Some of my writing has been making the rounds lately, though not all in this forum. Here are some links and excerpts to other things I have been working on, if you’d like to take a look!
Many thanks to Amy Romano and Lisa Kane Low, awesome midwives who invited me to participate in the creation of this survey. It was an incredible learning experience from the start, and the survey outcomes will continue to teach providers as well as women about the gaps in knowledge and access to birth control.
“…Another clear finding of the survey was a gap in knowledge about who provides birth control and family planning services. Only 26% of women were aware that certified nurse-midwives (CNMs) and certified midwives (CMs) offer family planning and birth control services, despite this being a specialty for the profession. Additionally fewer than 5% of the women reported that they had consulted a CNM or CM to make a decision about which type of birth control best suits their needs.
Midwives are uniquely positioned to address this identified knowledge and service gap in birth control and family planning for US women. While there are a full range of health care providers who offer birth control and family planning services, Breedlove said midwives are experts in this area and are an underutilized resource. Midwives serve as partners in their clients’ health care, and provide personalized services tailored to each woman’s unique needs—a care style that is especially suited to assist women in making important birth control and family planning decisions.
“While we are well-known as maternity care providers, CNMs and CMs provide a broad range of vital health care services to women through the lifespan, including guidance and counsel on birth control, and prescribing all types of contraception,” Breedlove said. “We listen to women and help them figure out what works for them at 18, 30, or 50—whatever their stage of life. Using an evidence-based model of care coupled with our education and training regarding family planning and contraception, midwives can help narrow this significant and harmful gap in family planning services for women.”
Because the ACA improves coverage for services related to sexual and reproductive health, Breedlove said its implementation will also afford women greater access to midwives, who specialize in providing these services. “As the ACA is implemented, many women will gain access to coverage for reproductive health services that they never have had before. This presents a real opportunity to do more to improve women’s knowledge about and access to effective family planning options. Midwives are experts in providing these services which are vitally important to women’s health,” Breedlove said…”
The Latent Phase: Check Yourself – Midwife Connection (ACNM Blog)
The first few days, weeks, and months at my job (now over one year ago!) were tough – and by tough, I mean mentally and emotionally exhausting. It was partly because I was nervous to care for women again after taking 6 months away from direct care to deal with graduating, moving, and credentialing paperwork, but it was also partly because my midwifery status was official. I was on my own with no one responsible to check my work, to assure me I was doing okay or that I was missing something. The realization that the responsibility was all my own was a shock to my system.
I felt overwhelmed reading the schedule and each patient’s associated complaints, especially when they included what seemed to be vague symptoms like general pelvic pain, irregular menses, or itching. What could it be? How would I be able to help? What if I didn’t know what to do? Of course, there were often other providers to ask, and another midwife could be just a phone call away, but conferring with colleagues is not always feasible for every patient concern or question or uncertainty. Sometimes, after collecting a patient’s history, I needed to step out of the room to check my resources. Here are some exit strategies I’ve used to get a moment alone while reassuring my patients:
- New evidence has just been published on that topic. Let me review the latest recommendations and I’ll be right back to discuss those with you.
- Let’s rule out a pregnancy or a strong urine infection: let me get you a cup and I’ll be back in a few minutes to go over the results and the best plan forward.
- I have had a few patients with this problem and I have been trying a few strategies to help. I am going to double check for the approach that would be best for you.
- I work with a midwife who has helped many women with this lately. Let me chat with her for a second and I’ll be right back.
- The truth is always an option! I want to make sure I’m giving you the best care possible. I need a minute to check a few resources, and I’ll be right back…
Continues at the link above.
The Latent Phase: Mind the Gap – Midwife Connection (ACNM Blog)
In my final months of midwifery training, I decided I needed to step up my game. I couldn’t quite put my finger on what they were, but I knew there must be a few hidden gaps in the transition from advanced student to practicing clinician – gaps that stretched beyond learning the evidence and memorizing facts. In my first few months of independent practice, those gaps became glaringly self-evident in the overwhelming sense of responsibility I felt. I now apologized to women when I ran late in the clinic, held the full weight of explaining my chosen management plan to a disagreeing collaborative provider, and decided how to discuss results over the phone. As a student, the full circle never stopped and ended with me; the full responsibility of patient care was never my own. I knew that when in a tight spot, I could look over my shoulder to the preceptor, and that midwife would speak up and clarify or do damage control as needed.
