Lottery results and international placement

Where was I again? Yes, just waiting for the results of the lottery for my senior placement. That waiting period after we sent in our choices was one of the hardest things I have ever experienced. I had multiple migraines and several panic attacks in the days coming to the result. It has been particularly hard because even though I felt my world was falling apart, I still had to continue with my obstetric placement that I was doing during that time. This placement on itself is already quite challenging with the long 24-hour shifts and the many issues obstetricians deal with that we have not been exposed to yet, so the added stress was not well tolerated.

The day we were supposed to receive the email with the placement allocation I could feel the adrenaline rising. I had multiple palpitations that day, and when the email finally came, I couldn’t open it. I was in the clinic, and I felt if the placement location was not what I was hoping for I was going to lose it in front of everyone. But as I left the clinic I still couldn’t open it. Opening the email meant having to deal with the results and potentially a bad one. I then drove to a friend’s house who calmed me down with some tea and food since I had not been able to eat anything all day. She then opened the email for me. When she put her hands on her heart and smiled, I knew there was good news. The email said Community Midwives of Halton. I started sobbing. I couldn’t stop crying, all the stress that was accumulated during the last two weeks exploded. For the longest time I couldn’t even get excited, I just felt relief.

Soon after my obstetric placement finished, I had to get ready for my international placement. In third-year, we have the option of doing our elective placement internationally. I had been planning on doing this placement in Brazil since I joined the program. I was going to spend a month in Brazil at a public hospital in Florianópolis, a small island near the south coast. My dad lives there, and I also have an uncle and cousins there. This is the place where I used to spend my summer vacations as a teenager. Lots of good memories from that place! I was a little nervous to leave my family for one month, but we were planning for them to come and join me during March break for a week. I organized my hours at the hospital so that I did double hours prior and after their stay so that I could have time off when they were there. It was the best family vacation we ever had. The weather was perfect, and we stayed at a house right on the beach. Beautiful sunsets, amazing food and lots of fun.

My experience at the hospital was also amazing. I saw more vaginal normal births during the 120 hours I did there than the 4 1/2 months of my normal childbearing placement in second-year. You are probably asking: but doesn't Brazil have something like 80% c-section rates? Not in the public system. Their c-section rate is the same as Joseph Brant Hospital in Burlington. They had zero assisted deliveries and zero epidurals while I was there. They do breech vaginal delivery, twins, VBACs regularly. It was a great learning experience. Also, they don’t have EFM (electronic fetal monitoring), so I got lots of practice with IA (intermittent auscultation). Keeping the woman off the bed seems to be their primary focus, so it was very refreshing to me since every single birth I participated during my second-year placement was with the woman on the bed and her back. I know… this is quite disappointing.

Midwifery is not regulated in Brazil, but it is also not illegal, so there are some midwives there. I got in touch with two home birth midwifery clinics while there and was even invited to do a talk about the integration of midwives in Canada at one the clinics. I do think about someday going back, so it was important for me to assess the midwifery situation there. Though Midwifery in Brazil does not come anywhere near what we have achieved in Canada regarding the scope of practice, consultations, and hospital privileges there is a seed planted there. It also gives midwives more freedom from the medical profession as they are not controlled by them. Just some food for thought.

Now I’m back in Canada and getting ready to start my senior placement. Lately,  I have often stopped and acknowledged that I am in my last year of this program. How did I get here? When I look back, I realize how far I have come, and I feel very confident about this upcoming placement. I had some opportunities to talk to my preceptor so far, and I believe that this placement is going to be more human than the previous one. I’m expected to follow only one midwife (4 clients a mother instead of 8) and only be on call when my preceptor is one call (not every single day except four days off we get a month). This represents a huge improvement in my ability to cope with the demands of the midwifery profession. I’ll try to keep writing during the placement, but if the time is short and the work is massive I’ll have the month of August off and will catch up then.

