Good questions
Oct. 22nd, 2021 07:32 am![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
whitewriter There's loads of posts I've been wanting to write lately but somehow time is being swallowed up by rewatching Seinfeld on netflix-- and after a few seasons I got bored of that, and so moved onto Simpsons on disneyplus (a membership I have for no reason other than through connections I got a 1 yr subscription for $15) but this question made me want to write to organise one's thoughts properly (rather than to remember interesting events).
A good friend of mine asked: "How does pregnancy differ to you and your understanding from what you've learnt in midwifery and working there?"
I'd have to say it differs quite wildly. -- and also, going through the process personally. highlights the significant gaps in my midwifery education that is solely up to me to fill.
The education of midwives in Australia, transitioning from RN to RM is very fast paced and lacks depth regarding a lot of topics that are really important to our daily work. They teach us how to work in the system, how to run a ward. Much like running an induction: how to follow the policy and protocol- and the basics regarding why certain things are "bad" and what we can do to "mitigate them" and what happens when they cannot be mitigated. We learn risk factors - but not deep pathophysiology.
Clinical skills like having conversations with women, when you only have half the information (systematic but not in-depth) can be really challenging.
The way the system works is, you come out as a graduate - and then you have approx 8 yrs to develop the knowledge (if you so choose).
There are a few types of midwives and whichever type you want to be (or combination of) is entirely up to you.
- you can work with the anecdotal evidence you see from your own practice in your own community.
- you can take your own time to study further topics you feel you are lacking in, you may or may not want to do courses in certain areas of midwifery to beef up knowledge that was skimmed over in that 1 years crash course.
- you can be a midwife who does the bare minimum to hold the qualification that they earned in 1 year, and focus on other things (ha. this is fast becoming myself to an extent, no matter how I try to avoid it).
Topics in midwifery that I thought was important but was glossed over
-gestational diabetes (ok so it affects approximately 26% of the pregnant population but it's significant)
-cholestasis of pregnancy
- female genital mutilation (which actually. I saw some at MSH -- it would be rare to see it elsewhere).
And this is how my uni got around these topics. The assignment was: pick a question and then make a pamphlet about x topic. I picked domestic violence because it looked "easy". (meanwhile, one of the male midwives failed miserably when he picked DV. Mostly due to his misunderstanding that midwifery is primarily a female field so your going to have to look at it from a woman's perspective, which he struggled with. I think he would have passed just fine picking gestational diabetes).
So in picking DV, I completely missed out on GDM, cholestasis and FGM, all topics I have had to deal with in the last 2 yrs. Minimally, have I had to deal with DV (by fortune most probably). and DV, is a topic that most women can at least relate to-- or get down with quickly.
I wanted to find the time to read other student's work but they were not shared and when I asked my mates no one was keen to share their pamphlet with me so I missed that opportunity. If we had class presentations or something that could have helped. But we didn't. So now, in my own time I need to do the assignment for the other 3.
Due to personal experience I think I've completed the GDM one, since I needed to understand what was happening - I just can't sit idly back and be blind. Not with my background. If I get diagnosed with cholestasis (unlikely due to my cultural background) then I'd probably be an expert on that too.
Other topics I'd like to know more about are:
PIH- and specifically - the link to all the blood tests we run (because I still look at the cheatsheet when I have a PIH woman).
The impacts of cesarean section
The impacts of induction - more pathophysiology about this.
Pregnancy and other organs eg, the thyroid I see women being put on thyroxine, i know hypothyroidism or hyperthyroidism can have significant impacts on the newborn- but that's about it (basically I know 0)
I still refer to my own research on GBS
Our own educator at SSH sent around an article which pretty much promoted that inductions were not the "negative event" that midwives promote it to be. I want to take offence at her sending that around. (I don't though since we should be much more aware of the deep consequences and pathophysiology of which we are trying to influence with inductions -- and also super aware of what the medical community are thinking about when they want us (cough order us) to run them.
don't want to run an induction? Don't be a hospital midwife. 'Nuff said.
Don't want to run an induction? Be prepared for a heated discussion with an obstetrician. Most midwives (including myself) does not have the background or time to prepare for something like that. One day, I'd like to be there. But that's a full 8 yrs full time later (or at least some deep thinking and research first).