It would have been helpful to test out the weight of that responsibility, even partially, while still within the embrace of an instructing or orienting midwife. Holding myself solely accountable, to a degree, for the beginning and end of conversations, or encounters, or arguments, would have introduced me to the idea that not only do you memorize everything, but there’s also the difficult social component of this work, and you have to do that, too. Take a few deep breaths: there’s still time!
For those of you in the last year of midwifery school or who are completing orientation at a new employer right now, here are some suggestions of tougher day-to-day activities to experience while still within arms’ reach of knowledgeable midwives:
Run an entire clinic day on your own.
From start to finish: see all of the patients, order all of the labs, run late and apologize to everyone, ask support staff or collaborative providers for help when needed, apologize for running late again, eat lunch while charting, handle the emotion of walking from a sad room immediately into a happy one, return messages, complete refill requests, and call with lab results. Of course you’ll need your supervising midwife to participate, but find a way for an entire day of responsibility to feel mostly yours.
Consult with collaborative physicians.
This part of midwifery can be the most trying, the most delicate, and at times the most infuriating. To leave a conversation with a collaborator and feel success and happiness or frustration and anger is to have been a midwife. Be the main communicator with a collaborator as often as possible while still able to defer to another midwife, and stretch your comfort zone with consultations…
Continues at the link above.
Breastfeeding Struggles Matter for Women – Tara Haelle at DailyRx.com
“Breastfeeding is not always easy for every mom and baby,” Tillman said. “It can take a village, ideally of people supportive of breastfeeding and experienced with feeding newborns, to support a woman in her first breastfeeding venture.”
She said that moms sometimes believe a baby’s irritation and seemingly inconsolable crying on the second night after birth can lead a mom to question whether she has sufficient milk for her baby, then leading to more doubt and discouragement in general about breastfeeding.
“As in the early days of pregnancy, providers should be available to women during this time of uncertainty to discuss normal body changes and address concerns for what is normal and what needs a provider’s attention,” Tillman said.
“It takes time for new mothers to learn the baby’s signals and become accustomed to the full spectrum of signs and symptoms of hungry babies, full babies, and comfort measures (not including food) for moms struggling to get through the first week,” she said.
Tillman noted that postpartum support in the US is greatly lacking, which is a disservice to moms and their babies.
“Providers can bill time for these visits under ‘Postpartum care of the lactating mother,’ and mothers can benefit not only from additional breastfeeding care but also assessments for postpartum depression, pediatric care coordination and time to answer the questions of all new mothers that otherwise may never be addressed in the first few days of the new family,” Tillman said…
Continues at the link above.
Artwork and music: Innovative approaches to physical assessment – Linda Honan Pellico, Kristopher Fennie, Stephanie Tillman, Thomas C Duffy, Linda Freidlaender, & Gillian Graham
Final publication of one of my graduate school research projects
Background: Observation and auditory skills are essential competencies for nursing practice. Research studies reveal that observational abilities are improved with visual training in an art museum and that the standing competence of auscultative skills is inadequate. This study details an innovative strategy to improve nursing students’ observational and auscultative abilities. Methods: A pretest–posttest experimental design was used in which 77 students in an accelerated master’s entry nursing program were randomized to either receive music auditory training and observation training in a museum and music hall or view a DVD of the music intervention and observation training in a classroom using handheld images and artwork display. Results: Students correctly identified approximately 68% of bowel sounds, 38% of lung sounds and 26% of heart sounds after this 2-h intervention, and significantly improved their observational abilities over time (p < 0.0001) on all measures with few exceptions. In addition, there were no differences between the groups over time for most measures, suggesting that the classroom experience is an effective pedagogy for improving observational skills. Conclusion: The activities of viewing works of art and aural training using music sharpen observational and reasoning skills of nursing students and auscultative interpretive abilities, and hold promise for medical education.