12Oct

Certified Educator, Again?

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I think sometimes I must be a glutton for punishment.  There can be no other explanation.  This summer, while assisting a friend at a doula training in Nairobi, we talked about the things we have done, and the things we plan to do.  As we talked I realized how important some things look on a resume–especially the right trainings when you are trying to work overseas. I had let my childbirth education certification lapse a long time ago.  Suddenly I see value in getting certified again.

Why?  Because this summer I’ll be working in hospitals in Honduras. Being an RN from the USA helps get my foot in the door, but if I want to make a difference I need to have credentials they can trust.  Honestly, to be successful at most things people are going to need to trust you. I can create a class for the hospital very easily. But I need to be someone they want to help them create a class, or it will just be something I make and they don’t do.

So next week, I’ll be skipping class to take a certification exam with a well-respected international childbirth education organization. I see it as a small investment in big changes.

Funny, I am now trying to be certified with an organization that was seen as the major competition for the organization I first trained with.  Shows you just how much you can learn and change in 12 years–and how much you can appreciate those changes.

11Oct

Apprenticeship

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I wanted to take a minute to share a frustration I have.  When my direct entry sisters criticize nurse midwifery because it does not follow the apprenticeship model, I’m not sure they understand how nurse-midwives are trained.

Nursing education is not like medical education.  There is classroom content, and there is clinical content, but these are not separated. You learn new things through reading and class, and then you go out and do them with your preceptor.  Sometimes things line up beautifully, and other times it doesn’t. When it doesn’t line up you may end up spending hours researching things you are doing in clinical before you get to them in class.

This is very similar to the apprenticeship system used by my CPM friends. Both systems provide the learner with opportunities for a new midwife to be trained by one midwife, or multiple midwives.  Both systems provide the learner with hands on learning.  Both systems expect the learner to be providing care long before they are proficient. Both systems provide the learner opportunities to learn about the interaction with families and how the presence of a midwife. Both systems usually expect the learner to be completing book learning at the same time.  The systems just use different titles.  Nursing calls the midwives who train you “preceptors,” but it doesn’t change the similarities to the direct entry apprenticeship.

All this to say, if you were thinking about a university nursing program but were turned off because you wanted an apprenticeship, you might want to look into the program again. You might be pleasantly surprised by what is possible–like apprenticing with midwives at a free-standing birth center or attending homebirths. Just pick a school close enough to midwives who offer these services and make sure it is a school where you can have a part in picking your clinical experiences.

 

10Oct

Menopause and several things like it

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Next week I will be presenting a workshop on menopause. This is to be my very time-consuming project at the end of my midwifery training. Except it isn’t the end, I still have a ways to go (combining degrees and all).

It is interesting to think about how I got to this point.  Ten years ago I would never have guessed I would want to present on menopause, I was still very birth focused.  But as I learned more about women’s health, my interests widened.  I never would have thought I’d like working with women to treat and prevent STIs, but I do.  Dealing with menstrual irregularities, love it. Birth, it is still there.  But it is only a piece of the whole woman, and I’ve always been about the whole woman.

I share this because as you consider your path to midwifery, I think it is important to think about all the aspects of working with women and families that appeal to you.  If I had chosen a path into midwifery with a more narrow scope, I know I would have longed for more and burnt out quickly.  For other women, having such a broad range of practice would only make them wish they could spend more time at births.  Who are you, and in what ways do you want to work with women?

07Oct

Into These Hands, Wisdom from Midwives

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I’ve been reading Into These Hands for one of my midwifery classes so I thought I would share a little about it with you.

The book is a collection of stories from a variety of midwives who have been involved in birth for over 20 years each.  They represent hospital, birth center and homebirth midwives. They represent DEMs, CPMs and CNMs.  They represent many ethnicities and work everywhere from rural areas to major urban centers.

I’m personally not liking the book as much as I had expected.  I find some of the stories difficult to read due to writing styles and the repetitive nature of the book.  But it is still interesting to learn about the different ways the highlighted women came into midwifery.

