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Reflection

The summer project is completed and I am finally home. It feels good to be in my own surroundings. It feels good to not be surrounded by people all day. It feels good not to have exhausting hours. It feels good not to have to rethink what I am saying in Spanish or to struggle through exams with a translator. But now I must return to my regular life of studying and paper writing, which can be equally difficult.

Two papers I will write today are reflections on the experience. The instructors assign us a topic or a question, and we write about that topic as it relates to our experiences on the project. As an example, one reflection I must write is about the disclosive (the trust that happens that allows patients to disclose information) space that occurs between a nurse and her patients – did it happen during my time at the foot care area and what helped or hindered it. I must conclude the paper with discussion of how this will affect my future practice.

I wish I could say that being a midwife means I will work with healthy women, not individuals with health problems.  I wish I could say the disclosive space for me will only be about fear of giving birth or becoming a mother. But to say “only” belittles the effect such fear has on a pregnancy, a birth and the first few days to months of parenting. And to assume that just because pregnancy is a normal healthy condition that every woman who becomes pregnant is healthy is nieve.

Not all women follow a healthy diet. Not all women exercise daily. Not all women get adequate rest. Not all women are able to stop their medications during pregnancy. Not all women have a supportive family. Not all women feel safe in their home. Not all women feel they have control over their circumstances. Not all women are comfortable with their sexuality when pregnant. Not all women enter pregnancy excited about being a mother – again. Not all women are willing to cut off smokers from their lives. When you think of all the things that affect a woman’s health, suddenly the opportunities for disclosure of important information can seem overwhelming.

The difficulty comes in the fact that the woman may not realize how important the things that affect her life are to her health – so the woman probably will not come to the visit planning to share such information. Instead, I must learn to create a space that helps the woman understand not only that everything matters – but that I am willing to help her through whatever struggle she may have. She must know I can be trusted with her shame or her fear or her anger. She must know I can help without removing her autonomy. I must counsel and educate and assess her total  health very quickly so I do not take up too much of her time.

All of this with the “normal, healthy, young women.”

In the fall I start more intense family nurse practitioner clinicals – and I will have to do all that with individuals who are sick.

 

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Jennifer Vanderlaan CNM MPH is the author of the BirthingNaturally.net website. She has been working with expectant families since 2000, training doulas, childbirth educators, and midwives. She has worked with midwives in Central America and Sub-Saharan Africa. Her interest in public health grew in 2010, and she is now a PhD student learning to become a producer of knowledge.

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