Thursday, March 5, 2015

So you want to be a midwife of excellence…and it starts with being a great student

This "Tips" post comes from Emily Likens, a recent graduate from MCU!

See Emily's practice website at: http://www.livingwatersmidwifery.com/
            A midwife is a high calling and midwifery will demand a lot from you. Compared to the big picture, the skill set a midwife needs for the actual birth is rather small.  A midwife’s “free” time will involve calls, texts, and emails from clients.  Questions ranging from ‘When is our next appointment?’-to-‘I am having bleeding’, will flood your phone at all hours of the day and night.  Having the ability to navigate the client/midwife relationship takes practice.  Learning how to set appropriate boundaries while still providing high quality care can be challenging.  Good thing preparation for this happens within a good midwifery apprenticeship. 
            You preceptor will invest a lot into your training and will expect 110% from you in return.  The preceptor/student midwife relationship requires both women to give and take.  Just as the midwife should be respected and given a place of honor, the student should be as well.  Understand this relationship is intimate and has similar characteristics to raising a child.  With that said here are some realistic tips on how to be a midwifery apprentice within the clinical setting.   

Do not “friend” your preceptor’s clients. 
            It is not ok to become friends or Facebook friends with them.   I loved many of my preceptor’s clients and could have formed easy friendships with them.  However, there needs to be a clear line between client and friend.   If a client “friends” you on Facebook, talk with your preceptor before responding.  If she says ‘no’, honor that.

Be early to appointments
            My preceptor liked to review the client load before clinic day began.  This was an important time we could talk about any client concerns.  Because I traveled over an hour to get to clinic, my preceptor knew there would be days this wouldn’t happen.  On days when I was running late, I made sure to text or call her so she would know I was still coming.  My preceptor also tried to call me if an appointment time changed or was cancelled.  Furthermore, it was important to my preceptor that I checked with her the evening before each clinic day to check her schedule, which I did.   

Do not text or take phone calls during the appointment
            Unless there was a family emergency, texts and calls were not allowed.  My preceptor preferred students phones be left out in the office commons, so they would not disrupt the appointments. 
           
Dress appropriately
            Every preceptor will be different on this.  My preceptor did not want tattoos to show and she asked for any face piercings to be removed.  She also did not allow any sleeveless shirts or tank tops, low cut or revealing shirts and skirts, and no jeans (jean skirts were fine).  Her clients typically were conservative and she aimed to make them feel comfortable with everyone involved in their care.   By dressing and acting appropriately in clinic, it is easier to integrate into your preceptor’s practice.

Listen
            Listening is a skill that needs to be practiced.  Don’t use the conversation as a stage leading to your performance. People who wait to talk are not really listening; they are barely hearing.  There are several types of listening that a midwifery student (and midwife) needs to be good at.  Here are three types of listening you will need to practice:
·         Social listening is the most common form of listening.  The listener is attending to the speaker, asks appropriate questions of the speaker, and may render a comment or two along the way.  Social listening creates a comfortable atmosphere between the parties; it is friendly, non-confrontational, and avoids controversy. 
 ·         Engagement. With engaged listening the two parties are actively listening to one another.  Each party benefits from the engagement; each feels heard and understood. 
 ·         Empathic listening. This form of listening requires that one attend not only to the words that are being said, but also to the tone, intent, and context. In empathic listening the listener is fully engaged with the speaker on multiple levels, often responding to the emotional tone and experience of the speaker rather than only to the content of what is being said. 

Because I practiced engaged and empathic listening, I remembered client details and situations.  When a client came back for their next prenatal appointment, I was able to remember our conversation and would follow up with the client (when appropriate).  What this did for me was to help my preceptor’s client know I was involved and I cared about them.  My preceptor also knew that I was listening to learn.  

Demonstrate to your preceptor that you are studying
            I would share my work with my preceptor so she could see what I was learning.  She would quiz me when we drove to home visits.  This helped her learn what kind of student I was, and also to gage what kind of responsibilities I was ready for. 

