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!
Friday, May 22, 2015
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.
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.
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 |
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.
Labels:
Helpful Tips
Monday, April 6, 2015
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!
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!
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!
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| 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
Labels:
Helpful Tips
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!
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!
Wednesday, January 14, 2015
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.
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| 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!
Labels:
Helpful Tips
Monday, January 5, 2015
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
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
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