I got another job interview! I will be flying to a far away state for this one. It is in a level 1 hospital, in a practice with OB/GYNs, midwives, and family nurse practitioners. In a pretty small town. Pretty meaning beautiful and pretty small meaning about 16,000 people in two zip codes. Could be fun! Would be very, very different from the life I've been leading in the city for most of my life. And a very different kind of job than that I looked at before.
Fortunately, I have a month before I actually fly out there to figure out all of my questions. And there are many. And there are many I probably don't even know to ask. One that they won't be able to answer is the number of intelligent, cute, outdoorsy single men who are looking for a woman. But if they want me to come & stay, maybe they should consider wooing me in more ways than one.
Leaving my hometown sounds awful and exciting and scary all at the same time. Only time will tell where I end up when this job search ends. I'll keep you posted.
Monday, February 28, 2011
Not quite time for an epidural . . .
Maybe I'm mean, but these are really fun births for me! This mom arrived at the hospital at 7 cm with a bulging bag, requesting an epidural, handling contractions beautifully. It took about an hour for the anesthesiologist to arrive, since it was the middle of the night, and when she got there, the woman stood up to reposition for her epidural, her water broke, and 3 contractions later, her little girl was in her arms. She didn't even push. That little baby just came right out with the uterus doing all of the work. Very cool. I think in the end, the mom was happy about how it went. She could get up after I was done repairing her minor perineal tear and take herself to the bathroom since she didn't have a catheter.
Any midwife preceptor would be proud of how quickly I put on my sterile gloves. I was even faster than the CNM!
However, I still have a lot to learn about maintaining a sterile field. Argh.
Any midwife preceptor would be proud of how quickly I put on my sterile gloves. I was even faster than the CNM!
However, I still have a lot to learn about maintaining a sterile field. Argh.
Sunday, February 20, 2011
2 babies this week!
The first was a woman pregnant with her second little girl. She had more protein in her urine than we like, and on top of her chronic hypertension, we called her pre-eclamptic, since she was term at 38+5 weeks, so brought her in for induction. She had a ripening agent called misoprostol overnight, and then the pitocin started around 0700, around the time that my shift began. She was pretty sure she wanted an epidural, and talked about "what a wussy" she'd been during her previous labor. I encouraged her to wait until she was 4-5 cm before getting the epidural, in order to prevent the epidural from slowing things down (hopefully). She relaxed in bed for the better part of the morning, and around 11 AM started getting more uncomfortable. My nurse checked her, and she was 4 cm! She got up and went to the bathroom, reporting some pressure, and a need to poop. SIDE NOTE: I love it when women need to poop in labor! It means that their body is either cleaning itself out because they're having a baby soon, or that the baby's head is actually pushing the poop out. Either way, things are looking good! So, back to the story, she ended up hanging out and laboring on the toilet for a while, pooping, and moaning, and crying. When I went in to see her, she really wanted her epidural NOW. I encouraged her through a few contractions, and calmed her down a bit. She was actually coping quite well, but didn't believe me when I told her that. When our nurse returned and said that anesthesia was on the way, I helped her get up to bed. Her epidural was placed just before noon, and when I checked her, her cervix changed during the contraction I felt from 6 to 7 cm! I ruptured her membranes (broke her water) and then left the room to write a note. Within minutes, I was back in the room, and she was pushing her baby out. We noticed that as the contractions built up, the baby would start pushing herself out, so we let her assist in her own birth. That was very cool! A lovely little girl weighing 8 lbs 13 oz was born at 12:32 pm. She had a tight nuchal cord, so I somersaulted her out, and put her right up on mom's belly. She had an awfully long cord, and I let it pulse for a few minutes before cutting it. Collecting cord blood was very messy - I'm not so practiced at that - but I did it, eventually. Then out came the placenta, complete and quite large, but with some calcifications, which can decrease blood flow to the baby. They may have something to do with the pre-eclampia. She had a midline perineal tear that I sewed up . . . great practice for me, and in the end it did look nice. By the time I left the room, baby was breastfeeding and mom, dad and big sister were all very pleased with the experience.
