Countdown is on!

I'm down to just needing four more births --- woohooo!!!

I also have a handful of postpartum office visits, and some menopause visits to do.

Then it's............practice comps.....comps.........BOARDS!!!!!!

I've been gone :-(

As you can tell, I have been gone for a few weeks.  It's been a pretty busy time in my life right now.  Very spiritual, amazing, awesome..........just all around fabulous.

Yep --- you guessed it --- I've been at Clinical Bound for my midwifery program!!  Very, very few people in real life know that I write this blog, but I just may be changing that.  I just have not made a final decision on that yet.

Just a heads up -- I probably won't be writing much as I start on my clinical adventures as a student nurse-midwife.  HIPPA and all of that privacy means I need to keep very (even more so!) strict limit on details, and of course, you know I do change many of the details when I retell stories.

It's just the nature of becoming a higher level practitioner and professional.

When I return home, and have some free time (ha!  What's that??) I'll be posting more of the birth stories you have submitted.  I have NOT forgotten any of them!!

Love
AtYourCervix

My midwifery sisters

I absolutely love and adore the camaraderie and sisterhood I feel with my fellow midwifery students.  I have to say, they truly feel more and more like my sisters in every way!

I cannot wait to see my sisters back in Kentucky (yeeeehawwww!!!) this summer.

Heck, if any of them are reading my blog, I just may do a big reveal while at CB.  Maybe ;-)

Panic: You may now commence

It is week five (? I think) of the last didactic term before I attend my clinical bound session in Kentucky.  I am officially starting to panic.

In addition to my regular course work to do (weekly readings and extensive note-taking/flash card typing for advanced antepartum, plus quizzes, forum postings and exams coming up; health policy: two big papers to gather data and write and holy crap one of them is due in two weeks!!!), I also have to get ready for clinical bound.  It's not as easy as packing my suitcase and driving to KY!  I have to:

Register for bound classes (next week) and start working on that information/readings/assignments
Submit a background check application
Pre-clinical interview with my regional clinical coordinator (RCC)
Fill out professional experience and learning needs papers to give to my RCC
Fill out clinical skills checklist and send to RCC and my CNM preceptor
Review policies in the school catalog
Review online clinical bound prep (generalized forum/info)
Get copies of all of my immunizations/titers
Copy my TB testing form from work, make sure it stays current
Send a slew of documents to the credentialing person for my school
Complete OSHA and HIPAA modules online
Sign and submit HIPAA form
Complete and submit a health form
Copy the following and submit: RN license, BLS/CPR, EFM monitoring course, NRP certification, proof of current health insurance

Then I get to:
Prepare for clinical bound by completing all prerequisite assignments and readings in two courses that will be added next week
Complete the module for the patient data information program that will be used in clinicals
Send in my clinical bound registration form & pay my fee to attend clinical bound ($720 at my last count)
Do the billing and coding module online
Attend a session on the patient data information program
Review the forum for "what to expect on campus"

Oh, did I mention the regular coursework I'm working on (drowning in) right now?  Yes, I thought I did mention it previously.

Somewhere in here I also have to talk to my preceptor about what her/my schedule will be starting in late July.

Panic.  Commence.

Winding down

I'm in the final two weeks of the school term, so things are starting to wind down. Thank goodness! Just two exams left to take. I picked up two more ink cartridges the other day (thank you ink fairy!), so I can finish printing up material that I need to highlight important info and study from. Yes, I'm an old fashioned kinda girl, and need the actual paper articles. I cannot study from a computer screen. I just........can't. I need to have my highlighter in hand, pen in other hand, and be able to mark up info and take notes on the articles themselves. It's just how I learn best.

I have some of the best study buddies to study with on Skype! This is seriously a great way to toss things back and forth at each other and to talk out the (sometimes conflicting) info that we are finding -- sometimes within the same source. Now THAT is very frustrating. How the heck are you supposed to know which part of the info is true or not? How will it be tested on the final exam? I do wish that we had more practice quizzes/questions to use to help prepare for our exams. I think that if I can get in the question/answer mode of application questions and choices, then I do better on my exams.

