Open house

jmacmidwife

Because we have our mid-term next week, we got together to synch our minds and discuss our notes.  We didn’t get through all the power points or topics and got side-tracked often, but we did get some studying in—better than nothing, right?  I did realize some points that I needed to relearn or learn for the first time.  That embryogenesis is not going to get the best of me! (insert evil laugh) Except that every time I crack the book to read it I feel like falling asleep. Come on Frye—make it jump-off-the-page interesting!

I also had the chance to go to SouthWest Tech for tonight’s Open House.  It was nice to meet the second year students.  I asked if she had any advice for surviving the next year and she gave me some good hints, like stay on top of your work.  We had a few people stop in to the classroom and meet with us.  Two young men came in once and asked what a male midwife was called. I didn’t know, but was glad to have the second year students there to answer that one! Then I invited them to look around the room. They had a good time looking at the models of bellies with fetuses.  It was surprising to me how much they wanted to touch them and how delighted they seemed in feeling something, which they had never touched or even had the opportunity to explore before.  It made me grateful for the few men in our field.  I am friends with one male midwife on Facebook.  He is a passionate CNM, which sometimes shocks even me! He can be quite opinionated on midwifery topics, but I am sure his family has benefited from his incredible knowledge and successful career. 

Another group that came in was a man and woman.  The man mentioned a new Down’s syndrome test out, which I Googled and found out about later when I got home. I am impressed he was so well-versed in the latest technology. Here the student and I thought he was a doctor or something as he inquired as to where our ultrasound machine was, what we did about malpractice insurance, and the word amniocentesis even rolled off his tongue! WOW, quite different from the guys who were feeling the bellies!  Overall, it was nice to meet the second year students and hear their stories and experiences.  I wish a meet and greet could be arranged every semester so we can all get to know each other and form a sisterhood of graduates.

Midwifery education on the bayou

jmacmidwife

The community college in Lafayette, Louisiana has been trying to get a direct entry midwifery program off the ground for years.  It finally looks like it will take flight this January.  How do I feel about this?  Well, it is unfortunate that I had to relocate my family 1,000 miles away from our home and separate my husband from me and the girls, but I do not regret it for a minute. 

I feel this way because I know some of the potential problems that the school is going to have—one of which is that there is not the volume of births for the students to attend because there aren’t enough midwives or clients.  Louisiana has a very small midwives association and no consumer support group.  Therefore, few consumers even know that midwives are still around. But this new program will definitely get eyes open, which is good for everyone!

My issue stems from the clinic component of the college—half of all births (assists or observations) need to be in a hospital setting and half of out of hospital births need to be in a clinical, birth center, or public health setting (I have no idea what that might be).  Finally, the remaining ¼ births will be in a home setting.  Now, don’t get me wrong, I am happy that more midwives will be made, but is this really the most effective mechanism—to require the majority of births be in a hospital setting? Seriously? I must be missing something. 

Plus, to make it all the worse, MANA and NARM apparently are supporting this curriculum.  HMMMMM. The last time I checked, MANA’s core competencies did not include hospital births.  And it isn’t like I think it would be invaluable AT ALL to be in the hospital. I was a doula for 5 years and gained incredible perspective and knowledge from attending births in hospitals; however, hospital births will not be the basis for my education and experience –besides—how will NARM even count these births on the NARM paperwork, unless they are making special concessions for this school? Currently, I believe NARM only allows for 2 hospital births to be part of its requirements.  So what are these students going to do with the other 18? And what about the transport rate? It isn’t like Louisiana doesn’t have a high surgical birth rate—oh yes, it is high, one of the highest in the country. Can these student midwives gain valuable experience from a c-section? Well, maybe the first one or two, but again, we are not training surgeons here! We are training home birth midwives!  So, why aren’t they training in that setting?  

And another bone of contention—a student cannot count more than 10% of total births from out-of-state experience.  So, even if that student was to get a rockin’ apprenticeship in Washington, she couldn’t take that experience and apply it to her educational component because that would be too practical, no wouldn’t it?  My understanding is that the NARM functions to provide a minimal standard in midwifery skills and competencies — towards creating a national standard.  How can a national standard have different qualifications? I feel that if the minimal standards are not being met that it will cheaper my degree and/or my CPM making this whole quest for standardization and respect for it null and void.

