Does anyone feel this way sometimes?! I used to think about this meme a lot while I was active duty!
But Happy Thursday to you! We are suffering from a Disney World hangover and at house but loving all the memories we made. And the littlest one and I have been sick for a few days. The only thing worse when your kids are sick are when the mama is sick as well. I always feel like the whole household crumbles a little bit when I’m under the weather.
Hopefully we’re all on the mend by the weekend.
Today I’m sharing the 20 Tips for Midwives that I’ve been posting on Instagram since the beginning of the year. The tips are meant to be small bites on ways to improve, bolster or challenge your practice. These are the things that I work on or towards throughout the year. And also things I challenge students or new midwives to do to prevent burnout in the profession or to keep that midwife fire kindled bright. Let’s dive in!
Tip #1: Go to a Conference!
Pick your conference(s) that you’re going to attend NOW and pencil those into your calendar! I was eyeing ACNM’s meeting in Chicago but didn’t get my life together or time off work to make that one happen this year. Maybe next year?! I submitted TWO abstracts to present in 2023. Check out the monthly newsletter for a running list of conferences (sign up at the bottom of the page) or Empowering Midwifery’s also maintains a list here: https://empoweringmidwiferyeducation.com/us-midwife-conferences.
Tip #2: Prevent Burnout
Think about how you are going to prevent burnout this year. Did you know the average career of a midwife is about 7 years? A 2019 study of 158 midwives found that 35% of midwives seriously considered leaving the profession. One third?!
Who are the midwives most at risk for burnout? Those with small children, higher caseloads and fewer days off (my hand is raised here for all three). A study of Royal College of Midwives (n= 1,997) noted that 83% reported moderated personal burnout and 67% reported moderate work-related burnout. That means it’s not just the midwifery side that burns out midwives – it’s what we’re doing at home too.
Are you burning the candle on both ends? Try these things TODAY to take a step to reverse burnout: get proper rest; eat nourishing meals and snacks; move your body (20 minutes a day is all you need to break the stress cycle); set boundaries at work and home; prevent ruts – find ways to challenge yourself personally and professionally!; maximize your routines to increase your efficiency; plan time for reflection (what’s working well and what isn’t?); find your mentors!; and ask for HELP. You can do it. Women need you at your strongest so you can pour into them. There’s a whole post from the 2021 State of Midwifery on preventing burnout here and a good post on how to recover from a 24 hour shift here.
Tip #3: Get Your Bag Organized
Take some time and organize that work bag! There are lots of things you may need in a 24-hour shift. My bag looks like this: toiletries (toothbrush, toothpaste, floss, deodorant, tampons/pads, baby wipes, anti-fog wipes for glasses, breath mints, Tylenol/motrin; glasses/glasses holder; extra contacts; face wipes); stethoscope; pens; prescription pad; folder for work papers; bag of nuts or other snacks; extra pair of socks and underwear; utensils (fork/spoon); handouts binder; hospital badge; pager; phone clip. I try to organize and restock my bag about once a month – or, maintain similar items in my cubby at work! It only takes a few shifts to figure out you probably are going to need to shower, or change your scrubs a few times, or brush your teeth more than once. Sometimes I feel like I’m the bag lady but I’ve had shifts where I have used every.single.thing. in the bag.
Tip #4: Find Your People
Start a regular gathering of midwives (virtual, by text or in person). It is both a stress reliever and a support system to have a group of people you can bounce ideas, patient cases, patient management, practice questions off of. Sometimes, only the people that have walked in your shoes understand where you are. I chat with some of my favorite midwives on marco polo on a regular basis – we call ourselves the “Mastermind Midwives” for fun. It allows us the chance to catch up and offer each other support or encouragement even though we practice in different states across the country. (Students – this person might also be a previous preceptor. I keep in touch with a bunch of students across the USA long after signing their affidavits of safety).
Tip #5: Try Something New This Week in Your Practice!
