Elder Student Project, Part 3: Interview with Bea*
For my interview with a Phase 3 student, I had a 20-minute chat Bea, who has been actively working as a primary midwife under supervision since April of this year. She is currently working at a birth center outside of Orange County, with seven preceptors. Bea attends about half of the 15 births they have each month. I immediately asked about how she juggles working with so many preceptors, because it seems beyond my capacity as a human being at this stage. Bea shared that while it is hard to get to know each preceptor in this model, she absolutely loves learning from so many people. She also pointed out that because there are many voices and opinions, the birth center has strict protocols all must adhere to, which has helped streamline her own learning and allowed her to find her role in this setting a bit easier than previous placements. It was obvious that Bea has quite a fondness for her current clinical placement, as she literally couldn’t think of anything she’s not enjoying about being in this phase as a student.
Of course, it’s not all roses on her end. Bea was clear that she has made many sacrifices along the road to becoming a midwife and continues to be the least reliable person in her friends’ and family’s lives because it’s her duty to show up for her clients first. And in terms of what’s expected of a student midwife in this phase, Bea also wasn’t shy in sharing that she has had to adjust her approach in this phase. While the previous phase of student midwife life meant catering to the midwife present and learning from them, it now means catering first to the client’s needs and learning from hands-on experiences. An area she is constantly having to work on is trusting her own intuition with pregnant and birthing clients, allowing the licensed midwife preceptors to back her up and step in when necessary. It struck me that this is quite a vulnerable and perhaps confusing place to be, straddling the line between independently competent provider and student or novice.
When asked about the specific tasks she is responsible for in the birth center clinic and at birth, Bea explained that she is now the primary care provider for all midwifery skills with clients she interacts with. In prenatal visits, she leads the way with taking health histories, performing physical and internal exams, and checks vitals consistently. At births, she is responsible for any cervical checks, providing suggestions for progress, monitoring fetal heart tones, catching babies, newborn exams, and more. Listening to Bea detail just how much she does with clients, I felt a bit of dread. I have attended so many births in our area with CPMs and student midwives and have yet to see a midwife allow the student that much autonomy and independence. I worry about finding a local preceptor/clinical placement in which I will be allowed that much development prior to graduation as a midwife.
Bea disclosed a couple other ways in which she has developed as a student in this phase. Though she was a doula for two years prior to entering midwifery school, Bea was also a CNA before that, so the shift into a more medical/healthcare role was not as big of a leap as she thought it might be. She stated that there have been times she thought a midwifery client needed a doula and felt called to jumping into that role, but she was busy and didn’t have the hands or energy available. Bea does still enjoy utilizing the doula knowledge when it’s called for and there’s space for it and believes there is a higher intimacy level when in that role due to the longer journey of prenatal care with clients as a midwife.
The other area Bea has had to adjust, perhaps to a greater extent, has to do with her own biases around consumer-led care. As a pregnant person herself, Bea did a lot of research and yearned to understand as much as possible before encountering it in real-time. She entered midwifery assuming others would be similar, and quickly found that assumption led to ill-equipped parents. She has been surprised many times now how much education people need around topics related to their bodily health and birth. So, she actively works to combat the internal bias around how experienced or educated clients may or may not be and provides education to all midwifery clients alike.
Bea closed the conversation by sharing a personal story and some advice. She detailed the events that almost led her to quit midwifery school during the assistant phase: Bea was fired two births into her first clinical placement-for which she had uprooted her life-and had to reconfigure everything unexpectedly. She felt embarrassed, outraged, and just fatigued by the whole ordeal and said that she would not have gotten through it without other student midwives supporting her for weeks afterward. So, her direct advice was this: “It’s going to be really hard and really fun and you are going to want to quit at some point. When you do, talk to other student midwives and dig deep to remember why you wanted to do this in the first place.”
Because I have already had weird challenges come up just in the first year of school, without even being in clinical placement with midwife preceptors, I sense that she is absolutely right about my future want to quit. Even if momentary. I feel validated in advance hearing her say it’s to be expected. And I feel comforted in the knowledge that other student midwives have seen their way through catastrophe.
*Name changed for privacy. Interview occurred live in Summer 2019.
Amanda Cagle is a professional doula, educator, and student midwife located in Orange County, CA who offers comprehensive services to growing families and birth professionals alike. Amanda can be reached via email at email@example.com or through www.yourbirthteam.com.