Clinical Update: November 18, 2015

Just a short update today--thank you for your patience during my time away. If you're old enough to remember that movie Four Weddings and a Funeral, just know that my vacation could have been made into a movie: A Wedding, Two ER Trips and a Day at Disneyland. Everyone is recovering from the festivities now, including my email message box--I appreciate your long-suffering as I get back on top of things.

photo courtesy of pexabay

I have just two quick things to let you know. First, we've simplified the requirements for CLNC 100 Clinical Portfolios. Now, instead of over 100 documents, you will be asked to select 20 practice directive documents--some will be specified by the syllabus, and some you can select your best. This gives you a chance to show off your best work, and gives me a better opportunity to give feedback that is explicit and constructive as you finish your clinical work. Details are in the class documents of the CLNC 100 class (Amendment to CLNC 100 Syllabus: Senior Project-Practice Portfolio). If you've already compiled your practice portfolio using the old instructions, we'll still accept those for the next few months, so don't worry. But look at the new directions--it's much simpler and will be easier to compile.

Second, you are probably aware there are about 3 weeks left in fall semester. If you are in clinical placement, please make completion of your end-of-semester evaluations a priority. We will be reminding your preceptors as well. This is a great time to check in with your preceptor(s) and yourself and see how you're progressing and what goals you'd like to set for next term. What is your next step in becoming a midwife of technical and professional excellence? If you have concerns, contact me about setting up an appointment to talk!

And one final reminder of the video resources available for CLNC 100 students--there are recorded live sessions on these topics available for viewing ANY TIME in your class documents and files:

• Clinical Orientation and Overview
• Starting Your Clinical Placement
• Preparing for Primary Births
• Applying for the NARM Exam

Have a wonderful Thanksgiving holiday--I hope you find much to be grateful for in your lives.

Bright Blessings,

Sarah Carter

Three Pillars of a Successful Apprenticeship

Today's post comes from Madeline Lutz, who will be graduating very soon!

Having just finished what I consider to be a difficult apprenticeship and hearing from other students that most apprenticeships are often wrought with bad feelings at some point, I wanted to write a little something about how to make an apprenticeship less difficult. Midwifery is stressful and draining and exhausting, and there’s no way to get around that fact. But midwifery is also amazing and joyful and can fill you up in a way that nothing else can. I think there needs to be a model that focuses on those good things and minimizes as much as possible the negatives. As it stands, there are too many midwifery hopefuls who “can’t cut it” or who “burn out.” The main reason for this is that midwifery apprenticeships have too much of the bad and not enough of the good. I think there is a way to make it better and my belief is that the three pillars of a successful apprenticeship for both the midwife and the student are expectation, communication, and evaluation.

Expectations is the place to start with almost everything. In any business relationship it is extremely important for each party’s expectations to be clear from the outset. An understanding must be reached that is pleasing and acceptable to both parties in order to know what to shoot for and what to evaluate in the future. Examples of this in a midwifery apprenticeship are how many hours are students expected to work doing tasks for the midwife such as charting, stocking, or cleaning each week. What appointments does the midwife expect a student to come to and when will those appointments be held? How much time off call will the student have and when? There are numerous possible answers to all of these questions. There is no one way for a midwifery apprenticeship to work. The goal of discussing clear expectations is to find out how this midwife and this student want the apprenticeship to work in order to meet both of their needs.

The next pillar of a successful apprenticeship is communication. Communication is imperative to any successful business relationship; therefore, it is important that one of the expectations laid out is that if one party feels like things are not going as they had hoped, or expected, that it is ok to bring it up and that the other party will have a respectful conversation with them. Another reason for the importance of communication is that while many of the bigger expectations have been set, there will still be many little expectations that pop up in our mind along the way, such as “I think I’m ready to take heart tones during labor,” “I feel like the midwife is taking advantage of my days off,” “I don’t feel appreciated for the hard work I did cleaning the office on Saturday.” Those little thoughts that we don’t even realize are expectations can get out of control and can develop into resentment if we aren’t careful. Successful apprenticeships will have big expectations laid out in the beginning of the apprenticeship as well as little expectations being made clear over and over again through communication throughout the apprenticeship.

