Six months later..

Tomorrow is a big day. January 19th (not 18th) marks the sixth month of me working as a CNM. It went by so incredibly fast. Last year at this time I was just beginning to learn how to deliver babies and never dreamed that I would be where I am today. As I ponder over the last six months, I feel compelled to share the lessons I have learned. Especially since I know a new midwife class is beginning integration and may travel down a road similar to mine. Here you go...

1. You will NOT know everything when you graduate. It doesn't matter how great your education was and how good your grades were. Midwifery is a learning process ALWAYS.

2. Since you won't know everything, say so. I have found that my patients are okay when I say, "I don't know, but I will find out." One of my biggest fears was looking incompetent. Incompetency comes with making mistakes you could have avoided by asking for help.

3. The anticipation of the pager going off at 2 am is worse than when it actually happens. I spent my first few months unable to sleep because I was anxious about maybe getting called for a delivery in the wee hours of the night. I mean, didn't we become midwives just to get these calls?? The anxiety does go away as does the fear of not sleeping. I have found I can survive on little sleep and that for now sleepless nights are few and far between (check back in March when I have 10 patients due )

4. Trust your gut. You know that little voice that says "stop, listen, act?" Don't ignore it.. I have listened and have gotten patients referred to physicians or specialists as needed and may have changed outcomes. It's an immense responsibility, but so worth it.

5. Be open-minded about how you practice as a midwife compared to how others practice. I have found that we all have something to learn from one another. I learn everyday from my doctors and fellow midwives but would like to think I have enlightened them in some way too.

6. Love your job. I have to admit that for the first few months I drove to work with dread and extreme nausea. I was perhaps letting my fear and anxiety get in the way of me enjoying what I do. There are still days that are more stressful than others but each day I try to remind myself that it was my passion for women's health and the birth process that brought me here. I can now say that I do love what I do and really mean it.

7. Don't forget to live your life. Okay, so the last few months were mostly in survival mode. I realize that six months went by and my children have grown six months older. I have to admit there were nights that all I wanted to do was eat and sleep. I may have neglected family and friends.. Now I am striving to be more outgoing, be more involved and go on dates with my husband.

I have quite a few patients that are in their sixth or seventh month. I feel a certain kinship with them as they have been with me since the beginning of my journey as I have been with them on theirs. We share amazement as to how fast the last six months have gone by. While I am settling into my role, they are preparing for a new one.

So for those students that may be reading this and know me personally. These next six months may be the hardest months of your student career. Learn all you can and keep an open mind about all of your experiences. It is difficult at first, but it does get easier and it's so rewarding on the "other side."

Gratitude

With the approaching holiday season, I like many will stop and reflect on all things happy and for which I have gratitude. Of course, I am grateful for my family, our good health and our home. I am very grateful for my job. Though not for the reasons some would think. Yes, it's nice to have income in a time when so many are struggling to find jobs. My reason for gratitude with my job goes beyond income, it comes from the feeling of satifaction and happiness that moments in my job give me...

One such moment in particular has been a pleasant surprise to me. I became a midwife so that I could be a bigger part of a woman's journey into motherhood. While I enjoy the moment of birth and the awe of the first glimpse of the baby, I have found being a midwife gives me a glimpse into what I feel is an even more amazing moment. Hearing the heartbeat for the first time.

My favorite OB appointment with my patients has become the 10-12 week visit. As a student, I don't think I had these moments as I usually encountered patients mid-way into their pregnancies so that I would be able to attend their births. Now that I have been with my practice for a few months I have had the privilege of return visits from the very beginning.

There is something almost magical about hearing a baby's heartbeat for the first time. The anticipation on the parents' faces speaks volumes as the doppler moves slowly across a still flat belly in hopes of hearing the faint sound of a small heartbeat. When that sound is finally heard, fast and strong, the reactions are amazing. In that brief moment, all is right with the world as parents and midwife alike share a thoughtful silence to better hear the new heartbeat. It's like a moment of hope and peace, for new beginnings. I love the laughter, the smiles, words of praise and the tears of joy. Sometimes I feel intrusive, like I'm stealing a private moment of happiness that isn't mine. Fortunately, my patients don't view it this way and for that I am grateful.

God Bless and Happy Thanksgiving!