My struggle is not really due to the book as much as to who I am and what I am training for.  I am a public health midwife focusing on international issues.  This book is very much written with an agenda for one definition of a midwife that does not fit my international understanding. But that is to be expected.  It is a book for Americans exploring the growth and role of midwives in America.  Since that is my main struggle with the book, I have no reason to think those of you without an international focus will have any frustrations as you read.

You may enjoy this book if you are looking to be inspired by stories of women working against the medical system to promote homebirth.  You may enjoy this book if you would like to see how midwives follow the midwifery model in a variety of practice settings.  You may enjoy this book if you want to learn about personal stories in the evolution of midwifery in America.

 

06Oct

Why Vaccines in Pregnancy?

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I know many of the women I work with are opposed to vaccines.  So I have decided it is necessary for me to have the best understanding possible so I know when to definitely recommend a vaccine, when to definitely recommend against, and how to help the parents understand the risks and benefits.

The first thing I often hear is that women want nothing to do with a vaccine in pregnancy, fearing it is unsafe for the baby.  This often comes up with the influenza vaccine.  CDC guidelines are clear that pregnant women should get the vaccine, but do you know why they recommend that?

1.  The recommendation is for the attenuated vaccine, not a live vaccine. This means the virus is not able to make you sick, but is still able to be recognized by your immune system to allow you to create a defense against the strains.

2. The defense you create to the influenza virus is transferred to your baby. These cells stay in your babies blood for about 6 months, meaning your baby is protected against influenza without having to get a shot.

3. When pregnant women contract influenza, they tend to be sicker than non-pregnant women. You cannot assume getting influenza in pregnancy is like getting a cold before you were pregnant.

4. Public health is about preventing disease, because the theory is if you prevent it then you do not have to deal with the problems the disease causes.

So these are the basic reasons CDC recommends pregnant women get an influenza vaccine. In terms of safety profile, the influenza vaccine has a pretty good one.  Even with H1N1, the basics of the vaccine stay the same it is the strain of virus that changes.  A group of virologists look at the strains of influenza present, then look at history to try to figure out what strain will be big next.  Some years they get it right, others (like 2009 with H1N1) they guess wrong and the major virus is not included in the vaccine.

I’m a vaccine cautious person, so what do I do?  While in school my choice is made for me, get the shot or no clinical.  But in reality I would choose to have the influenza vaccine while in school anyway.  Why?  Because in a health care office and in the hospital I am more likely than the general population to come into contact with the viruses.  If I get the virus, I will bring it home to my children and husband before I know I have it.  My children, though not asthmatic, have an unexplained asthma-like wheezy response to lower respiratory illnesses (perhaps due to my family history of allergies and asthma?).  It is my desire to reduce the number of these illnesses for my children to help prevent any asthma-like remodeling of their lungs.

Your decision may be different.  I’m sure if I didn’t have the children to think about, I might consider the value of the vaccine differently – but not being able to be in that situation I don’t know how my answer would come out.

05Oct

The Prenatal PAP

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I had the opportunity to attend a women’s health conference last week.  Not much on pregnancy, mostly preventing cervical cancer.  But one important take home point for everyone working with pregnant women.

The latest guidelines for pregnancy will be to perform a PAP test ONLY if the PAP is due.  It will not be a routine part of the prenatal visit.

And when it is due depends on many things, like the age of the woman and what type of testing she had for her last PAP and the results.  For example, if a woman has a negative PAP with HPV testing, she should not have a PAP again until 3 years – this isn’t she can stretch it out to three years, it is that she should not have it done again until 3 years.  It simply isn’t cost effective because the HPV testing has such good predictive value.

Good information to know.

 

04Oct

My Thesis

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I’ve had my thesis approved!  This means I can begin working on it.  So what amazing topic did I decide to pursue?  Actually its quite simple, and I’m a bit ashamed of our health care system that it has never been looked at before.

I’m doing a population based cross-sectional study to compare patient to provider ratios to see if there are differences in outcomes at either end of the scale.  I’ll take existing public health data on the numbers of physicians per county, and cross that with the vital statistics data for birth by county.  I did a similar project during my BSN up in New York, and the results were used by the Licensed Midwives Association to help remove the written practice agreement from the Midwifery Act.  Why?