Anyway, as we say in our circle of midwifery students "B=CNM". I am no longer reaching for straight A's, and am quite content with my hard earned B's in some of these classes.

Tick tock, tick tock ~~

Counting down the time til I go to clinical bound in Kentucky (July!) and start my clinical hours towards becoming a nurse-midwife! WOOHOO!!

Feeling the stress build up and up and UP!

I'm trying really hard to not get stressed out about everything going on in my life, but it's hard to NOT get stressed about it all!!

It's coming out in various chronic complaints and physical symptoms in my body. My IBS is acting up in a big way lately, I've had daily headaches, and I can never seem to get enough sleep and rest.

Our L&D unit is going through a lot of turmoil and some turnover, and we are critically short on nursing staff on some shifts. We are all feeling quite burned out, and many of us have voiced that we don't know how much longer we can take it. Something has to change for the better!

I'm winding down the term for school, and have one big test left to take in intrapartum. I need to still get my EFM certification test done for intrapartum as well. I have a huge paper that is about 75% or more of my grade for my market research class --- and I haven't even started writing that paper. It's due in exactly two weeks.

And all I want to do is crawl back into bed and sleep.............

........drumroll please

I am done with this term! And I passed both classes!! Time to celebrate!!!!

On the home stretch for the term

I'm officially in the last week of the term. Only two more tests to take, one in each class (Antepartum and Primary Care). Working on studying the material for both finals. I'm bounding back and forth in the classes with studying. I find that if I focus for too long in one class, I lose interest. When I lose interest, I start to find a million different things that I'd rather be doing........oh, like sorting laundry, vacuuming, painting the inside of the house, pulling weeds.........basically, anything to get me away from studying.

I have to finish strong this term! I have an "A" in both of my classes. I'm planning to keep it that way!

Finishing up an awesome run of time "off"

No birth stories recently, because I'm winding down a lovely, looooooooong stretch off from work! Been spending time with the family, enjoying Mother's Day (happy mother's day everyone!), and also studying my little tush off!

Primary care is actually going better than I thought it would. I'm finding the information actually very interesting (ha! go figure!), and I have definitely learned quite a bit.

Antepartum - well, since this is round 2 for AP, I'm trying my best not to slack off. I'm re-reading and re-formatting the information so I can study and memorize it all better. So far, so good! Getting an A in AP, and also getting an A in Primary Care. Halfway through the term, so let's keep it that way, huh?

So far, if I stay on target, I will start clinicals in July 2012. Yes, it's 3 months later than my original plan, but due to failing the final in AP last term, I had to add another term to my plan of study. Have no fear! I will get there!

I am ready to be done with the didactic work. It feels like it has dragged on and on and on and on..............well yes, it has dragged on. I've been doing this since Dec 2008/Jan 2009. That is 2 yrs and 5 months.

A freaking long time!

I find it hard to stay focused and stay inspired some days. It feels like it will never end. But I know it will. Just have to kick back, regroup, get my ass in gear and keep treading water.

Absorb and assimilate the information. Write and re-write the information and work on case studies and scenarios to comprehend it all.

Yep, I can do this.

Winter term 2011

I cannot believe that I have finished two years of school already. Granted, the first year was Bridge courses, and the first year of midwifery courses were more general type of courses, but still........

And I'm doing this part-time still! Which means two more years to go.

I love being able to cross off each term and the classes at the end of each term.



Winter term 2011 is just around the corner! I am "only" taking one class, but it's a doozy: Antepartum Care 1. Yes, there is a "one" after it. That means there will be another one later on - the advanced version of antepartum care.

Looking over the syllabus for this course, it looks to be a general overview of prenatal care. Now, I have a strong background in intrapartum care as a nurse, but prenatal care as a midwife? I have much to learn. I really hope to get a lot of information (and enjoyment, believe it or not) out of this course. This course builds upon what I learned in reproductive anatomy and physiology and expands it into midwifery management and practice.