Midwives are trained for "the normal" to identify the "abnormal" and then at that point to on-refer the woman. But as things are getting more and more complicated (we're working in migrant communities with more risk factors, well educated women who ask questions -- and for our own selves. We need to know how to support these women.
I've only had 1 booking in, and 1x appointment with the registrar (where I balled my eyes out about GDM) and the educator (who was actually more informative and less glossy-over but I still cried when she asked about risk factors) and I have to say the more information I got the more empowered I felt regarding the whole process, and the decisions being made. When I was given some information that guided me towards making the right decision- and statements that I knew I'd be looking up in the journals later.- and finding them to be accurately portrayed.
-- school can only prepare you for so much.
Like bereavement. It's not until you go through it yourself, personally and directly; that you can understand what the literature says. The feelings and emotions -- which, are probably experienced differently if your expecting them rather than not. Or able to look at yourself from a 3rd person perspective (which sounds extremely odd) -- but also, can be comforting.
Kinda reminds me of the series 'Six Feet Under' which had a multiple perspectives thing going on at times where the character was reflecting or looking at their own selves with their own lenses and knowledge - and how historical events then impact how they viewed themselves/their futures/their past.
I digress.
So back to the question at hand:How does pregnancy differ to you and your understanding from what you've learnt in midwifery and working there?
tbc
What was the question? Oh yeah.
1. The impact of various symptoms on the emotional journey of pregnancy.
- no textbook can bring real understanding of that. Just the same as I don't have understanding of the emotional toll of being an ICU patient.
That being said I understand what it's like to be a family member of someone whose in ICU, - albeit, one that had a planned procedure. That wasn't a nice experience.
2. GDM and its significance to one's life.
Research states that poorly controlled GDM (amongst other things) leads to increased rates of autism and other issues in offspring --
to control one's GDM you need....
- financial support (medicare)
- supportive working environment (no night shifts)
- self control in the face of celebratory food environments that are not GDM friendly (what do you order at a ramen restaurant?... so do you say no to your friend who wants to eat ramen? Or do you just risk a high sugar, OR, do like what I did yesterday - which was order the ramen, drink the soup and only have 10% of the noodles...
3. That feeling of wanting alcohol
I'm the worlds crappiest, super disinterested drinker. Honestly. I'll take 2 sips of Pete's and be totally satisfied. Or have 1-2 drinks for a whole night and that would be "heaps".
Now I can't have wine it's pretty much all I think about if I'm eating steak...
Apparently Ria says this is a common theme.
Can't really drink whilst breastfeeding either :/ Unless my supply is good enough I can pump and throw and still have enough for the kid.
4. How to talk about baby's movements in a manner that's realistic.
I still don't think I learnt how to explain them very well.
We tell women to notice a pattern or time of when a baby is usually active or asleep -
this is usually something that develops around 28 weeks and onwards.
Such if a baby is quiet when its usually it's active period- that this can be considered "reduced fetal movements" and you should tell us and we'll check up on baby (CTG, review, possibly more U/S etc.) I'm 24 weeks so developmentally there isn't a pattern yet (that is around 28+) - but I'm paying loads of attention. For professional as well as personal knowledge.
This is based on research that showed that women who underwent stillbirth, described feeling a gradual slowing or declining fetal movements prior to death.
Which sound horrible.
Overall I think the emotional impact of pregnancy is something hard to describe and learn about in classes and textbooks. The 10 women project part of registration is probably as close as it gets- if you can build that relationship with a woman, you will have a greater understanding of that experience.
A good friend of mine asked: "How does pregnancy differ to you and your understanding from what you've learnt in midwifery and working there?"
I'd have to say it differs quite wildly. -- and also, going through the process personally. highlights the significant gaps in my midwifery education that is solely up to me to fill.
The education of midwives in Australia, transitioning from RN to RM is very fast paced and lacks depth regarding a lot of topics that are really important to our daily work. They teach us how to work in the system, how to run a ward. Much like running an induction: how to follow the policy and protocol- and the basics regarding why certain things are "bad" and what we can do to "mitigate them" and what happens when they cannot be mitigated. We learn risk factors - but not deep pathophysiology.
Clinical skills like having conversations with women, when you only have half the information (systematic but not in-depth) can be really challenging.
The way the system works is, you come out as a graduate - and then you have approx 8 yrs to develop the knowledge (if you so choose).
