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Phase Three

This page showcases learning from the following classes I have completed in midwifery school:
All course descriptions are taken directly from the MCU Course Catalog.
Midwifery 3010: Complications of Prenatal Care
Midwifery 3060: Fundamentals of Waterbirth
Midwifery 3030: Complications of Labor, Birth, and the Immediate Postpartum
Clinic 3010: Phase 3 Clinical Practicum
Clinic 3020: Phase 3 Clinical Practicum
Clinic 3030: Phase 3 Clinical Practicum
Clinic 3040: Phase 3 Clinical Practicum
Clinic 3060: Phase 3 Clinical Practicum
Complications of Prenatal Care
This course covers complications during the prenatal period. Students will prepare midwifery practice directive documents that guide management for complications during the prenatal period. Case studies are utilized to demonstrate the application of clinical judgment and management within the scope of care of the Certified Professional Midwife. 
Poster: Infectious Disease in Pregnancy
Practice Guideline: Nausea and Vomiting in Pregnancy
Informed Consent or Refusal for GBS Testing and Treatment
Clinic 3010, 3020, 3030: Phase 3 Clinical Practicum:
Students act as primary midwife under supervision for appropriate prenatal, labor and birth, postpartum and newborn care duties with an approved preceptor and describe in writing, oral presentation or other appropriate demonstration, one case from each area (prenatal, labor and birth, postpartum and newborn care), linking knowledge or skills acquired in primary experiences with knowledge acquired in phase three of study, including current research in the field and composing at least one tool per case (such as a diagnosis flowchart, practice guideline or client education outline) that can be shared with peers. Students evaluate learning gained from total clinical experiences. Students should plan to spend a minimum of 100 hours in clinical placement during the trimester (an average of about 7 hours/week). 
During this school term, I was in 3 clinic classes as I was in a busy clinical placement and knew that I would have plenty of hours to triple up on this class.
Reflection Essay Assignment:

Reflection on Primary Experiences

         As I moved out of the assist role and into the primary role I clearly felt as though I was crossing an invisible yet tangible threshold. That feeling surprised me. I was so ready to move forward; waiting impatiently for that time to come. Suddenly, it seemed, I was on the downhill side of the climb; I could see the end more clearly than the beginning. It was freeing, it was bare, and it was scary.

        This term was the first term that I could technically start acting in the primary role as a student under supervision. I was surprised to feel a new sense of responsibility with that title change. I now feel more expectation from my preceptor to step up and take a role in education and other forms of primary care: physical assessment, content related to care plans, and more. Because of my preceptor’s increasing expectations of my role in the practice and in client care, I have had more opportunity to practice skills and convey recommendations and knowledge. I am thankful for the way she has slowly and appropriately increased my responsibility and handed me opportunities to practice and learn. It is through these opportunities that I have been able to detect nuances in cervical dilation, application of the fetal head on the cervix, estimate blood loss, assess extra-uterine transition of the newborn, and practice giving individualized support fueled by what I am being taught, what the client needs and prefers, and what my preference is as I develop as a midwife. When the opportunity arises for me to step out of my comfort zone as a student, to try something that I have only studied on paper, I respond with a “yes” to my preceptor, knowing that she has my back, she will support me, answer my many questions, and be there with me as I learn and walk in uncomfortable spaces that require stretching. It is in these spaces that I notice growth, sometimes in leaps and sometimes in baby steps. I still have most of my primary student work ahead of me, but I see the trajectory that I am on, and I know that it is a good one.

        There have been areas in my clinical work that have been challenging. The biggest strain I feel regularly is balancing clinical work in the practice and focusing on schoolwork. I admit that I do not balance these responsibilities well, in fact, I feel overwhelmed by both pieces most of the time. I have yet to find appropriate harmony between the two, and I wonder if it really exists. What does exist is constant stress, exhaustion, feeling like I can’t give my best to either, and a lack of focus on anything in my personal life or health. I have had to make peace with this as part of my journey through midwifery school. I have been able to communicate my school needs to my preceptor in times where I have class presentations or other time-sensitive needs; she has been understanding and has made space for me to attend classes when needed. One of the benefits of the intensity of the work at MCU is that there are many times when something comes up clinically that I have studied in a class or made a handout for. In those times I see clearly how the bookwork and clinical needs overlap, and I am thankful for the focus that MCU has required of me. 

        Some of the moments that will stick with me the most are times where my preceptor and clients have shown gratitude and given me unsolicited feedback on my knowledge and care. Hearing from a client that they were so appreciative of my care for them, my role in their experience, and that that they were thankful for me as an individual – I hope to never forget those words and sentiments. Furthermore, when my preceptor praises my care for her clients, reflects on my choice of questioning or individualized focus, or confirms my assessment to be the same as hers, my heart soars and I feel valued. There is so much pressure to improve, to succeed. As a student, you wear your heart and your worth and identity out on your sleeve; it feels as though everyone can see it, it is vulnerable. These kind words, assessments of growth, validation of skill, and reminders of identity and value within and outside of midwifery are priceless.

