Changes

There are no objects in flux, only flux itself.

-Some Wise Buddhist at Some Point in History

crescent moon
Photo by Flickr on Pexels.com

I always knew that when the time came to officially end my blogging journey, I would know. I would just feel it, as I have intuitively felt every single other major decision I’ve had to make in my life.

Last night, I knew.

I was walking out after sitting zazen and then chanting vespers at Dharma Rain Zen Center, a beautiful Soto Zen sangha that has become my spiritual home over the past six months. The waxing crescent moon lit the dimming almost summer sky, completely clear of clouds. It took my breath away, the simplicity of it. And it just washed over me.

I am ready to be done managing multiple social media profiles. It is tiring. It is not bringing out the best in me. It does not help me express the depth and nuance and compassion I seek to exude in the world. I worry about privacy–not so much for my safety, but the ways in which big business uses my data. I know it’s inevitable at this point. But I feel a driving force that can be summed up like this:

Simplify.

Simplify.

Simplify.

~

Let me be clear: my decision to pare down my social media presence is not a judgment, or a belief that others should, too. I have so enjoyed blogging and the sense of connection and community it has brought to my life as I grew from baby midwifery student to new grad to blossoming advancing leader, teacher, scholar. But I find these days that social media is draining my reserves. My experience is this: I don’t remember things as well. I rush to quick, snappy judgments. My eyes glaze over at the incessant, formulaic click-bait titles

Don’t get me wrong. The Major Reckoning and Disruption of Racism that is happening right now is long overdue. But in my own life, the Facebook and Instagram profiles I established to correspond with this blog aren’t the venues that best allow me to engage in that work.

So, they’re gone.

I rather unceremoniously deleted them both in a split second decision yesterday and felt the hugest weight lifted off my shoulders. I now just have one Facebook account and one Instagram account. I will use both periodically. I may not be on as often, or post or respond as much. Other times, I may be one a lot. I’m not holding myself to a particular narrative around what that engagement should look like.

What feels most freeing about this is the pressure (completely artificial, mind you), to somehow maintain my “real profile” and this alter ego of what Full Spectrum Midwife was supposed to be. It’s just me here, little old Lena, doing her thing. Learning. Growing. Creating more spaciousness in my life and work for things that feed me, so that I can continue diving into the shit-show of midwifery politics, disrupting ages of archaic thinking and practice, and help birth a new generation of midwives equipped to practice in a different way.

I’ll miss the community I developed…but in truth, it’s not really going away. It’s just morphing into other forms. Really, it always has. I have so many brilliant colleagues who are adept at navigating the social media world who will continue to bring to light the issues needing change. I may not friend as many people on Facebook on my personal profile. I may retreat for days, weeks, or months at a time, depending on what is happening in my life.

The thing that doesn’t change is my fervent belief in the power of midwifery care to change lives, and in new midwifery leadership to move midwifery forward.

Thanks for the ride, everyone, it’s been wonderful so far…and only gets better from here.

 

Transitions

road sky clouds cloudy
Photo by Gratisography on Pexels.com

Spring 2010.

After much heartache and doubt, I had just quit my job as a Montessori elementary teacher. It was scary, but I knew deep in my gut it was the right decision. I was feeling depressed about the whole situation, worried about finances, as B and I had just bought our house, and wondering what I was going to do next. I had never not had a plan and it was terrifying.

Somehow the universe had it all lined up for me. My friend Tel convinced me (didn’t take much convincing) to do a doula training and soon after I somehow got connected with Backline (now All-Options) and Planned Parenthood.

I spent the next few years volunteering as a peer pregnancy options counselor with Backline and as a patient support advocate at Planned Parenthood. During my time at Planned Parenthood I encountered nurse-practitioners and nurse-midwives practicing as fully independent clinicians, fully respected for their unique contributions. I witnessed the compassionate care that they provided to their patients during abortions and my world was blown open with new possibilities. I had never once considered a career in health care, but as time went on and I continued to discover the diverse ways in which midwives are situated to provide holistic care, I realized that I had just stumbled upon my life’s work.

Summer 2013.

I started the accelerated nursing program at OHSU, then went straight on to the midwifery program. I got involved with Nursing Students for Choice (now Nurses for Sexual and Reproductive Health). I worked as a nurse at a local abortion clinic while I was in school, supporting people through first and second trimester abortions. I knew that I wanted to provide this care someday as a midwife.