There are a few types of midwives and whichever type you want to be (or combination of) is entirely up to you.
- you can work with the anecdotal evidence you see from your own practice in your own community.
- you can take your own time to study further topics you feel you are lacking in, you may or may not want to do courses in certain areas of midwifery to beef up knowledge that was skimmed over in that 1 years crash course.
- you can be a midwife who does the bare minimum to hold the qualification that they earned in 1 year, and focus on other things (ha. this is fast becoming myself to an extent, no matter how I try to avoid it).
Topics in midwifery that I thought was important but was glossed over
-gestational diabetes (ok so it affects approximately 26% of the pregnant population but it's significant)
-cholestasis of pregnancy
- female genital mutilation (which actually. I saw some at MSH -- it would be rare to see it elsewhere).
And this is how my uni got around these topics. The assignment was: pick a question and then make a pamphlet about x topic. I picked domestic violence because it looked "easy". (meanwhile, one of the male midwives failed miserably when he picked DV. Mostly due to his misunderstanding that midwifery is primarily a female field so your going to have to look at it from a woman's perspective, which he struggled with. I think he would have passed just fine picking gestational diabetes).
So in picking DV, I completely missed out on GDM, cholestasis and FGM, all topics I have had to deal with in the last 2 yrs. Minimally, have I had to deal with DV (by fortune most probably). and DV, is a topic that most women can at least relate to-- or get down with quickly.
I wanted to find the time to read other student's work but they were not shared and when I asked my mates no one was keen to share their pamphlet with me so I missed that opportunity. If we had class presentations or something that could have helped. But we didn't. So now, in my own time I need to do the assignment for the other 3.
Due to personal experience I think I've completed the GDM one, since I needed to understand what was happening - I just can't sit idly back and be blind. Not with my background. If I get diagnosed with cholestasis (unlikely due to my cultural background) then I'd probably be an expert on that too.
Other topics I'd like to know more about are:
PIH- and specifically - the link to all the blood tests we run (because I still look at the cheatsheet when I have a PIH woman).
The impacts of cesarean section
The impacts of induction - more pathophysiology about this.
Pregnancy and other organs eg, the thyroid I see women being put on thyroxine, i know hypothyroidism or hyperthyroidism can have significant impacts on the newborn- but that's about it (basically I know 0)
I still refer to my own research on GBS
Our own educator at SSH sent around an article which pretty much promoted that inductions were not the "negative event" that midwives promote it to be. I want to take offence at her sending that around. (I don't though since we should be much more aware of the deep consequences and pathophysiology of which we are trying to influence with inductions -- and also super aware of what the medical community are thinking about when they want us (cough order us) to run them.
don't want to run an induction? Don't be a hospital midwife. 'Nuff said.
Don't want to run an induction? Be prepared for a heated discussion with an obstetrician. Most midwives (including myself) does not have the background or time to prepare for something like that. One day, I'd like to be there. But that's a full 8 yrs full time later (or at least some deep thinking and research first).
Midwives are trained for "the normal" to identify the "abnormal" and then at that point to on-refer the woman. But as things are getting more and more complicated (we're working in migrant communities with more risk factors, well educated women who ask questions -- and for our own selves. We need to know how to support these women.
I've only had 1 booking in, and 1x appointment with the registrar (where I balled my eyes out about GDM) and the educator (who was actually more informative and less glossy-over but I still cried when she asked about risk factors) and I have to say the more information I got the more empowered I felt regarding the whole process, and the decisions being made. When I was given some information that guided me towards making the right decision- and statements that I knew I'd be looking up in the journals later.- and finding them to be accurately portrayed.
-- school can only prepare you for so much.
Like bereavement. It's not until you go through it yourself, personally and directly; that you can understand what the literature says. The feelings and emotions -- which, are probably experienced differently if your expecting them rather than not. Or able to look at yourself from a 3rd person perspective (which sounds extremely odd) -- but also, can be comforting.
Kinda reminds me of the series 'Six Feet Under' which had a multiple perspectives thing going on at times where the character was reflecting or looking at their own selves with their own lenses and knowledge - and how historical events then impact how they viewed themselves/their futures/their past.
I digress.
So back to the question at hand:How does pregnancy differ to you and your understanding from what you've learnt in midwifery and working there?
tbc
What was the question? Oh yeah.
