, but a diaper booty is too cute and practical to pass up. I will have to remember that for my practice.

            I learned how to wash and sterilize instruments per the midwife’s liking.  I learned that it is best to complete your birth clinical forms as soon as you can coherently write them. I learned that it is ridiculous how long these journal entries take me. Journalling is not for me.

Doula differently

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            Today I went to a birth.  Yippeee! It was at the home of the couple that I had my very first prenatal. What a coincidence, I know! The birth was fabulous and I loved how the midwife is very aware and forward-thinking. It seems like she is always two-steps ahead. I can’t wait to be at that place too.

            I guess I did okay at the birth. The midwife is not the type to give feedback to apprentices. So, although I love her, I don’t think we will be a good match in the long run, because I am sometimes an idiot and need to be told what I am doing wrong.  If she won’t do this for me, then we may end up in a bad spot. I don’t want to change her, but I also don’t want her to get pissed and our relationship to go to a bad spot. I think she is a great person and would make a good friend.  However, she did give me a little bit of feedback, even though I know that was hard for her to do as she definitely did not want to offend me (and she didn’t). She explained that Amish women don’t like a lot of praise in labor.  Apparently in their culture, you should not tell them you are proud or that they should be proud.  Next time, I will be encouraging, but watch my words more carefully so that I don’t offend anyone.        

            I found out today that although this journal is for the birds, it will come in handy when I write my book someday.  One of my best friends and I have been planning on a book deal once this whole midwifery dust settles.  We have high hopes for ourselves—she wants to be on the MANA board and I want to speak at conferences like Midwifery Today.  Okay, speaking is not my thing, maybe I will just be present. I dunno yet.  However, the big epiphany today is that I couldn’t have done this journey without her.  Our relationship not only helps me get out of bed, but it keeps me from crawling back in.  I am eternally grateful that I found her before starting on this journey as I could not imagine going on it without her.  Her encouragement and support have been invaluable. Thank you dear friend.

Microcephaly baby

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I had the honor of riding around again with my preceptor today. I am so lucky, have I said that lately? She is so awesome and she is a midwife! Two of my favorite things! Although she normally picks me up and takes me to lunch, we had a long day today and didn’t even stop to eat. So, my lesson today is to eat a bigger breakfast. No, seriously.

            I definitely want to start doing more hands on skills, but am not sure if I should jump in and start doing them or continue to shadow. It is a hard line to walk figuring out what another person is wanting and thinking. I just want to be helpful.  An initial client came in today and the midwife asked me to do a head-to-toe physical and I couldn’t.  I had not learned that yet. WHY??? I should be studying this stuff in between everything else I am doing. I have got to get my game face on and practice these skills in my off time so I can do them when I am offered the chance.  They are not rocket science.

            I also had the opportunity to see the mother and baby who had microcephaly.  The baby was so adorable, but I cannot imagine having a baby and breastfeeding it for several months, then watching it die. We weighed the baby and her head was really moving and causing her body to move, which was surprising to me. Obviously, if the head is not big though, then there is nothing to anchor down the baby body, hence the almost rolling off the table. However, other than having a small head, the baby was very normal for her age.

Preterm labor

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This mom’s s/s were: lower/mid back pain, noticeable but non-painful uc, cramps, pelvic pressure, diarrhea, and mucous plug like discharge.  FHT were good.  No amniotic fluid was present. HMMMM.  So, an internal exam was done, she was high, long, fingertip, but soft.  No bloody show was evident on glove.   I noticed that this mom has not had to go to the bathroom when we arrive.  This is peculiar to me.  Another midwife was seeing this mom for her prenatals up to this point, and for this mom not to anticipate the urine dip at every visit by now, was weird.  Since we had just been here last week and she took forever to have to go to the bathroom—what mom at 35 weeks takes forever to go potty? The one who isn’t drinking enough! And what is a treatment for PTL?  Adequate hydration!  Her urine was cloudy, with high ketones and blood in urine. Now, I have issues with this dipstick. It has too many tests on one strip that it seems to bleed onto the other nearby tests, like the ketones, if high, will seep onto the urine square.  I try not to get too much urine onto the dipstick, but it inevitably seems to bleed.  I think when I get into my own practice; I will get a test strip with fewer indicators so that this doesn’t happen. It drives me crazy because at the other PTL visit, I tested the urine and saw a similar reading, but I didn’t think it was conclusive since it was obvious the ketones were spilling—all over the dipstick. Plus, it is hard enough to read those dipsticks with 12 indicators in electric lights, but when you only have a pen light or kerosene lamp—well, I guess I better learn fast. 