Following are some pictures of the hospital I worked while there:

Nurses Station

Triage

Squatting bed

Regular bed with squatting bar 

Birthing stool

Rocking horse

Flip-flops everywhere - even at the nurses station

One of the babies I caught

And now some picture of us having fun:

Beautiful flight with beautiful view of the mountains

View from out bedroom

View from living room

Bonding with my daughter

Family time

A waterfall we visited

Off course some fishing

Time with hubby

Market time

Healthy food every day

Senior Lottery – This is so hard!

The time has come to enter the senior lottery, the scariest part of this program. Of course, when the list of our options came out, it was not what I had expected. In the last year, the University has made some changes in an attempt to improve the support they give to students during placements. In the past, we were able to choose any midwifery practice in Ontario that was taking students for the particular placement. Many students were experiencing problems with their preceptors and due to some clinics' distance and the University lack of familiarity with some of the areas; the program was not able to provide better support to those students. With this in mind, they divided the clinics concerning its proximity to the university you are associated with. Though I can understand this reasoning, it has also created a limited amount of choices for students. Another change that was made is that many clinics are clumped into one choice. For example, Burlington and Oakville are considered one choice, the two clinics in Waterloo and the two clinics in Kitchener are regarded as another choice, the two clinics in Cambridge and the two clinics in Guelph are considered yet another choice. If you are interested in Cambridge and put down this as a choice, you may end up with Guelph. This is horrible, especially for people where moving is a major problem. In all, we only have eight choices of areas, and we have to identify our first top four. Then, it is up to the lottery and your luck to find out where you are going.

Have I said how terrified I am of this lottery? Way more terrified than the one in the second year. First, in second year, all of my four top choices did not involve moving. I would only have to move if I fell out of the lottery by not being chosen for any of my top four choices. For the senior lottery I’m about to participate now, there are only two choices that I would not involve moving. So, I have to choose two places I don’t want to move to as part of my top four picks. It is horrible to have to think about moving when the fact hasn’t happened yet. Second, the last placement was only for four months. The senior placement is three sets of three months with a month off in between, which means I would have to have other living arrangements for basically one year. Also, what is making me nervous is that in the second year lottery, my designated placement ended up being my fourth choice. So I know there is a real chance of me not getting my first two choices, meaning there is a real chance I would have to move and leave my five children and husband for almost a year. I don’t have any family in Canada, so I can’t count on any help. Imagine that.

There is also another factor aggravating the situation, and that is, the closest midwifery clinic to me, which is Burlington and Area Midwives, will declare a conflict of interest with me being a student there. This is because I had my last baby with one of their midwives and also had a business relationship with the clinic when I used to teach prenatal classes. The university says that if the clinic or the midwife feels that they cannot adequately assess a student for whatever reason, they should declare a conflict of interest. So there you go! No Burlington clinic for me. What makes it even harder is that the Burlington and Oakville clinics are clumped together into one choice; Halton. So I’m not entirely sure how this is going to be affected if I put Halton as my first choice. Can I just say it? This sucks! Big time. I’m still not sure what I’m going to put down as my first four choices. Then, the wait. Yes! Three weeks until we find out where we are going. Is this torture or what?

Did I mention how much this sucks?

Third Year

I haven’t posted for awhile because I have been seriously thinking about discontinuing this blog. It turned out my Normal Childbearing placement was much harder than I had expected. Not so much the huge learning curve that it is, but being in a midwifery student role. When you go back to school at the age I did, and you have been submerged in midwifery for the last 20 years, it is hard to accept certain things. Things that I cannot talk about in this blog. Part of it is the midwife I am being trained to be is not the midwife I had in mind when I applied. How could I have been so wrong about midwifery in Ontario? The first few weeks of my placement seemed like a dream come true until the reality of the "real midwifery" became apparent. I would love to be able to share my thoughts and frustrations here, but we have been warned by the ethics and legal committee from McMaster way too many times about being careful with what we post on social media. Examples of students that were expelled from school because of the inappropriateness of what had been said online were highlighted too many times. Of course, maintaining the confidentiality of clients and people you work with is a must, but there is huge fear of someone finding what you wrote unprofessional or inappropriate. When I’m censored on what I write, I feel I'm not true to the blog or reader. I have thought long and hard if it is worth continuing with the blog, but I do miss going back and reading my achievements when I need some encouragement. Of course, I could just journal at home, but somehow it does not give me the same motivation to write.

