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Phase One

This page showcases learning from the following classes I have completed in midwifery school:
Midwife's Assistant Orientation
Clinic 1010: Phase One Clinical Practicum
Breastfeeding
Clinic 1050: Phase One Competencies
Midwife's Assistant Orientation:
This course helps student midwives prepare to become efficient, trustworthy and competent assistants. This course is designed to give the student an understanding of the requirements and duties of a midwife's assistant. After having completed this course, students will be prepared with the theoretical background necessary for her clinical practicum. Students will understand the scope and principles of general skills used in a prenatal setting and will explore the role of the assistant through case studies. 
Field Guide (Pinterest) and Clinic 1010 *Connections Essay Assignment:

Connections to Midwifery Classes

 

            I completed an assignment for Midwife’s Assistant Orientation that described what to expect in a standard prenatal appointment. More than a dozen topics were covered. I remember completing this assignment and thinking that there was quite a lot that happens in each appointment. I really like the way the assignment turned out; it can be used by students as they familiarize themselves with what to do, or by clients as they are getting used to prenatal care with their midwife.

            From the academic view, it seems like there is a checklist of things that need to be covered at each client meeting. The student in me wants to memorize this list and be able to call it from memory when I meet with clients. This can turn into a cold or disconnected interaction if it ends up taking the shape of questions and answers exchanged back and forth in an interview style. Although my type-A personality likes the efficiency of that style, my clinical experience so far has shown me a much more pleasant way of conducting these appointments. I am noticing that the midwives I have worked with like to have a more relaxed style of prenatal appointments, and their clients are happy with the care they receive. I’ve learned that memorization and lists aren’t always the best way to accomplish your goals.

             I have attended a handful of clinic days with my preceptor and realized that through conversation and getting to know her clients better she is able to cover all the information needed to provide great care and document any growth and changes that occur. Her meetings with clients flow like friends sitting down to chat over coffee. Sometimes she specifically guides the conversation toward nutrition or exercise, and she might touch on any decisions that need to be made or questions about new symptoms, but overall the conversation flows naturally and she spends a lot of time listening. I have also noticed that the more she gets to know her client, the stronger the communication ends up being. After months of care, trust has been established and these conversations are comfortable. The midwife knows what normal is for each client.

              I had an “aha” moment after a few days I spent in the clinic with my preceptor. I noticed that the majority of the appointment time was spent chatting and doing some light education or shared decision making. It seemed that she almost forgot sometimes to take vital signs, check on the baby, and measure, etc. but I realized that of course, she didn’t almost forget to do those things – those things were just not the main focus of their time spent together. Aha! Of course, the basis of midwifery care is coming alongside a woman and partnering with her in her care during her pregnancy and birth. Checking and measuring and charting are important, but eye contact, and listening, and empathizing, and having tender conversations are important as well.

             Overall, I have learned that what we do at a prenatal visit is build relationship and trust. Yes we educate and measure and listen and chart, but providing quality care goes so far beyond those things. I am thankful to be learning from a midwife who doesn’t make her clients feel like only the measurable information is important, and who allows each client to determine the time that they need for each appointment. 

Clinic 1050: Phase One Competencies:
Students demonstrate practical skills and competencies necessary to begin assisting a midwife and prepare for Phase One Assessment. 
Skills and Knowledge Demonstration Videos:

Skills Demos

Skills Demos

Skills Demos
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Sterile Gloving and Sterile Field Setup

Sterile Gloving and Sterile Field Setup

02:32
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Birth Equipment Setup

Birth Equipment Setup

03:21
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Breastfeeding:
Students will learn about the historical and cultural background of breastfeeding, anatomy and physiology of breastfeeding, breast milk and the infant, the breastfeeding process, and potential problems. 
Client Handout Assignment:
Clinic 1010: Phase One Clinical Practicum:
Students observe at least ten births and describe in writing one case linking knowledge or skills acquired in observed birth experiences with knowledge acquired in first year of study, specifically the Midwives Model of Care. Students evaluate the learning gained from observed birth experiences. 
*Connections Essay Assignment is displayed above. Reflection Essay:

Reflection on Observed Experiences

 

             I feel very blessed to have a variety of birth experiences logged as observes. I have acted as a paid birth assistant for a midwife before I was a student, a doula, and also a student observing/assisting a midwife. My views and feelings about birth and midwifery have changed over time.