Creme brulee and quizzes

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I’ll tell you one thing, I will be happier than a primip crowning when our presentations are not scheduled on quiz days.  UGH.  On top of finalizing my Power Points, which is hard for me to do, because the editor in me wants to tinker with them all night, I had to make crème Brule for my project. Right, like the last thing I need to be doing before a quiz and presentation is cooking! Well, if nothing goes well with the quiz or presentation, then at least I will be able to eat my sorrows away!  Can I make a request for next year’s students’ sanity? Please space out these quizzes or make more of them so that our huge presentations are not due on the same day!

Well, I didn’t do as well as I wanted to on this test and it has shaken my confidence a bit.  I am not overly confident to begin with, so this does not help my outward appearance at all. But should I really care what it looks like on the surface, well, yes and no.  To a motherbaby, if I had an undesirable outcome or lab result, I would want to maintain some semblance of confidence that I am holding it together and confident in the process, regardless if she is. I don’t want to look like I am all washed up and unable to cope in her eyes. She needs a leader and one who will not lose sight of the shore, despite any obstacles coming their way. But wait…was it Christopher Columbus that said, “You can never cross the ocean unless you have the courage to lose sight of the shore?” Hmmm. I am confusing myself now.

I still don’t understand one question on the quiz, even after researching it though.  It asked what nausea and vomiting were cause from…either increase or decrease in progesterone or estrogen.  Well, I first chose progesterone, but then switched to estrogen. I don’t know why, even now. I think I thought that moms taking progesterone for preterm labor PTL were not nauseated and that is what I went with. I can’t seem to find a definitive answer either. Most sources say the cause is unknown; however, progesterone causes a relaxing of the cardiac sphincter in the stomach and increase in acid in the stomach, being the closest to the cause.  I am beginning to think this whole thing is fixed.

A visit from the dentist

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Some days it feels like I am attending medical school with all these huge terms and words I can barely pronounce and other days it feels like I am technically not even attending a school.  Today felt like the latter as a dentist and high school student came to visit.  Now, don’t get me wrong, it felt really good to have a day like this. It definitely helped me not feel so overwhelmed and anxious, but makes want to wake the world up with a big bullhorn and say—stop being so ignorant!

So after our preterm labor power points, a local dentist came to visit.  He was old and cute. He didn’t really have any idea what we were or parameter surrounding our profession, but that is common.  He admitted his ignorance; although, personally I would have rather him just read the pamphlet found just inside the building before arriving to our classroom.  Guess I can’t have everything! Some interesting things he discussed were: gingivitis in pregnancy is linked to pre-eclampsia and premature birth.  Also a 2007 study found that motherbabies with threatened premature birth, 33% had bacteria in their amniotic fluid! That is a great finding, in my opinion! This is a good reason to insist on good oral hygiene for motherbabies in my practice! Another Turkish study found that via nonsurgical means, if gingivitis was reduced then preterm births were also reduced by 50%. It was good to know that (for his practice at least) he can perform most dental work anytime in pregnancy up until birth. Likewise, if teeth are badly damaged, they can remineralize with a good diet and healthy habits.  Plus it was good to revisit the idea that teeth form in early embryogenesis!

While it was nice to have youngsters visit our program and want to be midwives, it is equally frustrating to hear why.  We had a high school girl visit (probably as a class assignment), but oh my goodness, she was not dressed to impress.  If I was going to a college, I dress like I am going to college. I know I may have to keep it in perspective that maybe she did not have the clothes, but surely some teacher of hers would have suggested looking serious as a criterion for visiting campus? I don’t know, maybe that is just me? So, she gave reasons for wanting to be a midwife like she likes babies and she saw many births on TV.  Time out. What? Seriously?  Where is the disconnect between what midwives really do and what people think they do? I can think of no other profession that is clouded in mystery as the midwife. Well, maybe a spy? HMMMM. Maybe we are just birth spies?  Oh, that thought will have to wait for another post.  This just baffles me and makes me want to take out a public service announcement to shout to the world that we don’t work 8-5 Monday through Friday and we don’t get to hold the babies. But for now, I need to tackle my perinatal infection paper.  Providing clarity to the world will have to wait for now…

Choosing words carefully

jmacmidwife

Well, my friend and I were in the lab yesterday and she mentioned her autoimmune disorder and how she doesn’t want to get any more immunizations.  This wouldn’t have been bad, however, the woman in charge of the lab and coincidentally, immunizations, did hear this.  So, she casually asked us about the program and how everything was going.  We talked about immunizations and the Amish among other things, but nothing too controversial or implicating or so I thought.  I knew better than to talk to people who are associated with my path. Not that everyone is out to get me or anything like that, but I have been bitten so many times by people who think they know better. Most people don’t trust midwives. They are ignorant about them and think they are weird for not seeking a 9 to 5 job with benefits and vacation days. They do not understand why we have to get up in the middle of the night or why we have to spend days with someone or why we have to leave at the drop of a hat. I need to remember that although people are well-intentioned, it is not always for my benefit.  I have also learned that my filter is not always on or it is not always filtering in a way that does not offend people. I know this about myself and am comfortable with working on fixing that filtering process from my head to mouth.  Others are not so forgiving or patient, which is fine, but again, something I need to remember.