 

Photo Courtesy of Flickr, CC license

The final pillar of a successful apprenticeship is evaluation. It is much easier to evaluate a situation when the expectations of how the situation should be working are clear and when communication is allowed and encouraged. One of the expectations laid out in the beginning of the relationship should be a timeline for regularly scheduled meetings where each party will evaluate and discuss if their expectations are being met and make a plan to meet them if not. Regularly scheduled meetings for evaluation will allow for the clear communication necessary for both parties to feel heard, respected and cared for. Evaluation meetings are also a time to adjust expectations as oftentimes the reality is much different than that same thing in theory.

Expectation, communication, and evaluation are the three pillars to a successful apprenticeship. I think if every preceptor and student appreciated their importance, we would have less resentment and discourse in midwifery apprenticeships overall. All of us are working towards the same thing: positive birth experiences for mothers, for babies, and for families. In order for us to provide that service to more women, we need more student midwives to complete their apprenticeships. I believe if more apprenticeships were built on these three pillars, we would have more midwives, help more women, and the world would in turn become a better place. 

Clinical Update: October 29, 2015

Happy Autumn!
It's what Winnie the Pooh would call "a blustery day" in northern Utah today, leaves and clouds blowing around in the wind, rain will arrive before too long and hopefully clear out in time for trick or treating this weekend. 

photo courtesy of Wikimedia

I hope you're doing well--just wanted to send a few quick reminders and notifications:

1. Upcoming Events
We have 3 upcoming Clinical Rounds in November and they all look fascinating. Learn from real cases, taught by real student midwives! Come to Clinical Rounds!
*Wednesday, November 4, 2015 at 11:00am MST: Ananda Morehead-Retained Membranes
*Wednesday, November 11, 2015 at 12:00pm MST: Hollie Moyer-Anti-C Isoimmunization in pregnancy
*Wednesday, November 18 at 11:00am MST: Rachel Maxim-Velamentous Cord Insertion

2. Guests at Clinical Rounds
While we're on the topic--sometimes preceptors or other non-MCU students are interested in coming to Rounds. This is just fine, but please, rather than just giving them the login information, ask them to contact me via my external email: ClinicalDean@midwifery.edu
I can give them the login info and make sure they know what to expect and how to participate appropriately. We want this to be a learning experience for our students, first and foremost, and include other students and midwives where we can.

3. Clinical Training Opportunities
Several new clinical training opportunities are posted on the bulletin board "Clinical Training Opportunities"--check them out!

4. State by State Project
We have 9 states up at http://midwiferystatebystate.blogspot.com/ now, and I have 8 more (Illinois, West Virginia, Indiana, Virginia, Ohio, Arizona, Florida and Washington) in process. I would love to get Oregon, New Mexico, Wyoming and Idaho to finish the Western US. Then we can fill in the Midwest (which is looking GREAT--thanks!) and get to work on the southern states and New England. If you'd like to help, the format is as follows:

So You Want to be a Midwife in …. <name of state>
Licensure/Registration: <what credential is offered, if any>
Application Website: <a link to the government website>
Additional requirements beyond CPM credential: <short explanation>
Other Things to Know: <links to state association or advocacy organization if available, other things to be aware of>

Thank you for being fantastic students and people,
Sarah Carter

Clinical Update: Every Mother Counts

This isn't a personal blog. I don't usually talk about my personal experiences or feelings here. But I'm going to today, because this is too important not to talk about.

When I was about 17, my dad took me to see the movie Schindler's List. He said, "We don't usually see movies like this (my parents were very strict about media consumption) but I feel like we have a responsibility, as people of German descent, to see this, to bear witness. Because the Holocaust happened, and because our ancestors were part of it, we have a responsibility to bear witness and make sure it never happens again." It was a sobering thought for a high schooler who grew up in a safe, comfortable world.

So why do I bring this up?

Because one of my colleagues shared this link with me:

http://dooce.com/2015/10/21/the-women-who-inspire-me-to-run/

and reminded me that once again I find myself part of a privileged class, bearing witness as racially biased, systemic violence occurs to women and their children in the US and around the world. And I have a choice--to turn away and pretend I don't see or am unable to help, or to try to intervene, to do something to save lives and prevent harm.

It's tempting to turn away. It's frightening and uncomfortable to see this happening. It hurts and it is frightening to look at this, to acknowledge that I might be even a small part of the problem. It would be easier to turn away. It would be easier not see.