There is one thing that I can say, and that is I was very close to dropping out. There were times when I didn’t think I could go on with another day. I felt so alone and isolated. I hated that I was not enjoying what I had waited for so long, in fact that I was dreading every day of it. My frustrations with midwifery were not the only hard aspect of the placement. The rigour of this program is beyond humane. Being on-call 24 hours a day with only four days off a month plus weekly tutorials that need preparation and online contributions is extremely stressful.  The witching hours, poor nutrition and stress made it very hard for me to manage my Fibromyalgia condition, which added, even more, challenges to this program. The lack of clear expectations from preceptors and working with multiple ones, also adds much to the frustration.

The following poem was not written by me but by a senior student. It was published in a newsletter for the midwifery students association, and it spoke so close to my heart that I decided to include in this post.

The fact that I had a summer placement and went straight into third-year, starting with an emergency skills’ intensive week and then six university credits taken online in six weeks did not help me process what I had gone through during the summer. I feel I need some serious counseling before I can get on with my senior placement. Which by the way, is right around the corner, because we should be getting our list for the senior placement lottery in mid-January. Somehow I need to find a way to get the strength to finish this program. Everyone keeps telling me that I’m almost there, but when I think of the senior placement, it brings a shiver down my spine. For now, I will just concentrate in finishing my third-year placements which I'm actually enjoying. I'm especially looking forward to my international placement coming in March but I will leave that for another post.

First Placement

Six weeks into the placement and I’m still loving it. I was going to write a post during my first week, but then I thought I should wait until I had a more realistic perception of this placement. During my first week I did mostly observation and there was nothing expected of me so it is very easy to enjoy. Now that I have completed one quarter of this placement I feel I have a better feeling of what the rest might be. I have to say that I hit the jackpot as far as preceptors are concerned. I love both my preceptors and I’m really enjoying the experience of working in a midwifery clinic. I’m finding the perfect balance between clinic work and births. I love how my schedule can change without any notice, like the other day I was heading to the clinic for a day full of prenatal appointments when we got called to a birth. My day turned out completely different than I had planed with a slimy baby sliding into my hands at the end of the day. How can I not love that? My preceptors are very rigorous about me taking time off to spend with my family as well as taking time to study.  They have no problems challenging me to try new skills, but at the same time being very accepting and understanding of common beginners mistakes. I feel I’m in a safe learning space where I can ask questions and be honest. For the first time in this program I feel I’m experiencing a learning style that I can really learn from.

The one part that I have to confess that I’m not enjoying that much is the tutorial component of the course. I have a great tutor and great colleagues in the group but the format of online conference type of thing is awful. You get to do scenario discussion with a whole group of women through just sound. I have to wear a headphone with a microphone for 3 hours and every time you want to speak I have to press a microphone button. There is no body language to read so often we end up interrupting somebody else who started taking at the same time as you. It’s talking into space and it sounds so unnatural. I really dislike this format but I understand that there isn’t another way to do it with us in our placement in clinics all over Ontario. However, my suggestion would be to not have tutorial run congruent to placement and maybe as a subject on its own during the semester before placement starts. I find it is extremely busy as it is during placement and we are constantly looking up things anyways, I don’t feel I have the time or the energy to write an essay on top of the learning we are already doing during placement.

The wait continues...