Also, feeling comfortable and semi-accepted by my peers has helped.  I am trying not to put too much emphasis on this though because I need to be focusing on my studies and not making friends. Besides, midwives are such fuddy duddies.  You never know when you can trust them or when they are going to run you over with a bus and back up to finish you off.

I feel like a lot of information is floating around up in my head.  Like many dots on a dot-to-dot page.  It seems like eventually they are destined to cross paths and connect, but until then I just keep adding more dots. I have decided that during the holiday break I am going to take a few books, maybe Frye and Walsh, and re-read them. Now that I have a basic understanding and grasp, I can begin to see the pattern, so-to-speak, and I am eager to revisit all the information that I have learned with clarity and vision. Hopefully, I will have time to do this.  I have to remember that this is not medical school. I went to college before and have a degree. I can do this. Yes, circumstances are more complicated now, but that doesn’t mean they aren’t doable. I need to learn to adapt, be kind to myself and patient, but keep insisting on high expectations.

Ultrasounds and IVs

jmacmidwife

Today I got to meet the midwife who works at the farm house, which is like an Amish birth center.  It was cool to meet her finally. It was only a few weeks ago that I found out there was a birth center near.  She showed us IV and venipuncture.  I was less nervous than I thought I would be and I got my needles in the fake arm every time! Score!  But I have no doubt I will be very nervous the first time I do it on a person.  Overall, it was cool to practice and not be afraid that I would hurt someone. The challenge will be remembering exactly what is written in the skills book though.  

I also attended my ultrasound appointment today at a doctor’s office. I thought it was ironic that in the waiting room, a poster had a poem entitled “The Ambulance Down in the Valley,” which basically means that prevention is better than the cure.  If this doctor believes that—then this is the place for me! The ultrasound tech, Deb, was very friendly and a great resource to have in your back pocket. We made small talk until her first client, an artery scan, arrived.  It was a middle-aged woman who had high cholesterol, so the doctor wanted to get an ultrasound of her arteries in her neck. The whole scan took maybe 10 minutes.  It was cool to see what she was looking at and have her explain it as she was going along.  I have had many scans, but it is not only uncomfortable to crane your neck, but half the time you are undressed, with a flimsy paper gown on, so you hardly feel like listening intently and trying to decipher line drawings on a screen.  This shadowing was an excellent experience.

Her second visitor was a woman who needed a pelvic scan for right ovary pain and dysmenorrhea.  Plus, her periods were unpredictable.  She was in her mid-30’s and had 2 previous uneventful pregnancies and births.  She was not pregnant now.  So she was sent to check it out.  It was neat seeing the ovaries. She had a few cysts (or at least that is what Deb called them) on her ovaries. I would have called them corpus luteum degenerating, but didn’t really know.  Thankfully, we saw what we need to on her, otherwise we would have had to use the vaginal probe.  And I have had one of those—it isn’t something you need someone else watching. However, we didn’t find anything noticeable and sent her on her way.  Deb showed me several different cases in our ‘down-time’ between clients and we discussed practically every part of the body, except hearts. She doesn’t do hearts.  One of the cases we looked at involved a 3-year old boy, which troubled me. He was taken to the doctor since he was using the bathroom all day at his preschool.  I just want to know—how many 3-year olds (potty-training ones at that) have mastered getting it all out on one go? Who knows, this poor boy may get beaten or something if he comes home with wet pants.  This made me want to go track down his teachers and tell them that if they don’t know normal physiology of a 3-year-old then maybe they should find a different profession! Little kids urinate often and if his urinating is not the problem then maybe the teachers should make the bathroom less inviting to hang out in!

Overall, it was nice to bounce ideas off a professional and be treated like one in return.  I felt respected, even though we differ in opinions on whether an ultrasound is needed or not.  What I didn’t like was that she was essentially diagnosing these women.  I mean I love assurance, but your insurance does not cover you to be saying stuff your mouth can’t cash.  It was out of her scope of practice to say anything medical to these women. Her job is to say, Hi, here is your gown, this jelly will be cold….etc. Maybe this prevention better than cure place is different? Maybe reassurance really is the cure?

