The graduate Midwife Road Less Travelled Part 3 - The Road Is Not Always Straight and Flat

Saturday, 23 June 2018

 Photo by Sergio R on Unsplash

In deciding to work in this model of care straight from university, I knew I was going to face some challenges.

The first challenge was going to be people's perception of my work, or my ability to work in private practice as a newly qualified midwife. The next challenge would be finding a structure which worked for Bron and I. Then, there was the financial challenge of not earning a salary. Finally, there was the challenge of trying to work towards endorsement as a Medicare eligible privately practicing midwife - my long-term role, which would enable me to continue working as a private midwife with my own caseload, and which involves a lot of jumping through hoops. I started the hoop jumping as soon as I started working with Bron, and thus begins 3 years minimum as AHPRA's circus animal.

I was really nervous to tell friends, family and my colleagues at the hospital I trained at about my decision to forgo the traditional grad position I was offered in Sydney to work at The Birth House. Most of my close circle of family and friends don't know a lot about home birth, haven't been exposed to it and I wasn't sure if they'd be supportive. While I got a few strange looks, and was asked a lot of questions about safety and what I'd do in emergencies, it was really clear to all my loved ones by the way  my eyes lit up when I spoke about it that I'd chosen a job I absolutely love, and over the past 6 months, they've all become a lot more accepting and supportive of my decision (I may have even converted a few into potential home birthers!) Not to mention the fact that taking this job kept me at home with my loved ones, rather than working fly in, fly out in Sydney.

My colleagues at the hospital I trained in were absolutely delighted for me when I told them. This job is my dream job, and I think that while some of them may have encouraged me to take a traditional grad job if I'd discussed it with them, they know I'm onto something really special here, and know how well supported I am by Bron. The first time I had to transfer in to the hospital with a client, I was shaking in the car on my way in. It was completely nerve wracking doing the transfer - were we making a good call? How would  be received by the midwives on duty? I wondered who was in birth suite and who was team leader the whole way in, and practiced my handover in the car. When I got to the hospital, the most lovely midwife was coming onto birth suite for the night shift - one I'd worked with a bit at the end of last year and got along with well. I was so, so happy to see her walk into our room, and she made the whole experience more like a homecoming than the scary transfer I'd built it up to in my mind. Over the following few days, I visited our client in hospital and ran into many of my old mentors, who were so beautiful, kind and helpful to us and our clients. I remembered why I had loved my midwifery training so much - the midwives at our local hospital are incredible, kind, intelligent and funny. most of all, they're great friends to work with.

Bron and I are still working out what structure works for us - my role is ever-evolving as our client load and needs change. Mostly, I do 6 hours of admin per week, Saturday morning antenatal classes, a few hours supervised clinic plus whatever birth plan meetings and births we have on. Sometimes I also mind Bron's daughter while she works, and more recently I've started liaising with the international student midwives we have coming to visit over the coming year, and I will be trying to fill their days between appointments while they are here. The days are fairly flexible, and I'm often back and forth to The Birth House and to our clients' homes  4 or 5 days in a week, despite my hours only being part time. When something isn't working, we just have a chat and try something else, and as the practice grows, so will my role within it, which is something Bron and I are both working hard for.

Not earning a salary is difficult at times. When we have a lot of births on, money is great! When we are quiet, my admin hours cover my rent and I'm thankful that I haven't been totally cut off from Centrelink yet, which tops up my pay when I'm having a bad week at work according to my fortnight's earnings, which I continue to report. I'm also thankful for an incredible landlord for our tiny little granny flat, and my partner who also subcontracts, but somehow always has work when I don't. I'm honestly very nervous for tax time, as my book keeping has been very lazy and I've got a lot of work to do to get my receipts and car log book in order if I don't want a massive tax bill. These are challenges I wouldn't face with a traditional grad role, but I gladly do because I love this job, and its flexible, part-time nature which gives me incredible work-life balance even while I pursue further study.

Which brings me to the next challenge - possibly the biggest one. To become endorsed by AHPRA, which will give me a medicare provider number, prescribing rights and make me able to get insurance for antenatal and postnatal care, and carry my own caseload, there are several hoops I need to jump through.