I managed to graduate in one piece, despite an unexpected pregnancy halfway through midwifery school and landed my first job right before graduation, when my little guy turned 11 months.

For the last two years, I’ve been in full-scope practice, which has been the most wonderful way to ease into midwifery as a new graduate. My clinic is a 10 minute bike ride from home, and three blocks from my son’s preschool. I have the best co-workers. I love catching babies, doing prenatals, talking about birth control, doing first Paps, exploring safe and pleasurable sex, reviewing the many options for breast cancer screening and hormone therapy and a million other reproductive health topics.

But my heart continues to be pulled back towards what drew me to midwifery in the first place: radically compassionate, inclusive full-spectrum midwifery, including abortion care. I just can’t shake that dream away. And in the meantime, it has become more clear to me that I also am not done with school (I don’t think anyone who knows me well will be surprised at this).

So, it is with boundless excitement that I announce I will be stepping away from full-scope midwifery for a while. Eight years after I first started as a PP volunteer, I’ve come back full circle and accepted a part-time position as a CNM at Planned Parenthood. I’m still pinching myself that it’s really happening.

In the time I’m not in clinic, I’ll be launching private mindfulness-based childbirth and parenting classes, based on the pioneering work of Nancy Bardacke, CNM, and Jon Kabat Zinn, who developed the well-known Mindfulness-Based Stress Reduction program.

I’ll be focusing in more on my work as Chair of the Diversity, Equity and Inclusion Committee for our local state affiliate of the American College of Nurse-Midwives. That will include developing more training opportunities to explore implicit bias, racism and white privilege in midwifery care.

And I’ll be doing more reading, writing, and research to lay the groundwork for applying to PhD programs in nursing education next fall. I’m ready to move towards academic practice and my long-term goal of innovative midwifery education and research. I want to explore how to better integrate anti-racism and equity training into nursing and midwifery education.

I want to know what the evidence-based strategies are for comprehensive nursing faculty training and program development to support students of color: how do we effectively support students in completing their clinical training without subjecting them to the chronic stress of daily microaggressions, stereotype threat, implicit bias and outright racism? How do we make sure that their transition into clinical practice supports a sustainable, life-long career?

I want all nurse and midwifery educators to be skilled and comfortable in facilitating conversations on racism, white privilege and structural oppression and their impacts on health outcomes. I want to understand how we cultivate students to be critical thinkers and creative disrupters of deeply embedded inequities in medicine.

And most importantly: I want to start doing all these things before I get too jaded and burnt out by the daily grind of our haphazard, wildly inadequate so-called health care system.

As I close out this year, I’m profoundly grateful for all of the experiences in my life so far that have led me to this moment. All of it has made me the midwife, activist, scholar, teacher, and writer that I am. I’m ready to take the next step in my journey and can’t wait to share more. If you’re interested in keep up with my classes and future research and consulting work, please check out my new website.

Believe Women

It’s late and I’m exhausted, but I can’t sleep.
Somehow I got through clinic today in one piece, precepting a midwifery student for the first time, seeing a few very, very dear postpartum patients for their last visit and trying not to cry, and trying to remain present for 16 more women in clinic after four incredibly busy work days in a row.
All the while I couldn’t stop thinking about Dr. Blasey Ford and her incredible strength and courage.
I couldn’t stop thinking about how how many of my patients this week might have experienced something similar to Dr. Blasey Ford and never told anyone: me as their midwife, their partner, their friends, or family. Statistically speaking, that’s at least nine women that I saw just this week. The weight of those unspoken traumas has felt even heavier in recent weeks.
I couldn’t stop thinking about my friends’ daughters, these young girls growing up in a world that still doesn’t value them equally to my friends’ sons. No matter how hard they try, when it comes down to it, the boys and men always seem to get the last word.
I couldn’t stop thinking about my own son, my sweet, tender, loving, nearly three year-old boy and the burning responsibility I feel to raise him to love and respect and listen to women. I don’t just want him to “help out” at home. I don’t just want him to vote for the “liberals.” I don’t just want him to not be a blatant jerk, a creep, or an arrogant mansplainer.
I want him to see how his own active engagement in the ongoing struggle for reproductive justice is tied to his own capacity for personal liberation and freedom. I want him to understand that anything less than life-long activism for equality means he is complicit in maintaining the status quo of the patriarchy.
I need him to understand that no means no means no means no.
I want him to have the courage to speak up when it’s uncomfortable in the locker room.
I want him to believe that living as a feminist in word and deed is just what a man does, not that it’s somehow extraordinary or deserving of praise.
All I could feel today was this suffocating, generations-old weight. Even if we weren’t talking about it during their clinic visits, every. single. woman I met with today knew what was happening. We were weary. It hung heavy and thick in the air, this dreadful, thousands-year old story. I hugged every patient and felt the hugs linger. Ancient and seemingly never-ending, this awful cycle of misogyny festers: no matter what we say, how eloquent, dignified, articulate, composed we are, still, we are not believed.
I don’t know what else to say, except there is no other option than to keep fighting for what we know is right.
Believe women.
I believe Christine Blasey Ford.
I believe all my patients.
I believe you.

