Worry-wart = new midwife

So, you’re probably wondering how it’s going. I’m in the middle of my third week as a new midwife, and it’s going…okay…so far, I guess. I wish I could sound more confident and enthusiastic about it at the moment, but I’m having a hard time feeling very confident or enthusiastic these days. Which is not to say that I am not absolutely *thrilled* to be finally working as a midwife, or delivering babies, or taking care of so many beautiful pregnant women (I am!!!), it’s just that my general state lately has been one of extreme nervousness and tension and uncertainty. Which is, according to many of my loving and supportive preceptors, something that is expected, and something that is normal for a lot of new grads, but even so…it’s not a very pleasant place to be living in at the moment. Even if I did expect that it would feel like this.

I think the nerves and tension is all coming from the sudden onslaught of responsibility. I feel unbelievably responsible, for everything, at the moment. Heavy with repsonsibility. I’m taking my patients home with me, worrying about them at night. And I’m so scared, with all of this new responsibility, that somehow I will totally, terribly mess something up. Which I’m sure I will, given that I’m new, and bound to make mistakes, and that some of the best learning you ever do is from your mistakes. It’s just…I can’t make huge mistakes. I really can’t. These are people’s lives and bodies and pregnancies and babies on the line, so…no mistakes, right? Except that how can you learn a new job, as a new grad, and not make mistakes? Do you see where the tension headaches and the knots in the middle of my back come from?

I’m still on orientation at the moment. I have three full months for orientation, which means that my orientation will finish sometime around Jan. 10th. Ostensibly, I can ask for more time, if I feel like I need it, but I do recognize that there is a strong hope that by three months in I will be able to work like a fully functioning midwife, someone who can be an asset to the practice. And I hope the same as well, although at the moment, I’m a bit terrified of being on my own, and I certainly don’t feel ready for that. Have I mentioned lately how NUTS this practice is? How busy and crazy and overwhelming and exhausting it is? Which is fabulous, on the one hand, and is certainly one of the reasons I picked this job (after a year of this, just think of all of the amazing experience I’ll have)…but, on the other hand, is incredibly overwhelming, exhausting, crazy etc.

The sheer pace of the place is enough to knock you out: in the clinic, on average, the midwives are seeing about 25 patients a day, often more like 28-30. IN ONE DAY? Good lord, how do you even have time to say hi to that many women, let alone ask them all about their health and bodies and pregnancies, or deal with all of the many problems and questions they have? Just to give you an example: one of the women I was taking care of last week had had a positive chlamydia test two months ago, had been treated, had then slept with her partner again (who had not yet been treated), had contracted chlamydia again, and had then been treated again. She had also had a positive PPD test (for tuberculosis), an abnormal pap result, and a prior cesarean, in the Dominican Republic, and was desiring a vaginal delivery this time around. So on my visit with her, we were talking about safer sex and what that involved, abstinence until her partner could be treated, a referal for her partner to the male STI clinic, the need for a chest x-ray (to follow-up on the positive PPD test), the need for a colposcopy during her pregnancy (to follow-up on the abnormal pap smear), and the importance of getting the operative report from the hospital where she had had her cesarean in the Dominican Republic, so that she could be counselled for a VBAC and receive a trial of labor with this pregnancy (in order to have a trial of labor at this hospital, women need written proof of the fact that they had a low-transverse uterine incision during their cesarean, and are therefore at lower risk for uterine rupture). And then we went ahead and did all of the normal pregnancy visit things: is the baby moving? How’s your diet? Looks like you’re gaining a good amount of weight. Vital signs stable? Urine dip negative? Measure the uterus, palpate the baby, listen to the fetal heart, review warning signs and danger signs. Are you still taking the prental vitamins and iron? Any questions? And then, after all of that, we did a chlamydia test one more time to make sure that she’d been adequately treated. The entire visit took me about an hour. And rightly so. But technically, she was a revisit, and was supposed to only take about 15 minutes. On average, I’ve been seeing about 9-10 women a day, on a good day for me. I just can’t go any faster than that without missing something or forgetting something or not picking up on something…in essence, making a mistake.