My second baby was a little boy born to first time parents who came in later that day, maybe around 1800 (6 pm), on their due date. This was a very young, very cute couple very excited to meet their son. Mom was in active labor when she arrived, at 4 cm. She wanted her epidural soon, although she seemed to be handling labor quite beautifully. Her labor continued, but slowed down a bit after the epidural, so I watched it for a few hours. Sometimes, an epidural will slow things down for a bit, but once the body adjusts to the new surroundings (the hospital) and the new physiology (epidural), things kick back in. But her labor was still somewhat spaced out, so we added a "whiff" of pitocin, starting at 1 mU/min and slowly increasing over several hours to 4 mU/min. Her contraction pattern got a little strange - not bad, but strange, with mild contractions one after the other for about 4 minutes, then a 1-2 min break, then a moderate contraction, then repeating that strange sequence. The nurse (one of my favorites!) and I decided to turn the pitocin off, to see if that would reset her contractions. Within about 20 minutes, her contraction pattern looked much better, and we never turned the pitocin back on.
About 2330, I went upstairs to get some shut eye. about 0100, my nurse called and told me she was feeling lots of pressure, so I went back downstairs to check her. She was 6 cm by this point, and the baby was getting lower. I ruptured her membranes, and her cervix changed to 7 almost immediately. I tried to determine what position the baby was in. Earlier, I had thought the baby was in ROA, with the front of his head turned toward her back. But this time, I wasn't so sure. Now that I could feel the head directly, rather than through the bag, I thought I felt the familiar 4 points of the anterior fontanel toward her pubic bone. Uh, oh. But I wasn't convinced, and her labor was progressing nicely. Her awesome nurse had been turning her from side to side, sitting her up, changing her position about every 30-45 minutes throughout the night. That can help baby find their position in the pelvis, and with an epidural, mom can't move around in the same way she would without, so rotating her often can make a difference in helping the baby find its way through the pelvis. This baby was finding his way. When she reported even more pressure at 0330, I checked her again, and the cervix was gone - melted away around the baby's head, which was now quite low. We sat her up and allowed her to labor down, meaning we just let her body push her baby down through her pelvis. Around 0430, it seemed prudent to begin actively pushing, since she was getting even more uncomfortable, and having uncontrollable shakes. But my nursing staff was busy getting someone else ready for a cesarean section, so we waited until just before 0500. That little lady pushed effectively for about 11 minutes before delivering a healthy little boy, born in a direct OP (occiupt posterior) position, or sunnyside up! He turned himself toward his mom's right side, then delivered his own anterior shoulder and right hand! I put him up on his mom's belly, where he took a big breath and cried out, turning pink. Good boy! The placenta delivered itself almost immediately, and it was a good looking placenta, with some minor calcifications. That little guy was 7 lbs 12 oz, and had some swelling on his head just above his forehead from his position in the pelvis. Otherwise, he was quite cute! Mom had a perineal tear, also, a second degree, but barely. Another repair - what good practice for me, and the midwife I was working with had some great coaching/instructions to help me do a neat job. That little guy was eager to breastfeed, and those parents were thrilled to finally meet him! The other fun part about that delivery was how involved the dad was. He had said earlier that he probably wouldn't watch, but he got pretty excited about it, and ended up standing on my left several times, watching the birth of that head. Mom was eager to feel her baby, so from time to time, she'd reach down and feel the head and get so excited to feel her baby so close. They were both so excited and into their birth experience, and it was fun to be a part of that with them.
Lovely!
My second baby was a little boy born to first time parents who came in later that day, maybe around 1800 (6 pm), on their due date. This was a very young, very cute couple very excited to meet their son. Mom was in active labor when she arrived, at 4 cm. She wanted her epidural soon, although she seemed to be handling labor quite beautifully. Her labor continued, but slowed down a bit after the epidural, so I watched it for a few hours. Sometimes, an epidural will slow things down for a bit, but once the body adjusts to the new surroundings (the hospital) and the new physiology (epidural), things kick back in. But her labor was still somewhat spaced out, so we added a "whiff" of pitocin, starting at 1 mU/min and slowly increasing over several hours to 4 mU/min. Her contraction pattern got a little strange - not bad, but strange, with mild contractions one after the other for about 4 minutes, then a 1-2 min break, then a moderate contraction, then repeating that strange sequence. The nurse (one of my favorites!) and I decided to turn the pitocin off, to see if that would reset her contractions. Within about 20 minutes, her contraction pattern looked much better, and we never turned the pitocin back on.