The reading assignments are what makes it a doozy! There are so many of them! The module reading list is five pages in MS Word (size 12 font, single spaced). Readings in Varney's, as well as additional textbook, and lots and lots of studies/articles/websites. It's a wonder that I still enjoy reading for pleasure after all of the required reading that I do each term in school.

I am so glad that I didn't end up signing up for another class in addition to this one for this term. I think I would have been too overwhelmed if I took another course with this one. But, that's just me. Full-time students take another class with this one. Me, however? I work 4 days per week. Plus we're moving in a few weeks. Plus the family at home - well, it all keeps me quite busy. I feel like I neglect those that I love due to studying as it is.

All good things come to those who wait (and work hard and push themselves to the limit, right?).

Bottoms up!

The following is an inspirational birth story, from another student nurse-midwife. I have changed some of the info for privacy.




It’s a Thursday evening at my hospital clinical site. I knew I would probably see 6 deliveries before 8:30 in the AM. My preceptor on this day is Mary. Mary is an incredible teacher and CNM despite only having passed her boards two years before. The two of us have earned the nickname “double trouble” from one of the physicians because well… interesting occurrences out of our control seem to be our norm. I could make a long list of “firsts” that we have experienced together. I have yet to have a dull rotation with Mary. I had just returned to the call room from examining a pt when the phone rings…

“ Hey Jessie,” says Mary, “Come on down to RM 15, we have just gotten a pt in that’s 7 cm, bulging bag and traveling fast. She’s a G3P2 VBAC, 36 and 5, Come break her water and we will have a baby” Off I go, I sure do love this calling of mine!!!!

I enter the room and spy Ana and her husband, I’ve seen them several times for prenatal visits in the office this was Baby Girl # 3 and I had even helped name her “Jennifer,” a fantastic perk of my job. Ana was from Mexico, she spoke enough English and I spoke enough Spanish that we had managed to build a very nice rapport. I was very pleased to be present for Jennifer’s birth.

There are several nurses in the room readying for delivery. I lower the bottom of the bed, glove up and Mary hands me the amniohook. Nice hard vertex presentation, large bulging bag, just a bit of an anterior lip, then AROM, and clear fluid. It was going to be easy. Ana bears down, my fingers still in. But… something is just not quite right, palpate around, what is that at 3 o’clock? Lips? Nope. Ear? No. Scrotom? Yep!
I glance over to Mary and in a remarkably calm voice, say:

“Glove up”

“Huh?” says she.

By this time Mary is taking in the rather “unable to ignore” saucer- sized eyes that I’m exhibiting.

“We’re breech”

Mary gloves and examines, “No I don’t think so”

“Three o’clock,” I reply.

“Oh Shit!” she says under her breath.

We were frank breech indeed, RST to be exact.

The nurses begin to scramble, NICU team is called. The physician is notified but in the middle of a section and can’t come, no other physicians are in house. It’s up to us, a fairly new CNM and, me her student.

I’m a girl of faith. I wear around my neck a silver Hebrew childbirth amulet that says “El Shaddai” or God Almighty. I repeat Psalms 121: 1-8 on my way into clinical. I know my help truly does come from the Lord. God is with me in RM 15, I am so very calm. During this birth, I am replaying our section on breech delivery in my head, the one that was on the IP test review recording. I could hear our instructor’s voice on what to do (thank you nice instructor and Ana and her husband thank you too). Above all, remain calm, don’t rush a breech and don’t let the baby rotate into OP.

Buttocks are crowning, I allow birth to the umbilicus and gently place my hands around baby’s hips. Mary pulls down legs one by one, baby emerges to neck, then I deliver arms one by one, shoulders following the Curve of Carus. The room is most definitely at a level of high tension, but I’m not paying any mind, all of my attention being focused on….

