To shadow an OB/GYN for a month
This month has been very different for me. Well, every month has been, but this one in particular has challenged me and amazed me in ways I hadn't thought possible.
My OB placement has so far been WAY different than I expected it to be. I'd heard from other students about 24 hour OB shifts at larger hospitals, where a student could expect to go to 7-15 births in a shift. The advantage of this is a large volume of experiences put closely together. It can rapidly increase skill in things like suturing that us midwifery students worry so much about developing.
Apparently, an OB placement at a small Level 1 hospital is not at all like that. In fact, although I'm on call a couple of days a week, I have yet to go to a birth with my OB preceptor in three weeks. And frankly, part of me is terrified. I had really looked forward to this placement as an opportunity to gain skill in suturing, and I'm just over a week until the end of my placement and it's likely there won't be a single opportunity at all. When I realized that, I had a major feeling of let down. I'm thankful at times like these that my Normal Childbearing placement was so busy and full of these types of opportunities. Hopefully this means that I won't be too far behind my classmates who enjoyed the benefits of repeated births in the same night to hone their skills. I'm also super thankful for one of the lovely midwives in this community who took me under her wing one night and brought me to her client's birth.
The great thing about this placement is how much gynecology I'm being involved in. I'm going to all of my preceptors gynecology clinic and surgeries, and there is SUCH a wide variety of experiences that I think it's amazing. I've heard from other students that many OB preceptors don't allow involvement with the gynecological patients but mine does and I am so greatful for it. The way my preceptor sees it, although our scope is limited right now, perhaps eventually we will become more similar to the Nurse-Midwife model in the U.S. where the midwives provide well-woman care throughout life, rather than just the childbearing year.
What has thrown me off, is how alone I feel. Opinions and management choices come up sometimes in OB clinic that I really struggle with. Sometimes it's because I'd prefer to present them differently (prenatal screening like ultrasounds or group B strep), and sometimes because I simply have a really strong bias that I haven't gotten over (like topics such as VBAC and circumcision). It's hard to hear the medical perspective when you've walked on the wild side your whole adult life. Sometimes, I'll have a typical day, but I'll end up crying all the way home and I can't even figure out why (and no, this isn't something that usually happens for me, only the odd day since I've started here). I think it's an internal battle. I believe in midwifery care, I would fight for it to the very end, and I made pretty radical choices as a client of midwifery care myself. So I think I'm fighting with myself because sometimes the explanations that my preceptor makes for the way that she practices make total sense. But it still goes against the way that I do things. It's hard to sit with that feeling - I like to know what is right. But it seems like maybe there isn't always one right answer. I should have already known that!
Anyway, the whole experience is pretty humbling. These doctors do not always deal with the same people that midwives deal with. When I have a day in clinic in midwifery care, I am usually very happy and feeling confident. I walk into a room with a client who is also usually very happy, have a great discussion full of respect and choice, give her good prenatal care, and am on my way. In this scenario, we have some of that, but we are also seeing those women who are not lucky enough to be in midwives care - those who are suffering from infertility. Those who are recovering from a miscarriage or abortion. Older women undergoing hysterectomies. Women who have lost their husbands and are now facing other health issues. Not a day goes by that someone doesn't cry in a clinic visit (or ten), because an OB/GYN, just like most doctors, are not always the bearer of good news. Sometimes these women are being called in to find out that they have cancer, or that they'll never be able to have the baby that they've so desperately wanted. Certainly midwives aren't always the bearers of good news either, but we definitely see it a LOT LESS. And in the midst of this, I see my preceptor as an amazing doctor. A little while ago, I looked into the window of the operating room to see her with a patient who was about to undergo emergency surgery.... and she was holding the woman's hand as she waited to fall asleep. How many doctors take the time to comfort their clients? I don't know, because this is the only one I've spent a lot of time with. But I hope she's among many like her.
Wednesday 21 November 2012
Friday 9 November 2012
Ping pong
Well, I've done it again. Things got all busy and all of my good intentions to post went out the window. I marvel at how much I used to post in first year. I felt like I was so strapped for time. I know I was very busy then, but I think at that point I hadn't really learned too much about prioritizing.
So, third year, you ask - how is it? Different! Dynamic, unpredictable, and exciting - combined with boring, predictable, and sometimes troubling. I've been bounced back and forth between so many different places and each one puts me into a new learning environment with new responsibilities and expectations. I love it!
For those who don't know the nitty gritty, third year consists of inter-professional placements - for me this semester, that means 4 weeks with a nurse in labor and delivery, 2 weeks in a breastfeeding clinic, 2 weeks in the neonatal intensive care unit, and 4 weeks under an obstetrician. Next term will be some elective placements and a virtual online placement. I can't emphasize how greatful I am for having the opportunity to see into the world of these other professionals. I wish that all of these disciplines had this amazing opportunity to witness the lives of their colleagues. I'd bet that it would breed a lot more compassion and respect between disciplines.
What all of these placements play out in reality is so complex. Sometimes, I'm observing. Sometimes, I'm thrown into the midst of things when I don't expect it. Mostly I'm somewhere in between. I have both loved and hated going from place to place so often. The great thing is that its helping my social skills - I'm meeting new people every day and needing to quickly establish rapport with them, which is an interesting skill that I have definitely NOT mastered. The other great thing is that I've gotten a taste of every hospital that I'd consider working in. Each one operates so differently! The social infrastructure is also very interesting to navigate sometimes. We're really in this unique place in these placements where we're following nurses and OB's, and observing conversation that sometimes involves slogging midwives. I've never explained what my scope of practice is so many times in my life - nor have I had to defend homebirth so much. (And after a few interesting conversations, I've decided to just not mention my birth history for fear of being judged too harshly).