So, this mom seems really anxious to me. She is full of energy and seems not confident of herself, which saddens me, but I have to remember that she came from a hospital birth.  I think she needs more coddling and reassurance than I am seeing her get from her midwife, but what do I know?  I feel like being a doula to her, where I haven’t felt that before with the other moms.  I think this is weird. Is it just because she is English? She just seems to be all over the place and not focused on enjoying these last few weeks. Stressing over them and waiting for labor to begin is not helping. Hopefully, she’ll become centered and at peace soon.  Apparently the mom was having a UTI, which was aiding in the PTL.  She said she felt as if one was coming on and she was urinating more and very thirsty.  Her husband went out and got her some cranberry juice, but the midwife was going to call in a prescription in the morning.  We didn’t have the black haw with us—gotta replenish those bags!  The mom didn’t have any wine (our second suggestion), so we offered Benadryl, which she accepted.   It worked like a charm on the 2nd dose and we waited a good 1.5 hours before letting ourselves out and going home.  Her uc must have subsided once she relaxed and fell asleep. 

Her plan was to do another internal exam and go from there. If needed, she would escort mom to the hospital, but hopefully, she needed some reassurance and a hug.   Since it was my day off, I use that term loosely, because I would have normally went, if I didn’t have a quiz that I was studying for tomorrow.  Plus, my kids were not expecting me to be gone today.  I told the midwife that I would check and see if the neighbor would pick them up and go from there.  Unfortunately, my neighbor’s mother had committed suicide today and I was not going to impose any babysitting favors upon her.  That must have been God’s sign that I didn’t need to go. Normally, I tell my girls that I may not be home and give instructions on what to do, but today they both had activities after school in different locations at different times and I didn’t feel comfortable trying to get a bunch of other mothers involved.  After today I will tell my girls just to walk home after their activities, but since it was such an unusual day, well, I had to say no to work as hard as that was.  

Flat earthers

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I don’t think she realizes it, but my midwife is such a wonderful person—kind, understanding, patient, and nice.  Who wouldn’t want to spend the day with her?

I arrived at the Farmhouse at 8:30. We got started collecting charts, going to the bathroom and making small talk.  It was 9 by the time we left and headed out to the store to purchase a birth tub/horse trough.  The other student had the honor of testing it out for us and we got a cute photo of her to place on a website. We didn’t get the tub as it proved too short, but we did get a shovel since the midwife said inevitably her students would be digging her out of the snow.  I think this jinxed us. (Read on.)

We arrived at our first Amish house, only to find hired help sitting near the house eating their lunches. The midwife explained that many times the mother won’t meet when hired help is around, so it is polite to go and ask if it is a good time to meet, before assuming she will want you as a visitor as the Amish do not want everyone knowing their private matters.  Indeed, this mother wanted us to return after the children were gone and when the men were working in the barn.  So we decided to visit the PTL mother from the week before since she was close by.  It was nice that this mother was in bed resting, but she admitted she didn’t feel much better and in fact she felt really relaxed after taking her tincture of Black Haw. She was also taking C&B formula, which had cramp bark, false unicorn root, and black haw.  We sat and talked for a few minutes. She seemed to be a bit more accepting to me, not that it mattered, but she offered us a seat.  She wanted her iron checked since with her last pregnancy, the midwife checked it every visit.  Although, we were not concerned with it—a few visits ago it was WNL—we took it and were glad we did.  Her hemoglobin was low! No wonder she felt bad.  We counseled her on iron-rich foods, like liver and onions, dried fruit, black-strap molasses and taking her Floradix.  Hopefully, she will increase it before birth.