Now at the foot of the bed standing directly behind me is Abebi. Abebi is from Nigeria, where she was a midwife, but, here in the US, she practices as an RN. Once we were to the baby’s head she whispered to me “Put your finger in the baby mouth, put your finger in the baby mouth.”( I’ll never forgot those words, or that lovely accent, being whispered in my ear) .Oh yeah, Mariceau-Smellie-Veit, for some odd reason I even remembered the name of that maneuver, I performed it, keeping baby’s head flexed. With the help of suprapubic pressure per Mary, and a little bit of coaxing baby’s trunk up and then down (Curve of Carus) birth was accomplished. Cord was clamped, and baby was taken to the warmer where the NICU team was waiting, Apgars were 3, 7 and 9, EBL 300, weight 6# 8 ( impressive being that Mom was a petite 5.0). By the way, those weren’t testicles, just very swollen labia. It was a “Jennifer” after all.

In review, I realized I was reflexively chewing my gum that I hadn’t had time to discard (perhaps an oral version of a worry stone?), at the time, I wasn’t afraid, I didn’t panic, and I agreed with Abebi who later told me “ A frank breech will often be the easiest delivery you will ever do, no shoulders.” Thank you God for never, ever leaving me and keeping me calm. That first clue something was wrong? The smoothness of the presenting part, I didn’t feel any hair on this baby’s head. With my couple being from Mexico, I was expecting a full head of hair, and when Jennifer’s head finally emerged (last but not least), indeed there was!

By the way, Ana’s perineum remained intact and she was so very happy with her vaginal breech delivery, that when I saw her recently at her PP visit she was still beaming but did request a very reliable method of birth control.

Know those textbook instructions for a vaginal breech delivery, practice them in your head, it’s will happen sooner or later. Also if you are lucky enough to have a Nigerian midwife present, LISTEN TO HER!!!

A birth story from Budapest

A Birth Story from Budapest

This was written by a fellow Frontier Midwifery student, Amanda Perkins. I have cut and pasted it below, because you need to have a subscription to go to the above link.

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Rapid breaths whispered through my throat in time with the pulsating screams coming from the labour room. My fingernails dug into my palms. The white plastic doors with the sign reading “acces interzis” literally translated “access forbidden” gave the impression that we were standing before a prison gate and not a labour room. I was caught between the worlds of student midwife and doula, in the country of Romania where I was respected as neither.

I began to watch my friend Georgiana intently. Her belly was full and tight with rushes. As my eyes met with her deep labouring gaze, she looped her arms around my neck. We swayed and rocked to an unsung lullaby. We went deep inside ourselves as we consciously blocked out the screaming, whirring, and fear so palpable around us. Then, as if she was the midwife and I the mother she whispered, “It will be okay” with great calm and awoke us from our trance.

She reached her hand behind her back to hold the sides of her drab linen gown together and trudged forward to meet her doctor in the labour room. Doctors and nurses flitted in and out of the labour room and I strained to see her past the thick plastic doors. Georgiana looked over her shoulder and smiled at me. I gathered my strength and smiled back. In an instant the doors slammed shut and I was alone.

‘Peace-bearer’ the phrase crossed my mind as I tried to block out the wails of women echoing from the tiled labour room. I began to pray and walk back and forth through the hall, cautious not to walk by any open doors where a nurse might find me and remove me from the entire labour and delivery floor. My heart ached as I thought of Georgiana in the large labour room by herself. How could I be a peace-bearer now?

My mind was suddenly transported to nearly nine months before when my midwifery journey had been conceived in Hyden, Kentucky. I remembered sitting in a folding chair, clustered with other eager midwife students, listening to a seasoned midwife tell her stories. Not once did I look at my watch. The tiny woman kept us spellbound with her sweet spirit and unwavering confidence in women and birth. When the question and answer time came this midwife sage surprised us. A question rang out from an inquisitive student midwife in the back of the room.
“Can you tell us about a time when you dealt with a postpartum haemorrhage and how you stopped it?”

