Miss Michael’s First Year

This post is SO late, but I wanted to share anyway…

This past spring, Kristina had been with our practice a full year so I sent her a list of questions to check in and see what she thought about her experience thus far. Here are her responses.

Can you believe it has already been a year, Kristi?

Nope! Time flies… I should say, I think that was about the longest interview a person has ever had! I even attended a Neonatal Resuscitation class as part of the interview process — talk about nerve wracking! But, I really appreciated how careful you were about who you were considering hiring. It also gave me the chance to get to know you all and to be thoroughly aware of what I was walking in to. There is such a wide range of midwifery practice and philosophy, and I am forever thankful that I have this opportunity.

I am not sure if I told you or not, but I had found the Believe website while I was still in school. I remember thinking how much I wished I could work for your practice! Your mission and philosophy, as well as all the great information on the site, piqued my interest. But, I was in Pennsylvania at the time with plans to move back to Minnesota, and I had seen that you did not have any current openings at the time. And yet, God moved in some very strange and wonderful ways to move me from Minnesota to Indiana… and to Believe!

I feel as if we met, almost by accident. You had moved here having accepted a nurse-midwifery position, and while we certainly needed a second midwife, I was quite hesitant about entrusting my clientele to another midwife. Our paths crossed and we explored the idea of a fellowship. What are your thoughts about this opportunity and has it met your expectations?

When I finished school, I had been in clinical for an unusually long amount of time. Most students from Frontier will complete all clinical requirements in about 6 months. Mine took almost exactly a year to complete, because the births I needed to complete in order to fulfill my requirements were unusually slow in coming. In fact, my preceptors started calling me a “tocolytic” (a name for a medication that slows down contractions), because the birth numbers were so few! But, in the end, I see this as a huge advantage, because while I was waiting on babies to come, I was able to do far more office hours and learn much more women’s health than I otherwise would have. I came out of my clinical experiences with a year of really good experience!

When I graduated, I wanted to continue to learn as much as I could. I felt that a “Fellowship” (mentoring) opportunity would be exactly what I would need to solidify everything I had learned in my year of clinical. I found a perfect match at Believe! You have not just given me a ridiculous amount of knowledge, but you have built a sense of confidence in myself as I moved out of the fellowship role and in to being independent. I love continuing to learn from you on a daily basis… (can I borrow your brain sometime?) My expectations were not only met, but exceeded, in the fellowship role. I highly recommend it for anyone new to practice!

We have discussed this quite a bit, but in my first year in practice, I had the opportunity to attend 16 home births. This is actually a busy year for a new homebirth midwifery practice, and I doubled these numbers every year after. However, in your first year, you had the opportunity to attend more than sixty births. How do you think this will benefit you and future homebirth families in your care?

Wow, great question! I feel so very blessed to have had the opportunity to attend so many births in my first year of practice! Every single birth, and every single primary care visit, brought new knowledge, perspective, and experience — one of the things I love about what we do is that no two people are the same, and no two experiences are the same! The number of births I have been able to attend is a huge benefit, as each one teaches me something new. I have had a wide variety of experiences in the past year, not just as far as numbers go, but as far as clinical challenges. I have managed two hemorrhages, a shoulder dystocia, resuscitation and intubation of a baby, identifying a newborn cardiac anomaly, breastfeeding challenges (which led to discovery of a brain anomaly), and several other incidental complications that some practitioners very rarely (or never!) see. Each of these situations has resulted in excellent outcomes, and the experiences in management of them has been invaluable in adding to my midwifery “tool belt” — which will only benefit our future clients!

You had nearly a decade of experience as a registered nurse, in high risk pediatrics and in the neonatal intensive care unit. Do you feel this has been an asset to your nurse-midwifery practice and if so, how? If not, how do you feel it has hindered you, and how have you overcome that?

One of the greatest fears I had was that I would gain experience in the “wrong” area. I knew I wanted to become a nurse-midwife at the beginning of my career as a nurse. But, I took a bit of a circular route to get to midwifery. After I finished nursing school, I choose to take a job on a pediatric bone marrow transplant unit, even though I was offered two labor and delivery positions. At first glance, it may seem that this was a foolish choice, but I knew that once I started working in maternity, I would never want to leave… and I also knew that I wanted to gain broad experience before I specialized.