But as challenging as that aspect of it has been, I find it such a privilege to be able to do these placements. I feel like I've developed a much better understanding of what sort of follow up care our babies that go to the NICU get. My NICU placement what such a pleasure. Although I saw more bottles and formula than I would have liked, shift work and predictable hours are lovely things and the staff at the NICU in Brampton have such a lovely working relationship with one another. I was also able to follow one of the nurses into the high risk births that occurred while I was on shift, which helped me to feel more comfortable observing cesareans and instrumental births.
My labor and delivery nursing placement was at the hospital closest to me, which was great for driving. The midwives here are newly implemented so it was interesting to observe the dynamic as they became established in a hospital that has never had midwives before. It was especially interesting to hear the nurses' side of the conversation, since I am (obviously) used to hearing any conversation about hospital relationships from the perspective of the midwives. Working as a labor and delivery nurse at a birth was also very interesting - there is much less freedom to manage the birth as I might choose to do it because the nurse is not the woman's primary caregiver. I found that very frustrating, not because I didn't respect the decisions the doctor was making, but because of the fragmented care that the woman was receiving, which was being split between a number of different people.
My breastfeeding placement was definitely the highlight of my year so far. I was enormously lucky enough to be placed at the Newman Breastfeeding Clinic and Institute. The doctors and lactation consultants at that clinic are amazing. I like to think of them as "breastfeeding midwives". Each woman that enters their clinic leaves there having received the combined recommendation of two lactation consultants and a pediatrician (and usually a student or two). I'd been aware of mixed opinions about the clinic before I came there, but truly, their approach is amazing. I am so grateful for the opportunity to immerse myself in their environment for as long as I did, and those of you who are entering third year - even if its not close to you, this placement is *so* worth the drive. I think it's made an enormous difference in how I'll be managing breastfeeding issues.
I've just begun my OB placement this week. I'm still new to it, and I'm quite certain it's going to deserve a post all on its own, so that one will wait for another day.
So, third year, you ask - how is it? Different! Dynamic, unpredictable, and exciting - combined with boring, predictable, and sometimes troubling. I've been bounced back and forth between so many different places and each one puts me into a new learning environment with new responsibilities and expectations. I love it!
For those who don't know the nitty gritty, third year consists of inter-professional placements - for me this semester, that means 4 weeks with a nurse in labor and delivery, 2 weeks in a breastfeeding clinic, 2 weeks in the neonatal intensive care unit, and 4 weeks under an obstetrician. Next term will be some elective placements and a virtual online placement. I can't emphasize how greatful I am for having the opportunity to see into the world of these other professionals. I wish that all of these disciplines had this amazing opportunity to witness the lives of their colleagues. I'd bet that it would breed a lot more compassion and respect between disciplines.
What all of these placements play out in reality is so complex. Sometimes, I'm observing. Sometimes, I'm thrown into the midst of things when I don't expect it. Mostly I'm somewhere in between. I have both loved and hated going from place to place so often. The great thing is that its helping my social skills - I'm meeting new people every day and needing to quickly establish rapport with them, which is an interesting skill that I have definitely NOT mastered. The other great thing is that I've gotten a taste of every hospital that I'd consider working in. Each one operates so differently! The social infrastructure is also very interesting to navigate sometimes. We're really in this unique place in these placements where we're following nurses and OB's, and observing conversation that sometimes involves slogging midwives. I've never explained what my scope of practice is so many times in my life - nor have I had to defend homebirth so much. (And after a few interesting conversations, I've decided to just not mention my birth history for fear of being judged too harshly).
But as challenging as that aspect of it has been, I find it such a privilege to be able to do these placements. I feel like I've developed a much better understanding of what sort of follow up care our babies that go to the NICU get. My NICU placement what such a pleasure. Although I saw more bottles and formula than I would have liked, shift work and predictable hours are lovely things and the staff at the NICU in Brampton have such a lovely working relationship with one another. I was also able to follow one of the nurses into the high risk births that occurred while I was on shift, which helped me to feel more comfortable observing cesareans and instrumental births.
My labor and delivery nursing placement was at the hospital closest to me, which was great for driving. The midwives here are newly implemented so it was interesting to observe the dynamic as they became established in a hospital that has never had midwives before. It was especially interesting to hear the nurses' side of the conversation, since I am (obviously) used to hearing any conversation about hospital relationships from the perspective of the midwives. Working as a labor and delivery nurse at a birth was also very interesting - there is much less freedom to manage the birth as I might choose to do it because the nurse is not the woman's primary caregiver. I found that very frustrating, not because I didn't respect the decisions the doctor was making, but because of the fragmented care that the woman was receiving, which was being split between a number of different people.
My breastfeeding placement was definitely the highlight of my year so far. I was enormously lucky enough to be placed at the Newman Breastfeeding Clinic and Institute. The doctors and lactation consultants at that clinic are amazing. I like to think of them as "breastfeeding midwives". Each woman that enters their clinic leaves there having received the combined recommendation of two lactation consultants and a pediatrician (and usually a student or two). I'd been aware of mixed opinions about the clinic before I came there, but truly, their approach is amazing. I am so grateful for the opportunity to immerse myself in their environment for as long as I did, and those of you who are entering third year - even if its not close to you, this placement is *so* worth the drive. I think it's made an enormous difference in how I'll be managing breastfeeding issues.
I've just begun my OB placement this week. I'm still new to it, and I'm quite certain it's going to deserve a post all on its own, so that one will wait for another day.
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