But I see. If you're willing to see too, you can watch the video below, or visit:

http://www.everymothercounts.org/pages/giving-birth-in-america

Today, I'm donating my income, the money I make--just today, to help. That's something I can do. It's not an enormous, big step, but it's something I can do right now, today. I'd encourage you to look at what you can do, whether it's volunteering in your own community, donating to a scholarship fund to help us get more midwives of color serving women of color, or helping Every Mother Counts.

This matters. We have a responsibility to mothers, as women, as human beings to bear witness and to hear our conscience voices. We have a responsibility to help. They need our help.

Overcoming Difficulties in Clinical Work

This helpful post comes to us from Jen Bertagnole, who will be graduating soon!

Clinical work can be rewarding and difficult.  What better way to solidify the knowledge you are gaining through schoolwork by putting it into practice in your clinical experiences?  Many times, students excitedly anticipate a clinical placement, only to encounter disheartening difficulties that can side-track them in their progress.  Here are a few suggestions in overcoming difficulties in clinical placements.

1. Be honest with yourself, your family, MCU and your preceptor about your readiness for an apprenticeship.  It was difficult for me to get my first preceptor to accept me as a student.  Four days before I was to finally start working with her, my adult stepson was diagnosed with a brain tumor.  I agonized about putting off a clinical placement that had been so difficult for me to secure.  However, I knew that it would be nearly impossible for me to juggle clinical work with this unexpected situation and everything else in my life.  I sent my preceptor an email, explaining the situation.  She was exceptionally understanding and allowed me to start my clinical work a couple of months later when my son’s health was more stable.

2.  Reach out to MCU and your preceptor when a life change occurs.  This can be a health issue, miscarriage, move, a change in marital status, death of a friend or family, etc.  Do not let pride, embarrassment, etc. keep you from being extremely honest with those that are helping you achieve your goals of becoming a midwife.  Even if you do not think the life event will impact your clinical or didactic work, REACH OUT.  Contact your house mother if you need help in doing this.   She can either help you reach out to teachers, the clinical dean, your preceptors, etc. or she can just touch base for a period of time to see how the life change is affecting your clinical work.

3. Look and think outside of the box.  I had wanted to apprentice with a local birth center but could not afford the fee they charged students.  For months I hoped for a way to make it happen.  Finally, I got the nerve to contact them and asked if I could work with them during the holidays for a reduction in of their fees.  To my surprise, they eagerly agreed, as out-of-town students rarely want to come during the holiday period.  If you never ask, the answer is always no.  Do not hold yourself back!!

4. Address problems in your preceptorship as they arise, with your preceptor in an honest, open way, away from clinical work, if possible. Do not take things personally, even if they are meant personally. A crucial part of your learning is knowing how to communicate in a professional, appropriate way. If you are concerned about your ability to do this, consider taking COMM 114: Communication Skills prior to beginning your clinical work.

5. Know ethical and unethical behavior, how to address ethical questions and the laws of the state in which you are apprenticing.  Courtney Everson is an excellent resource for discussing ethical issues that you may be uncertain about how to manage.  While you are certainly accountable to your preceptor, do not forget your responsibility to the client and (just as important), to yourself.  If you are uncertain about ethics and the laws regarding midwifery care, consider taking SOSC302, Ethics & the Law in Midwifery, before beginning your clinical work.

So often students eagerly look forward to beginning their clinical experiences without considering the difficult work that it can sometimes be.  While it is certainly rewarding, be honest with yourself about your readiness to add such responsibilities to your current life.  Being aware of some of the difficulties one can encounter during a clinical placement and how to address them can help you better navigate this exciting time in your midwifery career.

Clinical Tips: Things I Would do if I Could Start Over

Senior student Robin Belliston will be graduating soon and shared these tips with new clinical students:

First of all, I would figure out what I want to do and become before beginning. I would have a clear vision of my goals and expectations so that my preceptor would understand how serious I was about learning. Then I would be better at communicating. I would be honest about who I am, what I can do, what I know and don’t know, and what I hope to learn. I would communicate from the beginning about those expectations, disappointments, fears, concerns, and things I was learning. I would not be afraid to ask tons of questions until I completely understood various concepts, skills and situations that are crucial to know. I would realize that it’s okay to not know everything at first and that my preceptor can’t know what I don’t know unless I ask questions.