First, I need to do a Prescribing and Diagnostics course, which I begin as a part of my Masters in Primary Maternity Care through Griffith University in July. The postgraduate study, in my eyes, is the easy part.

Next, I need to get 5000 hours of experience across all settings - antenatal, birth and postnatal care. Now, working part time as a second midwife for births, this is the truly challenging part! I'm not insured for antenatal and postnatal care, so have to be under supervision, and I have absolutely no control over how long a birth takes! Often, I'm only there 4 or so hours, including clean up. To top it off, the 5000 hours needs to be completed within 6 years, which means I need to supplement my hours with casual work at the local hospital. BUT, the local hospital won't give me casual work without postgraduate experience. Hmm..... I can see your brain ticking over, and this is not adding up, is it? No. Sadly, it is not.

I've been working part-time for 6 months now. I've completed a certificate in immunisation for health practitioners, and I'm enrolled in my Masters degree, so a week ago, I emailed the Midwifery Unit Manager to ask about potential casual work at the hospital, but so far I've heard nothing back. I've asked a few times how much experience I need, and I've not yet been given an answer. I'm eager to get my foot in the door - not for money's sake, and not just for the hours, but also because there are many valuable midwifery skills that you use often in the hospital that are rarely used at home that I would like to maintain, and there are opportunities for continued professional development in the public health setting that aren't available privately. I"m trying very hard to be patient, and to enjoy the slow build that my grad year has given me - the nurturing, supportive environment and beautiful foundation to practice of normal, non-medicated, vaginal births that I have been so privileged to attend over the past 6 months. As a very driven, goal oriented person, it is difficult to be patient though. I want to get my hours done as quick as possible so that I can fully immerse myself in private practice and work to my full scope and full potential as a midwife. It's also difficult thinking that my fellow graduates in bigger hospitals are getting their hours towards eligibility so much faster than I am, as full-time midwives despite not getting the hands on home birth experience, and business experience that I'm getting with Bron. I have to remind myself every day of how blessed I am, that it's not a race, and that the experience I'm getting right now, and the job I'm doing, which I love so much, is worth more than the full time hours I'd get in a hospital. Even if I can't work in the hospital until the end of the year, my time there will come and my hours will build. In the meantime, I need to just enjoy the ride.

The fact that my scope of practice is so limited after 3 years of university education, and registering as a midwife is very frustrating. The fact that this restriction is at the hands of the only insurance company in Australia that will cover a private midwife appalls me. The challenges I'm facing in pursuing this career pathway are unjust and uncalled for. They are designed and implemented by the medical patriarchy, which is more concerned with reigning in autonomous midwifery practice, which threatens its livelihood, than with creating positive outcomes for women and babies.

Continuity of care with a known midwife is the absolute gold standard of care, and leaving the comfort and safety of your home is the first intervention in birth. Graduate midwives having access to working in continuity models of care is absolutely integral to midwifery thriving as an autonomous profession, and to women having access to the safest model of care there is. As we learn more and more about the long-term impacts of birth on maternal and neonatal health, and uncover the mysteries of the microbiome, and epigenetics and birth, its importance is highlighted. As women have more access to information highlighting the benefits of continuity of care with a known midwife through the internet, it is also growing ever more popular.

It's so important that new graduates like myself are supported to pursue this line of work. A study in Queensland reported that up to 85% of midwives in both public and private hospitals have fear around childbirth. Midwives working in continuity of care models did not report the same level of fear. The road is not always straight and flat, but I know I'm doing important work in paving it for future graduates, and making continuity of care more accessible to women. If you're a private midwife, consider how you can open your practice to a new graduate and show them what it truly is to be 'with woman'. If you're a graduate, seek out this kind of work, and if you're a pregnant woman looking for the best care you could possibly have, and a positive, empowering experience, step outside the system - hire a private midwife and support an autonomous midwifery profession. Consumers are the voice of change, and by demanding this service, you create opportunities for more women to access it.