Catch Up Monthly Chai

Monthly Chai, a sweet blog tradition started by Stephanie over at Feminist Midwife, has been a part of my blogging history since the beginning…although in recent years it’s been more like a once a year Reunion Chai. No matter. Sometimes I just need to sit down and write out all the things on my mind and in my heart. When someone asks me these days what my life is like is a midwife, it’s sometimes hard to know where to even start.

Do I dive into the sometimes grueling but also wonderfully rich and rewarding hours of clinic visits, sometimes seeing as many as 18 patients a day for concerns ranging from painful periods to prenatal visits to postpartum depression to recurrent yeast infections to low libido in the perimenopausal period? There’s certainly a lot I could share about the spectrum from routine to complete left-field that I can encounter from one patient to the next. It’s humbling to be reminded so many times a day how much there will always be to learn…but it’s one of many things I love about this work: I never, ever get bored. Also, I’ll be precepting for the first time this fall and I am over the moon excited.

Do I sigh and talk about my frustration over our low birth volume so far this year (not just our clinic, the whole metro area, really), and my wish for more consistent labor and birth experience on my call shifts? Or the fact that despite the low volume, I’m loving feeling more settled on the L&D unit, knowing and being known by the nurses and hospitalists I work with? The sense of relief of being in my second year of practice and just a wee bit more settled, more comfortable with what I know and don’t know, is real.

Or maybe I just head straight into what has become a quickly growing passion for perinatal/reproductive mental health. Some of my most meaningful clinical experiences so far have been with patients struggling with perinatal depression, anxiety, psychosis, and premenstrual dysphoria disorder. The more I care for these patients, the more I want to learn. I have been so lucky to be able to attend several great mental health focused trainings this year. Being recognized by my OB/GYN colleagues as the person “who loves this stuff” and having patients sent to me because of it has been incredibly gratifying. Here is also where I put in a little plug for the amazing Adria Goodness, PMHNP, CNM and her online course on Advanced Evaluation and Management of Psychiatric Illness in Reproductive Age Women. It is worth every penny, and no, she did not pay me to write this.

Likely somewhere in there, I’ll excitedly mention the year-long online training I’m starting next week to become a facilitator of Nancy Bardacke’s groundbreaking Mindful Childbirth and Parenting curriculum. Inspired by the Mindfulness-Based Stress Reduction model of teaching mindfulness skills, Bardacke (a CNM herself) tailored the MBSR curriculum to the specific needs of pregnant and parenting families. Having completed an 8-week MBSR on my own earlier this year and experiencing how transformational it has been in my personal and professional life, I am so, so excited to begin this training and deepen my own mindfulness practice. Next month I’m hoping to participate in a weekend mindfulness retreat for health care providers…a much-needed time to step away from the hustle and remember how to just notice.

And then I’ll just roll straight on into a slowly evolving pathway to my future return to school for a PhD. A recent presentation I gave in implicit bias in midwifery education has sparked an exploration into doctoral work in nursing education, researching what’s working and not working with the implementation of meaningful structural changes in curriculum, admissions, hiring, and leadership development to infuse midwifery programs with diversity, equity, and inclusion.

How do we measure progress? How do we measure success? What are the obstacles to more widespread change? How do we do a better job recruiting, retaining, fully supporting, and graduating more midwives of color? And same with faculty? I’m eyeing this great looking program in Diversity and Inclusion Leadership at Tufts and wishing it was online. I’m talking with anyone who is willing on their own PhD journeys (interested? contact me! I’d love to chat!), and trying to figure out timing of it all.