Secondly, I would overcome my fear of trying new things. I tended to always let my preceptor do the stuff I didn’t particularly like or feel comfortable with (newborn screening, blood draws, vaginal exams, etc.), so it took me much longer to learn these skills than it should have. I wish I had more consistently made an honest effort when my preceptor asked me if I’d like to do something. I would also be humble enough to take constructive criticism and work on improving. My preceptor often told me I needed to become more aggressive or assertive, and I struggled to not be offended by that, to trust her judgment and to understand why she was encouraging that. I am a pretty gentle person by nature and this was hard for me, but when I made the effort to do better at taking charge, not only did our relationship improve, but my abilities also reached a much higher level.

Next, I would understand that it’s okay for me to develop my own way of doing things. Each preceptor likes things done a certain way and when working for and with them, it’s important to do things the way they want them done. But I wish I had learned sooner that I can develop my own style without being a threat to my preceptor. When I did learn this, her respect for me increased, which allowed my self-respect to also improve.

I would also work on being more forgiving – of my preceptor and myself. There are good and bad prenatal days. Days are often long, and nights even longer at a birth and people are sometimes on edge when things are not perfect at a birth. Instead of being overly sensitive, resentful, or frustrated if my preceptor snapped at me or seemed annoyed, I would realize that she is most likely just stressed about the situation and it will blow over. I would try harder to look for the good and focus on the positive. I would forgive myself for making mistakes and for taking longer to do things than my preceptor who has over 40 years of experience more than I have.

I would definitely do better with my paperwork. I would understand the requirements thoroughly so that there wouldn’t be surprises when I got to the end. I would review and discuss skills at each clinic day, if possible, and have my preceptor sign the skills and visits at the time they occur. (This will save you countless hours, trust me!)

There are other things I would change, but these are some of the things that have made my experience as a student midwife wonderful and fulfilling.

Clinical Update: September 3, 2015

Welcome Back!

Just a couple quick notes as we start the new semester. If you are on clinical warning or probation, PLEASE contact Kaylee about resolving it. We want you to succeed!

Also, take a moment and make sure you've completed your Clinical Handbook assignment. All students need to do this assignment, whether it's your first semester or your last!

And REMEMBER! Clinical Training Agreements must be turned in before you start logging experiences. Take the time to go over and sign these agreements with preceptors before you start your placement--they are for your protection!

There are a LOT of Upcoming Events to look forward to this month:

CLINICAL ROUNDS
Clinical Rounds-Kassia Walcott-(not so) Transient Tachypnea of the Newborn
Wednesday, September 9, 2015, 12:00 pm Mountain Time 

CLINICAL ORIENTATION
For new students and anyone who would like a reminder of the clinical program and how it works.
Monday, September 14, 2015 at 1:00 pm Mountain Time
Wednesday, September 30, 2015 at 10:00 am Mountain Time

STARTING YOUR CLINICAL PLACEMENT
This is a session for students who are starting or about to start their first clinical placement this semester. We'll go over applying to the clinical program, preceptor approval, clinical training agreements and filling out log forms.
Monday, September 14, 2015 at 10:00 am Mountain Time
Wednesday, September 30, 2015 at 1:00 pm Mountain Time

PREPARING FOR PRIMARY BIRTHS
This is a session for students who are hoping to start primary births in the next year. We'll go over what classes, skills and forms need to be sent in to be approved for primary births, and what forms students will want to have once they begin that phase.
Monday, September 21, 2015 at 11:00 am Mountain Time
Monday, September 28, 2015 at 1:00 pm Mountain Time

APPLYING FOR THE NARM EXAM
Understand what forms need to be completed and sent where to apply to take the NARM exam.
Thursday, September 10, 2015 at 1:00 pm Mountain Time
Wednesday, September 23, 2015 at 10:00 am Mountain Time

And finally,

OFFICE HOURS this semester will be Mondays from 1-3 pm Mountain time (although not Labor Day!)


Have a wonderful September!

Clinical Update August 10, 2015

Just a few notes and reminders as we finish this semester!

 ###All Students###
REMEMBER! Clinical Training Agreements must be turned in before you start logging experiences. Take the time to go over and sign these agreements with preceptors before you start your placement--they are for your protection!

Also, please plan to complete your "Preparing for Successful Preceptorship" assignment BEFORE starting your first clinical placement if at all possible. Already started your placement? Do it now! These modules are very helpful and can help you get ready as you're completing your clinical application. I guarantee these are not busy work or extra paperwork--they are brief lessons that will really help you have a great clinical experience and solve problems that can arise with preceptors BEFORE they start.