Has it been a while since you caught a baby “hands off” or offered to let the dad catch the babe? Try it! When’s the last time you just sat by the bedside and offered encouragement to a mama for a half hour. (I’ve been known to sit in there longer than that…and no, it’s not an attempt to hide from the nurses.) What about encouraging your mama to birth in hands and knees, on the toilet, in the shower, or any position out of bed? For aches and pain complaints in the clinic – consider recommending Epsom salt soaks, TENS units, chiropractor care and physical therapy care. The sky really is the limit. Make your practice excellent with one small change at a time. Remember, you are the unofficial leader in the room and the families and nurses will look to you for recommendations to guide care.
Tip #6: Learn About Midwifery Sustainability and Practice Development.
Take some time and review the resources put together by Grow Midwives: https://growmidwives.com/resources/. They have some great videos as well on malpractice coverage, job negotiation, cover letters, team buy in, home birth practice, midwifery fee schedules, resume tips, tail coverage, RVUs…and MORE. These videos will help sharpen any midwife’s practice. They would also make a good “journal club” of sorts for any group of midwives.
Tip #7: Gather for a Blessing of the Hands
Need a boost of inspiration and to remember why you became a midwife? Does your team need a reminder of the sanctity and skill in the calling they were blessed with? Gather your team and do a blessing of the hands. The idea behind a blessing of the hands is this: each midwife, midwife student or provider involved takes a moment individually and together as a group, to reflect on the great responsibility each pair of hands bears for every mama and baby cared for as we shepherd the arrival of each generation. A seasoned midwife offers a sprinkling of water over each midwife’s hands and states a simple blessing “May your hands be blessed.” Then a poem or other reading is read aloud to the group. My favorite is hands by Jan Weingard…
These are my hands
Through these hands I have come to see the world
These hands have measured the growth of life and documented the stalling of time
They guide my ears to places where I hear the watch-like beats of tiny hearts
My hands have felt the hard bony framework of passages and the softness of muscles
Which will bulge like petals of a rose
My hands have opened windows to the energy of the souls of those I have touched
They have held frigid rigidity of steel instruments and the softness of a friend
There are stories in these hands, read from the pages of the work of women
With my hands I felt the power of the strength it takes to grow and release new spirit
My hands were born with the knowing of touch
The journey has added how and when and the time to ask for help
Teaching hands engulfed mine until they were ready to fly
My hands are joined in a circle which is unbroken through time
Sometimes my hands do nothing
Their most important work will be still with fingers laced and witness
The art of doing nothing has been passed from generation to generation
Mine have been taught by some of the most powerful hands to watch and wait
This is perhaps the hardest for hands born to touch
If I have nothing else to give you, let me teach you how to see with your hands
How to open the windows of life, and close the door softly when it is time
In the darkness It is you hands that will light the way
These are my hands
These are the hands of a midwife
My favorite line is about when our hands are doing nothing, that can be the most important work of all. (Fun fact: This is the most read post on the blog of all time).
Tip #8: Prioritize Sleep Hygiene
24 hour shifts…back to back shifts…being awake the whole shift. Midwifery is a hard calling. And it’s really hard on our bodies. When you have the chance, make sure the Z’s you’re getting are high quality so you can keep catching those babies for all the years to come. Try these tips:
- *Use black out curtains.
- *Use a high-quality sound machine (Dohm is favorite brand at our house – also consider putting one in the call room!)
- *Don’t love a sound machine, a simple fan will do wonders too.
- *Try to wake and sleep at the same times of day, each day.
- *If you have the chance to sleep on call, actually try to sleep – don’t be tempted by the full in-basket.
- *Avoid caffeine about 4-6 hours prior to sleeping.
- *Set your room to a cooler temperature.
- *Aim for comfort – soft sheets, comfy PJs…don’t skimp here.
- *Try to work out the day before – it can help you fall asleep.
- *Nix (or limit) the electronics and screens. They’ll still be there when you wake up. (On call tip: When I’m in the call room, I turn off the computer screen to get better sleep if there isn’t a strip to keep an eye on!)
My go to snack after a 24 hour call is a cup of Greek yogurt – easy on the stomach, high in protein. Yum. Find out more about sleep habits here: https://sleepeducation.org/healthy-sleep/healthy-sleep-habits/
Get better sleep, so you are well rested to give the best care to others.