I’m having a really hard time writing in the blog lately. I’m not quite sure why, because lack of time is not an issue right now. Maybe it’s because there are so many things I want to write about and can’t focus on something to get started. I have written at least five posts in my head, but never seem to be able to organize my thoughts once at the computer. I know that feeling all too well. You know, when you have to start an essay. I know what I want to write about, I have a million ideas of what to say, but once in front of the computer my mind just goes blank.

I was planning on writing once I was in Brazil again, at the end of February for a week. This time I stayed with another cousin, and he lives right in front of the beach. I mean, I could see and hear the waves from the balcony of his apartment.  I went to the beach every day, all day long, and it was once more very refreshing for my health as well as my mind. But it wasn’t until I was flying back and at 37000 feet altitude somewhere over the Atlantic Ocean, that I started to think about my upcoming placement. What triggered me to think of it was the sheer exhaustion of an 11 hour, red eye flight. As I toss and turn on my narrow seat, I started to think of how I was going to cope with all the sleepless nights, long hours, the learning curve, and the stress of being under pressure all the time. I mean, I have worked as a doula before and know well what is like to be up all night at a birth. However, after the birth I would have days to recover and that won’t be the case in midwifery.

View from my cousin's apartment in Rio

My daily meditation

You know, this placement is approaching faster than I can catch my breath, and I’m starting to get really nervous. Actually, I can say that a little panic is beggining to set in as I hear from many of my colleagues that they are at the end of their rope. They are almost there with only four weeks left of placement, and it is normal to feel fatigued and discouraged. I remember feeling exactly the same way at the end of every semester. I always survived so I keep telling myself this placement should be no different.

To calm my nerves and see if I would get excited again about midwifery, I started re-reading some of my favorite midwifery novels. Many of those novels inspired me to be a midwifery student even more than I already wanted and I remember when I read them for the first time, midwifery was still a far away dream for me, or I was still in the grueling process of becoming admitted to the MEP. Now I’m a second year midwifery student starting her first placement really soon and about to get a taste of the real thing. The books that I love the most are “baby Catcher “ by Peggy Vincent, “Lady’s hands, Lion’s heart” by Carol Leonard” and the “Birth House” by Ami McKay. I have to say the trick worked. I’m once more getting excited about being involved with births. It is great to read those books as a student, knowing that I will be a midwife very soon. Pregnant women and births have always been my passion and a huge part of my life, and as I have said before, I never felt so disconnected from it since I have started the MEP program. I am aware that this is about to change big time as soon as I start this placement and I will probably be begging to not see another pregnant woman in front of me by the time I’m almost done. But right now I just want to feel connected with the birth world again and devour new knowledge.

I still have another four weeks before my placement start and even though this may seem like an eternity for my colleagues doing their placement in the winter term and counting the days to be finished, I know it will fly for me. Especially because I have two trips planned for the end of April. I will meet my dad in California and take a road trip through Los Angeles, San Francisco, through the mountains (we will visit Lake Tahoe), down to Las Vegas, through the Grand Canyon and end up in Phoenix. I will then fly back home, will have two days to get my house back in order after being gone for 10 days (which I tell you, it will not be good), pack and leave for Orlando with my Family. We will be spending 4 days there and will visit Universal Studios. At this point, my dad will also have flown from Phoenix to Tampa beach and will meet my family and I in Orlando. He won’t be coming with us to the parks because he is there for an aviation fair. My dad is a pilot and, oh! by the way, so is my husband. Just in case you were wondering how the heck do I get to do all that travelling, pay tuition, be a full-time student and support 5 children. Yup, I get almost free tickets with Air Canada. Pretty cool, eh? That makes me think of where could I go for one of my electives in third year, which could be an international placement.

Allright, I think I will stop now, and this could be a topic for another post.

Break Time

Oh my gosh! I knew it had been a long time since I had written, but oh my… I didn’t realize it had been that long. My apologies for the long absence, I won’t even try to make excuses for it. I’ll just dive right into where I had left.