        My thoughts and feelings at the end of this semester are a bit more abstract than previously. I suppose used to measure success and growth more tangibly (I am comfortable there). I can now see growth in a different way. I still prefer comfort, clear assessment of change and growth, a path that I can track – but I am getting used to noticing growth through hard times, finding small things that show improvement, and sitting through discomfort as part of the process. Maybe I am in the stage of my studentship that can be compared to the transition stage of labor: increased discomfort, increased intensity, unsure if I have what it takes to make it to the end and what is coming ahead. But, there is no going back and there is celebration for my arrival in this stage as it marks progress toward my goal and the prize that is at the end of my journey.

Fundamentals of Waterbirth
This course presents the latest research and model practices regarding hydrotherapy for labor and birth. Waterbirth benefits, risks, and contraindications are addressed. Students will create practice documents, including care and cleaning protocols, client handouts, informed consent documents, and practice guidelines for use in practice. Practical considerations for a smooth waterbirth experience for client and midwife will be addressed. A variety of learning methods are used to address course objectives, including professional videos, student-conducted research, in-depth study of latest publications on waterbirth, online discussions, and interactive sessions.
Review of Umbilical Cord Avulsion:
Complications of Labor, Birth, and the Immediate Postpartum
 
 
This course covers complications in more depth for labor, birth and immediate postpartum. Focus is directed towards writing midwifery-practice documents for emergency care and variations of normal delivery, and preparing a research article for publication. Case studies are utilized to demonstrate the application of clinical judgment and management within the scope of care of the Certified Professional Midwife. 
Transfer Plan
Clinic 3040 and 3060: Phase 3 Clinical Practicum:
Students act as primary midwife under supervision for appropriate prenatal, labor and birth, postpartum and newborn care duties with an approved preceptor and describe in writing, oral presentation or other appropriate demonstration, one case from each area (prenatal, labor and birth, postpartum and newborn care), linking knowledge or skills acquired in primary experiences with knowledge acquired in phase three of study, including current research in the field and composing at least one tool per case (such as a diagnosis flowchart, practice guideline or client education outline) that can be shared with peers. Students evaluate learning gained from total clinical experiences. Students should plan to spend a minimum of 100 hours in clinical placement during the trimester (an average of about 7 hours/week). 
During this school term, I was in 2 clinic classes as I was in a busy clinical placement and knew that I would have plenty of hours to double up on this class.
Reflection Essay Assignment:

Reflection on Primary Experiences

            I am coming to the end of my student midwife journey. These words and this realization are hitting me hard. Can I really be almost done? Am I finally close to leaving the student identity behind, and picking up the midwife identity – to be a licensed healthcare provider? The weight of that responsibility and pride for my journey are heavy, but I feel prepared to carry them. 

            How has this last semester changed me? What have I experienced and accomplished? As I survey my clinical experience, I see that my skills have been honed and solidified; polished. I am by no means done learning, nor have I experienced everything, but I trust my training, I trust my response to emergency situations, I trust my skills, the muscle memory that years of practice have built. I hear myself counseling clients and reassuring them, saying hard things, and comforting them. I feel comfortable and happy in this place, at peace, at home.

            Recently, I had a clinical experience that rattled my edges. It was a birth complication that needed swift and skilled action and decision-making. I was there, managing the birth, supporting the father in his desire to receive his baby, but as the baby emerged, it was clear that something was not exactly right. We discovered what the problem was, and intervention was needed. What do I do now? I spoke to the midwife, I reassured and instructed the client, I responded to her questions, I reassured the father. I answered the midwife’s questions, I told her my plan, all the while manipulating, assessing, thinking, watching. The human body is a marvelous thing, and the labor process could not be stopped. The body worked to expel the baby, and I responded to that work. The baby was born, shocked, but well. Everyone exhaled their relief and joy. We reassured each other and the new parents. I could feel the adrenaline coursing through my body, it would die down soon leaving me space to process what had happened.

            Soon after, I spoke to my preceptor – I was looking for feedback, for reassurance, I felt unsure of myself and what had just played out. She was happy, reassuring with her words and body language. She reminded me what a midwife does: they act, talk to the other clinicians in the room, make a plan, reassure and instruct the clients, work with their hands, assess. Hadn’t I done all of these things? She reminded me of what she is looking for in student growth: acting, speaking, does the student freeze up? does the student know what to do when a complication arises? Did I do those things? Yes, I did. Did I understand the complication and what my clinical options were? Yes, I did.

            It all clicked then. This is what being a midwife is. This was the fruit of my hard work in clinic learning from my preceptor, and in school reading the texts and absorbing the material. This is why we make videos of ourselves modeling skills, why we write essays. We do these things so we can assess, act, resolve, reassure, and communicate when things aren’t smooth. We do these things to protect birth when it isn’t straightforward. We do these things so that we can carry the weight of responsibility of calling ourselves Midwife.

            I am faced with the fact that my identity is shifting. This is so much more than what I expected at the end of this journey. Who is this new person? Am I really becoming someone new, or is this who I always was? Maybe now I am a fuller, bolder version of myself. Maybe I fill out corners of myself that used to be void. Maybe this purpose, this weight, holds me firmly on my path – the path that leads forward to an unknown place. Is the destination the goal, or am I the goal? I have received something so unexpected, I’m not even sure I fully understand what it is. What a wild journey it has been.

Written Note from a Client:
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