Returning to the mother’s house that had the hired help, we went inside.  This mom was a talker! I have not seen or heard an Amish woman talk as much as this one did, so it was nice to know that the reason they were so quiet was not all personal.  This mother had varicose vein issues so was talking about putting the castor oil packs on her legs. I had never heard of this. The midwife suggested horse chestnut also. 

I had the opportunity to feel this mother’s belly.  Although I love to get my hands on the bellies, I am so used to palpating a third trimester belly, that a second trimester one is weird to me.  I have to get over this. It is normal for the baby to be small at this point and bounce all over the place.  It is just that I got so used to feeling for that softball sized head and bottom, that it is strange to try and chase a little one transversely.  Plus, this mom had a lot of fluid, which was even more challenging.

As we left this mother’s house, we got a flat tire on the side of some random country road.  Luckily we were able to pull off into a farmer’s semi-flat driveway, out of harm’s way.  At first we didn’t think we could change the tire. We got out the jack, found the spare, and pulled off the old tire.  WOOO HOOO.  And as if on cue the jack fell over and the car went Ker plunk in the sandy driveway.  Hmmmm. At this point, I racking my brain for a power point on car maintenance and repair.  I mean, surely we had seen a PowerPoint on this important aspect of midwifery care, right? Well, it wasn’t coming to me, but sheer determination or maybe stubbornness was shining through. We tried twice more before deciding that we needed a man. After attempting to flag down once with our unshaven, hidden-beneath-Amish-wear clothing, we decided to phone a friends.  She was on her way, when the kind old farmer whose driveway we had plopped down in rolled up in his mule.  In no time flat did he have our car jacked up and we were ready to roll.  Thank heavens for old farmers and good jacks.  So, we brainstormed that we should have a day of car maintenance or at least a speaker come and visit—maybe we could take a field trip to the auto bay and have those nice students show us the ropes on basic car care? Another brilliant idea was a PowerPoint presentation and at the very least we should all get a small floor jack engraved with “from babies to tires—if its flat we’ll fix it” at graduation. And next time I will remember to use a pair of gloves for this procedure.

More firsts

jmacmidwife

 I went to my first Wisconsin Midwives Guild meeting in Madison yesterday.  I started off the day with a quick and fast lesson in driving in near blizzard conditions and my car had its first salting.  I do hope driving won’t be this treacherous most of the time. 

The guild meeting was what I expected.  I say that because I was part of Louisiana’s Midwifery Association and had attended many meetings before.  Today, since many students and midwives at MANA, it was a small crowd.  I had the opportunity to meet many of my fellow students in the classes I took online in the spring. It was a nice opportunity to put names with faces and see whom is studying where and apprenticing with whom.  Not that I was surprised, but in Wisconsin there are many more students than there are midwives, just like in Louisiana. This makes me happy and sad at the same time. I am genuinely thankful that resurgence in midwifery is taking place, but not excited about having to vie for the same slot with many other eager midwives-to-be. 

I also had the awesome opportunity to attend my first Amish birth.  I very much appreciated everyone’s acceptance of me at the birth.  While I am still getting used to the culture of the Amish, I am becoming more comfortable with their nuances, which is a good thing, as I am not taking it as personal anymore.

The couple was so sweet and loving, but in a distant sort of way, different than of an English couple.  The husband did provide labor support, but it was humorous to see how, in spite of obvious uncomfortableness, the mother did not insult or disrespect the daddy, even though she pushed him away as the head was crowning.  These Amish women definitely live up to their stoicism!  This amazing mama HAD to finish milking the cows before birthing the baby. She hardly made a peep the entire labor, although she was clearly working hard.  The baby had an unusually bluish dusky head, which was hard NOT to stare at, but the hands, feet, and the rest of the body were incredibly pink and looked well perfused. It looked like maybe the baby his face pressed in a weird place during labor, breaking superficial blood vessels or bruising it.