1. The impact of various symptoms on the emotional journey of pregnancy.
- no textbook can bring real understanding of that. Just the same as I don't have understanding of the emotional toll of being an ICU patient.
That being said I understand what it's like to be a family member of someone whose in ICU, - albeit, one that had a planned procedure. That wasn't a nice experience.
2. GDM and its significance to one's life.
Research states that poorly controlled GDM (amongst other things) leads to increased rates of autism and other issues in offspring --
to control one's GDM you need....
- financial support (medicare)
- supportive working environment (no night shifts)
- self control in the face of celebratory food environments that are not GDM friendly (what do you order at a ramen restaurant?... so do you say no to your friend who wants to eat ramen? Or do you just risk a high sugar, OR, do like what I did yesterday - which was order the ramen, drink the soup and only have 10% of the noodles...
3. That feeling of wanting alcohol
I'm the worlds crappiest, super disinterested drinker. Honestly. I'll take 2 sips of Pete's and be totally satisfied. Or have 1-2 drinks for a whole night and that would be "heaps".
Now I can't have wine it's pretty much all I think about if I'm eating steak...
Apparently Ria says this is a common theme.
Can't really drink whilst breastfeeding either :/ Unless my supply is good enough I can pump and throw and still have enough for the kid.
4. How to talk about baby's movements in a manner that's realistic.
I still don't think I learnt how to explain them very well.
We tell women to notice a pattern or time of when a baby is usually active or asleep -
this is usually something that develops around 28 weeks and onwards.
Such if a baby is quiet when its usually it's active period- that this can be considered "reduced fetal movements" and you should tell us and we'll check up on baby (CTG, review, possibly more U/S etc.) I'm 24 weeks so developmentally there isn't a pattern yet (that is around 28+) - but I'm paying loads of attention. For professional as well as personal knowledge.
This is based on research that showed that women who underwent stillbirth, described feeling a gradual slowing or declining fetal movements prior to death.
Which sound horrible.
Overall I think the emotional impact of pregnancy is something hard to describe and learn about in classes and textbooks. The 10 women project part of registration is probably as close as it gets- if you can build that relationship with a woman, you will have a greater understanding of that experience.
no subject
Date: 2021-10-23 04:21 am (UTC)no subject
Date: 2021-10-23 09:25 pm (UTC)My 4 yr science degree (Bachelors with hons) only cost about 30 grand for all 4 years - and at the end: for both science and nursing I didn't have to pay back until I made at least 35 grand a year. At which, the govt would take 8% of my pay each fortnight until it was paid back.
I also applied for a taxation subsidy for working in an "in need" area (teaching and nursing are on the list) and so I also didn't pay the rising cost of inflation on that 36 grand either (so you debt does increase with time, but only approx similar to inflation) - so actually my debt decreased with me doing nothing much except .... keeping a job and paying taxes.
The Midstart program which got me into midwifery via a graduate diploma in midwifery, was 6 grand all up and you had to have a job to do the program. A job as a "midwifery student" but was also a registered nurse. Lose your job, you loose your spot entirely (at uni) and if you fail uni, you loose your job. The job pays you at your RN year level, for 4 shifts a week (ranging from day tonight, rotating roster). You don't get paid for uni. That being said, it's really easy to apply for another govt scholarship to cover uni fees - it's just a small essay thing, submitted by the correct date. I think I wrote it on a Saturday morning and boom, they transferred me 6 grand into my acct.
All the clinical hours need to be completed whilst you work those 32 hours/4 shifts a week (but inevitably to complete the course you'll likely do over in order to ensure you hit all the tick boxes required by the registration body) but not an excessive amount I don't think. If your organised, it's very doable. If you have other commitments you can't just drop (like, say, young children) it's harder.
I heard they wanted to stretch the year into 1.5 years, but never have. I think that's due to funding. Longer program, costs more money.
I can't think of any other reason. Largely education is public in this sector. There are few private college and universities who run healthcare type courses that are accredited for the large public health system - the few are religious based.
You can become a midwife straight out of highschool without nursing, it's 3 yrs. Cost is same as nursing. Much fewer student places available(whilst nursing is everywhere) a major contributing factor to a much higher high school score required (entirely due to demand v supply) I think the score rank (out of 100) is 90+ whilst nursing is 60s. From what I see, bachelors entry to midwifery doesn't make a better midwife however, I think due to lack of overall experience.