The name of my blog is currently a misnomer. I am quite decisively a rural midwife at the moment. But don’t take that to mean I’m not busy.
The fast forward version from my last post:
To Toronto for a month of testing, observation days, and other prerequisites for a clerkship placement.
Back home for a month, worked a few more shifts at Planned Parenthood, and made arrangements for my temporary relocation.
Now I’m in Alliston, Ontario, about seven weeks into my thirteen week clerkship. It’s about and hour and a half north of Toronto. It’s a rural practice, but it’s busy enough to support five midwives. I’m busy enough to be getting the numbers that I need, but I have enough downtime to not feel overworked.
I’m feeling pretty lucky to be here. Once upon a few months ago, after I sent that life changing email to the program director at Ryerson, one of the conditions was, “She (meaning me) needs to understand that there is a placement shortage, and while it is likely that we can find her the required 13 week clerkship beginning in January, February, March or April, depending on availability, there will be only one offered, relocation within Ontario is probable and no choice of site possible.”
That certainly induced some apprehension, but really? Wow. Everyone here is great. The team is a great mix of personalities. I’ve been treated like an equal. I’m not generally introduced as “a student”, I’m introduced as “a midwife from Chicago orienting to Ontario midwifery”. I’ve called myself a student when my latter descriptor is just too many syllables.
On a practice level, I’m feeling quite comfortable. The content of care and the way it’s provided is very familiar and comfortable. The pace of visits, what we talk about, what we do-this is how I used to do it.
And, obviously, babies only come out a few different ways. When I was at my first birth here, I startled myself a few times by remembering, “Hey. I’m in, like, Canada.” I’ve worked in enough hospitals, as a nurse and as midwife, that yes, this feels like another orientation. The rhythms, the things I say, the things others say, what we do. It’s all comfortable.
The practice has about a 90 %/10 % hospital birth/home birth ratio. I miss home birth a little, but it feels REALLY nice to be in a hospital again, having spent the past three years being demoted upon transferring a patient into the hospital.
That being said, it was a bit disconcerting to learn that at this particular practice, and at most practices in the immediately surrounding area, patients needing oxytocin or wanting an epidural are “transfers of care” to the OBs. Most of the time I’m able to take it in stride, that this is just how it’s done here, but I’ve had a few moments that felt a little like flashbacks: Oh god, this is why I left the States, and it’s here too????
I didn’t need any help clarifying this, but here it is, Universe: My three absolutes of the job I eventually get is for it to be a full scope, shared care practice in or around the greater Toronto area. “Full scope” describes the practices that maintain care of clients needing oxytocin and/or epidurals. The cherry on top would be a practice where I can first assist on c sections, but that tends to be the norm in rural/remote practices, not in urban centers.
A general difference is that the consultation process is more formal than I’ve done in the past. There is a document from the College of Midwives of Ontario that clearly spells out indications for consultations and transfers of care; for level two (usually requesting guidance for a particular problem) and level three consultations (usually transfers of care), we write a letter to the consultant and they send us a letter back with their recommendations. As tends to be the case with making paperwork more palatable to the involved parties, it’s tied to billing. We send the letter so the doctor gets paid.
Level 1 consultations are simply discussions between two midwives or a midwife and a doctor on not-particularly-harrowing problems, like anemia or a history of preterm birth. When I read this document for the first time, I marveled that collaboration is written into the process-it’s an expectation that even minor things are reviewed with other team members.
Reading between the lines, that means I’m finding a good deal of advance comfort and reassurance that I’m not going to be the Lone Ranger anymore. I wouldn’t trade my last few years of A Woman’s Place for anything, but I also never want to be solo again.
Of the difficulties I’ve had with my documenting, besides legibility, have been my abbreviations and shorthand. A few weeks back I got a list from some of my esteemed colleagues: Please document “homemaker” rather than “SAHM” (Stay at home mom); “TOC” means “transfer of care” here, not “test of cure”; “FH” means “fetal heart”, not “fundal height”. I, in turn, have had to ask a few of my own: What the heck does “KWTP” mean? “Knows when to page”, as in the education we provide of emergency situations of when our clients should page us.
And numbers? Hoo boy. I’ve received an instruction to write out dates: Jan 24, Feb 12, Mar 15; not 1/24, 2/12, or 3/15. Ya know why? Because there is no consistency of MM/DD vs. DD/MM. I’ve gotten all confused about dates when realizing that “1/4” meant April 1, not January 4. Government publications are reliably YYYY/MM/DD, and even that’s taken some getting used to.
I didn’t need to worry as much as I thought I would about the metric system. Parents and health care providers alike want weights in pounds and ounces, except for freshly immigrated Europeans. And while weights are requested in pounds and ounces, measurements are in centimeters. I’m familiar enough with Celsius because it was the norm at my first hospital nursing job, though I still have difficulty converting to Farenheit in my head. I just know that 36.5-37.5 is what we want in a baby, 36.0 is too cold, and 38.0 is a fever. For my car, I’ve made a little chart of kilometers to miles. I have both on my speedometer, but I still find having the numbers is helpful for deciding if and how much I can speed.
Regarding language, why, yes, we all speak English, at least 95 to 99% the same language. An interesting variant is that anesthesia is called “freezing”. Example: I was explaining to a woman after the birth of her baby that she would need some stitches. She nervously asked me, “I’ll get freezing for that, right?”
Another example: I went to the recovery room to check on a mom who had just had a c section to see if she was ready to see her baby. The recovery room nurse said, “Oh, no, her freezing is still pretty high,” meaning her epidural.
In general, I’ve already found myself slipping comfortably into saying “bum” instead of “butt”, “mum” instead of “mom”, and yes, “eh?” has slipped out a few times.
Another generality: I’ve been a coffee snob for a number of years now. I thought back in November, my first go round in Ontario, “Oh, I truly hope I don’t have to actually LIKE Tim Horton’s coffee to be a Canadian resident.” Tim Horton’s is as ubiquitous and as mediocre as Dunkin Donuts coffee, which is to say I need to add an espresso shot just to make it like real coffee. Much like in Chicago, however, I’ve found and fell in love with the local outfit, Coffee Culture. So my caffeine needs are being met.
I feel as if I could keep pleasantly rambling on. I’m enjoying my work, while looking forward to being the primary care provider again. I’m enjoying where I am, while looking forward to returning home. I’m enjoying thinking about my new, as-yet-mythical job, while reminding myself to stay in today.
I want to thank everyone who’s supported me on Facebook. It means more than you know.
I’ve been sitting here trying to think of a grand, flourishing conclusion. It’s just not coming. Perhaps that’s a reflection of my current slower pace, and isn’t such a bad thing. So, till next time….