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."

My beginnings...

As many of you know..well, because I announced it via Facebook, I started my new career as a certified nurse-midwife last week. I had waited to be able to say that for so long, but yet as I began my new career I was filled with doubt and honestly a few moments of.."I might have taken too big of a bite." I was trying to figure out in my head how many years more it would take me to pay off my students loans as an RN and how many shifts a week that would take. Okay, okay..so that may have been a fleeting thought, but it was there.

Last Monday, I was working along side on of my physicians. She is an incredible doctor and incredibly busy. So while trying to see a few of her patients, learn the computer charting system, remember how to be a practitioner, including diagnosing and prescribing meds, and not get in her way, the knots in my stomach grew. I felt slightly doomed. On my way home, I called one of my midwife friends to cry on her shoulder. Though she gave great reassurances, I was not really convinced. Upon arriving home, Adam threw open the door to congratulate me on my first day and was anxious to hear all the details, including how exhilirated I was to be finally working as a midwife. Instead I was without words as I could not describe what I was feeling. I kept saying things, like "It was okay" and shrugged a lot. Honestly, I had used all my brain cells for that day and could not talk. I was just immensely hungry, wanted a glass of wine and to go to bed. Poor Adam. He had invested so much of his time, love and support to get me through school and start my new career. I know my reaction was a let down for him.

The next day was not much better. I had to keep reminding myself that this was only day two and that I needed to give myself a little credit. Honestly, I think I put more pressure on myself than necessary, as the physicians and staff kept asking me how I was doing and offering their assistance. I felt very welcomed, but couldn't shake the feeling that they might decide that perhaps hiring a new grad was a mistake. Then a great thing happened..my midwife coworkers both on separate occasions approached me to ask if I was doing okay and that it was normal to feel what I was feeling. In fact, one of them told me that for the first few weeks after starting to work she would go home and not be able to talk. Her brain was just that tired and full. AHA! That sounded so familiar. Now they both seemingly breeze through their days..I felt better after hearing that.

Yesterday, I worked my short day and saw six patients...on my own. My nurse approached me and asked me if I had any preferences. *smile* Not yet, I told her, give me time. It was nice to start slow and be able to make the necessary decisions without too much time pressure. In fact, I had two new OB patients and it felt great to give care, educate, congratulate and reassure. I felt my midwife spirit being renewed as I sat with my patients and listened to their stories as they opened up to me. I did a few well woman exams and was able to connect and educate them my way. I began to feel myself changing as I know my midwife style is beginning to develop. Funny how I feel a certain kinship with my new OB patients, as it may take 9 months for me to really begin to know myself. And many years, to nuture. I know my schedule will be busier (I hope) but relish the idea of being able to build up and gain confidence along the way. So last night, I came home with a smile.

Real life begins on Monday...eek!

So here it is..my last weekend before I start my new career. I have been waiting for this for so long and had hoped to start earlier than the 19th. Due to technical difficulties, I had to wait and was a little bummed. Ironically, now that my start date is only a few days away I find myself suprised at how quickly this day came. I have had some anxiety and a few sleepless hours in the middle of the night..notice how self-confidence never seems to exist at 3am? I have noticed that a knot is developing in the center of my back and my stomach hurts most of the day...

Don't get me wrong, I am very excited and motivated to get started but WOW! I am going to be a midwife..I mean like for real..the enormity of my future responsibilties does not escape me and I think that is where some of my anxiety lies. I have been rereading my textbooks, looking up medications and calling upon my midwife sisters for advice all in hopes that I don't go in looking the fool and that my education will show itself easily.

Last week, I was working what would be one of my last shifts as an RN. The physician I was working with seemed impressed by me and told this to the charge nurse that day. He did not realize that I was temporary and not going to be a permanent fixture at that hospital. At the end of my shift, he approached me and thanked me for taking care of his patient. Then he proceeded to state, "You know, if you are really good at something, maybe you should stick to it." I know he meant this to be a compliment but that has been playing itself over and over in my brain...and self-doubt began to creep in.

Today..I decided that is all going to change. I know that I am not going in as an expert midwife. I still have so much to learn and hope that I always will continue to learn. I know that I am a safe and compassionate midwife, which includes asking for help from my colleagues when needed. I realize that if I didn't go into this with a little fear and uncertainty then maybe I'm a little to conceited to be doing this amazing job. I am going to be okay. I am going to take deep breaths and pull from my inner strength. I am going to keep my eyes, my mind, my heart and ears open to new ideas and knowledge. I am going to trust myself.