Because you know, there’s the fam, too. Little Tahini just started at his new Montessori school, which we are so excited about. It’s a 5-7 minute bike ride from our house, and 2 minutes from the clinic and hospital…which after our former commute, is simply heaven.

Now that he’s almost three (what the what?! how did that happen?), I finally feel like I can more fully engage intellectually and have been reading up a storm, making up for what feels like lost time in the fog of sleepless nights of nursing. A sampling of the teetering stack the bedside table right now:

The New Leadership Challenge: Creating the Future of Nursing, by Sheila Grossman and Theresa Valiga

Critical Race Theory: The Key Writings That Formed the Movement, edited by Kimberlé Crenshaw

Systems Thinking For Social Change: A Practical Guide to Solving Complex Problems, Avoiding Unintended Consequences, and Achieving Lasting Results, by David Stroh

Intersectionality in Action: A Guide for Faculty and Campus Leaders for Creating Inclusive Classrooms and Institutions, edited by Brooke Barnett

Parenting from the Inside Out: How a Deeper Self-Understanding Can Help You Raise Children Who Thrive: 10th Anniversary Edition, by Dan Siegel and Mary Hartzell (in my mind, required reading for anyone parenting or thinking about parenting)

and for fiction, Dream Country, by fellow Minnesotan and adoptee, Shannon Gibney.

In closing, I’ll share this wonderful Op-Ed by Michelle Alexander, which speaks to my current state of thinking about the political chaos that’s happening right now. It’s a good reminder to keep focused on the bigger picture. There’s a lot happening right now to resist, no doubt. But we need to keep dreaming for the world we want to see. There’s no shortage of new visions to midwife into existence.

As always, I love hearing from you. What are you reading, listening to, writing about? What would you research if you had unlimited NIH funding? Where do you want to vacation next year, what continuing ed events are you stoked for next year? Find me over at Facebook or Instagram.

Less Attachment, More Curiosity

This is one of the four “strategies for the long haul” proposed by Laura van Dernoot Lipsky in her new book The Age of Overwhelm: Strategies for the Long Haul. This book is a much anticipated follow up to her first book, Trauma Stewardship: An Everyday Guide to Caring for Self While Caring for OthersBoth of these books should be required reading for all midwifery students.

The Age of Overwhelm came as a recommendation from my therapist, and at the perfect time. I’ve spent the last few years swimming (sort of) through the chaos of finishing midwifery school, parenting a newborn, and starting a new job. Then there was the election. And the #MeToo movement. And all the school shootings. And the family separations at the border. And the upcoming fight around the nomination of Kavanaugh for the Supreme Court…and about a million other small and large devastating tragedies happening every day.

I may have spent the past year like a turtle: coming out for a look every now and then, and then tucking my neck back into my shell, focusing on the things I knew I could impact right now: settling into my job, keeping my marriage alive, figuring out how to parent sustainably. I can already see how this comes across. Privileged bougie “feminist” engages in armchair activism, if at all. Yeah, I’ve been taking a Facebook break, too, so I’m not even re-posting all the latest political commentary. And I have to say, I have no regrets. The echo chamber was deafening and I couldn’t do it anymore.

But the truth is, the unplugging was not for relaxation. It was for survival. The last post I wrote on this blog was almost a year ago, and it explored what now endearingly call my “late-late onset postpartum depression.” Technically, that’s not an official diagnosis, but in my mind, that’s what it was. The radio silence on the blog and social media and in the midwifery repro justice community in general was me trying to figure out how to move from the overwhelm into a space I could breathe freely and joyfully again.

So, when Lipsky’s book fell into my hands, I drank deeply. Took a breath. And began to remember all the things I already knew about how to heal but are so simply and elegantly presented here, little gifts of clarity.

Less Distraction, More Intention

Disconnect Less, Be Present More

Less Attachment, More Curiosity

Less Depletion, More Stamina

Four simple principles to not just keep afloat, but to thrive…in an age when the world seems on the brink of completely falling apart. It may seem cliche or too corny or woo to some, but this was the framework that helped me understand what I instinctively knew and was grasping for this past year.

***

I first learned about Mindfulness Meditation when I was an undergrad at Mount Holyoke. Each Tuesday I would make my way to the Interfaith Sanctuary, sink into a cushion, and just breathe. At first I was so exhausted that I would often fall asleep. My friend Sandy and I joked that we should call it “Contemplative Alternatives to Waking Consciousness.” Translation: Nap Time.

