Hello from San Antonio!

[Yasmeen Al-Marrikhi]

Hi smiddies!

I hope this email finds you all doing well and enjoying summer!  I'm hanging out in in Texas with Peter and while it's so nice to have a break and be together, this mountain of paperwork to get licensed/credentialled/everything else feels like a full time job.  I'm sure I'm not the only one a little overwhelmed?   A question- do any of you have a copy of our liability face sheets from our time at YSN?  Specifically, anything with our names on it?  I have one email from Cele with two very different attachments, but the credentialling service has asked for something with my name on it.  I can definitely reach out to her, but thought I would start here first. Thanks in advance!

Love,Yasmeen 

[hannah l]

Hi Yasmeen and smiddies!

In response to your question Yasmeen... I have no idea. That is a tricky one! My best guess to find out would be email Suselle or even Melissa Pucci. They have been super responsive to me for all my issues/questions with paperwork. The only email  I have gotten from Cele was a "good job on boards!" and "Bill and I are hiking 5 miles a day and I am spending hours in my garden" soooo I wouldn't count on her being super helpful.

In other news... How is everyone? How is everyone's job search or mountain of paperwork going?

I accepted a fellowship at the Birth Center in Bryn Mawr (thank you Elise for the hook up!!!) and will hopefully start doing some office work and orientation by the end of August. They actually took on me and 2 other new grads as "fellows" so it will be interesting and, I assume, super nice to start with some other new grads. I haven't met them yet nor have I even met with HR. I am just waiting for my Pennsylvania CNM license to come through (what an awful paperwork process) and then things should get moving. It definitely feels overwhelming all of the different licenses and agreements and moving parts to get to actually be a full-fledged midwife in PA, but it sounds like my job will help my through all the steps that come after getting my CNM license. While I wait for all of this to happen though, I am settling into Philly with Matt and having so much relaxing time which is amazing, soaking it in while i can. I am starting to feel like a whole person again!

I would love to hear how everyone else is doing and where people are ending up since we are now a couple month out from graduation. Can't believe we are already to the middle of summer!
Love,

Hannah

--
You received this message because you are subscribed to the Google Groups "YSNmidwives2015" group.
To unsubscribe from this group and stop receiving emails from it, send an email to ysnmidwives20...@googlegroups.com.
For more options, visit https://groups.google.com/d/optout.

[Camille White]

Hi Smiddies!

Congrats Yasmeen and Hannah on the jobs! I recently accepted an offer with the Midwives at Norwalk Hospital and am excited to be able to stay in New Haven. Hannah, you spent time with them, right? Whitney maybe too? Anyone else? Let's talk! My start date is October 12. I've been enjoying this time off so much, especially to be able to have so much more time with the girls. I miss midwifery a lot though…that next catch will be such a thrill! 

The credentialing process is a nightmare…I wish we had been better prepared for this! Yasmeen, I think Ann Thompson would be the best person to talk to regarding our insurance coverage. Maybe I'm the only one who didn't know this, but you don't need your license to get an NPI (it does ask for it on the online application, but it's not a required field.) Has anyone gotten a DEA? That one you need to wait for your license number, right? And what's the deal on registering with Medicaid/Medicare?

Hope everyone is having a great summer. Miss you guys!

Camille

[Lizzie Kitue]

Hi everyone,

Yeah Yasmeen sorry I don't know who to talk to about that, but I also haven't started the hospital credentialing part yet.

 I accepted a job at Beth Israel Deaconess in Plymouth, MA. I'm very excited, it's a community hospital and they do centering, waterbirth, and first assist. And it's about 40 minutes from Boston and from where my family lives. I should be starting in the office at the beginning of August while I wait for all the other paperwork to go through, eek! 

The MA license was actually pretty fast to get approved as soon as the transcript got out and AMCB sent in their verification. NPI was literally instant once you submit it so that was nice, but Camille I didn't realize you didn't need your license number for it. And isn't the NPI for Medicaid/Medicare? Or is there an additional process to be able to provide care to those patients?

Check if your state requires a substance control registration BEFORE the DEA. I thought I was supposed to get the DEA first but DEA requires the MA controlled substances to be done first. I was confused by what to do first and ended up calling and talking to a nice lady at the MA controlled substance place who explained it to me.

