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Entries in midwifery apprenticeship (1)

Friday
Jun272008

Discordance

Every once in awhile, I will find myself in a funky alternative space with a client. Things just don't seem to go right all the time. In fact, it sometimes seems everything is going wrong.

- I can't get the vein the first (or second or third) time.

- When drawing blood, it mysteriously squirts all over the client.

- The blood hemolyzes and has to be re-done.

- Appointments get moved, moved again and then questions about "When exactly was that appointment again?" happen.

- Communication is stilted.

- The client shows up at the office and I was told the appointment had been canceled, so I wasn't there.

- A lab test gets overlooked and has to be done later than expected (best not happen with tests like the AFP!).

When these sorts of things (and more!) occur, I feel like I am lurching clumbsily, unable to hit my mark. It's more than embarrassing.

This is happening (has happened) right now with a dear, sweet client. We had the oddest exchange about an appointment - my having the wrong email to contact her, calling her house phone that doesn't get much usage (having her mother's phone number for her second number!) and missing her calls when she called me. We did finally meet, but it was exhausting getting to that place.

I've squirted blood on my sister's white clothes and my mother-in-law's pants. I don't feel nervous at all when doing any aspect of midwifery... well, I'm not telling the whole truth there. It isn't second nature to suture or start IVs, but I can do it/them. So why do weird things happen - and why do the seem to happen to the same woman over and over?

A couple of years ago I promised a woman I would never leave her, yet the Universe had the sickest sense of humor and had another woman near pushing when the first woman was being transported to the hospital and I had to, indeed, leave her. That bitter, bitter taste still lingers. How could I have not known to not say such a thing? How obvious was that as I taunted the Universe? One thing after another went awry that night. Exhausted, I had to call in another midwife to attend the second woman and after I drove home in a stupor, learned the midwife had to transfer my client to the hospital for a cesarean... on a woman who'd already had a great homebirth previously! The first woman had a torrential hemorrhage and was barely functioning for weeks after her birth. During those first few days after the debacle, I could barely sleep, yet had to pull myself together enough to do postpartum visits on both women.

Why do these things happen? What are my lessons?

Having an apprentice (two!), communication can take on the "Operator Game" quality. Remember how that goes? A line of people next to each other, the first person whispering into the person's ear and the whispering continues down the line until the last person says the "message" outloud, everyone laughing at the mangled mess of words. It isn't so funny when lives are at stake.

How do I eliminate the miscommunication? I will talk with both my apprentices about clear communication - in writing. I find that texts and emails are extremely helpful between the women and myself. I also like emails with clients and print them all out and put them in their charts.

My apprentices (and clients) text a lot. A LOT. I will tell all of them that unless I text a response back, they are to assume I didn't get the message. It's distressing when I get a flood of texts two days after they were initially sent (thanks to Sprint).

On another note in the same vein...

...I have a wonderfully competent apprentice; she is beginning to take on her own clients as I supervise her continued growth. Yet, there is much she still doesn't know and it is my responsibility to not be complacent and assume everything is being done. It is ultimately my total responsibility to make sure nothing falls through the cracks.

Having an advanced apprentice, she does much of the care of my clients... the measuring, palpation, discussion... I correct and guide as the prenatals and births unfold. I have a newer apprentice and my advanced apprentice teaches the newer one the steps I taught her so long ago.

Yet, I am the midwife being hired. Where do I draw the line (with clients) between midwife and teacher? All women coming into my practice know I have apprentices and they (the apprentices) will be doing at least some of their care. But, maybe I am not clear enough about how much of the hands-on care is done by them.

I can't help but wonder (sounding like Carrie Bradshaw here), how much is the odd energy a sign that I need to take the reigns again and allow/encourage my apprentices to sit back and watch?

I'm doing just that with two clients (including the one mentioned above). Goofy things still happen when I am "in charge," but a shift in the energy must happen or else nothing changes. I'm hoping that with the movement, things will settle into a place of comfort.

Talking to the client helped a lot. When I brought up the strange interactions and lack of communication, she was visibly relieved, saying she was going to say something, too. Not only was she frustrated, but she and her partner were also somewhat annoyed. How competent does a midwife look if she can't even get appointment times right? Not very.

None of this is a reflection on my apprentices and I have told them as much. It is a complete reflection on me and my need to watch more closely. It is a precarious balance, instructing the apprentices, giving them leeway, allowing for mistakes so learning can take place and not allowing things to slip through the cracks. I'm still feeling my way as a mentor midwife.

So, let's see what happens with the changes. I look forward to more harmony.