About 2330, I went upstairs to get some shut eye. about 0100, my nurse called and told me she was feeling lots of pressure, so I went back downstairs to check her. She was 6 cm by this point, and the baby was getting lower. I ruptured her membranes, and her cervix changed to 7 almost immediately. I tried to determine what position the baby was in. Earlier, I had thought the baby was in ROA, with the front of his head turned toward her back. But this time, I wasn't so sure. Now that I could feel the head directly, rather than through the bag, I thought I felt the familiar 4 points of the anterior fontanel toward her pubic bone. Uh, oh. But I wasn't convinced, and her labor was progressing nicely. Her awesome nurse had been turning her from side to side, sitting her up, changing her position about every 30-45 minutes throughout the night. That can help baby find their position in the pelvis, and with an epidural, mom can't move around in the same way she would without, so rotating her often can make a difference in helping the baby find its way through the pelvis. This baby was finding his way. When she reported even more pressure at 0330, I checked her again, and the cervix was gone - melted away around the baby's head, which was now quite low. We sat her up and allowed her to labor down, meaning we just let her body push her baby down through her pelvis. Around 0430, it seemed prudent to begin actively pushing, since she was getting even more uncomfortable, and having uncontrollable shakes. But my nursing staff was busy getting someone else ready for a cesarean section, so we waited until just before 0500. That little lady pushed effectively for about 11 minutes before delivering a healthy little boy, born in a direct OP (occiupt posterior) position, or sunnyside up! He turned himself toward his mom's right side, then delivered his own anterior shoulder and right hand! I put him up on his mom's belly, where he took a big breath and cried out, turning pink. Good boy! The placenta delivered itself almost immediately, and it was a good looking placenta, with some minor calcifications. That little guy was 7 lbs 12 oz, and had some swelling on his head just above his forehead from his position in the pelvis. Otherwise, he was quite cute! Mom had a perineal tear, also, a second degree, but barely. Another repair - what good practice for me, and the midwife I was working with had some great coaching/instructions to help me do a neat job. That little guy was eager to breastfeed, and those parents were thrilled to finally meet him! The other fun part about that delivery was how involved the dad was. He had said earlier that he probably wouldn't watch, but he got pretty excited about it, and ended up standing on my left several times, watching the birth of that head. Mom was eager to feel her baby, so from time to time, she'd reach down and feel the head and get so excited to feel her baby so close. They were both so excited and into their birth experience, and it was fun to be a part of that with them.
Lovely!
Saturday, February 12, 2011
What kind of midwife?
I'm really struggling to figure out my next step after I finish school this spring. Obviously, I want a job, I want benefits, I want a PAYCHECK! But there are some options to what kind of job, and that comes attached to what kind of benefits & paycheck. Here are two options:
1. Out of hospital birth, aka OOH. This involves working with women very intimately during their pregnancy, being with them for hours and hours during the birth, and then caring for them postpartum. The clinic where you see them for visits is homey, comfortable, and no stirrips are present for any type of exam, whether it be for a pap smear or a cervical check. Prenatal and postpartum visits, alike, last 60 minutes. It is incredibly time consuming and wonderfully fulfilling. You create relationships that can last through several more babies, and sometimes even turn into friendships. When you sleep at night (when you can), you feel great about the work you do. On call 10 days per month, where you can be at home if no-one is laboring, or at a labor for hours and hours until that baby is born and mom & baby are safely out of the scary transition period after birth. And the pay is about $60K. Some benefits included. (Sounds great, right? I never made that much as a teacher!!!)
Or
2. Hospital birth. This involves working in a practice with a group, usually between 5-7 other providers. You see patients in typical clinic rooms for their prenatal visits, and depending on your schedule, their schedule, and other factors, you may or may not see the same patients over and over. Their visits are 20 minutes long. You may be on call at the hospital when they arrive in labor, or you may take over their care when your shift begins. Your shift is 24 hours long, not longer, not shorter. You leave when your patient is undelivered, possibly leaving her with a provider with different values about care, even though you are in the same group, and that doc is really a very nice person. And leaving a laboring woman can wreck havoc on her labor, causing a stress response, which can slow down labor, or cause it to even stop sometimes. (Of course, sometimes there is no change at all, but you never know!). Relationships with patients are good, the job is fulfilling, but the intensity and lifelong relationship just isn't there. With this job, there are 5 days on call for 24 hours each per month. 4 weeks of vacation, benefits, and $90K.