Here's the DEA's list of states that require some sort of state controlled substances stuff, see the middle column http://www.deadiversion.usdoj.gov/drugreg/reg_apps/pract_state_lic_require.htm 

 I was told controlled substances takes 4 weeks and then you can apply for the DEA (not sure how long that takes) And then there's a whole mess of getting approval by each insurer too (which I was told can take another 4-8 weeks). 

I think it was Tanya who said something to me like, "there's a lot of hand holding as a student and as soon as you graduate and pass boards it's like being pushed off a cliff."

Hope everyone's having a good summer! 

Lizzie Kitue, MSN, CNM, WHNP-BC

Yale School of Nursing 2015

RPCV Kenya 2009-2011

[Tanya Wills]

Congrats everyone!! We are all killing it as new midwives!!!

I got my license in NY already (it took less than a month) and I applied for a dea the other day. It cost me $731!!!!! I budgeted for all the exams and licenses but I blew it on this one. 

Npi was easy online and instant.

I've joined a home birth practice here and I feel so happy about it. That said, there is no privileging process for me as of yet (no cnm's who do hb in NYC have privileges anywhere - the hospitals - which are many - will not give them to us, but that has not always been the case here and we are hoping with the work the home birth summit is doing that will change).

I am sitting for my ibclc Monday but don't get results until October!! And it is the most expensive exam in taking - more than $600. And they only offer it once per year! So many barriers to this credential...

In any case, so far, life without school is dreamy and even better than I had hoped. I'm still teaching and expanding that end of my business the best I can. I know very little about business stuff! I spend four mornings per week with my kids and it's so much fun.

We are at the beach this week too. Hope you are all enjoying the summer!

Love

T

Tanya Wills, CNM, WHNP-BC, MSN, CLC, LM

Bradley classes on the upper west side

Certified Nurse-Midwife

Certified Lactation Counselor

www.manhattanbirth.com

347-512-9550

[Katherine Parker Bryden]

There are four very nice men taking our stuff out to a big truck. I am so glad that I don't have to dismantle an Ikea bunkbed or wrestle futons onto a truck. We leave tonight, have to be in Iowa for a dog vet appt at 5 p.m. on the 23rd, and I have to go get a second PPD placed on Friday. It gets read Monday, when I start orientation. My license is in process, and it sounds like the hospital's credentialing dept will do some hand-holding with the DEA and NPI number (it would be awesome if they pay for the DEA # too!)

I have been very lucky to see Camille and Carly a few times before we leave. We had a very nice beach day yesterday, a good send-off from the literal east coast. I am nervous to start this new job on Monday, and I am doing my best to trust that everything will be fine and that we have the training to do our jobs.

xo Katherine

[Lisa Spencer]

we are all so spread out!

apparently you need a job to get an NPI and DEA number.  i do not have a job.  the crushing failure and feelings of inadequacy are killing me.

but i am glad others are better off!  gives me hope.

l

Lisa Spencer, MSN, CNM

[Snell, Grace]

Hi you all-
Don't worry Lisa- you will get a job!!!
I was supposed to start at my new job this week, but since I'm still waiting on my MA controlled substances registration and can't apply for DEA registration til I have that, my start date will be sometime in the next 3-12 weeks. It's frustrating because I could really use the money and feel like I'm only getting more stupid by the day. On the other hand, it's a huge relief because I'm TERRIFIED. It's also nice to spend serious time with little Max (who turned 1 last week!). The job is at a federally qualified health center in Brockton, MA. Lots of complicated patients with comorbid conditions, 80% don't speak English, midwives get trained in first assist immediately. I think it may be crazy, but this sort of job is why I became a midwife, so I'm trying to pump myself up to dive right in when I'm actually allowed to start.
Hang in there during this transitional time, everybody!
XO,
Grace

p.s. Emily Martyn- can you change my group email address to grace...@gmail.com? Thanks!!

---

From: ysnmidw...@googlegroups.com [ysnmidw...@googlegroups.com] on behalf of Lisa Spencer [lisa.arie...@gmail.com]
Sent: Tuesday, July 21, 2015 7:22 PM
To: ysnmidw...@googlegroups.com
Subject: Re: Hello from San Antonio!