Vacation and hypertension

jmacmidwife

My mom is in town and watching the girls so I feel like I have a small space to breathe.  Plus I am travelling this week to Louisiana for my birthday and anniversary.  I have 2 days of total travel time to and from Baton Rouge so I should be getting much needed reading in and I am.  Not wanting to pay the fee to check my bag (I am such a cheap-o), I forgot that some items I was carrying might be questioned by security and they were. My husband had left his Allen wrench set (small pieces of seemingly useless metal to the untrained eye), so that was in my bag along with my Doppler and bottle of jelly.  Luckily the screeners were compassionate or had had home births, because they saw my Myles along with these suspicious items and just asked when I would be practicing! What an awesome start to my vacation, I thought! Respectful security screeners! Yeah! Likewise while waiting for my flight, a fellow passenger asked if we say mid-whiff-ery or mid-wife-ery because she had watched a show on TV that always messed up the word.  I guess I gotta get out more often or watch TV, because I didn’t realize that ‘normal’ people had such thoughts.  

After arriving in Baton Rouge, my husband had a conference in New Orleans.  So, we trekked south and parted ways as I went to visit my friends in the area and he went to sit in seminars.  Upon arriving back to reconvene with him at the hotel, I was perusing the topics for the poster presentation and lo and behold — a few researchers were presenting information on IUGR.  Well, I high-tailed my happy-self down to his conference and started mingling with the nerds.  Okay, I didn’t have a very hard time doing that part.  After finding my gold mine, I had a great conversation with an undergraduate working on figuring out how hypertension in pregnancy works.  In perfect timing, the researchers data pointed to oxidative stress as a factor in the high blood pressure for the mother, but also showed how this effected the baby during the nephrogenic period!! Hello!! We are studying embryogenesis right now J It was fascinating research, right up my alley or yoni, however you prefer to look at it.  Part of the research is quoted below: “Changes in nephron complement follow the blood pressure response in these studies suggesting that an insult during nephrogenesis leads to ‘programming’ of the kidneys resulting in disregulation of the normal regulatory systems involved in blood pressure regulation. Many regulatory mechanisms such as the SNS control sodium balance and an alteration in sympathetic activity can have sustained effects that result in long-term changes in arterial pressure.  In humans sympathetic activation is observed in low birth weight individuals and is increased in response to hypoxia in animals.”

Lego my ego

jmacmidwife

I actually listened to NPR on my way to meet my preceptor, not the whole time, but a good bit of it since I am rarely in my car anymore and rarely listen to the radio when my kids are around.  A great book was being discussed entitled ‘Letting go with love and confidence.’  It was about raising good kids.  I learned so much in that half hour that it astounded me.  However, I did not agree with everything said, I did realize that so much in life and learning is not about the grade, but about the effort.  If we consistently put in effort, we will consistently get good results.  Maybe not perfect results, but at the end of the day, no one is perfect, but you won’t be anywhere near your goal if you don’t try. Could this be true with my own schooling and midwifery pursuit?  Also, the authors discussed disciplining children, which almost every parent struggles with, as being a teaching tool and not a form of punishment.  Although I don’t usually punish my kids, it does sometimes happen and I don’t like it. So, it was great to be reminded of how we should go about teaching them when needed—What a great message to hear this morning! 

            This semester I am taking the online course ‘Marriage and Family’.  We have to post on the virtual discussion board often and my last post was about androgyny.  Well, I do believe our society at large is becoming more tolerant of ‘middle-of-the-road type sexes’ but we are still bound by our inherent biology as to what emotions and characteristics we can express—similar to genetics.  We are only going to express the gene if we have the chromosome, right?  Well, I try hard to assimilate my knowledge into each and every post.  I don’t like to read ‘yes I agree with your post’ or ‘very nice job’ or whatever.  That is a waste of my time.  So, if I expect others to put some thought into it, I do the same, plus, I consider this whole going through the motions a big ol’ fat waste of time if I don’t slowly put the pieces of my midwifery career together into something resembling a viable practice, because in the end that is the goal, right? So, after referring to research conducted in regards to the ‘tend and befriend’ theory that occurs when women are in stressful situations, tonight I got one of the sweetest compliments from a fellow student.  She wrote: 

 “It’s so refreshing to hear how you understand these issues in the context of your work as a midwife. I appreciated your Penny Simkin’s thought. I think this is a fine opportunity for our classmates to get a sense of how a midwife may view the world with a slightly different lens.  I hope others can appreciate your wisdom as much as I do.” 