Yikes! More sleep and $30K more money!!! What's the decision, right?
Well, as you know, if you know me, I'm a smart cookie who spent her first "life" being a teacher. Enjoying work every day (or at least most of them). But NOT making a lot of money. I could have quit teaching and made tons more money. But I chose to be a role model for children instead. Middle school ones. I must be crazy, right? So I guess I'm a sucker for punishment. I like feeling great about my job, instead of just having lots of money.
But, you say, you'll have 40-50K of debt when you finish school. Don't you want to pay that off?
Great thought. Yes, I do. As soon as humanly possible. So again, it seems like a no-brainer.
And still I struggle with the decision. What kind of care do I want to provide to women?? Where will I make the most difference?? Where will I feel more fulfilled?? Where will I be able to balance my life and my work most effectively??
I guess I have some time to figure it out. Until then, I guess I won't close any doors . . .
1. Out of hospital birth, aka OOH. This involves working with women very intimately during their pregnancy, being with them for hours and hours during the birth, and then caring for them postpartum. The clinic where you see them for visits is homey, comfortable, and no stirrips are present for any type of exam, whether it be for a pap smear or a cervical check. Prenatal and postpartum visits, alike, last 60 minutes. It is incredibly time consuming and wonderfully fulfilling. You create relationships that can last through several more babies, and sometimes even turn into friendships. When you sleep at night (when you can), you feel great about the work you do. On call 10 days per month, where you can be at home if no-one is laboring, or at a labor for hours and hours until that baby is born and mom & baby are safely out of the scary transition period after birth. And the pay is about $60K. Some benefits included. (Sounds great, right? I never made that much as a teacher!!!)
Or
2. Hospital birth. This involves working in a practice with a group, usually between 5-7 other providers. You see patients in typical clinic rooms for their prenatal visits, and depending on your schedule, their schedule, and other factors, you may or may not see the same patients over and over. Their visits are 20 minutes long. You may be on call at the hospital when they arrive in labor, or you may take over their care when your shift begins. Your shift is 24 hours long, not longer, not shorter. You leave when your patient is undelivered, possibly leaving her with a provider with different values about care, even though you are in the same group, and that doc is really a very nice person. And leaving a laboring woman can wreck havoc on her labor, causing a stress response, which can slow down labor, or cause it to even stop sometimes. (Of course, sometimes there is no change at all, but you never know!). Relationships with patients are good, the job is fulfilling, but the intensity and lifelong relationship just isn't there. With this job, there are 5 days on call for 24 hours each per month. 4 weeks of vacation, benefits, and $90K.
Yikes! More sleep and $30K more money!!! What's the decision, right?
Well, as you know, if you know me, I'm a smart cookie who spent her first "life" being a teacher. Enjoying work every day (or at least most of them). But NOT making a lot of money. I could have quit teaching and made tons more money. But I chose to be a role model for children instead. Middle school ones. I must be crazy, right? So I guess I'm a sucker for punishment. I like feeling great about my job, instead of just having lots of money.
But, you say, you'll have 40-50K of debt when you finish school. Don't you want to pay that off?
Great thought. Yes, I do. As soon as humanly possible. So again, it seems like a no-brainer.
And still I struggle with the decision. What kind of care do I want to provide to women?? Where will I make the most difference?? Where will I feel more fulfilled?? Where will I be able to balance my life and my work most effectively??
I guess I have some time to figure it out. Until then, I guess I won't close any doors . . .
Thursday, February 10, 2011
Challenges
While I could write about the great day of clinic I had last week or the fun day on call that I had this week, and even complain about how tired I was on Tuesday after sleeping maybe 4 hours, or how I didn't get to actually catch the baby because once that momma decided to push, it took less than 8 minutes until delivery, and the CNM beat me there, what I'm going to do (other than write ridiculously long run-on sentences) is write about me when I'm tired.