[Aron Mavros]

I'm in the same boat as you, Lisa. The imposter-syndrome abounds!
But I have a second interview coming up at a practice in Manchester,
CT, and have high hopes of something working out there. Florida seems
to be a no-go, but I'm ok with that.
So excited for and proud of all of you who are getting started! You
are my encouragement, and I know you are going to be amazing!

Aron

> www.manhattanbirth.com<https://urldefense.proofpoint.com/v2/url?u=http-3A__www.manhattanbirth.com&d=AwMFaQ&c=-dg2m7zWuuDZ0MUcV7Sdqw&r=KfBs9mMlMhpPx8KDGj2roUlrPuZoE4i7Su2apIRTnDs&m=TUhIsDlVJOk3undv8rFNj8_m2mgglbBBTr27Suya2YY&s=-QOT33EEdGdBNkXvlPQJB3BaHA5rupJDcteAqjnNi6U&e=>
> 347-512-9550<tel:347-512-9550>

>
>
> On Jul 21, 2015, at 10:00 AM, Lizzie Kitue

> <lizzie...@gmail.com<mailto:lizzie...@gmail.com>> wrote:
>
> Hi everyone,
> Yeah Yasmeen sorry I don't know who to talk to about that, but I also
> haven't started the hospital credentialing part yet.
>
> I accepted a job at Beth Israel Deaconess in Plymouth, MA. I'm very
> excited, it's a community hospital and they do centering, waterbirth, and
> first assist. And it's about 40 minutes from Boston and from where my family
> lives. I should be starting in the office at the beginning of August while I
> wait for all the other paperwork to go through, eek!
>
> The MA license was actually pretty fast to get approved as soon as the
> transcript got out and AMCB sent in their verification. NPI was literally
> instant once you submit it so that was nice, but Camille I didn't realize
> you didn't need your license number for it. And isn't the NPI for
> Medicaid/Medicare? Or is there an additional process to be able to provide
> care to those patients?
>
> Check if your state requires a substance control registration BEFORE the
> DEA. I thought I was supposed to get the DEA first but DEA requires the MA
> controlled substances to be done first. I was confused by what to do first
> and ended up calling and talking to a nice lady at the MA controlled
> substance place who explained it to me.
>
> Here's the DEA's list of states that require some sort of state controlled
> substances stuff, see the middle column

> http://www.deadiversion.usdoj.gov/drugreg/reg_apps/pract_state_lic_require.htm<https://urldefense.proofpoint.com/v2/url?u=http-3A__www.deadiversion.usdoj.gov_drugreg_reg-5Fapps_pract-5Fstate-5Flic-5Frequire.htm&d=AwMFaQ&c=-dg2m7zWuuDZ0MUcV7Sdqw&r=KfBs9mMlMhpPx8KDGj2roUlrPuZoE4i7Su2apIRTnDs&m=TUhIsDlVJOk3undv8rFNj8_m2mgglbBBTr27Suya2YY&s=0vHRoBk9M0K92E1rLFDprmnI0T8sU9T6Ib7HlcacDM8&e=>

>
> I was told controlled substances takes 4 weeks and then you can apply for
> the DEA (not sure how long that takes) And then there's a whole mess of
> getting approval by each insurer too (which I was told can take another 4-8
> weeks).
>
> I think it was Tanya who said something to me like, "there's a lot of hand
> holding as a student and as soon as you graduate and pass boards it's like
> being pushed off a cliff."
>
> Hope everyone's having a good summer!
>
> Lizzie Kitue, MSN, CNM, WHNP-BC
> Yale School of Nursing 2015
> RPCV Kenya 2009-2011
>
> On Jul 21, 2015, at 8:44 AM, Camille White

> ysnmidwives20...@googlegroups.com<mailto:ysnmidwives20...@googlegroups.com>.
> For more options, visit
> https://groups.google.com/d/optout<https://urldefense.proofpoint.com/v2/url?u=https-3A__groups.google.com_d_optout&d=AwMFaQ&c=-dg2m7zWuuDZ0MUcV7Sdqw&r=KfBs9mMlMhpPx8KDGj2roUlrPuZoE4i7Su2apIRTnDs&m=TUhIsDlVJOk3undv8rFNj8_m2mgglbBBTr27Suya2YY&s=prp1cLpJrR-YqWS1RYYh5SolBPtZdD3vUMKCg74R9dw&e=>.

