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Sunday
Apr282013

Nursing School Worries

I’ve had several women come to me lately telling me they are entering nursing school, but are worried about losing their natural/home birthing mindsets. While I haven’t gone to nursing school myself, I have talked many women through and wanted to share some of my thoughts about how to keep centered even while moving into the medicalized world of nursing and hospital care.

The biggest concern seems to be having to do extraneous things that have nothing to do with midwifery… orthopedics, cardiology, geriatrics, psychiatry… all seemingly so far from birth work, but in reality, have everything to do with birth –if you just look with a soft-focus lens.

Everything you do in nursing school (and nursing in general) has something to do with midwifery, even if they seem so far away.

Why would you need cardiology in birth work? Part of the job of a midwife is to determine if mom has a heart murmur or not. Heart murmurs can be indicative of underlying cardiac conditions that need to be addressed by specialists. Also, listening to newborn hearts is a crucial part of immediate postpartum care. If you’ve listened to a thousand hearts, most of which are normal, you are able to quickly determine if there is an abnormality in the heart you are listening to. As an apprentice midwife (out of hospital apprentice), you don’t get the chance to listen to the wide variety of hearts that you do in nursing school. It’s a distinct advantage to be able to hear so many hearts.

What would geriatrics have to do with midwifery? Besides listening to the heart advantages, there is also the ability to work with folks with depression, orthopedic issues (more on that in a moment), chronic pain and family dynamics… all aspects that have to do with the care of women in the childbearing year and beyond.

Orthopedics? What in the world does that have to do with birth? One of the first things a midwife does with a new baby is check his or her clavicles to see if they are broken. Knowing what a break feels like as well as how to refer out if necessary or even how to fix it can be crucial for a midwife. Plus there are other physical conditions a newborn can have that a midwife needs to be aware of: hip dysplasia, club foot or femur fractures can all be a part of what might happen in birth.

Time in psychiatry is infinitely helpful because midwifery is all about the psychology of things. Getting to know a family, deciphering whether there is abuse in the family or not, understanding eating disorders and more are all covered in the psych portion of nursing school, something that isn’t typically covered in non-nurse midwifery education. It’s something we pick up along the way. I learned a lot from my own years in therapy.

So, putting the positive spin on nursing school can help keep your eye on the prize of the nursing degree.

What of possibly losing the idealism of out-of-hospital or natural birth? Won’t nursing school ruin the belief that birth is normal?

I always find that question so interesting. If you have the belief and there is nothing to counter it, you’ll stick with the belief. If, however, you have information that shows otherwise and you change your viewpoint, then that is the perception you’re supposed to have. If there is nothing to change your point of view, then you will stick with it. But, nursing school does change perceptions because there is new information, why wouldn’t it? Does it make you not believe in natural birth anymore? Not in my experience. It widens your attitude towards birth, eventually bringing the two (or more) positions into alignment. Is there a way to be a nurse and still believe in home birth? Absolutely! There are plenty of nurses who have their babies at home. They are probably more discerning about whom they choose to oversee their births, but they do believe in their abilities to be safe while birthing at home.

You know you’re going to learn new information. Why wouldn’t you want it to blend with your already strong knowledge of birth? Do you really feel you will be brainwashed? Or might your beliefs be questioned. Now, that isn’t such a bad thing. We should be able to stand strong in our beliefs even as someone stands in front of us showing us counter-proof. If we shift, we are brilliant humans, using all the information at hand and developing a new mindset. There is nothing wrong with that.

Will you see things that make you crazy? Absolutely. Will you want to reach out and stop people from doing things that you know to be dangerous or bad? You bet. Will you do it? Or will you stand there and learn. You will learn. Even when someone does something that you think to be dangerous, you must sit still and learn because there really might be another way to do what you’re watching. And even if you say to yourself, “I will NEVER do that to a woman,” put the skill in the file drawer because you never know when you might need to do just the thing you’re finding abhorrent. I remember learning how to do controlled cord traction. My mind screamed at me to stop; it was a horrible thing to do with a placenta. But, I sucked it up and learned. Was I ever glad when I had to get a placenta out from a hemorrhaging mom. I never thought I’d use the skill, but thankfully, I paid attention and learned anyway. I’ve learned there can be a reason to use any skill you acquire along the way, no matter how awful it seems at the time.