Tip #9: Prevent Back Pain
Ask any midwife how tiring and taxing midwifery care is, and they’ll tell you how hard the trade is on the body. A few months ago, I moved a patient with a very dense epidural and pulled a ligament in my spine. Until that point, I took the health of my back for granted. It’s been a rough couple months – having 3 little kids hasn’t helped either – but I’m on the mend. I’ve been diligent about doing some back exercises after call or clinic shifts and wanted to share them for anyone looking for prevention or maybe some relief.
3 exercises to try after shifts:
1. Cat-cow: hold each position for 5 seconds, repeat 10-20x
2. Bird dog: alternate sides, holding for 3 seconds, repeat 20x
3. Lying cross over stretch: hold each side for 1min; repeat for longer periods as comfortable
I also love to stretch out my shoulders on a door frame (you’ll find me doing this at the nurses’ station on the regular), use a heating pad or use some good old icy hot. Looking for more? Check out www.bobandbrad.com – two physical therapists that are putting some outstanding content on YouTube. Take care of yourselves midwives so you can catch babies as long as you’d like, not as long as your body tolerates.
Tip #10: Precept a Student!
It makes sense…to make midwifery the standard of care, we need more midwives. The 2019 Midwifery Trends Report from ACNM cited that midwifery programs report limited numbers of preceptors and clinical sites as two of the main factors for lack of student placement in their programs. I want to offer a couple tips here:
*If you’re a new midwife, please establish your roots and grow into the midwifery practices you love. You should feel confident when you are precepting. If you don’t feel confident, it may not be time yet to step into preceptor shoes. It usually takes about 2 years to get comfortable with the role, sometimes longer.
*If you are a seasoned midwife, there are seasons to precepting. Don’t feel like you have to precept 24/7 – schedule breaks between students so you can feel the passion and thrill of catching those babes too! But try not to stay out of the game too long – we need you to raise up the next generation of midwives. Guide new midwives to A Midwife Nation or the templates to help encourage their learning too.
*Lastly, if you are burned out, please consider taking a break from precepting. Working too much and precepting too much can also cause burn out. Know where the limits are and don’t hesitate to ask a close friend if they think you might be close to burn out.
Tip # 11: Ask These 3 Questions to Improve Your Practice
Want to grow as a midwife this year? Want to keep those skills sharp?
Ask yourself these questions after each shift or clinic day:
*What went well today… and why?*
*What didn’t go well…and what could go differently next time?*
*What are the trends in my practice that I am frustrated with or want to change?*
Consider what changes you want to implement and try something new in clinic or on the deck next week. Think about what is going well this year and what you want to improve or change in your practice.
I’m working on communication/education with labor and delivery nurses. I try to think about how I talk about management with them and what communication could be clearer. I also try to educate about the WHY of the intervention (i.e. peanut balls are great – but we use them because they can shorten the first and second stage of labor!). What parts of your practice are you trying to improve?
Tip #12: Strive To Be A Disruptive Innovator.
That’s right, you’re going to strive to overthrow the “we’ve always done it this way.” You know there are better ways and you have the solution.
What’s a disruptive innovator? A disruptive innovator is exactly what it sounds like: you create something that disrupts traditional ways of thinking or practice.
First, think about what problem you are trying to solve at work, at home, in your career field, or in the community. Do you see a solution that others can’t see? Or can you improve an existing system to make it better? These questions might guide you:
- What is the most basic problem you are trying to solve?
- What is the solution to that problem? Is there more than one solution?
- How is your solution better than the existing solution or system?
- Is it a solution that you can share with others?
For the blog, I want to make midwifery the standard of care in the United States. That’s the end goal to a very long journey right now. But I’m in this game for the next 50 years. But along the way, I thought, how could we make prenatal care better? And that’s how the templates were born. Talk to any midwife and we talk about the same things over and over. But every conversation is also different because every patient is different. I wanted to create something that offered traditional education, guided the prenatal visit to ensure all components of care were discussed or planned, and then offered a bunch of next steps for the women and her family to pursue if more education was desired.