Despite all the challenges of choosing a non-traditional graduate job,  if I was offered full-time work in my first choice hospital from my graduate application last year right now, I wouldn't take it. I love my job so much. It's so worth every instance of stress, because working in continuity of care, in partnership with women who are making informed and empowered decisions about their births is the most amazing job in the world, and tucking a new family into their own bed after a home birth, leaving their house in the wee hours of the morning with the warm fuzzies inside me is a feeling I will never tire from.

The Graduate Midwife Road Less Travelled Part 2 - A Gentle Start

Monday, 26 March 2018

The front verandah of the beautiful federation home that is The Birth House

I started working with Bron in October, before I graduated. As a part of the structure of my job that we had agreed upon, I would be doing 6 hours a week of administration, helping Bron with the running of her business and learning the behind the scenes of being a private midwife. I was excited about this, because I knew it was setting me up for my future as a private midwife, and that I was lucky to have someone who had been doing it for years to learn from, rather than starting from scratch myself and making lots of mistakes. So, I started my admin hours straight away, started meeting Bron's clients as they came and went from the clinic while I was there, and waited for my registration to come through - hopefully before the baby that was due on Christmas Eve came. 

I met the woman who was due at her 36 week birth plan appointment, as Bron and I had discussed I would, and I was introduced to her as the second midwife for her birth. We discussed her wishes for her birth, and she had a few requests for her birth which deviated from standard care. We discussed reasons for and against, provided her with evidence relating to her decisions, discussed when risk factors might present themselves which would suggest deviating from her choices, and gave her time to process the information and come to a decision. When we left the appointment, suspecting that I would find it a massive transition moving from hospital policy to a practice of informed consent led by the woman, Bron asked me how I felt about this. I was surprised to find that I was actually totally comfortable with the woman's decision. I asked Bron some questions about how we document her decisions to cover ourselves legally, and then said "I trust the process. I trust birth. I trust that the woman is making the decisions she feels are best for herself and her baby, and that she is taking ownership of her body and her birth in her decision-making. I trust that we have given her the information to make an informed decision, and I trust you. I trust that we will document her decision correctly to cover ourselves legally, and I trust that I will be well supported by you in her birth, and that if there are any indications that we should divert back to standard care, we will pick up on them in a timely manner, and have those discussions with her." Every word of it was true. I trusted birth. I trusted Bron, and I felt so well supported in practice by her, that I felt comfortable with honouring this woman's wishes for non-standard care. In fact, I felt like that was exactly why I was working in this model of care.

My registration came through late December and a couple of nights later I got my first midnight call out! The woman worked beautifully with her partner in her birth, calling us to come late in the piece, and being 45 minutes away, I missed it entirely! I got there in time to watch her have her first breastfeed and birth the placenta. I checked the placenta, cleaned up the birth space a bit, tucked the new family into bed and drove home. I was back in bed before the sun came up, smiling ear to ear.

Over the following weeks, I attended a few more births - all of them beautiful, natural and calm. Bron and I started to feel more in sync working together. I worked with another private midwife in the area, Libby, a bit and I really enjoy seeing the similarities and differences in her and Bron's practice.  I feel really at ease working with both of them, and I commented to them both one morning after a team meeting that I feel like I'm exactly where I'm meant to be. They both gave me beautiful feedback about my presence at a birth and my way of working. To begin with, I didn't really feel like a "real" midwife. I sort of still felt like a student, but I'm slowly gaining confidence in my practice and at least I've stopped having to correct my signature from SM to RM on documentation. I drove up to the Gold Coast for a birth at 2am one night, and was coming home just as the sun rose. It was so beautiful and peaceful. I was totally in awe of my own life! I wrote this on facebook later that morning:

I love waking up in the middle of the night to a phone call, rushing to the car and driving through the still of the night, the only car on the road, to a birth. I love pulling into the street to see the lone house with lights on; thinking that's the one! And being present when new life enters the world. Sitting quietly in the corner of the room, writing notes and observing the woman and her support people as they work together to bring baby down and out. Anticipating needs and providing reassurance and encouragement. Seeing a family grow in an instant, as they meet the baby, and then tucking them up into their own bed to sleep, before heading back home to my own. I watch the sun rise from the road, and climb back into bed to sleep as the rest of the world wakes, feeling contented.