After my transplant position, I worked as a pediatric home care and hospice nurse for three and a half years, before moving to a maternity unit. My goal was to work as a labor and delivery nurse, but the only opening they had available was for neonatal intensive care. I was suppose to train to labor and delivery after a year, but because of several internal factors, I never did end up being able to complete that training. On the surface, it may seem that I may have been better off using all of those years to work only in labor and delivery, and gain as much experience as possible there, but I am so glad I had there other opportunities first!

I learned invaluable things from each position that only serves to help me in my nurse-midwifery career today. For example, I gained excellent assessment skills, including how to quickly identify subtle changes in a client’s status, from my time one bone marrow transplant. As a pediatric home care and hospice nurse, I learned how to operate in the home setting, and how t provide education and support in times of life changes. And, of course, having the years of NICU experience has taught me many things about how to manage newborn care. Overall, I see my broad experiences as an asset, for which I am very thankful.

Can you share with us you favorite birth experience? 

Yikes, how do you pick one? I have had the opportunity to deliver the largest baby in the practice, and the smallest… and have had births that are long and challenging, and births where I really get to sit back and watch the process unfold quickly and easily. Yep, I still tear up and love the moment of each baby’s first breath. But, I think one of my favorite experiences was with one of our VBAC mommas. She had a long labor, and she pushed for about 3 hours. We tried many different positions and techniques to encourage baby to move down — all of us there were working hard the entire time! Her baby finally was beginning to crown, and suddenly I could see the baby’s little whirl of hair on the back of her head rotate almost completely around to get her in to the perfect position to come out. The mama looked at me, right in the eyes, as we encouraged her… and she pushed her baby out beautifully. It was a huge honor to be there, and to share in that moment of victory and joy.

As a new midwife, did you anticipate having such a broad scope of practice within women’s health, as a primary care provider, or even as the primary care provider of neonates? Can you share some of your experiences this year that challenged, or inspired you?

One of the things that I have found most inspiring is the wealth of complementary health modalities that I get to learn and use. My clinical experiences in school were very much along the standard Western medicine model, and I am grateful for the opportunities to learn and use that modality. But, at Believe, I love our integrative approach to care. It just makes so much sense — figure out the underlying problem, and work in a truly holistic way to bring healing! I learn more every day about ways to use herbs, essential oils, nutrition, chiropractices, and spiritual healing to help our clients feel and live as “healthfully” as possible.

I can’t move on from this question though without mentioning how much I love caring for neonates. Most nurse-midwives, I have found, do not have this as part of their practice — and yet I see time and time again how valuable it is for the continuity of care to extend to our babies as well! One of my favorite experiences thus far has been to watch our smallest baby, born at 3 pounds, 13 ounces, grow, mature, and absolutely thrive. To date, she has more than tripled her birth weight in less than 5 months! Her case was challenging, as she was so tiny (potential issues included blood sugars, temperature control, feeding, growth and development, respiratory status, etc.!)… but I loved how you and I were able to work with her amazing mama and daddy to keep her out of the hospital and healthy at home.

When I asked last year what your goals were as a new practitioner, you said you wanted to learn more about herbs, grow your skills in breastfeeding counseling and teach women about natural family planning. Have you had opportunity to follow-up on these goals?

Yes! I was able to complete an extensive breastfeeding course in preparation for the International Board of Lactation Consultants exam! I have been working on studying for this and will take the exam at the end of the month. I have also enrolled in Aviva Romm’s Herbal Medicine for Women course, which I hope to complete within a year. I have been looking in to several options for training in natural family planning… stay tuned on that one!

What are your goals for your second year with Believe Midwifery Services?

I hope to complete the Herbal Medicine for Women course, as well as develop and teach a course on natural family planning. I have several other classes I will be putting together, including a “First Periods” class for young teen girls, and I can’t wait to work with you to create our upcoming class on Christianity and Complementary medicine. I am not sure if it can happen this year or not, I am looking forward to returning to Frontier Nursing University for doctoral studies, as part of their Family Nurse Practitioner program!

What makes this job uniquely suited for you?