And labor and delivery…wow. Where do I even start? I’m going fine so far, I’ve delivered three beautiful babies so far, but that’s only because I’ve been sheltered by my preceptors so far, and am not truly doing the entire job yet. They’ve been giving me one or two patients to manage so far, or else they plunk me down in the middle of triage to sort out all of the incoming women, and that’s fine. But that’s about as much as I can do right now. And meanwhile, beyond the doors of triage, there are all of the women who are in labor, who I can’t really keep track of at all. Room 5 is 6 centimeters dilated, room 7 is 8 centimeters dilated, room 8 needs another dose of cytotec, room 10 needs another note written on her at 2:00 pm, and room 5 and 7 need a note written at 2:30, and room 10 will need a note as soon as the cytotec is placed, which will happen just as soon as one of the midwives gets a chance…I have no idea how to keep track of the floor. I have tunnel vision. Keeping tabs on one or two patients is about as much as I can handle, and that is plenty to keep me busy. More than plenty. Admitting a patient, and getting through all of the paperwork, takes me a solid hour or so. I’m being very thorough…I’m proud of my notes, but I’m slow.

And the thing is, it’s okay to be slow right now. No one is yelling at me to be faster….yet. But I know…I dread…that soon enough, too soon, I will be off orientation, and then I’ll be in trouble. And granted, I’m sure that my ability to handle all of this will increase tremendously in the next three months, and worrying about running the floor at this point is fruitless and stupid, because no one is asking me to run the floor yet. So why even worry about it at this point? And yet, I can’t stop myself from thinking about it. I find myself worrying about everything right now.

This entry was posted in Hospitals, Labor and Birth, Midwifery, Pregnancy, Vaginal Birth. Bookmark the permalink. Trackbacks are closed, but you can post a comment.

3 Comments

  1. lovingpecola
    Posted November 1, 2007 at 2:23 pm | Permalink

    First, thank you SOOOO much for writing this post. I have been wanting and waiting for a new midwife to blog about her new role!!!

    Why are you consistently having to manage 2 or 3 laboring women at one time (and 5-6 in the future)? Are you doing shift work?

    Can you give rx/tx for chlamydia to the woman to give to her partner at your clinic? Some clinics do that…

    I’ll try not to ask a bunch of questions, I know you’re trying to *breathe* yourself!!!

    You’re doing great, awesome, 3 weeks already, WOW! I was thinking you wouldn’t deliver babies on your own that soon! That’s amazing. You’re amazing.

    You can do this!

    LP

  2. The Midwife
    Posted November 1, 2007 at 5:04 pm | Permalink

    The CDC recommends something called expedited partner therapy (EPT) for treating STIs, where you give the woman you’re treating a prescription for her partner in addition to the prescription for herself, and she brings it home to him and then he can fill it himself and get treated without having to go through all the hassle of scheduling his own visit to a provider and seeing a provider himself. Unfortunately, in New York state, this practice isn’t legal yet, so we’re still required to set up appointments for partners or recommend clinics for them to attend, but we can’t just write a prescription for them (yet! there is a proposed new law for this on the 2007 legislative agenda…not sure yet if it’s passed or not).

    And yes, I am doing shift work. I’m part of a midwifery service which manages patients in a clinic, and therefore we’re not able to give private one-on-one care to all of our patients, because it’s not a private practice. We’re not on call, we just work 2 L&D shifts a week, and deliver whatever women happen to be giving birth that day. Hence the craziness. But still, it’s very cool. I’ve caught 3 babies so far….and it’s just been….really, really incredible.

    Thanks for reading, and thanks (as always) for all of your support!!

  3. Posted November 3, 2007 at 9:19 am | Permalink

    First, big congrats on being a new midwife. I was interested to see in your description how “medical” the treatment of the L&D patients seems to be, despite having a midwife on hand. Any thoughts on that?

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