Undercover "Boss"

It all began the Friday before Halloween. Many of the office staff were dressed up in various costumes including Waldo, a butterfly fairy and a few other costumes of sorts. Of course keeping with professionalism but still fun nonetheless. One of our doctors walked by me, in *gasp* "nurses" scrubs with a stethoscope around her neck. She was not wearing her white lab coat, so thinking it was purposeful, I asked, "Are you supposed to be a nurse?" She stopped, looked astounded and wondered why I would think such a thing. Well. Let me tell you..doctors typically wear dingy, blue scrubs that don't fit anyone with a white lab coat that practically screams, "I'M A DOCTOR!" That day she was wearing black (cute) drawstring scrub pants with a hot pink and black fitted scrub top. Much like I wore during my short stint at Centerpoint Medical Center. She didn't think that she looked like a nurse and I chuckled to myself as I knew the "fun" she would have dressed "like a nurse." I playfully "warned" of what to expect being dressed as a nurse..such as being asked to find a chart..etc. I don't think she believed me. Okay, this should be interesting...

Well I was not disappointed...One day, this doctor was mistaken for a nurse while a disgruntled patient, upset with her care at another location came to us..she assumed Doc was a nurse and decided to confide in her how much she disliked most doctors..Fortunately, this doctor was able to laugh it off and shared a chuckle with the patient when the truth came out. Then she was given a chair to sit on in a patient's recovery room after a very long surgery and got an odd look from one of the staff members. He remarked,"Oh, I thought you were a nurse.." (Remember, nurses aren't allowed to sit, pee or eat.)

It does go both ways, however. When I wear those dingy, blue scrubs and my white lab coat, I am sometimes referred to as "Doctor." This happens most while I am making rounds on patients that I had not met in the office. I am always quick to correct them as I am NOT trying to be a doctor nor do I wish to be. But as my doctor got to glimpse these past few weeks, dressing like "a nurse" is not always ideal...especially when she got handed a dirty diaper by a patient while making rounds the other day. She was astounded that anyone would hand a dirty diaper to a nurse to throw away..yep, nurses get to clean up all the yucky messes.

So I will continue to wear my dingy, blue "doctor" scrubs, but will never forget how hard I worked to get here and how hard (and sometimes under-appreciated) nurses work. Meanwhile, my doctor continues be the "undercover boss." Can't wait to hear of her adventures..

Identity crisis

Nurse-midwife. Nurse. Midwife. Hmmm..the age old question was going through my head this weekend while on call. How do I most identify myself and where do I fit in? For the first time, I had a patient and might I add..she was MY patient..in labor at SMMC. While I have nothing but good things to say about the staff I met there yesterday, it was nonetheless awkward as I was not familiar to them as a practitioner. There's nothing like the feeling of being the "new kid on the block" and for me it holds a double meaning. I was asked how long I had been a midwife and when I answered I could sense the apprehension. It's hard not to take that personally but having been a nurse before becoming a midwife, I understand the reaction. I too am guilty of scrutinizing new practitioners and perhaps not letting my guard down until I deemed them worthy. Since I am for now unfamiliar with the staff and physicians, I found it hard to find a place to relax while my patient labored and rested with her epidural. I visited with the nurses for awhile but felt I just got in their way, so I went to the doctor's lounge. I felt just as awkward there as I felt like I had snuck into a secret realm. Trying to be inconspicuous I headed for the ladies room, which of course was being cleaned. I must have looked desperate as one physician piped up and suggested I use the men's restroom as he promised to guard the door. I took that as a sign of acceptance and went along with the plan. (Yep, I'm all about first impressions) As I came out of the restroom the doctor extended his hand to introduce himself and said, "You must be Dr. Darby." Nope, "I'm Midwife Darby." Yep, that's how I answered..identity crisis over.

Now it's for real...

Last Thursday I was informed via an email from one of my doctors that I have full privileges at both OPRMC and SMMC. It came across like this, "You have full privileges." Hmmm..I stood there for awhile looking at that email a little unbelieving and also slightly disappointed. I mean, don't get me wrong I am very excited about being an independent practitioner after working so hard for many years...but where were my flowers and my balloons? Okay, okay I know that's goofy and I know many practitioners get privileges every day, but this was my first time EVER. Oh well, I will just throw myself a little celebration with a glass of wine and a toast to my husband for getting me here.

Meanwhile, I was managing an induction of a woman who was having her fourth baby. The idea was that either a physician or one of my midwife cohorts would be in the room to observe my skills and to help with suturing as needed. When the patient was complete I called my doctor to let her know I would be catching soon. She said she would head over but she had one more patient to see and that she trusted I would be okay and to call if I needed assistance. So I caught...and afterward looked around the room and realized that was truly my first delivery without someone in the room or at the nurses station. I had written the orders, AROMed and caught baby without checking in with someone to make sure I was doing it right. I became giddy with this knowledge and yes, announced it to my patient and the nurses. They were witnesses to the birth of a new midwife. The most amazing part to me that while there is always a healthy dose of apprehension with every birth, I was not scared or fearful. I knew I could do this..what an amazing feeling!

So dear midwifery students (if you are reading this)..know that all your efforts, all that time away from family and all those moments of fear during a birth..will be worth it! You will know what to do and it will be amazing..