And to the wonderful physician...Yes, I was a great L/D nurse..but it took me 10 years to get there.

Se Habla Espanol?

This is a story I shared on Facebook on March 9, 2009. I thought I would revisit it since it still makes me chuckle to this day. It details some of the "joys" of being a student-midwife. Enjoy!

Se Habla Espanol? Okay, so clinicals have been going great. Everyday I get a little more confident and am becoming more independent in patient care. I have even tackled a little Spanglish to get me by in my return OB visits until the interpreter arrives. Today I walked confidently into a patient room who was about 24 weeks pregnant. " Hola! Me amo Sarah, student pardenta." (whatever that means). "Como est da?" (blank look from patient) "Mi ablo un poquito Espanol" (which means i don't know what the hell i just said) Unfazed by the continued silence by my patient, I continue with.."dolor?, contraciones? sanguina bahina? aqua bahina?, mucho mueve bebe?" all the while waving my hands and arms wildly as if to illustrate what I am trying convey. (for those of you who are lost, i was asking if she had pain, contractions, loss of amniotic fluid or bleeding from down there, and if baby was moving a lot) The patient was silent and looked slightly scared, look toward the door a few times as if planning to escape..then she spoke softly, "Please, Arabic." Well, that will teach me to be so confident...

My midwife..

Ten years ago today, I gave birth to Annabelle. It was a lovely experience and looking back now through a new midwife's eyes, I realize how incredibly lucky I was to have Anne Peacock, CNM at my side...and how she may have had an angel on her shoulder the morning of Annabelle's birth.

At the time, I was a nursing student finishing my capstone and getting ready to graduate. Annabelle was due on July 13th, but obviously had plans of her own. The night of June 22nd I began having sublte back pains. I had a gallbladder attack the year before and thought that I was getting ready to have another. I paged Anne and when she called me back she just told me to take a warm bath, drink lots of water and try to go to sleep. What?! But what of my impending gallbladder attack? She just reassured me that she didn't think it was my gallbladder and told me if I felt fine in the morning to come into work. You see, I was a nursing assistant at the University of Iowa OB/GYN clinic. I worked mostly with the physicians, as the managers thought that the midwives could do their own BPs, urines and weights. Every now and then, I would get sent to assist the midwives and I was in heaven!

So the next morning, I went to see Anne before my shift started. I was still having those nagging back pains, though I was able to sleep the night before. With a little gleam in her eye, Anne asked me if they were coming and going, hmmm...they were coming and going about every 10 minutes. Anne checked my cervix (which I thought was odd, because I was sure my gallbladder was spasming) and told me to go about my day. So I did.. As the day wore on I noticed that once in awhile I would have to stop to think about the pain as they sometimes took my breath away. This day I was a student, so my mentor Ann Freyenberger put me on a the monitor for a little NST during our lunch break. Wow! I was having contractions and I didn't even know! At the end of my shift, Anne checked me again and told me I was 2/80/0, to go home, eat and sleep. She said she thought the would see me sometime that weekend (it was Friday, June 23rd). When Adam came to get me and have dinner with me before going back to work, I told him what Anne said but he didn't seem too convinced. My contractions were still very mild and I was so sleepy. I didn't feel like eating so instead fell asleep. At 8pm, I was awakened by the most incredbile contractions, at 1030 we went to the hospital. My labor was pretty typical, I was cranky, didn't want anyone to speak. What I remember is Anne rubbing my legs and telling me that I was doing so good, wow..I sure didn't feel that way. I was complete at 1230 and started pushing. Annabelle was born at 1:04..into Anne's waiting hands.

It's what happened afterward, that gives me pause today. I remember the labor nurse searching for my fundus and rubbing continuously and Anne mumbling something about "Is it firming?" I saw the labor nurse shake her head no, and then Anne asked for some meds and I recieved two shots..now I know those were probably Pitocin and Methergine. Then Anne warned me of what she was doing next..what I know now as bimanual compression. OUCH! I did not have an epidural, so I felt everything. I realize now as a new midwife that my situation must have been dire and that I must have been hemorrhaging pretty bad for her to do that. She was so calm throughout, that I didn't realize how serious my situation could have been.

So today, on the ten year anniversary to my daughter's birth I would like to thank Anne Peacock, CNM for taking such incredible care of me before, during and especially after and for perhaps saving my life..so that I could be the Mommy that I dreamed of being.

In limbo...