###New Students###
Please take a moment and make sure you've completed your Clinical Handbook assignment before this semester ends. The Clinical Handbook and Clinical Orientation recording is available to help you in your CLNC 100 class! This should be done BEFORE your first semester ends, so if you haven't done it, the time is now!

 ###Students in Clinical Placement###
Don't forget to complete your Statements of Clinical Progress, Self Evaluation and Preceptor Evaluations and ask your preceptor to complete their evaluation of you too!

If you have applied to the clinical program but weren't in clinical placement this semester, just fill out the statement of clinical progress and let us know that!

 Have a great last week of the semester and finish strong--you can do it!
 Sarah Carter

Clinical Update July 29, 2015

The dog days of summer, indeed!

Just a few reminders as we approach the last few weeks of the semester:
1. New Students (and old students too)
Make sure you've completed CLNC 100's orientation questions from the clinical handbook (Section 2) before the semester ends. You can use the recorded Clinical Orientation videos in Class Files for help!

2. Upcoming Clinical Rounds
Wednesday, August 5, 2015 at 12 noon MDT, Jen Bertagnole presenting on Urachus. This will be the last clinical rounds for this semester. I am taking reservations for September and October if you are planning to present during Fall Semester--just send me a message with the week you'd like to present and your case topic.

3. NARM Requirements Update
<<<THIS IS IMPORTANT FOR ALL STUDENTS TO READ AND BE AWARE OF>>>
NARM has recently updated their requirements to include this:
"Regardless of when a student started the program, ... a minimum of 10 of the 25 Primary Under Supervision births must be attended in the US or Canada regardless of route of entry. (effective date for MEAC students- January 1, 2016)"

For most of our students, this makes no difference at all, but if you are an international student (outside the US or Canada) or otherwise have questions about how this policy change may affect you, please contact me ASAP and we can talk about your situation. If I've already contacted you and we've already talked about it, nothing has changed!

4. End of Semester
Don't forget, if you're in clinical placement, you need to complete the end of semester "paperwork" online and your preceptor(s) should complete their evaluations of you, online or on paper if they prefer. Turning in evaluations on time means Kaylee and I can spend our semester break with cold fruity drinks in our hands and our feet in a pool. Or, at least that we don't have to send reminder emails and clinical warning notices to students.

Have a fantastic rest of your summer!

Clinical Update May 22, 2015

Welcome to Summer!
Hopefully you're enjoying your semester and making time for relaxing fun over this long weekend. It's been an unusually wet spring in Utah and we're looking forward to some sun! This clinical update comes to you in seven very special parts.

1. Clinical Orientation
For new students (and students who'd like a review), one more session of Clinical Orientation is still available: Wednesday, May 27, 2015 10:00 AM MDT. See your upcoming events board for details and the link to sign up.
If you are unable to attend a live orientation, you can download and view a recording (in Class Documents for CLNC 100, under Recorded Live Sessions).

2. Optional Live Sessions
We also have 2 optional Live Sessions being scheduled for later this month. They are for specific situations, so if they seem applicable to you this semester, please plan to attend. They will be recorded for later viewing as well!
-Starting Your Clinical Placement
This is a session for students who are starting or about to start their first clinical placement. We'll go over applying to the clinical program, preceptor approval, clinical training agreements and filling out log forms.
-Preparing for Primary Births
This is a session for students who are hoping to start primary births in the next year. We'll go over what classes, skills and forms need to be sent in to be approved for primary births, and what forms students will want to have once they begin that phase.

3. Clinical Training Opportunities
Check the bulletin board titled Clinical Training Opportunities--I’m always posting new opportunities around the country for students seeking clinical placement. In the last month we've seen clinical opportunities in Oregon, Washington, Michigan and I just posted another in Virginia.

4. Upcoming Rounds Sessions
Tuesday, June 16, 2015 at 11:00 am MDT ViviAnne Fischer will be presenting and Wednesday, June 17, 2015 at 10:00 am MDT Karin Peacock will be presenting. See the Upcoming events bulletin boards for signup links to these presentation. There was a Clinical Rounds scheduled for next week, but we needed to move it to July 1. These are going to be great presentations--please plan to join us if you can!