It was equally as awesome to attend a birth with a calm, relaxed, non-dramatic midwife.  I loved her hands-off approach and trusting ways.  She did not jump to the pit right and really allowed the mom to trust her intuition while birthing. The placenta, although it looked meaty and healthy, had 3 nodules in it that were like fatty deposits—something I had never seen before. It was cool to encounter that anomaly.  I am definitely looking forward to my next Amish birth.

My first Amish prenatal

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The midwife picked me up at 7:10 and we began our long day first by stopping by the farmhouse to pick up some items. It was so awesome to drive with her and to be able to learn her philosophy and management and style.  She seemed to be quite together for having such a busy practice.  Our first prenatal was at a young Amish couple’s house. I was so nervous and excited. I had not been to prenatals in a long time, so I was unsure of just how this would go and usually it was for English people who were comfortable with everything from bubble gum to tank tops. The couple was cute, polite, and attentive. It was their first baby and there house was immaculate.  I took care of the urine dip. Squinting, I could make out the colors and realized I needed way more sleep than I was getting if I was going to make this apprenticeship thing work, especially if I was to try and see in the dark. The midwife was awesomely cool and allowed me to feel this mama’s baby belly, except for the fact that I said ‘oh, there is nothing in there.’ Ok. Deep breath. Breath out. Check connection in brain to make sure filter is being applies to EVERY word coming out of my mouth. DUH. I know that I don’t say this to moms, ever and I just did. Way to go. (Shaking head). Thankfully, the midwife was uber kind and said you know these Amish women hang on every word we say. Yes, I understand and will remember lesson one. At least the other student had called in sick to clinic today, so I got to look foolish in front of one less person.

We had a breastfeeding call to attend to after this visit, so we went over and visited a mama with a 1 year old. She had a suspected clogged duct and I got to take BP and pulse again. And boy was I rusty. I kept forgetting which way the air thingy was turned so I was pumping it up a bit much I think. Poor mamas. I need to get my act together. I don’t think I was hurting them, just annoying I am sure, or at least they were looking at me like that. I ask the midwife if I could offer a piece of advice for the mom after she disclosed that she did not have a pump and her baby was not breastfeeding anymore to get the milk out effectively. I had learned an old trick to take a warm canning jar—a big one—maybe a quart and heat it up with warm water then quickly dump the water out and apply the mouth of the jar to your breast. This heat will act like a suction and draw out the milk. Now hopefully these women will not scald themselves, but this technique seemed right up their non-electronic alley.

I was a bit surprised to see how different each Amish house was. I guess I had a preconceived notion that they were these entire hand hewn log house with huge wood burning stoves and kettles—nope, not all. Their houses are open though and the bedroom seems to have a movable wall made of doors? I saw this in two houses today. I was also surprised by the cribs in the parents’ room. I guess I would have thought they co-sleep with their kids. I guess you learn new things everyday.

Hemoglobinometer

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We had an all-Amish day again, so I was dressed again for it. I think I may have to buy some more skirts though or just keep washing these over and over. Anyway, the first visit we saw a mama who looked real worn out and had a terrible cough.  She wanted a cranio-sacral treatment for herself and her son. I had had the opportunity to see cranio-sacral therapy done before, but this was more like massage to me. 

Next we went to a home where the mother was making bread and showed us this huge quilt! It was so beautiful.  It seems to me that these Amish women like hearts as many of their homes and blankets are adorned with them.  I also learned via my assigned reading that when an Amish woman gets engaged, she is given a clock from her man.  She in turn gives a special embroidered hand towel to her man.  What a cool custom! 