The midwife’s eyes lit up. “Ah, yes.” She began. “Red heads, they seem to bleed more than other women. I recall a mother who had delivered in a hospital and haemorrhaged with her first birth. She then asked me to attend her home birth. I agreed but told her this time she couldn’t bleed.”

It seemed that the midwife had finished her story. Another student midwife called out eagerly, “So what happened?”

As if slightly surprised that we had not understood the story’s resolution the midwife said calmly, “Well, she had a beautiful birth of course.”

I remember that I still didn’t understand until this midwife was asked to share her trade secret. “Take up knitting.” She said. We sat in stunned silence. Knitting? This was the ancient midwife’s secret?

“Your peace becomes the mother’s peace. Your calm becomes her calm. She is giving birth, you are attending. Her space is sacred. You will know when you need to act but most of the time you will knit.”

My mind lurched out of the serene memory and into the present as I felt Georgiana’s hand touch my shoulder. “Hey,” she said quietly, “I am back but the doctor said I haven’t progressed very far. So I guess....” Her voice waivered as her shoulders slumped forward.

‘Peace-bearer.’ Again the phrase flashed in my mind. This time imbued with meaning. I was calm now, peaceful. I met Georgiana’s eyes, golden brown like the Romanian fields after harvesting. As our eyes met I heard her sigh and a deep breath was released from her body. I felt the whisper of her breath on my cheek.

I had not brought my knitting with me but as we walked the halls of the Bucharest maternity hospital, I felt safe simply being with Georgiana. I could not change the dank conditions of the hospital nor would I be able to catch her baby, but I could be with her. And with my calm spirit I protected her sacred birthing space.

Nearly 24 hours went by of resting, labouring and hourly doctor checks. Now when we would go to the labour doors I would peacefully accept my role outside the doors. I knew that if I had any chance of being with her during the birth it would mean waiting patiently outside for Georgiana during each monitoring session. As the night became early morning I started to sing softly outside the labour room. I sang songs of thanks and songs of life. I prayed and hummed and waited.

The hospital was full and Georgiana was told she could not labour until a bed ‘cleared out’ in the eight-person labour room. Stifling my laughter at our vain attempts to control women and their bodies I did nothing but look Georgiana in the eyes once again. “You will know.” I said, “You will know when it is time to give birth and there will be a place for you and I will be with you.” I felt myself speaking with the same confidence with which I remembered the wise midwife remarking to the woman who had haemorrhaged with her previous birth, “This time I simply told her she couldn’t bleed.”

The next morning soon faded to afternoon and then early evening when Georgiana told me, “I think I know.” We walked back to the labour room, this time I pushed through the white plastic doors with her. A nurse stopped me, “Who are you?” I showed her my Frontier student midwife badge and smiled, “My name is Amanda. I am a woman who loves to be with other women when they give birth. I am a nurse and in school to become a midwife.” My sincerity seemed to take her aback. “Come on in,” she motioned.

Georgiana laboured for the last two hours in a high bed, nearly four feet from the ground. The seven beds around us were filled with other labouring women, groaning and writhing alone in their pain. ‘I will not forget them.’ I thought to myself. ‘But now I am here for Georgiana, now I am her peace-bearer.’

I sat on the bed next to her, rubbed her back, met her eyes and whispered every few minutes, “Look at me Georgiana, not anyone else. Look at me…” The labour room assembly line eventually led us to one of the two delivery beds set up in the space adjacent to the labour room. I helped Georgiana step up to the table and lay down for her birth.

It was painful and the common practices of technocratic birth were dominant. Her perineum was cut, the staff impatient, and the environment cold. Baby Mathias was born healthy but immediately swooped away by doctors. But I was with her. Georgiana did not give birth alone. And she gave birth with a midwife whispering in her ear, “You are beautiful, you are strong, and I am with you.”

Amanda Perkins | Student Midwife