I grew up as the daughter of a pastor. My family knew and understood what it meant to fulfill a calling — and how to live life around the needs of others. This job has many similarities — I truly see it as a ministry that the Lord has called me to for this time. There are definite challenges to this midwifery lifestyle (i.e. always making plan with the caveat, “unless I am at a birth”; being attached to my phone 24/7; days and nights without sleep, trying to find that elusive life/work balance, etc.) — but I think growing up in a “ministry mindset” uniquely prepared me for this! Also, I am forever thankful that I get to work in an environment that allows and encourages me to live out my faith.

One thing I loved about my home care/hospital job, and even my bone marrow transplant job, was the opportunity to truly get to know my clients. I loved seeing them on a regular basis, and being able to tailor my care to their unique situations. I love that this is a part of our primary care model and maternity/home birth! It is a family environment, both among our clients and among our staff. Our philosophy of natural, holistic medicine is a passion of mine. I also feel that my experiences are used in unique and wonderful ways, such as being able to use my NICU experience to care of our babies.

I am also particularly blessed to be able to work with you! I can’t say enough about how much I learn from you every single day, and what an inspiration you are — not just to me, but to everyone you come in contact with. I love that we are philosophically so similar — this is a unique gift, considering the wide range of practices and ideas in midwifery today.

What would you like our readers — clients and associates — to know about you?

I would like them to know what an honor it is for me to do what I do every day. I cannot imagine doing anything else!

Food For Thought

Food for Thought

"It is much more important to know what sort of patient has a disease than what sort of disease a patient has." Sir William Osler

Food for Thought

Happiness is underrated and critically important to health. Seriously! Unfortunately, many people just have no idea how to be happy. Aviva Romm

Food for Thought

Physicians simply do not have time to be what patients want them to be: open-minded, knowledgeable teachers and caregivers who can hear and understand their needs. Snyderman and Weil

Food for Thought #1

They say that time changes things. But you actually have to change them yourselves. Andy Warhol

Food for Thought

To think is easy. To act is hard. But the hardest thing in the world is to act in accordance with your thinking. Johann Wolfgang von Goether

Food for Thought

"Birth isn’t about avoiding one set of realities in favor of another. It’s about embracing all facets of birth--contradictory, messy, or unpleasant as some might be--as vital to the whole." Rixa Freeze PhD

Food for Thought

Why I appreciate being a certified nurse-midwife, as opposed to choosing another route for midwifery: I feel learning the science is vital so the art of midwifery is safe and effective. Dr. Penny Lane, nurse-midwife

Food for Thought

When the debate is lost, slander becomes the tool of the loser. Socrates

Food for Thought

To accomplish great things, we must not only act but also dream; not only plan, but also believe. Anatole France

Food for Thought

"Science and uncertainty are inseparable companions. Beware of those who are very certain about things. There are no absolute truths in biological sciences - only hypotheses... 'We need to train medical students and residents more in the art of uncertainty and less in the spirit that everything can be known or that it even needs to be known.'" Grimes (1986)

Food for Thought

American physicians are rewarded for doing things to patients, not for keeping them well. Grimes, 1986

Food for Thought

The false idol of technology. "Having a widget screwed into one's scalp has become an American birthright." Grimes, 1986

Food for Thought

"Between 1985 and 1987, a hospital instituted a successful program to reduce its cesarean rate. The rate fell from 18% to 12%, losing the hospital $1 million in revenues - no small sum in those days." Goer & Romano, 2012, p 37

Food for Thought

"Obstetricians are much more likely to perform a cesarean when they wrongly believe the baby weighs 4000 g or more based on sonographic estimates than when the baby actually weighs this much but the obstetrician did not suspect it." Goer & Romaro, 2012, p 35

Food for Thought

"If you play God, you will be blamed for natural disasters." Marsden Wagner (2006)

Food for Thought

An education isn't how much you have committed to memory, or even how much you know. It's being able to differentiate between what you know and what you don't. Anatole France

Food for Thought #3

"Birth is not only about making babies. Birth also is about making mothers - strong, competent, capable mothers, who trust themselves and know their inner strength."

Barbara Katz Rothman PhD (1996)

Food for Thought #4

Believe there is always, always, always a way.

When you have exhausted all possibilities, remember this: you haven't. THOMAS EDISON

Food for Thought #5

"All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident." Arthur Schopenhauer

Food for Thought #2

Yet you brought me safely from my mother’s womb and led me to trust you at my mother’s breast.

Psalm 22:9