5. OFFICE HOURS this semester will be Mondays from 1-3 pm Mountain time (although not Memorial Day!). You can also call our shiny new clinical extension and someone from the clinical department will respond to you ASAP.

6. Just a reminder, all of your “assignments” for CLNC 100 and any lab classes should be uploaded via the class as PDF files if possible. If you need to send a file you can’t upload or send multiple files, please send them to Clinical Dean Assistant (Kaylee Ridd).

7. Finally: You can visit the Clinical Department blog for updates like these as well as helpful tips, events and news. The address is: http://midwifingmidwives.blogspot.com/ and I highly recommend bookmarking or subscribing to it--it has pictures!

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.

Clinical Update: April 6, 2015

Happy Spring!
This Clinical Update comes to you in 3 parts, brimming with new life.

First, this Thursday, April 9 at 12 noon MDT, Rita Willis will be presenting at Clinical Rounds on Marijuana Use During Pregnancy. Make sure you've viewed the clinical rounds Ground Rules before attending.

Second, the End of Semester Evaluations are going on online! Kaylee will be sending you links later this week, so watch for that! If you already filled out or had your preceptor fill out the paper evals, that's ok, we'll accept them. But look for the new online version!

On the bulletin board, there are several Clinical Placement Opportunities listed. Take a look! And You can find a series of Helpful Tips from recent graduates on our blog:
http://midwifingmidwives.blogspot.com/search/label/Helpful%20Tips

Two weeks left of the semester--I wish you all the best and if you're in clinical placement, don't forget your end of semester evaluations!

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

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!

What I Wish I Had Known....11 Tips for Starting the Clinical Program

This post is courtesy of new graduate Liz Stika-a few tips for students in the clinical program!

Paperwork

1.       Make binders

About a year and half into my preceptorship I saw another student’s paperwork that she was preparing for NARM.  It had all of her clinical numbers, her NARM application, and clinical feedback paperwork neatly in plastic sleeves.  It was organized with dividers and color coded, and a far cry from the water and coffee stained stack of miscellaneous papers I had in a pile at home.  That beautiful and durable binder was perfect for carrying with me to births and was worth the extra effort to put together.

Along with the binder for official paperwork, make a binder for your Practical Skills Guide.  The spiral binding does not last, and the pages start to get pretty stained if your guide comes along to births too.  Luckily, I got the advice to pull out the spiral binding and three-hole punch the pages for a binder.  This way, my skills guide was ready for signatures in the moment.  I started keeping the signature pages in plastic sleeves as well for organization and protection. 

2.       Carry the binders with you

My pile of clinical paperwork was not organized and it was a mess.  Finding the right papers took me a long time, and I was embarrassed at my lack of organization.  Not to mention the risk to the paperwork of getting wet and messy.  So I didn’t consistently bring them with me to births or to clinical days and that just got me more behind.  Once you have your binders set up, keep them handy in a birth bag, or in their own file bag (Craft stores carry great bags for organizing papers for reasonable prices.  They’re always on sale).  That way, you can grab them and always have them on hand when you have the opportunity to get a signature. 

Photo courtesy of Brian Smith on Flickr (CC)

3.       Get signatures in the moment. 

Sometimes it seems like it just breaks the beautiful midwife flow, or sometimes it’s 7 AM after 24 hours at a birth and all you want is to go home.  But if you take 60 seconds to pull out your binder, fill in the information and get your signatures you avoid many hours of headache trying to repair the damage of charts that are incomplete or out of order.

4.       Use pencil

I am embarrassed to admit how many times had to rewrite my logs.  So, moral of the story- use

pencil, double check, go over with pen, then have your preceptor sign- in the moment.  It will only take a minute a more. 

5.       Keep a master client list

One thing that saved my paperwork was my master client list.  I worked with several midwives and I kept this list without fail for every homebirth midwife client I spent time with.  I included the client’s name, my personal code, the midwife I worked with. Somehow, I kept up with this list and it saved me when my official paperwork was subpar and I needed to track down a particular client. 