Let’s review this simple, yet profound post.  While yes, she didn’t give a whole lot of input and it is *cringe* a waste of time for others to read, but oh Mylanta! What a sweet compliment!  I am over the moon contented with myself right now.  I had to marinate in the awesomeness of that note for a few minutes before humbling myself and denouncing that I am NOT a midwife yet just because I posted something which built on my past experience and education.  But, yes, I am heading in the right direction and I couldn’t be happier about that!  Now, as long as my lens don’t get covered in $hit, everything will be just fine.

Quiz and presentation

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I am trying to study for this quiz. The amount of material is barely surmountable. I wonder how many questions will be one it? There cannot be many since it is only a quiz and only 25 points, plus we have to present our alternative modality findings.  All I can say is thank goodness this quiz is multiple choice.  It gives me a little wiggle room and helps prepare us for the NARM. Yeah!

I was happy to find so much information online and in texts regarding my presentation: homeopathy.  I am planning on playing the party game—Pictionary for part of it because we are supposed to add an element of creativity. However, I am a bit worried I am going overboard with the creative part and hope it fulfills the sharing in depth knowledge part of the requirements. We only have 15 minutes, which normally I would be sweating worrying about talking for that long, but adding this game seems to take much pressure off me. Balancing information and play time will be key, I believe.

I didn’t realize that Folic Acid was that important. I was glad to take that CEU credit online quiz so that I could learn more about it. I knew it prevented birth defects, but had no idea every woman of childbearing age should be taking it. However, it makes sense that they should as half of all births are unplanned.  Although the online information seemed akin to a vitamin commercial—I know a disclaimer was made and given stating no Big Pharm was involved, but…..my skepticism shines through as I see that folic acid is better absorbed than folate.  This causes alarm to me, much like giving babies vitamin K shots after birth. If we weren’t made to have it, then how have we survived this far without it and why are we messing with that? What (in our genes, environment, food, water, air, etc.) is causing a reduction or inability of us mothers to utilize this seemingly treasured resource? It goes with my theory that we don’t value death enough. Our society has become scared of dying instead of seeing it as the last step—and a noble one at that— in the cliché circle of life.

Well, I did better than I expected and it will be curved, so I think I will be doing ok.  I felt like it was a crap shoot on most questions.  Some, like the embryogenesis, I had not studied that much in depth, so I didn’t know what the answers were.  I did get the bonus questions too, which helped. Now that I know what to expect it should make the next exam easier to prepare for. I tend to over-think the questions and study way more than necessary. With so much material, it was easy this time around, not to do that, thankfully.  

I still haven’t heard from my preceptor-to-be.  Feeling a bit bummed just because I haven’t started anything yet, but also relieved that I haven’t started anything yet as I am able to get most of my work done and still be a fairly good mother on most days.  Plus, I really want to get my Wisconsin permit before I begin any clinical site so that I can ‘count’ all my moves. LOL It seems as though I have settled in and am getting familiar with the ladies in my class, which is a great thing!

My homeopathy presentation went great, too!  I felt a bit nervous speaking in front of my classmates, and I think I am sometimes hard to follow. I need to work on not putting too much information on slides. I think I am way over-thinking these PowerPoint’s, but I want to include so many of the neat facts that I am learning and I hope my classmates appreciate that. I was surprised that I stayed under my allotted time, too, but I guess when you are nervous, you talk quicker.  I enjoyed learning about the other alternative therapies also, but it was aggravating to see that some of the students did not put as much time or effort into theirs as I did in mine. A rubric would have been a helpful tool to have for this project. Plus, I can’t believe YouTube videos were included in the presentations. GAK! If we are to be professionals, then we should never have YouTube videos in our slide show. Unacceptable if you ask me. It is akin to citing Wikipedia as a source!!!

