written by Cherylyn
Instructor: Liz Stika
Today was our last class of the term, other than our Skills Day on Saturday. Liz was our instructor again, and we were thrilled to have her back.
The topic was Prenatal Testing. We discussed reasons for testing, like establishing a baseline, detecting or excluding a problem, confirming a problem, classifying a problem, and monitoring the course of an illness and/or the response to treatment. Liz explained the differences between screenings and diagnostic tests, and then we delved into the common pregnancy tests by trimester. For the first trimester, we discussed blood tests like the PB panel and hCG, ultrasound, genetic screening, and quad screen. For the second trimester, we covered checking glucose, palpation and auscultation, watching for liver issues (including pre-eclampsia, hypertension, and HELLP syndrome), and the 20-week ultrasound.
Tests for the third trimester may include additional bloodwork (like CBC), Rh antibodies, group beta strep, amniotic fluid index, ultrasound, and non-stress tests. Testing for post dates pregnancies could involve electronic fetal monitoring, more frequent prenatal visits, daily kick counts, and biophysical profile. We also discussed when transfer of care might become necessary for post dates or high risks that may show up. Although we were all feeling ready for a summer break, Liz assigned a good amount of homework to complete within the next month. Along with the video lectures the school will give us each week, we’ll be keeping our brains working on these subjects before we return in the fall!
written by Sariah
Instructor: Liz Stika
Today we learned the ins and outs of Basic Prenatal Exams.
A prenatal exam consists of: vitals, urinalysis, palpation, and questions and answers.
We began our day with a TED Talks video of a presentation by Abraham Verghese: “A Doctor’s Touch”: https://www.ted.com/talks/abraham_verghese_a_doctor_s_touch
Some of my favorite quotes from the video are:
“Never short change a woman of her physical exam, pay attention to the diagnostic tests, build trust, build a relationship.”
“Rituals are about transformation”
“We’re losing a ritual. We’re losing a ritual that I believe is transformative, transcendent, and is at the heart of the patient-physician relationship.”
After the video we discussed the importance of taking vitals at prenatal visits, and about establishing a baseline at the first visit. We talked about normal ranges, and the types of things that can cause variations from normal. Then we dove into practicing taking vitals on each other, including blood pressure, respiration, pulse, and temperature. We then discussed urinalysis, and all the things to check for at each prenatal visit. There were a lot of notes to take, as we covered the details of what to watch for and what variations could indicate in a pregnant woman’s health. The day culminated in, you guessed it, analyzing each other’s urine. We ended by playing the midwive’s version of Pictionary. We were given homework to practice taking blood pressure at least 20 times over the next week, and reading more in-depth information about urinalysis.
written by Cherylyn
I was expecting today’s class to be all about newborn assessment. When we showed up first thing in the morning, we were told that DyAnna, a certified midwife, would be giving a presentation explaining the process of getting certified as a midwife through the North American Registry of Midwives, and then we would move on to the instruction about newborn assessment. The NARM process is confusing at best for most prospective midwives, but Dy did a good job of breaking things down and explaining it to us. Some of the students expressed feeling overwhelmed by the information, but I had a sense that I could take a step-by-step approach and make it work. There’s a saying about how you eat an elephant by taking one bite at a time. I felt this applied very well to the NARM certification.
Next we had our newborn assessment instruction by Roxanna. I already knew and loved Roxanna, and newborns are my favorite part of childbirth, so this was a really fun class. We talked about the extensive newborn exam that midwives do within 12 hours after birth. I remembered my own experiences, how the midwife’s exam was much more thorough than that of the pediatrician! I realized that as midwives we are the front line, and it’s important to be thorough and attentive. The midwife also has a special role in that she often cares deeply for her clients, and is able to do the assessment in a gentler way than other care providers might do it. I felt gratitude for the role I would provide for future clients, and that those clients have access to caring and skilled midwives.
written by Amy
Around nine in the morning I walk into midwifery class. The usual hum-drum sounds that accompany groups of women are present. Once I tune in a little more, I find that unsurprisingly the talk is not about the usual everyday female’s life. TV scandals, where so-and-so got her hair done, or how some poor husband did the wash wrong and consequently bleached all the clothes. Instead, the talk is about nothing other than mothers and their babies, children born into this world, and where, when, why, and how we can help. The vitality of class are the moments when every aspiring midwife (or in many cases, already practicing midwife looking to fill in the gaps of her education) joins in the sharing of knowledge outside of class time. The sharing is unattached to grades or points. It is purely women helping other women be better.
The class comes to order. We sit still and silent for half a second while the instructor introduces herself. We have never met Liz before, and yet we know her. She trained at MCU and has around eighty births under her belt. For the next five hours we delve into the history of midwifery. Out comes the long sheet of butcher paper. As we cover the different aspects of midwifery history, we skept colorful memorials on the paper in a kaleidescope time line, from the Ice Age until present time. We draw the names of those who have left their mark in history; names like Jane Sharp, Birgit Lee Fuller, Louise Bourgeois Voursier, Martha Ballard, Mary Breckinridge, and Ina May Gaskin. We hear their stories and read of their triumphs and discoveries, all that they contributed to knowledge, understanding, life, and love. They now leave in our hands. That heritage is every human’s right. Along with that comes the responsibility to do our very best, try our very hardest to help God’s children into this world.
written by Cherylyn
Today’s class included all the CSM students. It was the UMO Conference, and we were required to attend the first half of the conference. The students met an hour early and discussed school business and what our role would be in the conference. Tara Tulley asked us to take notes and write a critical analysis on at least one case from the peer review.
The conference itself started with a peer review, in which midwives presented case studies from their own practices. They explained challenges that came up in the cases, how they were handled, and what the outcomes were. We listened, took notes, and asked questions. The midwives who presented were Roxanna Mauer, Maria Cranford, and Diane Bjornson. It was really interesting and educational.
The peer review was followed by a long pot luck lunch and meet & greet. This was my favorite part of the day because I got to mingle with experienced midwives, ask questions, and listen to their stories.
The last half of the conference was optional for the students, and I stayed. Melissa Chappell gave a presentation about orthorexia, a newly-defined eating disorder in which extreme health-conscious eating leads to malnutrition and/or disease. We did an oral quiz to help define orthorexia and watched an interesting documentary about it online. Melissa explained about healthy nutrition and how midwives can help their clients who may struggle with orthorexia. She also popped some fresh popcorn, and it was delicious.
Tara Tulley finished with a lecture about understanding the relationship of PMAD’s (perinatal, postpartum, mood, and anxiety disorders), eating disorders, and BID among pregnant and postpartum women. Tara is a midwife and counselor who specializes in eating and mood disorders. We talked about the new definitions, including PMAD, postpartum OCD, and eating and feeding disorders including anorexia nervosa, bulimia nervosa, binge eating disorder, and OSFED or UFED. We learned that women with a history of eating disorders or physical or sexual abuse may be more prone to PMAD, and that almost 50% of people with eating disorders also have depression. We also learned that 75% of women are concerned with losing weight within two weeks after giving birth.
All in all, it was a wonderful conference, and I was very glad I stayed for the whole thing.
written by Jennifer Peck
We started the day off with the students each writing two questions for a class quiz about the past week’s homework. As we wrote our questions, we shared what went well this week in our lives. We also discussed some of the nutrition facts we learned last week and we talked about heirloom seeds and starting a school community garden. Sariah offered to let us use her yard and Melissa suggested she oversee that as her term project. Sariah has worked on a farm, so she was excited about doing it. Other students were trying to decide what their projects would be, and we discussed ideas.
We took the quiz. Melissa read the questions aloud and we wrote our answers. Afterward we corrected the quizzes as a class and discussed the answers.
Next, we learned three pregnancy exercises: kegels, squats, and pelvic tilts. Melissa explained each of them to us, and then we tried them. For kegels, we stood as Melissa talked us through them. For squats, Melissa had Amy come to the front of the class and demonstrated a supported squat in which she stood and held onto Amy’s hands as Amy squatted as low as possible. After that, we all went into a larger room where we practiced pelvic tilts.
We then returned to our seats and broke into pairs. Using our food logs from the past week, we took turns acting as the midwife/client, giving suggestions on how to improve our diets. Afterward we discussed our observations as a group, and how we can suggest better nutrition without being critical.
Next we talked about common pregnancy complaints and broke into two groups to practice having each person be the “teacher” and the rest of the “class” ask questions about their pregnancy issues. It was fun, especially because some of our students were very convincing actresses!
The next topic covered was dilation, effacement, and station. Melissa demonstrated how a deflated balloon can be used as a model to show the approximate size and shape of a non-pregnant uterus and cervix. Next we reviewed a nutrition article that we’d read for our homework, and how it could be used to encourage critical thinking.
One of the last topics we discussed was comfort measures. We talked about which comfort measures would be appropriate to teach in a childbirth class, and Melissa demonstrated the roving body check. We then watched a birth video online. Finally, Melissa guided us through a progressive relaxation practice before class ended. No one wanted to get up to leave after that!