Yes, but what does that mean?

Ah, a common phrase that often goes through my brain while at work. Yes...well because I'm usually a very agreeable person. Yes..well because I don't know what else to say and don't want to look stupid. Yes..because that's the only answer I have right now and I need to go look up the answer. Confused? Well, good because sometimes so am I.

Yes, but what does that mean? I often think this when a lab result shows up on my computer desktop at work. If you happen to be at my office and I'm staring at my computer screen and not blinking..no, I'm not bored or trying to sleep with my eyes open. I'm thinking..HARD. I am most likely looking at an abnormal result and am deciding my plan of care and treatment. Fortunately, that phrase is slowly dwindling and while I still count on my fellow practitioners as resources, I am finding that I know what "that" means. Now if only I can get rid of that twisted, nauseated feeling I get in my gut whenever the abnormal result first appears...

Yes, but what does that mean? Yep, sometimes you have to spell it out for me. That's what I was thinking when I was told this last week that I have temporary privileges at both OPRMC and SMMC. Until now, my call days have consisted of me simply answering calls and sending patients in if needed. I was not able to admit patients or make rounds independently. Now apparently, and yes, I had to ask for clarification...I am able to admit midwife patients, give orders and make postpartum rounds. WOW. Are you kidding me? I have waited so long to get to this point that it hardly seems real. I will still need to be proctored through more deliveries as I have only had the opportunity to catch two babies so far. But that's okay with me. Somedays I am suprised by the willingness to let me triage phone calls and make rounds. I have been treated like a trusted colleague since beginning with this practice and sometimes it unnerves me but at the same time it's so invigorating!

Yes, but what does that mean? There it is again that stupid phrase. I was thinking it this morning as I rounded on two postpartum patients by myself this morning. Nope, I wasn't thinking it while seeing the patient or viewing the chart. I was thinking it when I couldn't log into the computer after trying for half an hour and under the curious stares of the nursing staff. You know when you are trying to be inconspicuous and the computer makes that obnoxious sound..well I drew some attention. So much for looking competent, when I had to call my Dr. who was fortunately rounding on surgical patients, to come log me in... Do I take that as an immediate sign of failure or just a bump in the road? That remains to be seen..

So here I sit, my first weekend of call and darn it if everytime that beeper goes off and a message comes across the screen that I don't think..yes, but what does that mean?

Highs and lows..

So I am nearing my second month of being a certified nurse-midwife and while I still have some anxiety and doubt, it is lessening with each day. Last Monday I was first-call for the practice. That means I took all the phone calls and sent patients to the hospital as needed. Since I don't have privileges yet, that was the extent of my call. Easy, right? Well for most people it would be but this is me we are talking about. I only got paged four times..twice before 10pm and then again at 5 and 6 am. For most, that would mean a pretty good night's rest. Nope, not me. I was up nearly every hour checking the pager to make sure it was still on..neurotic, I know. So my clinic started Tuesday at 7am with one self-inflicted, groggy midwife but hey, might as well get used to not getting much sleep!

While waiting for hospital privileges to go through I have been reinstated "student" so that I can be proctored through some deliveries. So last Wednesday I had the joy of once again receiving babies into my hands..it was awesome but incredibly nerve-wracking. The first delivery was with one of my doctors, who I might say, loves to teach. This was good for me, but as most teachers and preceptors know..this can make it hard for you to step back and be the observer. We literally had just run into the room as this was the patient's third baby, so didn't have time for a game plan as to what was expected of me. Well, duh..deliver the baby right? As we both stood at the foot of the bed, both gowned and gloved, both watching and supporting the perineum..I was beginning to wonder if I was really supposed to "catch" or just observe. Turns out my doc was waiting for me to move her over out of my way, while I was simply waiting for her to move. I finally took initiative and positioned myself to be able to receive the baby easily. I must say..it felt good to be back but was I sweating!! My second delivery was with one of my midwife coworkers (with Doc at nurses station) and it went well despite a very slight dystocia. (yep, lost another five years of my life to stress)

While I am anxious to be part of births again on a more regular basis, I have to say I thoroughly enjoy clinic. Educating patients on their health and simply listening to them is so rewarding. I have gotten to share in tears of joy and unfortunately, tears of sadness. To be able to comfort, educate and reassure is what makes my job so enjoyable. The month or so has been like the last three years of grad school on hyperdrive...abnormal Paps, STD screenings, menopause (which is getting less scary by the day), OB visits, preconception, contraception and vague pains that I must try to find solutions to. It all keeps me on my toes and I literally feel my mind going 100 miles per hour...but I love it. I have now been working long enough that I am having return visits of MY pregnant patients..nothing makes me smile more than my name on the chart under "Patient Provider."