Everything felt right in those first few weeks of working in this way. I was in a blissful, private midwife, normal birth bubble. Everything about it still feels right 3 months in, and I'm really appreciative of the gentle start I've had to life as a registered midwife thanks to the support of Bron and Libby. Taking the road less travelled isn't straightforward though. I've come across a few challenges, which I'll discuss in my next post.

The Graduate Midwife Road Less Travelled Part 1 - Making the Decision

Sunday, 18 March 2018

Photo by Matt Duncan on Unsplash
Wow. I really thought I'd blog a lot more than I have since I made this blog in November, but truth be told - I've struggled to find the creative energy as I transition into life as a Registered Midwife, juggling work, further study, skate commitments (which to be fair, are usually all I want to commit to), and home life. But here I am, tapping away at the keyboard in a tidy home, with the honey-cinnamon scent of home made granola wafting over to me from the kitchen, having just completed an assignment for the course I'm doing. *sigh* - a rare moment where I feel like I actually have my shit together!

I'm almost 3 months deep as a Registered Midwife, and the past 3 months have been filled with absolutely wonderful experiences and learning opportunities, so I thought now would be a good time to share a little bit about my work, and why I have shunned a traditional graduate position in a hospital to work in private practice fresh out of university.

I haven't always wanted to be a midwife, but from my first day of university there has been no doubt in my mind that it is what I've been called to do with my life. 
I haven't always wanted to be a midwife, but from my first day of university there has been no doubt in my mind that it is what I've been called to do with my life. Furthermore, it became clear very early on in my practice that I wanted to be a private midwife. All throughout my degree, on placements in the hospital, I was continually let down by the public health system, which I felt undervalued the role of the midwife, and treated birthing women like a product on a factory conveyor belt, with designated stops for diagnostics, testing and delivery. *shudder*  (I hate the word delivery being used in birth, but that's a whole other blog post!)

Don't get me wrong, we are incredibly lucky to have a free at point of contact public healthcare system here in Australia, with the option for not a single medical bill for your entire pregnancy and birth, however I just didn't feel like I fit with that model of care as a midwife. It leaves no room for individuality in practice, with policies and guidelines dictating your every move as a midwife, and it leaves little room for respecting the woman's individual birthing experience, either. I hated not having time to spend with women to listen to them (they tell you all you need to know and more if you just give them the space to do so), or to provide adequate information to facilitate informed decision making, and sometimes I felt unable to provide evidence-based care, due to policy, time constraints or the wishes of the medical staff who oversee the women's care in the hospital. My goal from the start was to learn as much as I could in the hospital in my time there, learn even more outside the hospital in my own study, and just get the three years' full time experience I needed to be endorsed and get out!

In my third year of university, I went through all the paces of the student midwife looking for a grad job. I had a resume and cover letter written by week 2 of semester 1. I had multiple appointments with the careers advisers at the university. I had my selection criteria written and reviewed by the careers adviser and 3 separate midwives a month before it was due. I networked with the hospital staff at the hospital I wanted to work in, and applied for grad positions in 4 separate states of Australia. I practiced for interviews by myself, with other students, with the careers adviser and with practically anyone who could stand listening to me rabbit on about NSW Health CORE values for longer than 5 minutes. Through my networking, I got a job as an assistant in midwifery at my first choice hospital, and I worked as many shifts as I could in the hopes of showing the interviewers what a fantastic midwife I would be.

I ticked all the boxes on paper, and then I went for my interview.

There were 12 of us interviewing for the two positions at my first choice hospital. We all went to the same university. We nearly all had the same experience in the same hospital. We all had our resumes, selection criteria and practice interviews with the same careers adviser.

I went blank on one question, missed some key information and was a knot of anxiety for 4 weeks after the interview as I awaited the first round of job offers for NSW Health.

I didn't get the job. I cried all day at the prospect of moving away from my family, of doing fly in, fly out midwifery in a capital city, of leaving my boyfriend and my dog here on the North Coast and going at it alone in my first "adult" job in a strange city somewhere.