As many of you may know I have been moonlighting as a labor nurse while waiting for my new job to start. While I enjoy (mostly) the work I am doing, I find myself struggling at times between my "identities" as you will... One of the reasons I quit my previous job as a labor nurse was so that I could fully immerse myself into the role of practitioner. It's not as easy of a transition as some would think. The first task was to take charge of the labor room, being able to give orders to a labor nurse was difficult for me as I identified with them and their work. At first, I would back down or agree when a labor nurse suggested something or was not doing what I had asked for. As a student midwife, I was in the room more than perhaps some nurses were comfortable with and would find myself adjusting monitors and messing with iv's..sometimes viewed as intrusive by the nurses. I found it hard not to be on the unit staring at the strip myself rather than trusting the labor nurses to report back to me their findings. The enormity of my responsibility was heavy on my shoulders and I wanted to be sure everything was done right. It wasn't until someone pointed out to me that I am/was a labor nurse too, wouldn't I be offended if the practitioner continuously double checked my work? Hmmm...that gave me pause. Now here I am (temporarily) on the other side of the labor bed again...not as in charge as I once was and that has been difficult for many reasons. I was just beginning to develop my style of education and preparing my patients for their birth experiences, their options and risk/benefits of procedures..now I am under someone else's style and method of care. Recently, I had a patient who had spontaneously ruptured the day before she presented (she thinks) and presented for rest and then pitocin augmentation. The patient wanted to know if I thought she could still labor spontaneously overnight as she wanted to try for a natural childbirth. I told her that it was possible as she was having a few contractions that were palpating moderately. I reported off to the next oncoming staff and told her of my findings. She scoffed at me and pretty much told me how incredibly wrong I was...my midwife soul was wounded. But then, on my long drive home I thought about it..that nurse while having many more years of labor experience than I lacks what I think is vital to every woman..the power of belief. Belief in her body, belief in birth, belief in the power of positive thinking. I have seen a woman go into labor spontaneously after many hours of being ruptured and I felt sorry for this nurse for perhaps not having the opportunity to experience such an amazing thing. So here I stand at the crossroads teetering between on career and another. I have learned that labor nurses work incredibly hard and that midwives are incredibly needed.

One more step..

Okay, I know I'm a dork, but this makes me feel pretty happy. My name on a business card...how cool is that?

The road less traveled by..

One of my all time favorite poems is "The Road Not Taken" by Robert Frost. I have it memorized and in fact, two years ago taught it to Annabelle so she could recite it at her school talent show. She rocked it and I was ever so proud. Over the years the poem has come to mean more to me than ever. Part of the poem describes staring down a fork in the road and trying to decide which path to take. The road not taken is not necessarily a road not taken by everyone, but the road not taken by you. It's about taking chances and seeing where it will get you. This resonated with me last fall when I was offered a chance to teach for two universities. By taking this job I would be leaving a comfort zone, learning a new job all while being a student myself. It turned out to be one of the best decisions I ever made. Through teaching I was reminded of the basic fundamentals of nursing, perhaps new and aggravating to my students, but somehow the basics grounded me and pushed me forward. I got to see birth and adore new babies through their eyes and it was exhilarating! This teaching gig also made me a constant at the hospital I am about to become a part of. I would often get asked which hat I was hearing that day, student or instructor? Somedays I did both..taught for the alloted hours and then when my students were gone would often "switch hats" to become the student once again. This allowed me to get to know many of the staff and physicians..and allow for many late night conversations at the nurses' station, that I believe led me to where I am now and where I am going. I don't believe any of this happened by luck or chance, I do believe it was a God thing. I also believe that good things can come by taking the road less traveled by...

Why blog?

Anyone who knows me well will most likely be suprised that I am blogging. There are many reasons why I've decided to do this now, one of which includes insight. As a student, I pored over blogs, websites and anything else I could to help me in my journey through school and now as I am entering my first job as a newly certified nurse-midwife. While my focus will be mostly my midwife adventures, obviously while perserving the privacy of all my patients, I will include some Darby family fun. So here it goes...

While in school, I couldn't wait to get out into the real world and begin practicing midwifery. Though I do realize I still have so much to learn and will always be learning, I took for granted the safety net and support system that being a student provided. In fact, the first few days after classes were officially over, I cried. A lot. After talking it over with a few people, I came to realize that being a student-midwife had become my identity. And that identity was gone. I felt lost and a little betrayed that I was being released so seemingly easily into the professional world. It took me a few days of grieving to realize that I was ready and was thankful that my instructors and mentors thought so too. I signed up to take the boards as quickly as I could and began to study...

I became official on May 21st, 2010. Sarah Darby, CNM.