Over time, I figured out the rhythm of the hour. The sitting. The walking meditation (sometimes on a beautiful hand-painted labyrinth made by students and staff from the Office of Religious and Spiritual Life). The dharma talk. More silence. For the three years or so that I went to meditation each week, that hour was a much-needed respite from the intensity of intellectual, over-stimulated left brain. Then I graduated over time, the practice slipped away. Life became “busy.” I was “too tired.” There “wasn’t time.”

Haven’t we all felt this? Isn’t this what we all bemoan to each other when we meet up (three months after we planned to) with friends for a drink?

So this past winter I took an 8-week Mindfulness-Based Stress Reduction course. MBSR is a well-studied intervention for improving mental wellness in a variety of contexts including chronic illness, pain, and stress. It strips down the practice of mindfulness to its bare essentials and step by step, builds up the foundation for a sustainable mindfulness practice. Well, that’s what I was aiming for, anyway. Let me be the first to say that I’m not yet meditating daily (don’t worry, you’re not the only one!).

It was the piece about curiosity in Lipsky’s book that initially hooked me in. When I read that phrase, I realized how deeply I had fallen into survival mood. I hadn’t felt genuinely curious about anything, including myself, in a long time. And then, in the Less Distraction, More Intention section, there was a little sub-section entitled Protect Your Morning. A jolt of recognition flooded my body. I laughed out loud on reading it, and when my therapist asked what I was laughing about and I told her, she said something that give me chills. “You know, I’ve probably shared with a dozen moms so far. And Every. Single. Mom. reacted the same way you did.” There’s a potential in those quiet moments in morning that I want to reclaim.

I see it in my patients, too. We are all so deeply starved these days for real connection, for meaningful conversations, for a space in which it feels safe to be vulnerable (thanks, Brené!), for a sense of purpose and a feeling of being able to effectively make change in the world. And it may start with putting our feet down and protecting those first minutes of the day, a few precious moments to breathe and cultivate curiosity rather than dread, fear, anxiety, or just plain numbness. Before the children wake. Before the emails. Before reading the news, listening to the news podcast, scrolling through Facebook, logging into Epic.

I’ve mostly been avoiding the blog in the past year because I realized I wasn’t sure what I wanted it to be or what I wanted to do with it, and I didn’t want it to end up feeling like every post was the same. My first blog had a clear purpose: to chronicle my journey as a student. There was a beginning and a natural end. This one, I’m not so sure yet. But I’m still curious. I feel like sticking my neck out from the shell more often these days. But I want to be intentional about it. I have some ideas percolating, but until I have a bit more clarity, I’m going to give myself permission to go slowly.

Thanks for hanging in there, anybody reading this still. I’ve gone way over 140 characters, there are no clever hashtags for this rambling post. If you have any thoughts about what you would enjoy reading here, I’d love to hear them. I may end up deciding to make this blog private, more of a journal space for myself. I’m not attached to anything yet…something will unfold organically on its own time (just like all those post-term babies I’ve been catching lately).

The Gestation of a New Midwife

Sweet Darkness

by David Whyte

When your eyes are tired
the world is tired also.

When your vision has gone,
no part of the world can find you.

Time to go into the dark
where the night has eyes
to recognize its own.

There you can be sure
you are not beyond love.

The dark will be your home
tonight.

The night will give you a horizon
further than you can see.

You must learn one thing.
The world was made to be free in.

Give up all the other worlds
except the one to which you belong.

Sometimes it takes darkness and the sweet
confinement of your aloneness
to learn

anything or anyone
that does not bring you alive

is too small for you.

 

***

The other day I realized that I had been working at my current practice for about 9 months. I figured it out because I was seeing patients at term who I had seen at their initial prenatal visit. We all kept marveling at how quickly those 9 months had flown by.

My patients talked about the physical transformation of pregnancy, the aches and pains, the new sensations, as well as the emotional labyrinth of preparing to welcome new life into the world and their families.

My own introspection led me through those early weeks of disbelief that I was actually working as a midwife. The giddiness, the initial fears, hesitations and insecurities…and then the sheer overwhelm, fatigue, and weariness of integrating into a new clinic family and culture all are very fresh. The fumbling to try and settle into the new rhythm, develop my own flow and voice in my new role overlapped with my son’s transformation from babyhood to toddlerhood and suffice to say, the lack of sleep helped no one in my house.