I was offered a job in the western suburbs of Sydney, and I was miserable at the prospect of taking it. I messaged Bron, a local private midwife and mentor of mine (she had facilitated my clinical supervision meetings for the best part of a year, and offered me many opportunities to experience what antenatal and postnatal care looks like in a private setting as a student, despite me never being placed with her through uni or being allowed to attend homebirths as a student at my uni). I knew I wanted to work in private practice as soon as I could, and she had mentioned the possibility of a bit of work as a second midwife at births to me a while back, but mostly I just wanted to chat with her about forging a pathway back to private practice from what I was certain would be a very high-intervention, high-risk graduate job in Sydney.

Throughout my whole degree I'd been told by midwives and other health professionals that I needed to consolidate my practice in a big, busy hospital for a few years before turning to caseload or private practice...
You do not build trust in the birthing process from working in a tertiary hospital, you build it from observing normal births.

Throughout my whole degree I'd been told by midwives and other health professionals that I needed to consolidate my practice in a big, busy hospital for a few years before turning to caseload or private practice. All of these health professionals worked in those same big, busy hospitals. But when I sat down with Bron in her office, which smelled sweetly of the jars of plant matter she uses in herbal medicine, she turned to me and said "You do not need to work in a big hospital to be a good private midwife. You do not build trust in the birthing process from working in a tertiary hospital, you build it from observing normal births." She offered me work on the spot as a second midwife for births. It wasn't full time, it wouldn't pay as well as a traditional grad position, I'd be limited in practice by the tight constraints of insurance on private midwives, but it was local, it was private practice, and it was with Bron, who I knew would be an amazing mentor. I told Bron I needed to go home and talk to Jake about our options. I messaged her within a couple of hours to say that I'd accept the job!

Rolling into the new year!

Wednesday, 3 January 2018

 Sunset on New Year's Day on the river in Ballina. There were dolphins in the distance, too.

Happy New Year, everyone! I hope 2018 brings you all that you wish for.

How did you spend your New Year's Eve? I went for a skate early in the evening with some friends, and we had a BBQ at the skate park, which was lovely, then we rushed our dog to the vet at 10pm with vomiting, fever and lethargy. He was one sick and sorry little puppy! He stayed in overnight and most of the next day getting medication and fluids. While he was at the vet, Jake and I went to the beach, me armed with a book and Jake with a kite, to take our minds off him. We had a really lovely day, and when we went to collect the little terror at dinner time yesterday, he was in much better spirits. He's home on antibiotics now and almost back to his usual hyper-active self.

I've never been much of a New Year's Resolution-er?-ist? or one to follow through on goals, stick to budgets, and all that jazz that we associate with the 1st of January, but this year I'm making a real effort to be more organised in life and to really make the most of every day. I've just started my own business, with most of my (somewhat small, start-up) income coming from sub-contracting to other local midwives as an admin and second midwife for births, so the need to be organised is a bit more pressing this year. I need to do my own book keeping, and be in charge of my own work hours, continued professional development, expenses and pay my own tax. All while working towards becoming an endorsed midwife, so that I can take on a caseload of my own. This all takes a level of organisation that I am entirely unused to, so for the first time in my life, I'm setting goals, using a planner and I've even booked 5 weeks' consultations with a life coach to put me on the right track and keep me accountable!

In case you're interested, I bullet journalled my 2018 "Goals and Intentions", which I've copied out below (you don't want to see my scrawling, messy writing, or my poor attempt at BuJo doodles. Trust me.). Perhaps publishing them somewhere more visible will help keep me motivated.

