Successful Field Study

This helpful tip post comes from a senior student preparing for graduation: ViviAnne Fischer.

If there is one piece of advice I could impart to a student beginning an apprenticeship, it would be to lay the foundation from the beginning and communicate any and all expectations. In addition to discussing things like on-call time, clinic days, financial arrangements, the length of the apprenticeship, etc.; you need to discuss time she will set aside to teach you and sign off on skills, vacations and personal days, what will happen if you are sick, what you need to move from assistant to primary stage and anticipated timing, how difficult births will be debriefed, how criticism will be communicated, and when time will be set aside to communicate new expectations when you are ready for more responsibility or move to a new stage. Open and clear communication will minimize conflicts and create a more successful relationship.

The student-preceptor relationship has an inherent power imbalance, anytime there is a power imbalance the relationship is susceptible to abuse. Ideally, equal energy/resources should be exchanged between the preceptor and student to minimize this. We give our time and offer them a free assistant and they teach us and give us access to their clients to learn. At the heart of a healthy relationship is respect for one another. Too often students stay in apprenticeships when the mutual respect is not there. The feelings this leads to within a student does not prepare them to be competent and confident midwives…..it is better to leave and find a new way. If you apprentice with more than one midwife you will likely have some wonderful experiences and some terrible ones, each will teach you important lessons, but you do not need to tough it out when the fit isn't right. My hope is that midwifery programs, students, and midwives will not tolerate this behavior that ultimately undermines the heart of midwifery.

photo courtesy of Wikimedia

Be patient with yourself, be kind to yourself, and recognize that hands on learning takes time and practice. Many of us begin our journey to midwifery after we have successfully navigated other areas of life. It is odd to be in the position of learning and fumbling again. Obviously it is important to get these skills down and know them, but each time we fumble it is an important lesson…..we need to reflect and learn. Recently a friend started a new relationship with a midwife. After learning that each midwife does things differently and believes their way is the right way, she discussed how it is her goal to learn how this midwife wants things done and never have to be corrected more than once. As a new student she used to agonize if she had to be corrected, she has grown past this. As we build skills we will make some mistakes, be kind to yourself and aim to not make them more than once.

It is obviously important to not make mistakes that jeopardize lives, you should know enough before you attend births alone with a midwife to not find yourself in this situation. Ask the midwife to set aside a few hours to review your role if NRP is needed, if there is a shoulder dystocia, what she will need you to do if there is a postpartum hemorrhage, etc. Know your NRP well and practice. I used to go over steps in my head on the way to births or as I was setting up the oxygen and baby tray. Be prepared and then sit on your hands until action is needed. Trust that your preparation is enough to be competent in emergencies. With preparation these situations will build your confidence.

Last but not least, I will leave you with this quote by Vicki Penwell “Smart midwifery is using all your senses to observe while doing nothing to help when birth is working, using all your skills to do everything needed to help when birth becomes life-threatening, and honing the astute ability to always know the difference.” Learning this art is the goal of our clinical experience. Keep your eye on the destination up ahead and trust you will get there if you stay on the path, however rugged it may be at times.