And that’s the way it is with nursing school. Even with all the things you think you’ll never need to practice home birth midwifery, you are wrong; you will utilize every extra skill and piece of education that comes out of nursing school. Midwifery school, even more so. But that’s a different post.

I hope this helps those wondering about nursing school and having concerns or second thoughts. I hope you’ve found some peace about the possibilities that await you in a place completely foreign from anything you’ve ever known. What an adventure! I only wish I had gone that route when I was your age. But now I get to share my old lady wisdom with you all who might go on to be awesome nurses and possibly certified nurse midwives. I am all the way behind you. Go for it!

Monday
Jun272011

Circumcision & Nursing School

Great question from a Facebook reader (paraphrased):

I have serious concerns regarding my future goal of becoming a Certified Nurse Midwife. I don’t support infant circumcision unless it’s for medical reasons and I’m seeing that many midwifery schools require at least one year of experience in obstetrics. I don’t want to be involved in any way with MGM (male genital mutilation); is that inevitable when working in L&D? Would there be any way around this so I don’t compromise my beliefs?

To my RN & CNM friends, do let me know if your program was different and what, if anything, was done if something came up that was against your beliefs. This is a fantastic question to explore!

I say:

First, not sure why you think L&D has anything to do with circumcision because circs are done postpartum. The postpartum RNs are the ones that help in that arena. L&D nurses, unless they're rotating through postpartum, won't have to concern themselves at all with it.

Second, part of the process of nursing and then midwifery school is to expose you to other sides of issues you haven't thought of yet... not because you're stupid, but because you haven't had the opportunity to explore them. I used to be quite the breastfeeding nazi, really believing ALL women could breastfeed and the ones that said they couldn't really weren't trying hard enough. When I had a client tell me she wasn't going to nurse about 20 times and I kept telling her how great it was and how if she just tried, she'd find out how much she'd like it. She finally leaned over and got in my face, telling me she'd been molested and the primary part of her body molested was her breasts and she was going to bottle feed. It was then I realized, not only is breastfeeding a woman's choice, but that sometimes, the most empowering thing a woman can do for herself is to schedule a cesarean/bottle feed/have general anesthesia/etc. Things I wouldn't remotely consider can be the most empowering to a mom.

Now, I know the arguments about circ... very well. I circ'd my first son, but not my second. After studying to become a Jew for 15+ years, I left Judaism behind because of two issues: circumcision and the mikvah (the mikvah's a different story). Yet, we all make choices that affect our child forever. I do believe a family should let the baby make his own choice, but I also know that some families who choose to vaccinate their children live with those consequences... just as the families that choose not to vaccinate have to live with the reality that the decision might mean death to their child. Believing that circumcision is the only time a family should consider letting the grown person make the decision is absurd. Mothers & fathers make decisions for their kids Every. Single. Day.

So, while I believe that, for me, the circumcision decision is best left to the adult person to make and I whole-heartedly believe in educating (NOT terrorizing) parents about the realities of circumcision, I also believe there is a tolerance that can come, not only for allowing parents to make their own decisions about this issue, but that you are able to release the decision-making to the parents about all sorts of issues you disagree with.

For, farrrrrr more often, you will stand in a room with a woman you know has zero business (in your opinion and experience) being induced, but who is choosing to be... with a woman who was bullied into a cesarean... with a woman you are required to counsel to be kept in bed... and the long, long list goes on and on.

(Adding for this post -) Think about the different cultures you’re going to see, the cultures where women are less than the cows on the street. You’ll be assisting at those births. You’ll be there for the births hold religion above all else (hmmm… some types of Judaism, anyone?) and nothing you say would change anyone’s mind, so you know to do your job and leave the religion to the families involved.

I admire your stand... please know I do. But, I encourage offering families some grace and finding a place of peace that parents really are doing the very best they can with the information they have.

(Adding again -) Doctors are not forced to learn to do abortions when it is against their beliefs. As a homebirth midwife, I wouldn’t have accepted a client that had beliefs extremely counter to my own. (They wouldn’t have selected me in the first place, but same thing.) If you were asking if you had to circumcise a baby to get an RN license and is there a way to bypass that requirement, I’d be first in line to help you find a way to avoid that requirement. But, dealing with circumcision as an RN is going to be different than that. Trying to maneuver your education based on a family’s legal choice is almost akin to burying your head in the sand. Please don’t.

Not sure if this helps, but do hope it offered other ways to look at the topic. Much good luck on your path!