When I spoke with E on the phone the first time, she spoke softly because her house is small and her infant son was asleep. That conversation only lasted ten minutes because the little man woke up and took his mama away from the beginnings of her relating to me her experiences being a second year student at Yale’s nurse midwifery graduate program. But we connected the next day and got a chance to speak for over an hour while her son slept on. Here are some bits and pieces of her sharing that stood out to me, rehydrated from the notes I took...
E: Studying to become a nurse midwife in this three year masters program is extremely intensive and challenging. It definitely has been hard for my relationship with my husband (I'm now 27 and we've been married 5 years) and puts a major weight on the relationship for various reasons. During the week, there is MAYBE one day per week that I can dedicate for free time, but all other days I am preparing for the next exam, project, clinical subject, etc. I have changed a lot because of being in such a demanding environment. Just the school component of my life is so emotionally taxing and energy draining that there's little left over (let alone the time) for more intentional time spent with my husband.
There's also the financial component where I have accumulated a lot of student debt with this program and my husband is the only one able to work while I'm in school. Now we have our first child who is several months old, but we're trying to figure out when I will be able to take maternity leave after I graduate in one year and need to begin working. So we're already needing to plan for our next child.
Every woman in my nurse midwifery program is at a different point in their lives; some are older and have kids who are through school already, which makes a large difference in terms of the kind of time they can dedicate to their studies, their jobs, and their families. Most of the students here aren't in relationships, don't have kids, or have kids who are more independent (college, etc.)
Me: Something that I am curious about is how you and other nurse midwives (students and full-fledged professionals) interact with their patients during antenatal appointments and exactly what kind of support they can provide at that time. I wonder this because I'm hearing from some nurse midwives working in hospital as well as private clinic settings that they only have about 10-15 minutes with a patient for an appointment before they have to move to the next one...
E: Yes, that's right. Actually, we should be taking 15-20 minutes for an appointment with a returning patient and I really struggle with time management, which is why I was actually referred to our program director as my preceptor because I was taking about 35 minutes or so for one of those appointments and even up to about 1.5 hours for a new patient antenatal visit, which were told should be limited to 45 minutes. During appointments we need to do various physical assessments, checking for preeclampsia, etc. and go through a detailed checklist. But if something comes up for the patient and they need to share more to answer a particular question or they want to talk about their experience or any challenges they're having with their pregnancy, I WANT to give them the time and space to do that important sharing and to be able to support them...but I would need to keep moving along down the list so I could then see the next patient. And this is hard for me to do, because I wish I could be able to have more time to connect, to support, and to listen to my patients if that is what they need.
The program director gave me a scripted line that I had to practice in order to enforce my time management with seeing patients. Rather than letting my patients speak more openly, if something came up that was deviating from my checklist, I was to say, "I'm sorry to hear you're experiencing these things. We have a social worker in the building, would you like to speak to them?"
Of course I try to be as positive, kind, and warm with my patients as possible while I'm conducting my evaluations, but it's become clear to me that my role is not to a counseling one/one of deeper connection.
I've tried to connect with patients and I got in trouble.
If I could do it over, I would go to school to become a social worker. There is so much self development in these programs (I have several friends who are in social work masters programs currently who have just been blown away by their own growth). I have had to work hard to make time for myself or else there is no self...I'm so busy and always have such a demanding workload...the program is so intent on delivering the core content in a set amount of time that there are exceedingly few opportunities for self-learning/enrichment/care. I've had to be a rebel in the sense that I've had to pursue that self-learning outside of my studies and at times choose to not study on certain evenings in order to go to a kind of retreat, or just give needed time and creative outlets to myself.
I would also choose to become a social worker first because it's the kind of job where you can have a more structured work schedule and therefore have more time with family and I would be around for my kids more. I think that I would then pursue midwifery once my children became older and do home births because I could take on only one or two each month and be able to dedicate my energy to it in advance (instead of being on call most of the time). I think that would have helped me keep my passion more intact and healthy. Then I would have the life wisdom granted to me by my age and experience as a mother to offer to other mothers, which is something I feel I really lack now as a midwifery student who has--until recently--not experienced pregnancy and birth personally. I feel like I am a learning woman and am very much still needing to work with stuff from my childhood.
It's important to think about this choice of yours to begin a program like this and commit to becoming a CNM. If you choose this route, you cannot walk away from it after the first semester saying, "this wasn't for me." Because by that point you'll already be at least $30,000 in debt for that first semester and you won't have many options but to continue thru to the end.