            When I first started assisting, before I was a student, I was so happy to see birth outside of a hospital setting. It was a breath of fresh air, and I enjoyed it. I thought that everyone should have a home birth, and I wished for it to be possible and more affordable and accessible in the community. I loved the client/midwife relationship and really saw the value in the Midwives Model of Care. As I moved back into doula work I brought with me some skills and knowledge from the home birth world, which really served me and my clients well. I knew how to support and encourage women through un-medicated deliveries, I knew that women could deliver their babies in all sorts of different positions like squatting, hands and knees, or hanging from a door. I felt much more trusting of the birthing process. Moving back into the midwifery world and home births again I am reminded of the knowledge and trust that the midwife possesses, and the beauty of birth. I no longer feel that every birth should be at home, and I have a respect for families who make an educated decision about their birth location and choose a hospital birth. Deciding to be in midwifery care and have a home birth is a lot of work for the client. I am seeing that the Midwives Model of Care models shared responsibility and decision making between midwife and client and that each party has to be present every step of the way (NACPM, 2014). Not everyone wants this type of care, and I have grown to a place where I can respect that. I have experienced birth with client who was not low risk enough to deliver at home but wanted to be as low intervention as possible. I learned a lot with her about how to still find places of peace, trust, preparation, and informed decision making. Thinking outside the box and bringing a certain belief or atmosphere to an otherwise cold and stark hospital room helped tremendously. It was rewarding for the client as well as myself as she had a beautiful un-medicated hospital birth that included all of the things that were important to her. I think that remembering these perspectives will serve me well as I continue to grow into my midwifery skills and start to practice on my own.

           I often think of what life will be like when I am a practicing midwife. Right now it feels very far off so I don’t have a clear picture. I do notice things that are done at births and I feel intimidated by the skill that is needed for them; I am not at all ready to catch a baby. My experiences so far have helped me accept that not all women will birth at home, nor do they want to, and I am okay with that being the truth. Through my observe births, I see that there isn’t always a good match between midwife and potential client, and it is okay for the relationship to not move forward, in fact it is good to recognize it at an early stage and find a midwife better suited for that client. I also see that midwives have different beliefs about how to practice. Things like ultrasounds, IV use, nutritional counseling, VBACs are all hot topics and each midwife decides how she wants to handle them (within their laws). I am finding that I enjoy using fewer interventions, and I feel that I need a lot more training to be completely comfortable with that. Right now I see that the more I try to check, diagnose, or get my hands on something the further I get from what I love about midwifery care. I really enjoy sitting back and reading the woman, trusting her instinct, and being on point with her prenatal care and the relationship that is built there.

           This semester I have attended a few clinic days with my intended preceptor, and one birth so far. I am seeing that I need to develop my skills like shared decision making, palpation, and using the pinard and fetoscope for fetal heart tones. Continuing to go to clinic days will help me develop those skills and keep them fresh, as will assignments in classes that apply, such as video demos, and continued research about prenatal topics. I have noticed from these days as well as a few births attended with the midwife that clear communication and feedback is very helpful as I learn and process from birth events. I retain and feel more confident about my skills and knowledge when I am able to debrief or get feedback about my input. I also do well when I have some time to prepare for the role that I will play such as assist at a birth or participate in a prenatal appointment. I can think on what to do, and when to do it, and my brain seems more organized. It also helps to have organized supplies as well. I plan to continue communicating about what I am experiencing and how I can improve, and keeping a clear head and organized workspace as I increase my skillset and responsibilities in my apprenticeship.

          I am thankful for this time spent observing birth in multiple settings. I am able to go back and see that my thoughts and my skills have grown a lot in this time. As this phase of my education is coming to a close I feel very prepared to move on to the next phase and excited about all of the things that I will learn and experience.

Reference

NACPM. (2014). Midwives Model of Care. Retrieved from http://nacpm.org/about-cpms/midwifery-model-of-care/

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