2018 Goals and Intentions:

  • Participate in the #moxiskatedaily2018 IG Challenge (skating every day and posting on instagram)
  • Take up yoga classes
  • Write in my reflective practice journal once a week
  • Write more!
  • Create good eating and cleaning habits
  • Use less plastic
  • Start my masters degree
  • Get midwife immuniser certification
  • Be patient - with Jake, with friends and family, with life and with work.
  • Save some money
  • Keep my car clean 
  • Read for pleasure - at least 20 books
  • Get 2 days/week regular work (I currently have 1 regular day + births)
  • Document my life - through video, blogging, journalling and photography.
  • Reach scrim level at roller derby
 My first day of the #moxiskatechallenge2018

I feel really happy and motivated moving into 2018, and am already working towards some of these goals - I have skated the past 2 days, enrolled into the immunisation course this morning and here I am, documenting my life. I'm really hoping seeing the life coach helps me to keep the motivation going over the next 5 weeks, and well into the future. I'm using my bullet journal at the moment to keep track of some of my goals, although I'm not really a big fan of the format. I've ordered a time planner from Kikki K to take over from the bullet journal, which I think will be much more my style and add structure to my planning, and I'm working on some custom printable pages to suit my needs both as a midwife and in my personal life. I'll share more on my planner when it arrives. 

Me and my little family - Lou much more himself after his trip to the vet!

I've tried to keep a good balance between work goals and personal goals for the year, as well as setting goals of different sizes, and goals that link in together to help keep it all fun, achievable and keep a good work-life balance. I'm really hoping that the Moxi IG challenge and the yoga help me towards my goal of reaching scrimming level at derby by improving my agility, balance and fitness.  Similarly, the immunisation course, masters degree and reflective practice journal all feed into helping me get 2 days a week consistent work, and becoming an endorsed midwife, and the journal, writing more and documenting my life all link in together. 

Have you set any goals for 2018, or are you winging it and just taking what life has to offer? Any tips for a beginner business owner and novice organiser?  I'd love to hear from you!

Starting Fresh and Outfit of the Day

Thursday, 2 November 2017

Hello! How are we all? It's been a long time since I blogged, although starting up again has been on my mind for a while. A long, long while! Ever since I got back from my trip to Europe in 2016, after catching up with Amy, Ella, Kirsty, Erica, Magdalena, Libby and Sophie, blogger pals I met through Little Foal about 5 or 6 years ago? I ummed and ahhed about whether I should continue with Little Foal, which provided me such an warm and fuzzy blog community for quite a few years, but a lot has changed since my days at Little Foal, and it didn't really feel like it reflected my personality anymore. I'm hoping that this little space will give me a new creative outlet, and grow with me for years to come.

Welcome to The Saltwater Blog!

Turning a new leaf feels nice. My goal with this space is to fill it with pieces of my life as I venture out as a Registered Midwife, and enjoy my afternoons and weekends with my boyfriend, Jake and our pup, Lou, in our little seaside home in Lennox Head near Byron Bay in Australia. Jake and I have big travel goals for the next few years and some life goals, too, and I want to bring this blog along for the ride to document our lives together. You will also find me sharing my interests - my love of skating, fashion, cooking, crafting and reading.

These photos were taken today at the sand spit in Ballina. The ocean was a bit rough for a swim today, so we headed for the flat water at the spit with Lou for a play. Lou is 5 months old now, and he's growing so fast! He's incredibly playful, and getting more and more adventurous as the days go on. Over the past couple of weeks, he's slowly started venturing into the water and today for the first time, he actually came in deep with Jake and I while we swam! He looked like he was having a ball paddling around and chasing after Jake and I, and he looked so cute bobbing under the water to fetch his ball. We are so relieved that Lou loves the water, because the beach is where we spend about 98% of our free time.

Don't let the long sleeves fool you - today was HOT! This dress from H&M is actually super cool in the heat though. It's so billowy and made from a light material that keeps the sun off your arms in the sun. It's probably the only reason I'm not burnt to a crisp today. We try to take Lou to the beach at least once a day, and even though it's only the start of October, I'm already starting to tan. The bag is from Mexico,  and was brought back for me by my little sister after her recent trip to South America, the belt is from Bali, the sunnies are D&G with prescription lenses and the hat is a $12 K-mart jobby that I picked up on the way to the spit today.

If you're reading this, I'm incredibly glad you are giving my  new little corner of the internet a chance. I'm hoping to post a couple of times a week, and I have a few post ideas lined up ready to go. I'm so glad to be back in the world of blogging, and I look forward to sharing more of my life here on this blog. I hope you will be back again soon!

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