What Makes A Good Fit?

SoontoBeMidwife returns! After an extended time off from writing following finishing my program, going on an epic trip to California via bike (and getting engaged along the way!), passing my boards, and beginning the job hunt, I’ve been drawn back to writing about midwifery, even though I am currently not practicing. 

Throughout my (so-far) two month long job hunt, I’ve thought a lot about what kind of job I would want for my first foray into the midwifery world. What would make me happy? Do I want to practice full-scope midwifery (this means doing all kinds of reproductive health care as well as pregnancy care and births)? Would I be happy working just in GYN? What kind of philosophy does the place I’m applying to have regarding midwifery? Are there even any other midwives that practice at this clinic/hospital? Would it be ok for my partner and I to move away? For how long? 

There are a multitude of questions that I ask myself, nearly every day and the answers to those questions has evolved over the period of my job hunt. At first it was, “Full-scope or bust!” and then, “Well….maybe I’d be happy at a non-full scope job” and then, “Actually, I really want to be an abortion provider. Maybe GYN is for me for this time in my life.” 

I have counted up all the applications, interviews, and interactions I have had with midwives, recruiters, and hiring managers these past two months. My grand totals stand as follows:

47 applications

13 interviews (some with the same practices multiple times)

0 offers. 

Needless to say, it’s been a trying few months. Each day I feel gripped with fear that no one will ever hire me, but then one e-mail or phone call can return the giddy hope of a great practice, a new city, and the beginning of a career. 

However, I feel like I’ve learned incredibly important lessons about how to find a job, and find a job that I actually want, and for me, that all comes down to the fit. One of the questions I ask every interviewer is, “What are you looking for in a candidate?” This gives me valuable insight into who they are as a practice and what they value. To me, finding the “right fit” is essentially the same as saying “This is who I am as a midwife. Will I be supported in this practice?” 

But who am I as a midwife? 

I had the unbelievable joy and pleasure to watch eight other women transform into midwives with me, and each one of us has different styles, different skills and passions, and are all very different kinds of midwives who will find homes in practices that are all very different from one another. Each one of us will find our “perfect fit”, and some of us will end up in lovely homebirth practices that limit their patient load to only a handful of births a month, and others will end up in high-volume hospital-based practices, and others chose to forge ahead in GYN care at reproductive health clinics. The differences in what kinds of midwifery there are continue to astound me.

So who am I as a midwife? What do I want? 

I do know that I want to work in a practice where I see many GYN patients, do birth control counseling and management and can practice applied feminism in my midwifery care. 

I do know that I want to be able to work in an environment where I can be a clinical teacher.

And most surprising to myself, I want to eventually work in medical education. Not just midwifery education, but work in a multidisciplinary environment where I am involved in the training of Family Practice and OB/GYN residents, which invariably means that my dream job will be working in a hospital environment. 

If I went back in time and told the Me who was starting midwifery school two plus years ago that my dream would be to work in hospitals and be an integral part of medical education, I would tell you that that was crazy. The midwife I thought I wanted to be when I started would have worked in a small, homebirth practice.  I know that, although someday I would like to learn the valuable skills of out-of-hospital birth, my passions lie in the battleground of hospital birth. I feel drawn to hospital policy, want to dig in to a position where half the staff has no idea what makes a midwife different from a doctor, and I want to be on the front lines of changing birth from the inside out. 

This is not to say that out of hospital midwives do not change the culture of birth or play a vital role in changing birth for the better in this country . They are amazing people who have incredibly valuable skills who attend  the kinds of births I hope to have with my babies someday. 

However, I feel the drive to put on my midwifery hat and venture into the world of medical education and practice, because while even though midwifery is growing, more than 88% of births are still attended by physicians in the U.S. I approach midwifery practice much like I approach politics. Change will not come from without. I cannot leave the hospital and magically expect change to come, much as I cannot leave the struggles I am involved in because they are not “radical enough” and criticize from the outside. You’ve got to meet people where they’re at. And right now, where they’re at is in the hospital with physicians. 

Imagine what the world of women’s health care would look like if every Family Practice and OB/GYN resident had a “Normal Birth” clinical requirement?

Imagine what it would look like if every Family Practice and OB/GYN resident had to do clinical rotations with midwives and learn how we conduct prenatal and GYN visits? 

Imagine if every Family Practice and OB/GYN resident could say, “Oh, let’s try a position change, I had a midwife teach me that once.” or “I trained with a midwife, and so my pelvic exams are a little different.” 

Imagine if physicians all over this country could say, “You are having a healthy, normal pregnancy, and I’d like to consult with my midwife colleague about that and refer you to her.”

I believe that midwives have a key role to play in medical education, and we’re beginning to get a seat at that table. If we want to seriously improve women’s reproductive care and create better outcomes for everyone, OB/GYNs, Family Practice docs and Midwives have got to all be practicing together, trust each other, and be educated together. 

Right now, I’m unsure where I’ll begin my midwifery career and what it will look like, but at least for now, I’m damn sure of where I want it to end up. 

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One Response to What Makes A Good Fit?

  1. Riah says:

    Very well put, Michelle! The most lasting changes usually come from within.

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