A self reflection

I have two days of hospital call as an SNM coming up this week.  Hoping for some more births!

So far, I feel good about doing postpartum rounds (seeing women, post op c/s or postpartum vaginal), doing their physical assessment, making sure their needs are met (breastfeeding, pain, incision/perineum, emotional), then writing the SOAP note on their exam.  (SOAP = subjective, objective, assessment, plan).

Writing SOAP notes -- very different then writing notes as a nurse.  It's hard to change from thinking like a nurse to thinking like a provider/midwife.  It's just.....different.  You know how you become an expert at something, and then you learn something new and have to start all over as a novice again?  That's what this student midwife role transition is like for me.  What I have known for over 10 years has now changed.  The basics and physiology of pregnancy, labor, birth and postpartum is not any different, but rather, it is the care provider role that is different.  I honestly don't now how better to say this!

Postpartum examples --

Nurse: physical assessment of the woman & baby, help with breastfeeding, provide extensive education re: breastfeeding, baby care, self care.  Ask provider for medication orders, treatment orders, discharge orders.  Documentation: checklist for physical assessment and patient education.  Annotate if outside the normal values on checklists.  Spend far too much time on paperwork. Spend several hours total with the woman and baby during your shift.  Frequent vital signs and physical assessments, depending upon how far postpartum she is.  Manage IV if she has one.

Midwife: physical assessment of the woman, evaluate emotional status, evaluate breastfeeding relationship, provide education, assess if pain management regime is adequate, prescribe medications as needed, order labwork as needed, order consults if needed, consult with MD as needed.  Documentation: free text SOAP note, decide what type of treatment/plan of care is needed, if consults are needed.  Spend 10-20 minutes with the woman.  Move on to the next woman.

Some similarities.....some differences.

So far, I feel like I am spending less time with women, getting to know them less as the student midwife, versus when I am working as the RN.  I was not expecting to feel this way at all!  I really enjoy bonding with women and their families as I help them through the labor process and in the early postpartum period.  As a student midwife, I am back to the mode of my technical job functions (get this task done on this person, move on and get this done on the next person, document, get the next task done on the next woman, etc).  This is the learning portion that I am not a fan of: learning new tasks/jobs, and having to learn how to organize it all in my brain as well as proper documentation.  As I become more comfortable with the new job role, and more comfortable with my documentation, then I know that I will be able to look beyond the tasks that need done, and be able to sit down and really spend quality bonding time with women, getting to know them and their families more.  <---- because THAT is my favorite part of my job/career!!!!

Sigh.  Yes my fellow Frontier CNEPers, you can call this a written reflection.  Those things we dread so much?  It's actually helpful to me, to be able to write it all down and work it out "on paper", or rather, on my computer screen.