Then there’s the “second trimester” of my gestation as a new graduate, which included a period of depression and let down after years of dreaming of this moment in my life.

The above sentence took me three months to be able to write down on paper, let alone share publicly.

It’s been on my mind all the time, of course. I’d go back and forth about whether I wanted to write about it or not, waffling between wanting to share my truth and not wanting to disclose something quite so personal. The more I thought about it, though, the more I was reminded of the stigma surrounding depression that my patients face on a daily basis. We as clinicians—midwives, nurses, OB’s, MA’s, therapists—we are not immune from the complexities of mental health challenges.

I would never counsel a patient that she should keep her depression hidden. It’s up to each individual, of course, to disclose how and when they choose. But I do know that there is deep power in storytelling and sharing, that hearing other people’s shared experiences decreases the isolation and stigma surrounding things like depression, abortion, drug use, teen pregnancy, among others.

So here it is. After years of studying, developing clinical skills, the endless call shifts, working as a RN to gain clinical experience needed for licensure to achieve my dream job, persevering through incredible exhaustion to get through school while parenting a newborn…I fell into an inexplicable and all-encompassing depression when I finally arrived.

It shouldn’t have taken me by surprise, but it did.

I thought I only suffered from seasonal depression.

I thought I had my life together.

I though the financial stability of my new job would ease the months of stress about money.

I thought I had a great community of support (which I did, and still do).

And yet.

Despite all all these things, I found myself underwater in that persistent undertow of a current beyond my control that I can only call depression: that feeling of complete detachment from the pleasures of life. I put on my midwife face every day and came in and did a great job and loved my patients…but it took incredible effort.

Eventually, I had a series of realizations that I needed to be taking the advice I was giving my patients and extend that same reminder of self-care and love to myself. Of course, the impacts were immediate. I am happy to say that I am slowly emerging from the dull fog and finding my rhythms and habits to help keep me active, rested, and nourished. I’m biking to work. I’m taking time for myself. I’m planning solo and family travels. I’m gently working on integrating more physical activity in my life—for the first time in my life, I’m working with a personal trainer (and believe me, I am NOT a gym person!!!). I’m slowly reconnecting with friends and rebuilding that network of support that I let go of during school and after my son’s birth.

I share all of this not to elicit pity or sympathy, or stand on a pedestal to push a particular agenda about the narratives of depression. I share my experience to reassure other aspiring and current midwives that being depressed while being a midwife happens. You are still worthy of love and respect. It’s ok to take the time you need. It’s ok to go through the motions sometimes. Know your limits, make a self-care plan, enlist your community of support to help keep you accountable for that self-care…but most importantly, know that you’re not alone.

The work we do take immense, unimaginable amounts of emotional and physical energy. We bear witness to some of the most intimate, joyful, terrifying, transformative life and death moments of a person’s life. We don’t just accidentally become midwives. It take extraordinary effort to get to where we are in our professional lives…but we are whole people, just as vulnerable to stress, fatigue, overwhelm and anxiety as anybody else.

So, as someone who has coped with depression for my entire life, I offer you my solidarity, my support, my witness to your journey.

Monthly Chai: April 2017

IMG_4095

Hello dear readers. And hello, April. I’ve officially been working as a midwife for three months. I’ve survived the first trimester. And just as I reassure my pregnant patients that most of the time, the worst of the nausea wears off by second trimester, I’m reassured by the fact that I feel more settled and (ever slightly) more at ease as a new baby midwife. I won’t ever have to experience those first three months of being a brand new midwife again…and you know, I’m so ok with that.

Signs of spring are everywhere here in Portland: the daffodils are in full glory, the cherry blossoms are stunning, and there’s even been glimpses of glorious sunshine in recent days. After a long winter of illness (oh, those little toddlers in full-time daycare–they bring home all the germs!), I feel like a new person, ready to take on the world…or at least, to take on some new projects at work.

I’m discovering that one of the best ways to make myself known among my collaborating OB’s is to volunteer to draft clinical practice workflows/guidelines. In my practice, a lot of what we do is evidence-based, but not all of it…and much of it is not currently documented in an easy to access manner with up to date references. So, after three months of observing and learning my clinic culture, I’m diving in and providing my research and midwife perspective on such things as misoprostol management of miscarriage, substance use screening in pregnancy, and early screening for gestational diabetes.