The lottery results were announced in October and I got my last choice, Community Midwives of Hamilton during spring/summer term. Yay for not having to move, crap for not having a summer break. I could be complaining about how terrible it will be to be in placement when my kids are off school and how I’m not going to be able to go camping and all, but instead I will concentrate on how having a summer placement can work for me.

Second year turned out to also be very stressful. I really enjoyed clinical skills but the speed and the amount of information thrown at us was overwhelming. Pharmacology and reproductive anatomy took a great deal of my studying time which often resulted in me panicking before a clinical skills exam having totally ignored it until the day before. I remember one occasion, the day before my midterm clinical skills exam, where I was so frustrated with the interruptions at home that I ended up checking into a hotel so I could study no-stop until the exam the next day. I was so burned out at the end of this semester and my fibromyalgia was so intense that I don’t know how I would have gone straight into a winter placement. Given that the 3 weeks off we have between the semester and beginning of placement are during the Christmas holidays, it really means no rest for me. Even though I absolutely love this time of the year I do find it exhausting.

So, instead of starting a placement completely burned out I took a trip to Brazil with my family. Yes, you heard me right. I went to Brazil for 3 weeks! It was an amazing and invigorating, well needed vacation. I hadn’t been to Brazil in 15 years and I didn’t realize how much I had missed my roots. It was so hot there, with temperatures in the 40’s degree Celsius! The sun gave me the energy I needed for recovery and the laid back pace of being on holiday without schedules or worries relaxed me in a way I can’t remember last time I felt this light. But as with everything, vacations also come to an end. 

Now I’m back here in Burlington and the below zero temperature is really getting to me. Within a week of being back I’m already in so much pain again. I can’t even blame it on stress as I have nothing going on right now that is causing me stress. There is only one thing to blame; the weather! Once more I’m grateful that I ended up with a summer placement because I am always so much healthier when the weather is warmer. This way it will be a lot easier for me to cope with the demands of the placement, such as stress and tiredness, without the added physical challenges I experience in the winter.

I feel mentally rested after this holiday and am starting to get the itch to get involved in midwifery again. It is only end of January and I don’t start my placement until the end of April. What am I going to do for the next 3 months? I keep hearing from colleagues about them attending births and I can’t help but feel a little envy. I still have a lot to do before I feel ready to start placement and I have plans to do some more traveling too, but I do dream about how my experience in placement will be. How will I cope, will we manage as a family with the challenge of the kids being off school in the summer, but ultimately how will my body handle the physical demands of midwifery. My biggest fear is that this disease will get on the way of my dream of becoming a midwife. I worry that I will physically not be able to perform my chosen profession. Sometimes I feel I need to move to a place where it is summer all year round. But where could I go and still be able to work as a midwife? Midwifery does not exist in Brazil and for me to work there with pregnant women I would have to either be an obstetric nurse or an obstetrician. Here in Ontario we have an amazing structure for the midwifery profession. It is legislated and regulated, it is also funded by the government, and we are independent and self regulated profession. Sure there are many areas for improvement but compared to any where in the world we have it really good here. If I stayed here, would I be able to take all my vacation time in the winter, go somewhere warmer, and only come back when it is not so cold anymore? I feel so insecure right now. I always do when I’m in the middle of a fibromyalgia crisis. It’s like being in the middle of a blizzard where you can’t see an inch ahead of you and you feel lost and scared. Right now I feel like I’m the midst of this blizzard that is so cold and dark, like I’m never going to see the sun again. But wait a minute! It is cold and dark and I haven’t seen the sun since I came back from Brazil! No wonder! Anyways, probably next time you hear from me I will be in Brazil again for a last fix me up before placement and I’m sure you will hear a totally different tone to my writing.

The kids and I on our way back from the beach. This day it was 45C! My oldest son wasn't there that day.

View from the balcony where we were staying.

Hubby and I enjoying the beach!

And now time to enjoy a "chopp" (Brazilian draft beer)