It is simple public health policy, really.  When you show that there is a lack of providers in an area, and that willing providers cannot get into the area because of a bad policy, the policy can be removed.  Public health policy is rarely moved by the effect to the individual, and once we accept that we can start to do more population based studies on midwifery care.  Law makers do not care that women who use midwives have less cesareans, until they know that districts that integrate midwives have lower costs due to decreased cesareans.

So, that is the basic and the reason why.  It will be a lot of work, and I’ve pretty much decided I need to stay for an extra semester to make up clinical time and finish my thesis – which pushes my graduation to 2013 instead of December 2012.  But at some point I need to sleep, so I’m almost OK with the extra months.

03Oct

Menopause

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This semester each student midwife will be creating their own 45 minute workshop on the topic of their choice.  There are two schools of thought on this.  One is to choose the topic you feel the most confident in, so you can create a fantastic workshop.  The other is to choose the topic you feel the least confident in and become an expert.  I went with the later and decided to do my workshop on menopause.

Let me first state that I am not covering hormone replacement therapy.  A colleague has taken that large portion to create a workshop.  We are scheduled to present together on one day, my presentation first and her presentation to follow. As best I can figure, everyone it the program is very interested in the information we will be presenting.  Some of the CNMs I have spoken with are interested as well.  Seems this is a topic that tends to get brushed over in many programs.

As I research the topic I find how little is actually known about this topic. I was able to find the recommendations for staging of menopause from the STRAW, but how crazy is it that it took us this long to even try to figure out that it might be helpful to understand the timing of the menopause process.  I think of it like the Tanner stages for puberty, there should be “stages” you can clearly see in women as they progress through the next phase of sexual maturation.

The other thing that is mind blowing as I research is how integrated estrogen is to the body.  Estrogen receptors are in the brain, in the bones..well everywhere. Just another reminder that a woman is MORE than a uterus.

11Sep

Accepting the Unexpected

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I just received an email update from a woman I almost know–a social networking friend also involved in birth activities in Sub-Saharan Africa.  I had to laugh at the end of her email.  She never thought she would pursue a midwifery registration in her home country, but that is exactly what she is doing. Why laugh?  Because her story mirrors mine. My goal was never to be a midwife by vocation, but to improve the health of women in resource poor areas.  Yet here I am with a BSN and enrolled in a major university midwifery program.

At the same time, I have friends who would love to be midwives.  Women who feel called to be midwives and want to have jobs in their communities as baby-catchers. And these women are not quite there yet.  They continue to hang out, pursuing other avenues until the time is right.

Life is funny like that.

 

30Aug

The Challenges of Dual Degrees

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There are two other students who started the dual degree program with me last year.  One is also an FNM student, but she is starting her clinical courses this semester (1 year behind me). The other is women’s health, so she completed her clinical courses over the summer. Honestly, balancing the two programs is starting to be difficult.

The first issue is scheduling conflicts.  All three of us are double booked for at least one time slot, which means we will need to record one class or get the information from a fellow student.  This is partly because the nursing school and the public health school schedule classes very differently, but also because as dual degree students we need to take so many more classes to finish.  So now we are each faced with the weekly challenge of deciding which class is more important to be present for.  Ugh.

The second issue is…scheduling conflicts.  To complete the clinical courses for nursing we need to attend clinical hours. The nursing school schedules classes to allow three days a week for clinical time.  The public health school, having no such requirement, does not.  So this semester I have classes four days a week and still need to work in clinic hours for midwifery and family practice.  This is the reason I needed to stop doing my clinical time at the birth center four hours away – I would simply loose too many hours to travel.

The third issue is thesis writing. We each need to begin work on our thesis, but without the basic public health courses under our belt we are not really ready to start working on the project.  Doing original research is not an option because we have not taken the bio-statistics course (normally taken in the first semester of your first year) yet.

The program directors have learned, and with the group of MSN/MPH students starting this fall they have instituted some changes.  The students will complete their year in residence in public health, then move over to the nursing school.  They still have the option to add in additional public health classes while in residence at the nursing school, but they will have the epi and stats background to make the most of their time in both programs.

I’m glad they made the changes, but I would have done it again the hard way in an instant.  Because my goal is broader than a midwifery practice, I need the additional skills of the MPH training. Besides, I love the classes I am taking.

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