Plan Ahead and Prepare

6.       Communicate about skills

When you start your preceptorship, be clear with your preceptor about expectations for skills.  How will you practice?  What do you know and what do you need to work on?  When will you sign them off?  Will you have skill days, or discuss your goals before a birth?  The clearer you are together from the beginning the easier it will be to establish good habits.  My experience in several instances was the longer I waited to establish expectations the more awkward it got to start.  Even though this is easier emotionally in the short run, it leads to assumptions and private contentions that can get in the way of a healthy working preceptor relationship.  By going over your skills requirements with your preceptor from the beginning, you can map out a course for your apprenticeship that will be satisfying and beneficial for you both.

7.       Review

Make time to review cases.  Ask questions about what you could have done differently.  Research complications and learn from every situation you can.  Be honest about your choices and mistakes.  One mistake often leaves me feeling like a failure, or that I am on the wrong path trying to become a midwife.  But as an apprentice, and even as we join the sisterhood of midwives it is important to remember we are learners and that mistakes are steps to deeper understanding. 

8.       Start the NARM application…now

Read the NARM Candidate Information Book (CIB) and print out the appropriate application pages now so you know what you will need in the end.  This will give you a framework for your experience and help you avoid unnecessary effort.  I was so focused on finishing clinical numbers, I didn’t even look at the NARM application until I was ready to fill it out.  I had to clean up a few things, and get extra signatures from midwives I no longer worked with in order to finish the application.  It was awkward, unprofessional and unnecessary. 

(A note from the Clinical Dean: MCU students can find their forms at: http://narm.org/testing/graduate-of-a-meac-accredited-program/)

Midwives are People too

9.       Protect and Honor Vulnerability

Midwives take on students for many reasons, and I can’t speak for them all, but it seems to me that bringing on a student takes a lot of courage and humility.  More than hiring an assistant the presence of a student opens the midwife to constant scrutiny.  I didn’t really think about this until I was reaching the end of my clinical time and thinking about being a preceptor myself.  Students are in the process of becoming midwives and so every decision the midwife makes is mentally weighed against what the student has learned or how the student would have done differently.  It’s a very vulnerable space for a midwife to be in and as students I think it’s our responsibility to protect and honor that vulnerability by maintaining confidentiality, treating our preceptors the way we would wish to be treated when we are in their shoes, and by handling disagreements professionally

10.   Practice Reciprocity

As an apprentice I often felt I had little to offer.  The burden of responsibility for a client ultimately lies with the midwife, and it took a while before I felt I could truly be helpful.  The principle of reciprocity implies mutual benefit; giving and receiving.  Just like I mentioned above, it took me a while to really appreciate how hard my preceptors were working for me. Even though I couldn’t always offer equal professional help, I tried to show appreciation in other ways.  Helping with charts, organization, a gift or a heartfelt note can provide balance and that element of mutual benefit. 

Move Foreward

11.   Have Faith

Everyone’s circumstances are different, but I have found in my own experience that generally people want to help you succeed, and when you are open, opportunities present themselves.  Opportunities often come with sacrifice and a whole lot of work, but they will come.  There is a light at the end of the tunnel and every experience provides the backdrop for your future practice.  I asked around, sometimes several times, to work with several local midwives, saved up to work at a local birth center and even found my own clients for the last few primaries. It took about 3 years with a break for my own baby in the middle.  It took perseverance, faith, creativity and a lot of support.  Good luck! Your talents are needed and the work will be worth it  

Visit Liz's new practice on Facebook

Thanks for the tips, Liz, and best wishes as you graduate and start your own practice!

Clinical Update: January 5, 2015

Welcome back!
It's snowy and cold here in Utah, but this morning I heard the birds singing. Winter is here!

We had a record number of graduates in 2014--31! Congratulations to each of them! My hope is to have at least as many graduates in 2015, so if you are preparing to graduate and take the NARM exam in 2015, send me a quick message! I can advise you on the process and offer a lot of help to make sure you are ready to go.

Clinical orientation live sessions are available, if you'd like a refresher on the clinical program and requirements. Check your upcoming events page for details and registration information.

Other clinical live sessions will be scheduled based on who needs them. If you're interested in
Starting Your Clinical Placement: sign up here
Preparing for Primary Births: sign up here
or Applying for the NARM Exam: sign up here
Make sure you mark the session you need by January 15th!

We will be scheduling Clinical Rounds--if you'd like to present, please send me a message with your case topic and when you'd like to give your presentation. I will respond with a couple options of dates and times and we'll get it on the calendar!

Best of luck as you start your classes this semester and I look forward to working with you during the term!
Sarah Carter