Transitions

As I alluded to in a previous post, there are new, exciting things on the horizon for 2015. Tomorrow, I will give formal, written notice that I will be leaving my current position in order to move to a position in a full-scope practice.

Over this past year, I felt the familiar tug to lay my hands on pregnant bellies and feel little ones dance under my fingers, but knew that my day to return to the birthing world would come. I attended a conference this past fall and saw old professors, preceptors and other midwives in the community and knew that it was time to return to home to birth.

It is not as though I haven’t enjoyed my time working in reproductive health, but as a former classmate put it to me a few weeks ago, “it just doesn’t light me up inside.” There are big things that I will miss, first among them being an abortion provider.

Some of my most challenging, although joy filled days, emotionally were the days when I would help educate women before their abortions, discuss birth control options, and talk women through the emotions associated with their abortions. On procedure days I got to slow down a little bit, meet people where they were at, ask them about their lives, their partners, their decision. Those were the days I most felt like a midwife at my job; where I could hand tissues over and hug, or laugh when a woman jokingly says she’s really “filling up her abortion punch card” after two back-to-back contraceptive failures.

In this past year, I’ve had numerous colleagues, medical residents, and even former professors ask me if I “plan to practice midwifery” again. My (somewhat snarky) response has been that I practice midwifery every day. I was talking with one of my good friends the other day who has been having a rough time at her job lately and we discussed how midwifery is an approach. It is a philosophy of care and I truly believe you can be a midwife and be a family practice doc, or a psych NP or working in reproductive health.

There will be other things that I miss about my current job, and many things that I will not miss. In no particular order, below are the things I will miss the most:

1) My totally amazing, dedicated, hilarious co-workers. I literally could not do my job without the great support staff that helps get patient histories, figure out what is going on, and who preemptively tell patients no, we cannot address your birth control concerns, your vaginal itching, and do a full well-woman exam in a 10 minute visit.

2) First pelvic exams. I will surely do some of these in my new practice, but because I work primarily with very young women, a large number of the pelvic exams I do are a woman’s first exam. It is such an honor to teach women about their bodies and ensure that they have an empowering, comfortable first pelvic exam that will leave them more likely to return for follow up care in the years to come.

3) My male patients. I have really struggled this past year to provide health care to men. At first, I saw it as a necessary evil, mostly because I was unfamiliar with the anatomy, and had a difficult time getting men to take me seriously at first. I settled into a great rhythm providing care to men, especially in the past few months, and I will really miss the humor, the awkwardness, and sincerity that I see with my male patients.

I will miss men asking how they can protect their partners by getting the HPV vaccine. I will miss HIV + men asking me about PrEP so they can protect their partners. I will miss the awkward laughter and comments like, “so, this is actually happening. I gotta pull out my dick, now, right?” I will miss men letting down their guard and telling me that they feel vulnerable, but that they are glad they can talk to someone about what is going on.

4) My patient population. I absolutely love working with folks that have low health literacy, many of whom have poor access to health care services, may be facing poverty, unemployment or underemployment, drug addictions, and many of whom are not English speakers. I truly believe that low-income and low-health literacy populations are the most deserving of midwifery care (although everyone deserves a midwife!) because our philosophy is one that is more likely to meet women where they are at, explain things slowly and comprehensively, and make sure that patients feel comfortable with the plan of care. Most of my patients have medicaid or other state-sponsored insurance, and it is these folks that get the absolute bottom of the barrel when it comes to access to quality health care, but are the folks that need and deserve the most listening and the most compassion.

As great as some aspects of the job I’m currently at are, there are definitely things I will not miss:

1) 10 minute visits. This is my hands-down primo daily frustration. I once had a former professor laugh out loud when I told him they schedule our visits back-to-back every 10 minutes. He thought I was kidding. I am constantly running at least an hour behind, only to have time to pop into a room for 5 minutes to refill a birth control prescription. It is impossible to discuss fully diet and exercise, smoking cessation, safety at home, vaccinations and preventative care, as well as check in with my patient’s immediate needs of contraception or STI screening.

1a) Related, I miss having a full 30 minute lunch period where I get to eat, pee, zone out and actually come back for the afternoon refreshed. Although I know that I should (and am legally allowed ) to be taking every single lunch and break period, I know that when everyone’s just going to wait longer if I take my full (or any of my) lunch, I will put the patient’s needs ahead of my own and just carry on with the afternoon.

2) Walk in visits. In some ways I am very glad that the clinic takes walk in patients, especially as someone who has a history of very rapid-onset urinary tract infections. In other ways, this sets me even further behind in my schedule, leaving me frazzled, running around like a mad-woman, apologizing right and left for running so far behind schedule.

3) Related to numbers 1 and 2, I will not miss the absolute volume of patients that I see. The most devastating thing to me is that I do not remember my patients. I do not remember them from week to week, their stories, or what we talked about (with the rare exception). It is deeply painful to me as a health care provider to walk in to a room and know that I saw this patient previously only to realize that I could not pick them out of a line-up.

One of the reasons I went into midwifery was for the human connection. The rawness and realness of a connection that happens in such a specific time in a woman and family’s life was something that moved me into this difficult, rewarding profession and it is something I miss deeply.

Lastly, below are some of the things that I am most looking forward to as I make the jump into full-scope practice:

1) Belonging to a community of midwives and providers that are all similarly passionate about women’s health care and birth justice. I am so excited that I will get to practice with one of the amazing women I went to school with, and who has continued to be an inspiring support and resource through our first years of practice.

2) Build new skills and really challenge myself. I had a difficult time during school with birth, mostly because I was working in a hospital and with some providers that did not support physiologic birth. But, on those occasions that I was with preceptors that believed in me, supported me, and viewed birth as normal and healthy, those births filled me with joy.

I have a lot to learn (and re-learn), and I have no illusions about this big transition, and know that this next year will be long, difficult, and rewarding as I return to the beautiful world of birth work. I am more confident in who I am as a provider after this past year and I am hoping for a smooth transition back to baby-catching. As one of my midwifery school classmates reminded me, “they’re still coming out the same way.”

3) Take on my own midwifery students. Most of the students I have worked with over the past year have been medical residents, who, I will definitely miss, but I cannot wait to take on my own midwifery students and help others grow into this role. Midwifery students are a special kind of creature: fire in the belly, fiercely compassionate, unsure of themselves and green on the inside, but chock full of knowledge and passion. I had to laugh out loud when a beloved former professor, in the same sentence, agreed to be a reference for my upcoming new job and asked how long it would be until I could take a student.

I feel excited and ready to transition into this new role although I am also steeling myself for a new year of challenges, doubts, and growth that I will surely go through. I don’t start until mid-February, so stay tuned!

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One Response to Transitions

  1. Alison says:

    Your patients, wherever they are, are so lucky to have such a thoughtful and compassionate health care provider!

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