>
>
> --
> You received this message because you are subscribed to the Google Groups
> "YSNmidwives2015" group.
> To unsubscribe from this group and stop receiving emails from it, send an
> email to

> ysnmidwives20...@googlegroups.com<mailto:ysnmidwives20...@googlegroups.com>.
> For more options, visit
> https://groups.google.com/d/optout<https://urldefense.proofpoint.com/v2/url?u=https-3A__groups.google.com_d_optout&d=AwMFaQ&c=-dg2m7zWuuDZ0MUcV7Sdqw&r=KfBs9mMlMhpPx8KDGj2roUlrPuZoE4i7Su2apIRTnDs&m=TUhIsDlVJOk3undv8rFNj8_m2mgglbBBTr27Suya2YY&s=prp1cLpJrR-YqWS1RYYh5SolBPtZdD3vUMKCg74R9dw&e=>.

>
>
> --
> You received this message because you are subscribed to the Google Groups
> "YSNmidwives2015" group.
> To unsubscribe from this group and stop receiving emails from it, send an
> email to

> ysnmidwives20...@googlegroups.com<mailto:ysnmidwives20...@googlegroups.com>.
> For more options, visit
> https://groups.google.com/d/optout<https://urldefense.proofpoint.com/v2/url?u=https-3A__groups.google.com_d_optout&d=AwMFaQ&c=-dg2m7zWuuDZ0MUcV7Sdqw&r=KfBs9mMlMhpPx8KDGj2roUlrPuZoE4i7Su2apIRTnDs&m=TUhIsDlVJOk3undv8rFNj8_m2mgglbBBTr27Suya2YY&s=prp1cLpJrR-YqWS1RYYh5SolBPtZdD3vUMKCg74R9dw&e=>.

>
> --
> You received this message because you are subscribed to the Google Groups
> "YSNmidwives2015" group.
> To unsubscribe from this group and stop receiving emails from it, send an
> email to

> ysnmidwives20...@googlegroups.com<mailto:ysnmidwives20...@googlegroups.com>.
> For more options, visit
> https://groups.google.com/d/optout<https://urldefense.proofpoint.com/v2/url?u=https-3A__groups.google.com_d_optout&d=AwMFaQ&c=-dg2m7zWuuDZ0MUcV7Sdqw&r=KfBs9mMlMhpPx8KDGj2roUlrPuZoE4i7Su2apIRTnDs&m=TUhIsDlVJOk3undv8rFNj8_m2mgglbBBTr27Suya2YY&s=prp1cLpJrR-YqWS1RYYh5SolBPtZdD3vUMKCg74R9dw&e=>.

>
> --
> You received this message because you are subscribed to the Google Groups
> "YSNmidwives2015" group.
> To unsubscribe from this group and stop receiving emails from it, send an
> email to

> ysnmidwives20...@googlegroups.com<mailto:ysnmidwives20...@googlegroups.com>.
> For more options, visit
> https://groups.google.com/d/optout<https://urldefense.proofpoint.com/v2/url?u=https-3A__groups.google.com_d_optout&d=AwMFaQ&c=-dg2m7zWuuDZ0MUcV7Sdqw&r=KfBs9mMlMhpPx8KDGj2roUlrPuZoE4i7Su2apIRTnDs&m=TUhIsDlVJOk3undv8rFNj8_m2mgglbBBTr27Suya2YY&s=prp1cLpJrR-YqWS1RYYh5SolBPtZdD3vUMKCg74R9dw&e=>.

