One might ask, how is it possible to have social anxiety and work in a field where you are constantly meeting new people,asking them to tell you about the most intimate details of their lives, and form meaningful, trusting relationships in 15 minute visits?
Excellent question, dear readers. It has taken many years, lots of self-talk, and lots of practice.
There is a myth that seems to exist that those who go into the health professions and midwifery especially must inherently be outgoing and comfortable in social situations. Rewind to the night before my first midwifery clinicals:
I am sitting on my bed, rocking back and forth, terrified about being in a room alone with a patient come the next morning. I was a nervous wreck, envisioning myself stumbling over my words, unable to explain basic concepts, dreading forgetting to ask important questions because I was so nervous. But above all else, I was scared that my patients would see me as scared, awkward, and stupid.
Spoiler alert: midwifery students are often scared, awkward, and stupid. And they are supposed to be. They are full of knowledge and passion, but maybe haven’t figured out how to not slime themselves with ultrasound goo all day long. Instead of dreading this very reality, it took nearly the whole of my first year through school to stop comparing myself to people who have been practicing for years to embrace the awkwardness that comes with learning this profession.
Through school my biggest help was role play with classmates, practicing little shpeils in my car on the way to clinical, running scenarios in my head, and attempting to find ways to make myself comfortable so that I could make the women and the families that I cared for comfortable (hint: fake it ’till you make it is a real strategy).
There was no easy fix and I felt awkward (and still do sometimes) well into my first year of practice. Why do I tell this story? Because just as I was beginning to feel comfortable and competent after moving from the GYN world back to working in OB, I was asked to do something no one with social anxiety likes to do: facilitate group prenatal visits.
My practice recently began a Centering Prenatal Care program, as described from the CenteringPregnancy website:
Centering is a multifaceted model of group care that integrates the three major components of care: health assessment, education, and support, into a unified program within a group setting. Eight to twelve women with similar gestational ages meet together, learning care skills, participating in a facilitated discussion, and developing a support network with other group members…
Through this unique model of care, women are empowered to choose health-promoting behaviors. Health outcomes for pregnancies, specifically increased birth weight and gestational age of mothers that deliver preterm, and the satisfaction expressed by both the women and their providers, support the effectiveness of this model for the delivery of care.
I first learned about Centering while still a student and loved the idea that prenatal care could not only be something that women engage in individually, but that provides for a social connection that is so often lost regarding pregnancy in our society. Gone are the days of elder mothers and grandmothers who guide us through this vulnerable time, leaving most women to feel like they are in a singular journey.
Not only did I love that prenatal care could occur in a group setting, the entire philosophy of this care is focused around the notion that instead of having the “Expert” (midwife or doctor) give all the answers to the questions of the “learner” (patient), this model recognized the diverse life experiences of women and their families. In Centering it is not my job to provide answers and make sure that the question gets answered in the most quick and correct way, but instead to elicit the knowledge and experience of the women that I am in the group with.
Furthermore, women take their own blood pressure, weigh themselves, keep their own shadow-chart so they can track their pregnancies. Not only does this de-mystify what we do on our end, but also gives women a greater sense of control and engagement in their care. It very much embraces the Montessori model of “teach me to do it for myself,” which is another philosophy that I have come to love.
The Centering model mirrors a radical pedagogy of education that I hold dear and that is put forward by the Marxist philosopher Vygostky. His theories are mostly related to child cognition and development, but profess that social interaction and culture are large parts of how people learn and also emphasizes a group, facilitation-style learning model. This is starkly different than the “banking” model of education, which assumes that knowledge can simply be explained by an expert and “banked” into the knowledge bank of the learner. If you’re feeling industrious, I definitely recommend reading this article on Vygotsky’s revolutionary theory of psychological development
So, as we have established, in theory, I could not be more excited to participate in this model of care. In reality? I was nearly nauseous during the Centering facilitator training I did a few months back, envisioning awkward group conversations, groups spinning out of control, and yet again, ended up rocking back and forth on my bed basically trying to figure out how not to feel like this:
I have now had two group sessions using this new model. I can wholeheartedly say that, while mildly awkward the first night, the vibrance, excitement , and diversity of experience the women and families that are in my group bring far outstripped my fears.
In the first two nights I learned more about these women, their families, and their pregnancies than I often do after working with folks for the entirety of their pregnancies. Everyone laughs, brings food, and even though the folks in my group come from very different backgrounds, watching them bond over their shared experience brings me so much joy.
It is easy to see now why this model has so many positive outcomes, including fewer preterm births and higher breastfeeding initiation and continuation rates. My patients bring so much insight and excitement into each group that it is easy to see how women become more empowered and feel more in control of their own care and their pregnancies.
I’ll keep you all updated over the coming months working with this new model of care, but for now, this is how I’m feeling about our blossoming Centering practice: