life is wonderfully crazy.

Hello world! Whoever is left of this little blog world, that is! I can't believe the last time I wrote was October. So much has happened since then. Here's the short version:

• Dove into my first midwifery job which I started in September. Laughed and loved and cried with my patients, welcomed beautiful babies into the world. 
• Enjoyed a December vacation with the Janiecs! Concentrated time in Disneyland with our niece and nephew - it was a dream!!!
• Had wonderful holidays, was able to spend Christmas in Tucson together with family and Christian! Anyone who has one medical person in their family nonetheless two knows this was truly a Christmas miracle!
• Survived residency interview season and away rotations. Spent a lot of time apart. 
• Created a rank list for the Match. Changed our rank list. Changed it back again. Cried a lot. Stressed out. Changed the list again. Submitted list! Ranked all Emergency Medicine programs.
• Match Day!!!! We did it! We matched our top choice in EM and will be staying put! We are thrilled!
• Job opportunity! I am offered an interview to work at a freestanding accredited birth center! Be still my heart! I interview, am offered a position, and take it! Sad to leave my wonderful friends/colleagues/patients at my previous position. Excited for this opportunity - I thought birth center work wouldn't be a possibility for me for years to come!
• Graduation! No words. I'm sure you can imagine. My best friend and partner, the man I love more than anything on earth, has achieved his goal of becoming a doctor. If I were more proud I might explode into a million pieces. 
• Birth center sea legs! Loving and adjusting to my new surroundings. I catch my first baby in the water! Now I see what all the fuss is about surrounding water birth...how amazing! Loving midwifery and loving my new job. Enjoying many sleepless/exhausting nights with cute, crying, pooping rewards at the end. 
• Residency! Christian begins orientation for residency June 16th! First doctor job right around the bend!

As you can see, things are moving and changing at the speed of light around here. We are so thrilled and tired and overwhelmed and grateful, we're just trying to make it all slow down so we can soak in every moment. I have been so busy living I haven't begun to have time to write it all down. And thinking about it now, I'm very much okay with that. So I don't know if/when this space will be revisited. Maybe for occasional updates? Maybe I can make it happen once every few months? Maybe not? Either way - know we are well and very much enjoying this season of our lives, both personal and professional. Thanks for reading and caring.

XO
Ash

fa la la la LAAAAA.

Helloooo world. I was reminded over the weekend by my sweet mother-in-law (hi Lori!) that it has been a while. And she is so totally right. I wish I had new and exciting info to share besides busy busy blah blah blah. Let's see what I can do.

So, Halloween happened. It was low-key (per usual) and awesome. We handed out candy and watched spooky movies and the weather was awesome.

Christian spent the last few months doing a rotation with local EMS. He had a blast with the firefighters and had a kick ass schedule of 24 hours on and 48 hours off. And, as usual, after a good long 24 hour shift there was lots of catnapping (or dognapping, I guess).

Currently Christian is in full blown interview mode. He has been to about half of his interviews so far (in fact, he was at one today). I've been missing him like crazy as he jet sets all around the country making programs fall in love with him - which isn't hard to do. :) He has enjoyed all the programs he's visited and every time he calls me after an interview he's all, "I loved that program so much! It might be my favorite!" He just denied doing this on the phone a few hours ago immediately after his last interview but it's totally true. His unbridled enthusiasm for most things in life is one of the things I love most about him. He sees the positive in every program which is going to make creating our rank list hard! He has interviewed pretty much exclusively in AWESOME cities, so I at least have the assurance that wherever we move (or if we stay) we'll live someplace amazing. Like Seattle where he got to combine an interview and a visit with his sister and her family (including our favorite kids Reese and Lily).

I haven't been able to accompany Christian to any of his interviews (I'm making a sad face as I type this). I've read many a med spouse blog where they're able to follow hubby/wife around the country to check out prospective cities and programs and I'm pretty jealous. Last time I posted I had just started my new job and haven't been able to take time off to go with. He is giving me good info from each program and city but it would've been great to be able to explore every place together. Plus, I miss this dude.

The job is going well. Being a new nurse-midwife is different than I imagined it would be. It is more stressful, more beautiful, more frustrating, and more joyful than I could have realized. I am in love with my patients. I am forming relationships with them and they're inviting me into their family for a brief moment in time and it's amazing. I am also learning to deal with the ins and outs of operating in an office setting and as a part of a team made up of front desk staff, billing, medical assistants, nurses, and more! It has all the ups and downs of any job with substantially more ups. Until recently I have been in the office Monday through Friday seeing patients for prenatal visits, annual exams, and gyn issues but hopefully by Friday my hospital privileges should be in place so I can start taking call and attending births! I miss it so much and can't wait to be there for my patients I have come to love.

Tools of the trade.

Organized chaos. Or just chaos. 

So there it is. That's only a tiny piece of life lately and I'm exhausted just typing about it. On the horizon: VACATION with husband and previously mentioned favorite kids. I am so excited it's ridiculous. More later. Hope all you med spouses with partners on the interview trail are hanging in there. We ordered graduation regalia....I can see the light at the end of the tunnel!

Oh...can't forget a few gratuitous photos of Vies!

Love,
Ash

Personal statement.

Tell me you don't just dread writing a personal statement...you'll be the first person I've met to do so. What a pain! Talk about yourself...don't brag but don't ever be negative. Point out your strong points but give examples. Don't use flowery language, don't use clichés, don't write too much, don't write too little. Reading, editing, and re-reading a certain almost-physician husband of mine's personal statement this past week was both exhausting and awe inspiring. First of all, the time has finally come in our medical school journey for Christian to apply for his first job in medicine as a resident. I know I always say this (and so does everyone else) but I really can't believe we're here. I feel like we were just moving into our first house together two hours from everyone/everything we know and love to start this adventure and now it's coming to an end (at least this chapter). Christian submitted his application on Monday and we applied to programs all over the country. Now we wait for invitations for interviews to start coming in...then interview season, then our rank list is due in February, then Match Day! I know I've written about Match Day before but it's a day we've been thinking about since his first year of medical school.

Enjoying San Francisco while checking out the EM program.

Second, after working with him on his personal statement and application I just oozed pride for days. He is one hard-working sonofagun, did you know that?! Seeing all his accomplishments on one page is really cool and makes him look like the badass he really is. Can you tell I'm proud? Honestly, you don't have to be a genius to get into medicine (I've seen geniuses fare worse than their average-brained classmates!) - but you do have to be a ridiculously hard working person and have a relentless drive and spirit. Christian is all of these things combined with a love of people and of being helpful. He is kind and gentle and will be (and practically is) a spectacular physician. I can't wait to see where the next chapter takes us. I know as long as he's the one holding my hand everything will be just fine.

In other news, I am a practicing midwife. Have you heard?! Today was my second full day on the job at my new practice. I feel so fortunate to have been hired here. The other midwives feel like my sisters...they are compassionate and hilarious and smart. I am learning the ropes of the office this week and next week (including a new EMR system....yuck). Combining this with the fact that I am still new in my practice and gaining my bearings clinically, this has been (and will probably continue to be) one of the more challenging times in my career. I am glad to have a supportive group of providers surrounding me and hope to make the transition as smooth as possible. My actual license is pending one last thing out of a long list of required documentation, paperwork, fees, more paperwork, etc....once these dang fingerprint results are back I'll be good to go. As scary as it can feel there is really no where to go but forward so forward it is. As hospital privelages are applied for, I will hopefully be catching babies by November/December. What a lovely holiday season this year will bring for me. :D

I have an office. And a desk!!! And a wall to decorate with all my lovely (cough::expensive::cough) diplomas! And I have business cards...very official. 

September is flying by....a handsome someone just had a birthday that we had to spend apart (thanks med school) and before we know it we'll be in October which happens to be that handsome someone's favorite holiday! We always have great fun around Halloween and I'm looking forward to this year. What are you looking forward to?

Happy Wednesday.
xo

CNM.

I've worked really hard for this. So. Excited. More to come.

Love,
Ashley CNM MSN

STEP 2 DEFEATED!

Scores are back for Step 2! Husband conquered!!!!! We are so pleased with his score - and what a load off!!!! All he has left for the entirety of med school is Step 2 clinical skills, which he isn't too concerned about. Then sub-Is of fun (including a sub-I in Ghana!), match, and graduation! I can't believe we're here....it felt so far away for so long. I know I say it every time but there is not one second of one day that I am not proud of my husband and all his hard work. Proud of both of us actually. Go us.

wahooooooooo!!!!!!

July 24th was a nutty day. It was the day that (by some serendipitous twist of fate) both Christian and I were both scheduled to take the biggest exams of our academic careers (second big exam for Christian after Step 1 last year). Christian had to pick a Step 2 date based on what was available at the closest testing centers and my comprehensive exam (passing is required to graduate) was prescheduled at the beginning of the semester...by some miracle they happened to fall on the same date. It had already been nice studying like crazy people together and now we would get to celebrate jumping these hurdles together! Yay!

Thank goodness I had finished season 3 before I started studying...GOT could've been my downfall...

We spent the week out of town where Chris had scheduled his exam (mine is online so I could take it anywhere). The days before the exam we dedicated to reviewing and re-reviewing anything and everything...I had a lot of freak-outs/breakdowns (per my usual) and Christian continually reminded me I'm a special midwife snowflake and the smartest lady and all that (per his usual). He kept his game face on - he worked SO hard to prepare for this, just like with Step 1. I am unbelievably proud of him if anyone hasn't noticed. 

Pre-exam cramming. Pun intended. 

Game day came and we busted out - five hours/176 questions for me and nine hours/~350 questions for him. I received my fate via email a few hours later....

At Georgetown we need an 83% to pass all our exams, including our comprehensive exam. I got my grade back later - 88%! It was a huge relief to know I didn't just barely pass (although passing is passing, don't get me wrong!) but that I worked hard on mastering the material and it was reflected in my score! Christian has to wait for scores back in September but we were just so relieved to both be done, at least for the moment. In the meantime he's busy being awesome and winning awards....

From the article his school wrote about him! That's my husband y'all!

So that leads to these big few weeks...my last weeks as a graduate student and Christian's first weeks of fourth year emergency medicine sub-Is! I have only a few assignments left and one presentation this week along with a few more days of clinical. Then at the end of this week my degree will be complete and I will be cleared to sign up for and take my board exams. And then I'll be super official!!! RN, BSN will be replaced by MSN, CNM, WHNP-BC (much more of a mouthful). In med school world Chris is absolutely loving his first sub-I and is really looking forward to fourth year as a whole. It's so great seeing his hard work pay off...the residents and attendings love him (what's not to love, right?) and he is doing work he enjoys. Win win.

You may be thinking, next step job hunt! Way ahead of you: I am employed! I had an interview last week with a great midwifery practice in our area and I was offered a position! The practice is within short driving distance from our house, as is the hospital I will be attending births at. I am thrilled to have a place to begin my career and am so grateful they wanted to take a chance on a new graduate midwife! I am equal parts excited and completely terrified. More on this transition as it's happening!

Me and mom celebrating over dinner with my family.

So, as you can see big things are happening around our house. To all of our cheerleaders reading this post, you are such a huge part of why we are where we are at this moment (and why we're both smiling). We love our jobs and are surrounded by the best people. What more could we ask for?!

Call a midwife!!!

[Note: Welcome Medical Mondays blog hoppers! I am resubmitting my post from last month's Medical Mondays because I got the link in juuuust under the wire last month and I didn't label it well so I don't think it got a lot of traffic (and dammit this post is so important to me, especially to share with other members of the healthcare community!). So forgive me if you already read it and welcome if you haven't!]

I'm writing up this post hoping to hop on the Medical Monday train for July! I've been meaning to write it for a while but I've been so busy trying to finish up school and I've been using my time off to sleep. Brief intro: I am a student nurse-midwife and my husband is a fourth year medical student (I can say that now! Holy cow!). We are busy, tired people and that's pretty much the gist of our life. Okay, that may be slightly dramatic but that's how it feels right now as we are in full-blown study mode - I'm taking my comprehensive exam (must pass to graduate!) and he is taking Step 2....on the same day....in three weeks!

As previously stated, I'm currently rounding the home stretch of my master's degree in nursing and I'm going to school to be a certified nurse midwife. For some reason midwife is a funny word to the average non-medical guy or gal (and don't get them started on midwifery...seriously, people giggle when I say midwifery!). For some reason it conjures up all kinds of images, most quite far from what modern midwifery is and what midwives have to offer women and their families. I'd like to take this opportunity to briefly educate my colleagues in the medical world and the consumers of reproductive health care (hey ladddiesssss!) about midwifery (hee hee) and why I want to be your midwife!

By the way....male midwives do exist (I've met some great ones!) - and they're still called midwives. 

What is a midwife? Why do you need one? The term midwife means 'with woman' and midwifery is the oldest profession of all time! Women have been having babies...well...forever, and have been supporting one another through it for just as long. And although much of the public sector is uneducated about who we are and what we do, modern midwifery has so much to offer women, families, and the American health care system!

I am going to school to be a certified nurse midwife (CNM) [note: there is another kind of midwife - the certified professional midwife (CPM) - who trains through a combination of structured coursework and traditional apprenticeship model with an experienced CPM. CPMs usually practice in the home birth or birth center setting. We are lucky to have some truly fabulous CPMs in our community. You can learn more about them here!]. CNMs fall into the category of APRNs (advanced practice RNs) which also includes nurse practitioners, certified registered nurse anesthetists, and clinical nurse specialists. It means we are RNs with graduate degrees (either master's or doctorate level) preparing us for practice as independent health care providers. What that looks like varies by state, but in general we see patients, manage their care independently, and have prescriptive privileges. APRNs either collaborate with physician colleagues to co-manage patients that fall outside of their scope of practice or can refer their patients to the appropriate physician as needed. And while much of the country now knows a lot about the nurse practitioner and what he/she does, midwifery still lags behind.

Me watching while my professor teaches a classmate how to place an IUPC (intrauterine pressure catheter) on Noel, the pregnant simulation mannequin that will actually mechanically give birth to her simulation baby. Poor Noel, she gave birth at least twenty times that day!  

Now I'd like to debunk some midwifery myths, to give you a better idea of what it's like to have a midwife as your care provider!

Myth: If I want a midwife to attend my birth, I have to give birth at home or in a birth center.

Fact: In 2010, 95.7% of CNM-attended births occurred in hospitals, 2.2% occurred in freestanding birth centers, and 2% occurred in homes. More than 50% of CNMs list physician practices or hospitals/medical centers as their principal employers. You are more likely to find a CNM practicing in the hospital setting than anywhere else. If you'd like to have your baby in a hospital, a midwife would love to care for you! On the flip side, if you are a healthy, low-risk woman and have never explored the possibility of out-of-hospital birth, I encourage you to! Women who give birth in birth centers are more likely to avoid unnecessary interventions, more likely to give birth vaginally, and the outcomes for both mom and baby are as good if not better than in hospital birth! You can read more about the findings from the study I'm referencing and how to find a birth center in your area (just go check one out!) at the American Association of Birth Centers. Fun fact: there are more birth centers in the state of Texas than any other state in the country.

 Myth: If I have a midwife, I have to have a "natural" birth...that's not what I want (gimme my epidural!).

Fact: Midwives believe pregnancy is a normal physiologic process. Pregnant women aren't sick! They're just pregnant! We are trained experts in NORMAL birth and are wonderful care providers for low-risk pregnant and laboring women. Midwives generally avoid unnecessary interventions in the absence of problems and can help prevent the cascade of interventions that often lead to cesarean deliveries (which come with the risks of major abdominal surgery and should be avoided when possible). However, midwives are only partners in the care of our patients. As was taught to me  by a professor of mine and as I like to tell my patients: "You're driving the bus!" If your plan involves an epidural, we are happy to see that you get one and have the safe and special birth experience you were hoping for. If your plan involves an unmedicated birth, we are so happy to assist you with this as well. Our training includes non-pharmacological pain relief options and labor support, and unlike many other providers many midwives will remain present to "labor with" their patients and provide support from the time a woman becomes active to the time she gives birth. 

Myth: But I'm in deep trouble if something goes wrong, right?! What if something happens with my baby?! 

Fact: Midwives are just one part of the fabulous health care team that works as one to take the very best care of you and your baby. Remember when I said midwives are experts in normal labor and birth? It means we are trained to recognize deviations from normal early in the process and make the proper collaborations/referrals as needed. For example, a midwife can co-manage with a physician a patient who has perhaps had a high risk pregnancy but is expecting a normal vaginal delivery, allowing patients to get the best of both worlds! If something changes, every midwife has a supporting physician she can call for either consultation or collaboration - we love our physician partners! If you need a cesarean delivery, our physician partners will be there to perform your surgery, often with your midwife in the OR as first assist! (Many midwives have special training to assist physicians in the OR with cesareans and/or other gynecological surgeries.) Midwives are also trained in emergency procedures and are equipped to handle obstetric and postpartum emergencies if they happen (like postpartum hemorrhage and shoulder dystocia).

Myth: Wow...I really enjoyed my midwifery care for pregnancy and birth. I'm bummed I can't see her again until my next pregnancy.

Fact: Dry your tears, ladies! Midwives are trained to care for women throughout the lifespan! We preform well-woman annual exams, Pap smears, breast exams, STD testing, and can counsel you regarding birth control options...then write your prescription once you choose one!  We are also there for gynecological problems and can see you if you're having issues with your periods, pelvic pain, or any other concerns about your lady parts. As always, we partner with skilled physicians to refer our patients as needed. Midwives have the wonderful opportunity to care for women throughout their lives, often forming deep, trusting relationships that promote quality care and empowerment of women to be active in their own health and wellbeing. 

And we always encourage audience participation! Image from Midwives of New Jersey found here. 

If by some miracle you're still with me, thanks! Thanks for taking a moment to learn a little more about midwives and what we do. I didn't even begin to get into how midwives are cost-saving for a nation way in over its head on health care spending. I didn't get into how our current system of maternity care is not providing the best outcomes for moms and babies that it could be, and how midwives can and will be an integral part of positive change. I also didn't mention that I believe midwifery is a calling and that my love of caring for women and families is deep in my bones (and I'm not the only midwife who feels this way). These are all discussions for another day. :)

Additional midwifery resources:

• The professional association for CNMs, the American College of Nurse-Midwives has many resources to look through including my favorites:
• Midwifery: Evidence Based Practice - a summary of midwifery research
• Pearls of Midwifery - a PowerPoint presentation explaining the "pearls" of midwifery care
• Documentary film The Business of Being Born - understanding the biases that all documentaries are made with, watch this film with an open mind as it examines the current system of maternity care in the U.S. and how we might do better. The film really emphasizes the difference between hospital and out-of-hospital births without really exploring the benefits of in-hospital midwifery birth, which is a great option for so many women. [Currently streaming on Netflix.]
• And for fun (and for the love of great television!): Call the Midwife - a British series about midwives in East London in the 1950s based on the memoir of midwife Jennifer Worth. The show boasts more popularity with British viewers than Downton Abbey (GASP! I know!) and captures the heart of midwifery in so many ways. [It is also currently streaming on Netflix, with more recent episodes streaming on PBS.com.] 

Again, thanks for stopping by, thanks for reading, and thanks for learning more about what I do. If you have specific questions about midwifery or would like to know more, you're welcome to email me - thinkedthinker [at] gmail [dot] com. 

Have a safe and happy independence day!!!!

xo,

Ash