>
>
> --
> You received this message because you are subscribed to the Google Groups
> "YSNmidwives2015" group.
> To unsubscribe from this group and stop receiving emails from it, send an
> email to

> ysnmidwives20...@googlegroups.com<mailto:ysnmidwives20...@googlegroups.com>.
> For more options, visit
> https://groups.google.com/d/optout<https://urldefense.proofpoint.com/v2/url?u=https-3A__groups.google.com_d_optout&d=AwMFaQ&c=-dg2m7zWuuDZ0MUcV7Sdqw&r=KfBs9mMlMhpPx8KDGj2roUlrPuZoE4i7Su2apIRTnDs&m=TUhIsDlVJOk3undv8rFNj8_m2mgglbBBTr27Suya2YY&s=prp1cLpJrR-YqWS1RYYh5SolBPtZdD3vUMKCg74R9dw&e=>.

>
>
> --
> You received this message because you are subscribed to the Google Groups
> "YSNmidwives2015" group.
> To unsubscribe from this group and stop receiving emails from it, send an
> email to

> ysnmidwives20...@googlegroups.com<mailto:ysnmidwives20...@googlegroups.com>.
> For more options, visit
> https://groups.google.com/d/optout<https://urldefense.proofpoint.com/v2/url?u=https-3A__groups.google.com_d_optout&d=AwMFaQ&c=-dg2m7zWuuDZ0MUcV7Sdqw&r=KfBs9mMlMhpPx8KDGj2roUlrPuZoE4i7Su2apIRTnDs&m=TUhIsDlVJOk3undv8rFNj8_m2mgglbBBTr27Suya2YY&s=prp1cLpJrR-YqWS1RYYh5SolBPtZdD3vUMKCg74R9dw&e=>.

>
> --
> You received this message because you are subscribed to the Google Groups
> "YSNmidwives2015" group.
> To unsubscribe from this group and stop receiving emails from it, send an
> email to ysnmidwives20...@googlegroups.com.
> For more options, visit https://groups.google.com/d/optout.
>


--

Aron Mavros, CNM, RN, MSN
203-892-7130

*Do not be daunted by the enormity of the world's grief. Do justly, now.
Love mercy, now. Walk humbly, now. You are not obligated to complete the
work, but neither are you free to abandon it. ~Jewish Talmud **commentary
on Micah 6:8*

[Caitlin Miller]

So nice to hear how everyone is doing and where we're all winding up! I had taken a job in PA and was all set to start looking for places to live when HR called me to tell me that the job actually "fell through," i.e., they realized they no longer had the budget for it? Whatever it was, it sucked. But it's okay now, because I'm super pumped to have taken a job back in my old stomping ground in Greenfield, MA. All is well that ends well. Until I move into the 300yo farmhouse I spontaneously sprung for a lease on (it has a woodstove, guys, and an apple tree!), I'm hanging out with family and friends and the puppy and doing lots of fruit picking and reading and yoga and basically discovering who I am again after 3 long years.

Thank god for Lizzie already having a job in MA, or I wouldn't have a clue how to do all this paperwork. I have four RN licenses, (CT, MA, ME, AZ) and guess which one I can't find in order to make a copy of it for my MA CNM license app? That's right, the MA one! So I had to order a new one. Which takes 2 weeks. So many face to palm moments, but my sister keeps reminding me that in 6 months, none of this will matter, because we'll all be settled and working and won't even remember how stressful this part of it is.

Anyway, I hope everyone is doing splendidly and is enjoying time with the loved ones we've neglected for so long. And to those starting work soon - good luck! You will do AMAZING. We're all there cheering you on.

xo

Caitlin

[Caitlin Miller]

Hey everyone!

Hope everyone is totally in love with midwifery and their jobs and lives and every single moment you feel the sun shining down on your face (sarcasm? Me? NO NEVER) but just in case you're not totally thrilled with where you are, the job I had originally planned on in PA is now open again and they're looking for someone, and would be open to a new or recent grad. It's in Lewisburg, PA, where Bucknell is. I liked a lot of what I saw when I originally interviewed, and if anyone is curious about them, feel free to email me.

xoCaitlin

--

Caitlin Miller, MSN, CNM
Pioneer Women's Health at The Birthplace
caitlin...@gmail.com
c: 585-590-0470 / w: 413-773-2200

[Katherine Parker Bryden]

Miller -- If we have this mug, then we can only love our jobs and lives and the sun shining on our midwifery faces. And it is on sale at the ACNM Online Shoppe right. now. (See attached)

     I was on call this weekend - a personal record of NINE triages in 7 hours, 4 of whom came in because I was apparently running a special on early third trimester pelvic pressure with a side order of vaginal discharge, Saturday only. One of my favorite grand multips came through just to get some tea and sympathy because she has a bad case of TOBP at 28w4d. Nothing really wrong, just uncomfortable and wanting some company, or maybe a little chance to get away from her other kids and husband for a few hours. She left all smiles, helped herself to a cup of ice on her way out. 