Some topics are more work than others, but I’m finding it’s a great way to get to know my OB colleagues and share the latest research with them. They’re excited to have someone eager to do that work and make it efficient for them. It’s also been super helpful in making sure our triage RN team (we adore them!!!) is on the same page with us about triaging various situations, making communication about key urgent situations more streamlined. It’s a win win for everyone.

Other new developments: I’ve been recruited to be the “marketing committee.” There are still other channels I have to work through, as my practice is physician-owned, but I get to help develop marketing strategies and priorities for the midwifery practice, which I find to be both exciting and a challenge. It’s something we don’t talk about much (or at all?) in our training as midwives, but the business of running a midwifery practice requires just as much care and attention to detail as the clinical aspects of running a practice…and it’s a steep learning curve. I’m grateful for the ACNM Administrative Handbook to help bring me up to speed on some basics. I’m soaking up as much of the wisdom and experience of our clinical lead midwife as I can.

Oh…and then there’s benchmarking. Apparently my love affair of spreadsheets has won me the coveted role of benchmarking guru in our practice. I’ve been slowly working on refining our data collection system, which has been really fun (yes, really!). I’m looking forward to being able create a system that’s user-friendly for those middle of the night births while also allowing us to actually use the data to improve clinical practice.

So what am I doing on my off days you ask? Basically, trying to relearn how to live a normal life again. It’s been so long since I haven’t been in school, I’ve forgotten a bit what it’s like to have time off. Like, real weekends, sometimes even three day weekends, depending on my call schedule. It’s been lovely to be able to spend more time at home, just relaxing, reading for fun (I’ve been devouring John Lewis’s March trilogy, an amazing comic series on the civil rights movement).

I’m recommitting myself to a more regular schedule of movement and outdoor activity now that the rain is easing up a bit, including regularly biking or walking to work (it’s only an 8 minute bike ride or 25 minute walk, I really have NO excuse). Last fall I had made a goal of biking Mackenzie Pass this spring. I don’t know if I’ll make it this year (June is fast approaching!)…but I am relishing every opportunity to get my heart rate up. Of course, it’s also a great de-stressor, since reading the news these days brings on regular fits of fury and rage. I’m sure I don’t even need to link to any recent examples of how the current presidential administration is f*ing everything up. You know.

What are your spring passion projects? What are the things you’re wishing and dreaming about for your midwifery practices? What seeds are you planting for the coming year in your personal and professional life? How are you pacing yourself to keep up stamina for the long haul? I’d love to hear from you! Comment below, or find me over on Facebook. I have a new Full Spectrum Midwife Instagram account, now too!

 

 

Testimonial in Support of OR HB 3391

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Photo credit: Evelyn Shoop, Rewire News

My name is Lena Wood and I work as a certified nurse-midwife in NE Portland, Oregon. I am a Korean-American adoptee and the mother of an 18-month old who was conceived unintentionally despite using birth control during my midwifery training. I have a background in elementary education and have volunteered as a pregnancy options counselor and a patient advocate at Planned Parenthood. I have also worked as a registered nurse at a private abortion clinic as well as at a primary care clinic serving primarily migrant farmworkers. This rich and diverse experience informs my strong support for the full passage of Oregon House Bill 3391, the Reproductive Health Equity Act.

Every day, I witness how guaranteed access to high quality, culturally responsive reproductive health care impacts all of us, regardless of race, sex, gender, or class. As both a nurse-midwife and a recipient of midwifery care, I am intimately aware of the many complex situations that might bring an individual to seek some kind of reproductive health care: an unintended pregnancy, a miscarriage, a sexually transmitted infection, a breast lump, or desire for more genetic screening because of a strong family history of breast cancer, among many others.

I can’t think of a single patient I work with who would not be seriously impacted by the potential lack of access to comprehensive reproductive health care, myself included. When I found out I was pregnant, I was in the middle of a rigorous midwifery program. Despite having a usually very effective long-acting reversible contraceptive method (LARC), I happened to fall into the less than 1% of people who do get pregnant with a LARC. It was vital that I receive a pelvic ultrasound right away to assess if I had a potentially life-threatening ectopic pregnancy—because I had insurance, that cost was covered. Once I decided that I was going to continue the pregnancy, I needed prenatal care. Again, because I had insurance, much of my prenatal care was covered. While I opted for midwifery care for my pregnancy, I ended up needing obstetric care for a cesarean section anyway, as my baby was breech. Without insurance, I would have had to pay thousands in health care costs for that surgery.