Meeting potential preceptor

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I was glad that my preceptor had a birth yesterday, because I ended up taking a 3-hour nap.  She called me last night and we rescheduled for today, but an hour later, which was even better (for me) than yesterday’s appointment time—I could see my kids off to school with enough time to breath.  The day began great—I even got on the road ahead of time.  The weather was beautiful and my GPS didn’t even get me lost despite my having to drive over 100 miles away in a direction I had never been.  I loved driving through the quaint towns snuggled up against the rolling hills.  I passed into Minnesota—my first time ever being in the state—without any fireworks, thankfully.  The final leg of the trip took me beside the Mighty Mississippi, which up North here, looks eerily calm compared to the muddy swirling madness seen in Baton Rouge.  I almost felt for a moment like jumping in and floating down river to visit my husband. His building overlooks the river, but quickly jumped back into reality for just as I pulled into my town of destination, I coincidentally had to go to the bathroom and a Target was right where it needed to be.  Ironically I had been hoping for a big box store, since I had a homework assignment in which I needed to go down a toy aisle.  I was in luck!! 

Being over an hour early, I had time to shop, snack, and find my way to the beautiful building where my preceptor’s office was located.  It was downtown, in an old building and wow, did it have character.  It oozed with old-timey love of high base-boards, lots of glass, huge carved banisters — so authentic—what a place for a midwife’s office.  After walking up the stairs and looking around at the hodgepodge of businesses sharing the same floor, I became aware of my ever-growing anxiety.  I took some rescue remedy, which settled me down tremendously.  I sat and waited, texting my friend Tera that I had arrived and noticed my underwear were inside out.   She texted back—better than your shirt.  So true, it is all about perspective.

My Preceptor arrived within minutes, so I didn’t wait long. She was simple, yet sophisticated looking. She had several bags and I helped her with them.  She invited me in and I looked at her office and waiting room. It was small, but she had everything that was needed.  We sat down and started discussing the logistics of this whole arrangement.  At first, I didn’t know if she liked me at all, actually, I have no idea if she likes me now, and that is weird to me.  Normally, it would bother me if we didn’t find each other compatible, but I really don’t care if she didn’t like me.  That sounds terrible, let me explain…I hope that whomever I have the opportunity of spending my ‘formative’ years with, is more than comfortable with me.  She trusts me with her reputation, her livelihood, her everything.  I can’t afford to misrepresent myself and she cannot afford to take on every student who comes knocking at her door.  Having said that, I think she has much to offer me.  I loved the fact that she offers well-women care.  I believe cradle-to-grave service is not only important to women, but it is that same midwifery continuity of care philosophy that we espouse, so we should be taking care of the whole women, before, after, and during her fertile cycle.  She has years of experience and attends homebirths (only 1 or maybe 2 every 1 or maybe 2 months)—therein lies one of the big problems.  We both have similar concerns, which are both brimming with validity.  Childcare is HUGE.  Yes, I can plan all I want, but I have been to 3-day births.  It isn’t fun to have to worry about your kids and it isn’t fair to them.  All I can do is try my best to make arrangements now, but when we are dealing with births which are at least 2 or maybe 3 hours away, there will be several days and nights I will not make it home to see my kids.  It doesn’t bother me now, but it might cramp my style later.  So, if the births are that far away—will I even make it to them or is it worth it to me to drive 2 hours to an hour long prenatal visit—only to have to turn around and drive home? I don’t know if that is fair for my preceptor to not have the opportunity to teach me and get to know me or is that not a requirement? 

Also, will I be able to get the number of hours necessary for graduation? NARM requires 1350 hours, yes, I understand that it is a guideline and I hope to go over that requirement and then some, even if I am legally able to be papered.  Numbers are not important to me.  Learning the skills to be a competent, proficient midwife are, having said that, my Preceptor has a very small practice.  Next week is a ‘busy’ week for her and she only has 1-2 appointments a day.  So, let’s do the math—if I need 1350 hours in 5 semesters (I am adding 1 semester for starting early), that is about 15 hours a week needed for clinical hours.  I can also do the math this way—this is a 2 year program (365 x 2=730) I would need almost 2 hours a day, every day for two years, to get those numbers, minimally.  So, unless, I am counting my drive time, then I have no idea how this is going to work and for the record I don’t mind driving, I actually expect to drive.  I knew that the possibility for a drive as long as 3 hours was there when I signed up for the program.  I just want it to be worth it hours-wise.  If it was a busy clinic or a day when several prenatals were scheduled I would feel much better about spending $3.72 a gallon for gas, but this hit and miss stuff is for the birds.  So, we ended with a sweet hug and an understanding that we both needed more information before moving on.  She was going to contact the school and figure out the logistics, since I would be her first student ever.  Apparently the school had sent her a student a long time ago, but she had never even been to a birth so my Preceptor had said right off the bat that it wasn’t going to work.  All I can think was that she didn’t say that to me, yet.