     Ended the shift with a sort of chaotic unmedicated NSVD at shift change -- in a half-size c/s recovery room (because the unit was packed to the gills s/p floridly psychotic, poorly babysat psych patient setting off the 5th floor psych unit sprinkler system during a suicide attempt and flooding the three floors below, including Peds, which got moved to the NICU, and all the NICU patients are housed on the labor floor), with the patient, her boyfriend, his mom, his sister, his aunty, patient's mom, two aunties, a ten year old cousin, patient's BFF and her fifteen month old, me, the midwife who needs three more proctored births (who literally walked in and took over from me with only time to glove up and catch the baby as she crowned and was born, and if mama's perineum had been shorter, she would have missed the birth), the midwife coming on call, the labor nurse, two stabilizing baby nurses and a scrub tech. The ONE person who needed to be there was the OB, and she missed the birth by five seconds and then wouldn't sign off, even though the baby was inches from the perineum and hadn't even gone to mama's belly yet...le sigh. In case you didn't catch the number, that was 16 people in the room. The family was stuffed in on the wall-side of the bed, and as baby was born, they gave the mama and baby a huge cheer and standing ovation that would have made Richard Jennings proud. 

     In all seriousness, 7 1/2 months in, I am thrilled with my job. We have a <10% cesarean rate, supportive back-up OBs who are very kindly training me to first assist (and I am avoiding the 65 year old male, Nigerian OB who is known for peering over his half-glasses and saying, "NurseName, NurseName, NurseName...What ah you toing?" and literally slapping people on the wrist if they don't intuit what he needs immediately. And he also apparently cuts buttonhole sized incisions and needs forceps or vacuums on the regular because of this. I was told not to assist with him til I have done 20 or so surgeries. 

     All the rest of y'all, please send stories from the vagina trenches, and waterbirth protocols from your hospital if you have them (special shoutout to Lizzie for her practice's guidelines!). We have a waterbirth committee and I am the collector of research, evidence, and all things paperwork you. I will share my nitrous protocol in return if you are lobbying for that and need examples. :)

     Ok, as usual, I wrote way too much, now time to go back to the hospital for another 24 hour shift...

Big smiddy love to everyone!

Katherine 

[Elise Kaye]

Hello everyone! 

I love not being a student - that is the best part of my job. If I had known a year ago when I got canned from my first integration placement and my second one said the only way you will get your numbers is to be on call literally 24/7 for the next 2 months that I would be happy with a job I don't think I could have brought myself to believe it. I felt so miserable in school - trying to figure out midwifery and the system as a whole with not much faith in anything. 

But I was glad to be proven wrong. I took a job with that second integration site in Chicago. They strung me along all summer and with the credentialing process taking 2months I finally started in October. We are a 3.5 midwife practice with 2 back up OBs. We are pretty low volume avg 15-20 births a month (although march is like 40, yikes for us!) - we don't even have showers in some of our labor rooms, most of our moms detest breast feeding, not sure what our csec rate is but I'm just concentrating on mine so far, and keeping perineums intact so I never ever have to do a repair!!!! Haha not the most midwifery-ie kind of job but love the patients and my partners/staff/OBs are kind and super supportive. I still have newbie blinders on and my Spanish is still very rocky but getting better. If anyone ever moves and works here I would highly recommend an immersion class beforehand. I spend 2 days in the clinic and take 2 24hr shifts where I take call from home. Sometimes I work all 24hrs, some days I get the whole 24hrs to myself if no one pages me or comes in. We have family practice residents who do triage - which can be great or terrible depending on who you get. So a nice gradual entry into the job. I still haven't experienced certain things yet, so when my first real dystocia comes I really hope all those very realistic sim labs are burned into my brain. 

My dad who is a physician said it takes 5 years until you feel comfortable doing work in the hands on medical field...thanks dad that makes me feel all kinds of ways but at least I'm 6months closer to that 5yrs right now.

I think the next annual ACNM meeting is Chicago in 2017 so if anyone decides to come/needs a place to crash please look me up!! 

-elise

<image.png>

[Gmail]

So, so good to hear from folks. 

While I'm glad to not be in school anymore, i can't say I love this. Mostly I'm just terrified everyday. Reading about Katherine and a water birth committee is so distant from my reality- we don't even have telemetry where I am! I'm jealous, but reminded that midwifery is an expansive field and we are all midwives in our little parts of the world. 

When I'm in the office, I'm scheduled to see patients every 15 minutes. When I'm at the hospital, I'm trying not to crap my pants in fear. More than 80% of our patients are non English speaking, and it's really hard to do a new OB visit with an interpreter in 15 minutes, especially when it's a 36 week entry to care. It doesn't help that I'm just slow as a newbie anyway. Thank goodness for a quick vaginitis check! I'm excited when I have a normal patient whose only complication is chronic hypertension. Our c section rate is sky high because of prior c sections in other countries with no records available. I've been first assisting since I started, which is a surprisingly satisfying experience. It seems like every patient develops preeclampsia, or has a clotting disorder or diabetes, or is a 27yo G14P8. I am so focused on consulting with MFM and managing complications that I'm afraid I will forget basic midwifery. It seems like every delivery is accompanied by postpartum hemorrhage or some crazy thrombocytopenia and I'm always looking for something bad to happen. Lots of magnesium sulfate and transfusions and cytotec and uterine massage. And so much triage. Ugh. I "caught" my first IUFD a couple months ago. It was awful. 

This is tough, guys. Sometimes I wonder if I would have done this if I really knew what it would be like. Thank goodness I adore the patients. I think this first year is supposed to be tough. Right? 

Holler!

Sent from my iPhone

[lizzie...@gmail.com]

Hi everyone,

Wow that sounds crazy, Grace. Things are going well here, I love the other midwives and our docs, though I'm starting to feel burnt out already. Not sure what everyone else's schedules are like but I just got off a 12 day stretch with no days off, just post call days which I spend sleeping since almost all my 24hr shifts include running back and forth between multiple laboring patients and triage patients with no break. We also do Centering groups in the evenings, which is lovely but also means we have 12 hr office days sometimes. One of the midwives had to leave abruptly in December so we picked up her shifts too. 

We are the only practice at our hospital and patients choose if they want to be midwife or doctor patients, and people are definitely choosing midwives overwhelmingly, which I love, except when it means a lot of nights where I have 3-4 labors plus a few triage patients and the docs have none. And the midwives take the phone calls too so when someone calls at 11pm for something silly like updating their phone number in our system or asking for a birth control refill (true stories) I have to step out of a room while pushing with a patient to deal with it. Luckily the docs are great with helping out, And I am getting better at multitasking, I just don't get to do as much patient support. I almost had a barehanded delivery the other night since the nurse forgot to put gloves on the table and the head was already out by the time I got the gloves on. 

It's crazy, I am no longer the newbie at my job, we hired a new grad a few months ago and another one will be starting in April. I've also been first assisting, which has just been a learn as we go thing, but Nell Tharpe does live first assist courses so the other new midwives and I are going to a course in a few weeks. 

I'm just trying to get more of a life outside work going now. I joined a book club in the hopes of having some pressure to read books since when I come home from work the last thing I want to do is use my brain... I go up to Boston sometimes too so if anyone wants to meet up let me know. 

I couldn't make ACNM work this year but I am planning to go the the women's health NP conference in September in New Orleans. And to the other Massachusetts midwives: there's a Partners in Perinatal Health one day conference in May that I will be going to http://www.piphma.org/save-the-date-2016. Maybe I'll see some of you there

Hope everyone is doing well!