What gave me peace of mind throughout the entire process of bringing my son into the world was knowing that I had access to quality care, care that would ensure my safety and that of my baby. After his birth, I knew I wouldn’t likely have to worry about getting pregnant again too quickly because any contraception method I chose would be fully covered by my insurance company. This allowed me to continue my studies and graduate from my midwifery program. I now have the incredible privilege of serving other women and their families as a midwife, providing them the care they need to control their reproductive health and achieve their life goals. Supporting this bill’s successful passage into law will help make sure that I can keep doing my job well: safeguarding the health of current and future Oregonians.

How I Keep Hope [in times such as these]

  1. Sometimes I let myself admit it would just be so nice to put my fingers in my ears and pretend this clusterf*#! of racism, misogyny, xenophobia, etc. isn’t happening. That lasts about a second at a time.
  2. Then I snap out of it and sign up for more Google news alerts from my elected officials, and weekly action lists. I write letters and postcards, make phone calls. I show up at town halls and go down to the state capitol to lobby for legislation that would ensure full access to reproductive health care.
  3. I donate as much as I can. ACLU. Planned Parenthood. The National Network of Abortion Funds. Backline. APANO. Black Lives Matter. Standing Rock.  And I buy feminist art.
  4. I scour my friends’ favorite blog lists and save reading and podcast and film lists for both myself and for my son. The lists are miles long and I will never have enough time to read it all, but I keep making lists. I read, as much as possible, works by people of color. I inhale poetry. Soak in music, all kinds. Sometimes, I crank up Gorecki’s Symphony No. 3 as loud as I can and just lay on the floor, absorbing the sound waves through my whole body. I sit in silence, too, try to slow down and find my breath again.
  5. I talk more about politics with my friends and those I work with. I ask questions. I listen. Try to create space for peaceful disagreement. Cultivate comfort with difference. Push myself out of my bubble as much as possible, but of course, I already know, not nearly enough. I live in a city that is 75% white, after all.
  6. I let myself cry sometimes, wondering what the hell kind of world I’ve brought my son into. But I remember, too, that play and laughter are healing. These both keep keep me from taking myself and my despair too seriously: I am, after all, among the less likely targets of any kind of violence or discrimination.
  7. I show up at work every day ready to radically listen. In each 15 or 20 or 30 minute appointment, I do my very best to set aside all preconceived notions of how things should be and just make space for what is. It’s not always easy. I’m not always as graceful about it as I could be. But I do my best.
  8. At every birth I attend, I whisper silent blessings of peace, justice, and compassion through my hands. Midwifing new life into the world is sacred, holy work, and it keeps me from tuning out and shutting down. It is impossible to do this work with a closed heart.
  9. I wake up every morning, whether I’ve slept well or not, and put one foot in front of the other, acknowledging that resisting the current political agenda will not happen overnight. I keep calendars of House and Senate sessions by my desk so I can see the big picture leading up to mid-term elections. Right next to a list of my MoC and their phone numbers.
  10. I remind myself that the alternative is not really an option anyway. James Baldwin’s words reverberate in my ears for days after seeing I am Not Your Negro:

“I can’t be a pessimist because I’m alive. To be a pessimist means that you have agreed that human life is an academic matter, so I’m forced to be an optimist.”

(If you haven’t seen this film, by the way, get yourself to the nearest theater, ASAP. It’s one that needs to be watched several times.)

Preparing for Your First Interview

After a 6 month or so hiatus from blogging, I’m so excited to be back with a new blog. As many of you know, I’m no longer a student midwife, but a real, certified nurse-midwife now!

I’ve received a few requests recently for tips and reflections on my experience of interviewing for my first midwifery job.

Rest assured, I was just as nervous and worried as you, wondering how to adequately present myself in a way that felt authentic and true to who I am while acknowledging that I was a new grad with limited experience.

After lots of self-reflection, asking other experienced midwives and new grads for their input, I pulled together the following resources to help me prepare for that interview.

Since we’re coming upon interview season, I thought I’d share this Google Doc with you all as one option for you to organize your thoughts. Feel free to add to it or edit it as you wish, and please do share any thoughts and tips over on Facebook!

Other Resources for New Grads:

The Latent Phase: an ACNM blog series by Stephanie Tillman, of Feminist Midwife

ACNM Workforce Resources: more on contract negotiation, state practice environments, and more