On my interview last week, one of the questions was, "What are you like after 30 hours of no sleep?" At the time, I wasn't sure. I've never gone 30 hours without sleep, and said so. I still haven't, but I've had time to reflect on who I am when I'm tired and overwhelmed. So here it is:
I get cranky. Not with those around me, but with myself. I get really upset at my lack of brain power, organization, ability to complete a task. Little things that I can usually blow off make me more upset than they should. I'm more likely to spill things (drinks, a bowl of cereal) and then get angry that I have to clean up. I am later than usual getting things done. And sometimes, hopefully rarely (but you'll have to ask those around me), I throw a little tantrum. Like this morning. I'm tired, but slept last night and the night before, so I've gotten 4+6+7=17 hours of sleep in the last 3 nights. Not really that bad (although I'm much nicer with 24 hours of sleep in three days). I'm behind on my school work, which is stressing me out, since it feels unlikely that catching up is possible. And then my phone died last night in the middle of a conversation. Not like it died and needed to be charged, but it died. Not working. Which meant that this morning when I was supposed to be calling another state for a phone interview, I couldn't. (I'm writing from the Apple store where my iPhone is now restored).
So the short story is that all of this stress caused me to have a temper tantrum about not being able to find a check that I wanted to deposit. Out loud, around a friend. Not directed toward her, but she had to see me just getting angry about something fairly unimportant. Ugh.
Fortunately, she's a good friend. She tried to calm me down. She still loves me.
And I'll get over it, move on, and try not to throw such a fit next time.
On my interview last week, one of the questions was, "What are you like after 30 hours of no sleep?" At the time, I wasn't sure. I've never gone 30 hours without sleep, and said so. I still haven't, but I've had time to reflect on who I am when I'm tired and overwhelmed. So here it is:
I get cranky. Not with those around me, but with myself. I get really upset at my lack of brain power, organization, ability to complete a task. Little things that I can usually blow off make me more upset than they should. I'm more likely to spill things (drinks, a bowl of cereal) and then get angry that I have to clean up. I am later than usual getting things done. And sometimes, hopefully rarely (but you'll have to ask those around me), I throw a little tantrum. Like this morning. I'm tired, but slept last night and the night before, so I've gotten 4+6+7=17 hours of sleep in the last 3 nights. Not really that bad (although I'm much nicer with 24 hours of sleep in three days). I'm behind on my school work, which is stressing me out, since it feels unlikely that catching up is possible. And then my phone died last night in the middle of a conversation. Not like it died and needed to be charged, but it died. Not working. Which meant that this morning when I was supposed to be calling another state for a phone interview, I couldn't. (I'm writing from the Apple store where my iPhone is now restored).
So the short story is that all of this stress caused me to have a temper tantrum about not being able to find a check that I wanted to deposit. Out loud, around a friend. Not directed toward her, but she had to see me just getting angry about something fairly unimportant. Ugh.
Fortunately, she's a good friend. She tried to calm me down. She still loves me.
And I'll get over it, move on, and try not to throw such a fit next time.
Tuesday, February 1, 2011
Job interview
I think I choose employers who have different/unusual types of interviews.
For example, when I interviewed to teach at the school where I worked for 10 years, I was asked to "audition" as a teacher, meaning I had to plan two lessons to teach to kids I had never met, while those considering me for employment observed. It was fun and scary all at once. I guess I did okay, since I got the job.
Well, now that I've started my job search, I've entered a new type of job interview. This weekend, I interviewed with a small out-of-hospital birth practice in a small town. The woman interviewing me picked me up at the airport, drove me around town, took me for a short hike, and then arranged for me to meet her co-workers and students, as well as some other folks in town, by hosting a potluck dinner and teaching event at her house that night. The teaching event was to practice putting in IVs, so we each took turns practicing. We went over how to put in a "bleb" of lidocaine (like a TB test) to make the IV hurt less. It really works! But feels funny, too. Anyway, I put one IV into an experienced nurse, and felt very awkward about it . . . it was my second one ever. Then it was my turn to get one. I learned that my forearms have really difficult-to-find veins, so she had to try my wrists, and the first one blew out, leaving me with an impressive bruise! Good to know what our patients feel, right?
The next day was the actual "interview." The same woman (the owner, and a midwife) took me out to breakfast with her office manager, who is a midwife wanna-be, and apparently pretty good at catching babies all by herself if necessary! We had a great meal, and they had a long list of questions for me. It was fun! One of the questions was about how I act after 30 hours of no sleep - basically they wanted to know if I was a bitch to coworkers. Ha! I hope not! (Guess it's good question, but what am I going to answer? Yep. When I'm tired, I rage around the office! Right!) They wanted to know about teamwork, cooperation, how I feel about LMs, my perfect job, etc. Overall, terrific questions, which allowed for a fantastic conversation.