Elizabeth Kitue, CNM

BID Plymouth OBGYN & Midwifery

[Katherine Parker Bryden]

Lizzie, you need to tell your answering service to filter non-urgent calls like that if they come at night - you are too busy for that BS, and the answering service can tell the update phone number person to call during office hours, same for birth control refills, "emergency" yeast infections, etc. My favorite 'why-did-this-get-routed-to-me-at-2-a.m.?' call so far has been a newly diagnosed gestational diabetic whose call I returned at 2 a.m. who wanted to ask if it was ok for her to eat a handful of almonds, or if it would mess up her sugar numbers in the morning? Whaaaat? Woman, take two almonds and call me in the morning! I don't feel burnt out yet, but just freakin' tired, and old. I spent my last two post-call day mornings first assisting at a birth because we were a little short staffed, and the other one covering for our on-boarding midwife so she could get her last proctored birth in this week, so I worked, not 12 days straight, but 11. And then I slept in til 1:30 this afternoon. Lame-O. I am going to the ACNM this year, could stay at my grandma's house, or could spring to share a hotel room -- if anybody else is interested, let me know.

XO

Katherine

[Emily M]

Greetings from Vermont, Smiddies!

I'm hanging in there too, mostly liking (loving?) my job, but also feeling overwhelmed and terrified and exhausted. Turning my pager off at 0801 is my new favorite hobby. My coworkers (4 other midwives and 3 OBs) have been so welcoming and supportive. 3 of the 4 other midwives started in our practice as new grads or with <1 year of experience, so they are very good at orienting and on-boarding new midwives, and it's been wonderful to have support from midwives who just went through this a year or three or seven ago. The OBs have been incredibly patient and kind as I figure this all out too. We are about to start Centering, which we're hopeful will be great for our incredibly varied patient population and for us as providers. At facilitator training in Boston, I met two of Lisa's colleagues from Baltimore, and reconnected with Bree, one of the GEPN OB preceptors. It's nice to have midwifery be a small world community. Last Friday a current GEPN from Vermont, who is also a sometimes doula at our hospital, shadowed me in the office while she was on spring break to reconnect to midwifery after her psych rotation. It's incredible to think that just a few years ago that was us, and now we're people with CNM after our names!

The patient population in Brattleboro is really interesting, as I'm sure Jesse can attest to too, as she works in the other OB practice that delivers at my same hospital. We don't run into each other a whole lot, but we were both there for chaos last night! Last night is a great example of the breadth that I've seen: first, a totally healthy, normal AMA multip who had labored at home all day arrived to the birthing center complete. I raced over to the hospital (thankfully 2 blocks away) and caught her baby in a beautiful, intimate, natural birth.

While I was pushing/suturing, another patient came up to the ER. She had been a patient of ours in other pregnancies, but is homeless and had no prenatal care with this pregnancy. We have a lot of opioid abuse in the area and are also always suspicious of that. She arrived in the ER with "cramping and weird vaginal discharge," aka, labor and copious thick mec. She had no idea how pregnant she was. My collab OB and I scrambled around to order her labs and figure out her gestational age.  We learned she had had 1 NSVB, and then 3 c-sections. While waiting for the ultrasound machine she said she needed to push, and was found to be 8cm. We scrambled around to get the OR team to the hospital, and of course in the process of getting that done, she progressed to fully and the OB decided they would just trial pushing. We were all put on standby. After several minutes of pushing, the respiratory therapist rushed out to request me at the birth, which seemed very weird to me. I walked in and the OB said "so, she's breech and I'd like you to gown and glove to be an extra set of hands for me." And indeed, there was a little butt crowning, or mooning, or whatever you call it when a baby's bum is presenting. And so, I assisted in a vaginal breech birth after 3 c-sections. Not something you see every day for damn sure. It actually went smoothly, and just after the birth and passing the baby off to peds and respiratory, the OB turned to me and said "I can't believe we just fucking did that." My thoughts exactly. Yup, we get quite a spread around here, especially with a full moon. Special thanks to Jesse, Hannah and Caitlin for already hearing/reading this story... I've been telling everyone I can. Giving report to the oncoming CNM this morning was especially exciting.

I miss seeing you guys regularly and hope that you're all doing well! I'd love to be in better touch!

Emily