At this visit, it was an initial prenatal visit, even though she was almost 6 months along. Many of these Amish women will not see the midwife many times before or after birth.  In fact, seeing them 4 times before the birth is a lot. WOW.  So, we went over many papers, answered questions, and did the usual vitals, except for the fact that her bedroom was super dark.  It was raining that day, so on top of not having any manmade light, we didn’t have any sunlight to aid us either.  It would be ok.  I just have to get used to it.  We used a hemoglobinometer today.  I had never used one like this. It was hard for me to match the green colors, but again, I guess it will get easier. I could at least see how you could get close to a number and that is important. 

Substitute Apprentice

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Got a call this morning from my teacher and I nearly died. You just don’t expect your professor to call you at home on a Saturday morning.  After playing phone tag for what seemed like an eternity, we connected and discussed me filling in temporarily for a fellow 4th year student who needed an emergency leave.  So, I was jumping up and down, well as much as my old legs could jump. How exciting! I had never been to the farmhouse, well, I had never done anything with a Wisconsin midwife as of yet and I was excited to be able to help, even temporarily.  I called the midwife and she was super sweet and explained that she needed someone to be on-call for births for 4 days and to attend a prenatal day on Monday. ACK. How exciting! And I was just saying I didn’t want to jump into a full-blown apprenticeship, but wanted to start. I guess someone is listening?!

 I had lots to do before then.  I got right to my homework so I could have that piece of the puzzle figured out. My oldest daughter had to go to a slumber party that night, so if I had to go to a birth, my little one would have to stay at my neighbor’s house.  I had to go and figure out those logistics.  Plus, my youngest daughter was supposed to go to church the next morning with a friend and I had to drive her. Would I be here to do that? Additionally, I had to hem my daughter’s costume and iron it. Luckily, I don’t mind sewing as it can double as doing something related to midwifery—lacerations, right?  I had to pick out my clothes for the morning, make lunch and get my kids organized as I would be leaving be they would be and arriving home after them. Oh and one last item on my list of things to do was to make a snack for my daughter’s class. Fortunately there are only 17 students.

How do midwives juggle their time? This was a lesson in time management, one I need on a constant basis. My goal this week will be to get as much done as possible and stay as relaxed as possible. Can this be done? Thankfully, this opportunity was coming during a week we had no homework in Antepartum. But I was still not able to do everything I needed to do this week as it is grant season in college.  This means my husband and his colleague’s send me grants to review and edit.  Although they have shortened from 25 pages to 12 in the last year, it is still a lot of work.  I only got to my husband’s colleague’s grant and can’t finish his. *sigh*

Reflection

jmacmidwife

In what ways do you think this experience might affect you as an individual?  I believe this experience is making me much more patient as I have to pace myself.  I am getting invaluable experience with time management and managing my time as well as my daughters’ time, but it has still been an adjustment to really focusing on getting in the habit of getting it done.  I am a procrastinator at heart, so this has been a hard habit to change, but one that needs to be eliminated. Being away from home has made me more forgiving of the little things my husband used to do that annoyed me, but strengthened me in that I know I can still not be physically with him, but make it work.  This experience is also giving me the opportunity to live in a different climate around different cultures.  This is verifying that I am adaptable as a person and can do anything for 2 years, even if that means living in an apartment.  Since I am not a journaling-type of person, this journal has been challenging.  So, although I prefer to talk things out, journaling has worked for me thus far.  Ask me this in a month and a half, though, when the thing is due.

In what ways do you think this experience is affecting you as a student midwife?  I love this experience. Even though I do not have a preceptor, I am in no hurry to jump into a full blown apprenticeship.  I do want to start, just because I know I need to apprentice for a year, at a minimum for NARM standards and I don’t really want to be in school forever.  But I am here to learn the books, read the books, and understand the books.  Yes, I love apprenticing, but having a good foundation of book-knowledge, I believe will help me with the challenges I will encounter in the field and enable me to at least have a jumping off point before going and researching more. 

Overall the combination of experiences I am receiving will not only affect me personally, but also professionally one day.  In my practice, I will employ all of these effects.  By having the opportunity to utilize them, it will hopefully make it easier to run my business.