Then we headed back to their office, where I got to see the clinic in action. I did attend two visits with one of the midwives - we saw a 4 week postpartum mom, with her baby and husband. What a fun & cute family! We then saw a 22 week prenatal visit of a pretty strange couple, who really didn't have much to say. I had fun, anyway, and it was nice to see this midwife in action, since I hadn't had a chance to chat with her much yet.
After one more spin around town, we stopped for sandwiches and then headed for the airport. Overall, it was a pretty fun interview! And really, it was my first official interview since 1998.
Will I leave my current city to move to this small city? That is a tough question. The job is pretty perfect. Everyone there was so nice, and seem like great people to work with. The practice is well established, growing, and running well. It's pretty much the perfect job! But leaving my life here seems like a huge move. There's no easy answer for this one . . . and either way, I don't get what I want!
I got another e-mail today asking for a phone conversation later in the week in another small town far from home. I guess this is really happening . . . who knows what the next 6 months will bring!
What kind of midwife do I want to be? Who do I want to work with? How far from home am I willing to move? These questions are milling around in my head . . . fortunately, I don't have to answer them now.
Okay, gotta go study. Three exams to take in the next week!
For example, when I interviewed to teach at the school where I worked for 10 years, I was asked to "audition" as a teacher, meaning I had to plan two lessons to teach to kids I had never met, while those considering me for employment observed. It was fun and scary all at once. I guess I did okay, since I got the job.
Well, now that I've started my job search, I've entered a new type of job interview. This weekend, I interviewed with a small out-of-hospital birth practice in a small town. The woman interviewing me picked me up at the airport, drove me around town, took me for a short hike, and then arranged for me to meet her co-workers and students, as well as some other folks in town, by hosting a potluck dinner and teaching event at her house that night. The teaching event was to practice putting in IVs, so we each took turns practicing. We went over how to put in a "bleb" of lidocaine (like a TB test) to make the IV hurt less. It really works! But feels funny, too. Anyway, I put one IV into an experienced nurse, and felt very awkward about it . . . it was my second one ever. Then it was my turn to get one. I learned that my forearms have really difficult-to-find veins, so she had to try my wrists, and the first one blew out, leaving me with an impressive bruise! Good to know what our patients feel, right?
The next day was the actual "interview." The same woman (the owner, and a midwife) took me out to breakfast with her office manager, who is a midwife wanna-be, and apparently pretty good at catching babies all by herself if necessary! We had a great meal, and they had a long list of questions for me. It was fun! One of the questions was about how I act after 30 hours of no sleep - basically they wanted to know if I was a bitch to coworkers. Ha! I hope not! (Guess it's good question, but what am I going to answer? Yep. When I'm tired, I rage around the office! Right!) They wanted to know about teamwork, cooperation, how I feel about LMs, my perfect job, etc. Overall, terrific questions, which allowed for a fantastic conversation.
Then we headed back to their office, where I got to see the clinic in action. I did attend two visits with one of the midwives - we saw a 4 week postpartum mom, with her baby and husband. What a fun & cute family! We then saw a 22 week prenatal visit of a pretty strange couple, who really didn't have much to say. I had fun, anyway, and it was nice to see this midwife in action, since I hadn't had a chance to chat with her much yet.
After one more spin around town, we stopped for sandwiches and then headed for the airport. Overall, it was a pretty fun interview! And really, it was my first official interview since 1998.
Will I leave my current city to move to this small city? That is a tough question. The job is pretty perfect. Everyone there was so nice, and seem like great people to work with. The practice is well established, growing, and running well. It's pretty much the perfect job! But leaving my life here seems like a huge move. There's no easy answer for this one . . . and either way, I don't get what I want!
I got another e-mail today asking for a phone conversation later in the week in another small town far from home. I guess this is really happening . . . who knows what the next 6 months will bring!
What kind of midwife do I want to be? Who do I want to work with? How far from home am I willing to move? These questions are milling around in my head . . . fortunately, I don't have to answer them now.
Okay, gotta go study. Three exams to take in the next week!
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