Last day of clinicals

Yes, it’s true, my antepartum/well-woman gyn ambulatory clinicals ended today, with a lot of mixed feelings involved! On the one hand, I’m thinking: thank the gods that’s over, because I need every spare millisecond to study now. On the other hand, I was just getting to the point that I was starting to feel like I had a clue, and was actually beginning to feel like I was doing an okay job (how’s that for a tentative sentence?) The pieces were just starting to fall into place, just in time for me to leave. And while I still have many objections to the clinic, such as how medical the care is (which, some would argue, is a good thing, but in my book midwifery care is very different from medical care…although it certainly incorporates many important aspects of medical care… but with a kinder touch…and the care at this clinic was definitely on the more medical end of the spectrum, if that makes any sense at all), I did learn an awful lot while I was there. The importance of speed was omnipresent, and I had more than one preceptor explain to me that unfortunately, that’s just the reality of our healthcare system, and that I should enjoy myself as a student because that’s the only time in my career that I’m actually going to have time to spend with a client…and maybe that is the case when you’re working in a large, hospital-based clinic, but damnit, why does it have to be like that?? These women deserve so much more than 15 minutes of time, and even though a midwife may be able to give them a very high quality 15 minutes, it’s still 15 minutes! For myself, I think I’m really going to have to think about where I want to practice when I graduate. I’ve always known that I’ll be doing homebirth someday, but homebirth isn’t something I am prepared to do as a new graduate. My original plan was to get a job in a hospital practice for a few years after graduating just to finish learning the ins and outs of the System, getting confident in my practice, and finally (finally!) moving on…but now I’m thinking that maybe I should graduate, and move immediately into where I belong: apprentice myself to a homebirth midwife, learn about the other side to midwifery care, the side that involves hour long prenatal visits, and using herbs more often than drugs, and existing almost completely in a world where birth is viewed as normal, and you never have to worry about appeasing the system, or worry about “taking too much time” with a client…but is that reality, or would that just be me turning my back on women that need my help, in order to work as a luxury midwife in a luxury setting, with the luxury of time?

But I digress. The point is, I learned a lot in clinicals. Tons. Basic stuff: I can now put in a speculum and find the cervix right away almost every time. I’ve learned how to be gentle with my exams, and how to ease women into them. I’ve taken some very good advice from a very wise midwife who’s been doing this for years, and have worked hard to get into the habit of always telling women that their cervix is beautiful (because how often do women hear that their bodies are beautiful? And especially from a healthcare professional? And especially that particular part of their bodies, which they have probably never seen, and may never have even thought about before…but how nice to hear that it’s beautiful! Wouldn’t that make you feel good about your body?), ensuring that they have tissues in their hands before I even begin the exam (a small modicum of control during a very exposing and vulnerable experience), and telling them that their pelvis is nice and roomy, just perfect for giving birth (and even if their pelvis isn’t enormous, who knows how big their baby is going to be? It could be a tiny little six pound baby that will slip through a small pelvis with nary a squeak. I just don’t think there’s any point in planting seeds of doubt about a woman’s ability to give birth vaginally, and certainly not during her initial prenatal visit, when you have no idea how large her baby will be! Most women grow babies that are the perfect size for their pelvis, assuming they’re allowed to labor in an upright position, and use whatever position they need during the birth, and squat and rock and roll and etc. etc.; epidurals are another thing altogether, don’t get me started). I’ve gotten much better at looking at women’s labs, taking a health history, starting to see the larger picture and formulating the appropriate plan to take care of them in the best manner possible (although the plans are still pretty difficult). All of this is stuff I wasn’t capable of 2.5 months ago, so these are all huge steps.

I do wish learning hurt a little bit less. I wish all of this were an easier process. I’m really getting nervous about my intrapartum clinicals next semester (actually catching babies????? You’ve GOT to be kidding me!). Antepartum is so complicated and difficult as is, and I still have SO much more to learn—I can’t even imagine intrapartum. But it’s nice to be able to look back over the past two months and see that progress has indeed been made. And then breathe a huge, whopping sigh of relief because thank the gods it’s over, and I can finally turn my full attention to my homework!!!

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2 Comments

  1. Posted May 1, 2006 at 8:35 pm | Permalink

    15 minutes is horrible, isn’t it? Yet, even in medicalized practices, most women end up forming a very unique and special bond with their women’s health caregiver, whether it be with an OB/GYN or a midwife.

    I also wanted to let you know that I have been thinking about your FGM posts for days now. Wow. Such a shocking thing – we always imagine we’d know just the right thing to say but moments like that just happen so suddenly. For the record, I think you handled it perfectly. You acknowledged what had happened to her, without being insulting to her culture, and you left a window open in case she wanted to discuss it further, which she did not. You will be an incredible midwife. :)

  2. Posted May 2, 2006 at 2:28 pm | Permalink

    This sounds awesome. I can imagine that it is difficult, but as you said, look at all you have accomplished. Next semester will be hard and then you’ll back, and by the end you’ll be comfortable with everything!

    It must be awesome to be able to actually see the progress. I can’t wait to be there!

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