Welcome to the Bronx

Well, I didn’t exactly get thrown into the deep end, but I wasn’t eased in quite as gently as I might have hoped, either—so I guess, all things being equal, my first day of clinicals certainly could have been much worse. I met my preceptors, and they both sort of threw me for a loop. The first one is very no-nonsense and to the point (although very very efficient and thorough); she didn’t smile much, and was definitely somewhat intimidating at first, until I got to know her a bit better. The second one was very gentle and soft-spoken and full of smiles. They both had very different teaching styles. My first preceptor carefully explained each patient to me before I met her: we went over labs, she walked me through the documentation, highlighted important areas that I had to discuss with the patient, and basically helped guide me through the management process. She was also very willing to let me shadow her for a few patients, and join her in whatever room she was in. My second preceptor would say things like “how about doing that new OB admission in room 3?” and would then leave me to it, although she was always very patient with me whenever I asked her questions, which was almost all the time. I guess, on my very first day of clinicals, a little bit of both methods of precepting was probably a good thing.

And what a first day! I saw 7-8 revisits (i.e. women coming in for follow-up appointments after their intitial prenatal visit), did one initial visit pretty much entirely on my own (and oh boy, all the mistakes I made!), and finished up with one postpartum visit. It seemed like an incredibly full day. So many fundal height measurements, and Leopold’s manueavers (which I’m getting much better at—I was actually able to tell when the baby’s heads were down, by the end of the day, and I got to feel what “balloteable” feels like, when the baby’s head is down, but not yet engaged), and so many gorgeous, gorgeous bellies, and little squirmy babies that would move beneath your hands while you were palpating. And I was absolutely amazed by the diversity of patients I saw: it would seem that the Bronx, even more than Manhattan, is a microcosm of the entire world. So few of my patients spoke English as their primary language. I saw one woman from Albania, with her two adoreable kids in tow, and one woman from Bangladesh, in a gorgeous silk sari with all kinds of spangles and bangles and beads on it, bracelets up to her elbows, enormous jeweled tear-drop earrings, and a jewel-studded nose-ring, and this was just her average, every-day wear. I saw a woman from Mali who only spoke French, and I ended up having to use an interpreter through the phone bank in order to talk with her. She was absolutely gorgeous, tall and ebony black, with enormous silver earrings, and short-cropped hair, and a large scarf wound around her head, and a beautiful, proud pregnant belly. I saw a woman from Pakistan who wafted a delicious curry smell through the room every time she moved, and was wearing a sari made of curdoroy. Two Latina women, one of whom (my initial OB intake that I was doing on my own) only spoke Spanish. There was also a Jamaican, and two African Americans, one a devout muslim in full burka. What a roster! I felt like the entire world was parading through the door.

So few of these women have health insurance. One or two had only just arrived in this country. Almost all of them were on WIC. One was convinced that the reason she’d miscarried her first child was because she’d bounced over too many potholes in a rickshaw in her home country. One was terrified about her risk for cervical cancer, because she’d only just learned that she’d had an abnormal pap. One was told, for the very first time, that she was Hepatitis B positive. One told me that her boyfriend had just recently hit her for the very first time ever while she was holding their baby, and that she’d fallen flat on her back in order to protect the baby. She’d called the police; she wasn’t pressing charges, although the ACS (Administration for Children’s Services, the child protection program in NYS) was now inovlved. We talked about whether she felt safe or not, how she could protect herself and her baby, what resources she could use if it ever happens again, and that if her boyfriend is capable of hitting her once, chances are very good that he will be capable of hitting her again.

Afterwards, overwhelmed and exhausted, I feel a bit stunned. And amazed. Funny how so much of my experience with midwifery so far has been helping one very specific population of women—a population for whom having a midwife, and a doula, and a delicious, natural childbirth is very much a luxury, reserved for women with insurance, and the education to know that they want that kind of birth in the first place, and the money to afford doulas, and birthing balls, and private midwives. However, there is another side to midwifery, with which I’ve had very little experience so far: the side that takes care of the women without health insurance, without disposable income, with children in tow, for whom natural childbirth isn’t a luxury, but a reality, because you can bet your bottom dollar that these women without health insurance, and without private doctors, aren’t going to end up with cesareans unless they really, truly, need one. It’s so heartening to see that these women also have access to midwifery care, which, in my most humble opinion, is the best kind of care out there—the best of both worlds.

And I bet for many of these women, going to see a midwife feels so much more natural than going to see a doctor for their prenatal care, anyway. Who attends most of the births in Mali? I bet you anything it’s not a board-certified obstetrician.

I have a feeling I’m going to learn so much from my clinicals, and not just how to manage prenatals, or do a good bimanual exam! And I’m really looking forward to Friday’s clinicals, where I’ll be working in Family Planning. The nerves have somewhat dissipated, although I know I still have a long way to go.

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