Be teachable
            Being teachable and humble stands out as the most significant and critical attributes for success.  If you want to end a preceptor/student relationship quickly, be prideful and arrogant.   Friends, teachers, mentors and coaches are all willing to share their knowledge with modest people who are genuinely willing and eager to receive information. Your preceptor will be happy to teach everything she knows about a given topic when she knows you are receiving what she has to say. 
I saw many students come and go due to an un-teachable heart.  No midwife has time or the energy to teach a student who is not teachable.  Pride and arrogance make the worse kind of student. 

Be available
            Sorry to tell you this, but your family time will be intruded on.  In fact, you will be asked to drive in inclement weather; miss vacations, holidays, and birthdays (even your own); your sex life will get interrupted; your husband and children may not see you (literally) for days; you will make plans with the caveat “unless I get called to a birth”.  All these things have happened many times as a student and it is just part of being a midwife.  You will end up carrying your phone into the bathroom, leave it on 24/7, and freak out when you can’t find it.  The bottom line is you will have to be accessible and available to your midwife.  I was at a mothers group when I got a call from my preceptor.  She couldn’t get a hold of the student slated to attend a particular birth and the mom was in labor.  That student was not invited to another birth.     


Keep your home life at home
            Midwives are busy and their clients require a lot of energy.  As a student, you are not the focus.  Appointments with clients are not to be commandeered by you.  Your personal problems and struggles need to stay at home. 

You are not the priority
            Your preceptor does not have the time or energy to chase after you and hold your hand.   Rather, communicate your needs to your preceptor in a professional way.  Learning how to communicate effectively takes practice but it will hold you in good stead throughout your life.  If you need clarification of her expectations simply ask, don’t try to guess, you are not a mind reader!  My preceptor and I struggled with communication and in the end it did cause hurt feelings within our relationship

Take care of your paperwork right away
            Have your preceptor sign off your paperwork at the end of each clinic day.
I did not do this and it took almost 100 hours in chart audits and paperwork at the end of my apprenticeship to prepare my paperwork.  It also required my preceptor to spend time verifying all of my work.  If you need your preceptor to sign paperwork, make sure to remind her during a free period or at the end of the day.  You never know when your apprenticeship may come to an end so get it taken care of right away!

You are not the midwife
            Clients are paying your preceptor for her time, expertise and skill, not yours.  Don’t ever put your preceptor in a compromising place.  If you disagree with something that came up during an appointment, talk with your preceptor after client appointments are done.  Ask her if she can explain why she suggested XYZ to her client.  If you directly challenge your preceptor, you are essentially saying you know more then her, which is not true.

Here are some benefits that happen when you are able to apply these tips:
  •          Your preceptor will be more willing to have you participate with her clients
  •         You learn to consider others needs and strive to make them feel comfortable
  •          Your actions will tell your preceptor that you are serious about midwifery
  •         These traits will go a long way to establish yourself as a professional midwife

Wednesday, March 4, 2015

Clinical Update: March 4, 2015

Hello, students! I am at the conference this week and celebrating our wonderful 35th year as a school. Last night we had a record 31 graduates honored and I got to personally congratulate 6 of them!


We also are hosting wonderful classes (like Neonatal Resuscitation!) and meeting lots of students in person. I'm getting excited already for June and hope to see many of you there--Utah is beautiful in the summer.

We do now have a full set of recorded live sessions in the class documents for CLNC 100: Clinical Orientation, Starting Your Clinical Placement, Preparing for Primary Births and Applying for the NARM exam. You can download and watch/listen to them any time you like! We'll offer live sessions of these each again next semester, but any time you need a refresher, it's there!

Kaylee and I are working on a Clinical FAQ document. Look for our post on the bulletin board where we're collecting questions people frequently need answers for!

Looking forward, there is a session of Clinical Rounds scheduled for April 9--Rita Willis will be presenting on Marijuana Use in Pregnancy. Make sure before attending your first session of clinical rounds, make sure you have viewed the clinical rounds ground rules session.

Finally, I am still taking submissions for Clinical Rounds in Summer Term: June, July and August. If you'd like to present, please contact me soon!

Have a wonderful week!