And here’s the thing…when I researched “components of prenatal care” there wasn’t a lot out there. Women have millions of prenatal visits each year and the education during prenatal care is actually built around the interventions of prenatal care. Does that sound backwards to you? It did to me. I started a journey to write a blog and invite people into the story of how to increase midwifery in the US/world and to create some tools that would revolutionize prenatal care.
I didn’t have anyone that told me to start with these platforms…I found them all the hard way. But for those out there that need a little spark to their disrupting, these are the things and people right now that I’m loving for everything I’m trying to learn (or relearn) about blogging, social media and all things related to disruptive innovating.
Platforms:
- @Canva
- @linktree
- ConvertKit (for email/newsletters…)
- WordPress/WooCommerce
Podcasts:
- Build Your Tribe by Chalene/Brock Johnson
- Don Miller – Business Made Simple
- Online Marketing Made Easy by Amy Porterfield
- The Goal Digger Podcast by Jenna Kutcher
- Writing Podcast by Anne Kroeker
Tip #13: Learn A New Skill This Year
What’s on your list to improve your midwifery practice or skills?
– Learn colposcopy.
– Learn a new language. (Try duolingo.com)
– Learn spinning babies.
– Become certified in a new area (postpartum depression, perinatal loss…)?
– Start a blog or a podcast! (It’s never too late to start.)
– Take up a new position in a community group or midwifery group.
– Join Toast Masters and polish your public speaking skills.
– Apply to present at a conference.
– Go back for another degree or specialty.
Love all these ideas? Make a 1 year and a 5 year plan and get to accomplishing those goals!
Tip #14: Deliver Through The Oblique
Want a tip from the granny midwives for your practice? Try to deliver those baby shoulders during restitution when the shoulders are moving into the widest angle of the pelvis (bonus: you’ll prevent some shoulder dystocias too!) Try it in your next birth and see what you think!
Tip #15: Get Your Vitamin D
Sunshine or supplementation, our bodies need vitamin D. This seems so simple, but how many of us are indoors our whole 24-hour shift or sleeping/napping through the sunshine hours? Or, worse yet, we’re on the computer screen far more time than we are outside. Vitamin D can be obtained through sun exposure, foods or supplements and plays an important role in the body’s bone growth, inflammation reduction, cell growth, immune function and glucose metabolism. The daily amount recommended for most adults is 600IU (international units daily). Take a good look at your diet, sun time and supplements and make sure you’re getting the recommended doses. Try these foods too to boost intake in the diet:
Salmon, 3oz, 570IU
Mushrooms, white, raw, sliced, ½ cup, 366IU (who knew?!)
Soy, almond, oat milks, 1 cup, 80IU
Egg, 1 large scrambled, 44IU
Tuna fish, drained, 3oz, 40IU
Cheddar cheese, 1oz, 17IU
No one probably eats cod liver oil, but it’s the winner: 1 TBSP = 1,360IU (someone please tell me how this actually tastes.)
Read more about vitamin D here: https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/
Tip #16: Freshen Up That Discharge Teaching!
I always talk about postpartum education and improving postpartum care. It’s going to be a passion of mine for decades and it is going to need constant improvement as women continue to struggle with more and more disease and comorbidities.
A few years ago, I streamlined by discharge education that the patients went home with after realizing that the typical paperwork we went home with (or that the education offered by the postpartum nurses) wasn’t always hitting the mark.
Postpartum mamas are not just tired. They’re EXHAUSTED.
– They want to know what appointment they need and when.
– What to call for in an emergency.
– How to get some help with breastfeeding.
– When to return to sex
– When to start their birth control (and what kind is okay for nursing?)
….it goes on and on…
But the theme is that the questions are pretty specific. So why are the education documents so generic? They don’t have to be. Use your templates and smart phrases to make them better.
Here’s an example of my template:
“Vaginas are amazing and heal remarkably well, even with large tears or episiotomies. Generally, healing of the tissue is complete by your 6-week postpartum visit, though it may take months for everything to ‘feel normal’ with sex. If you had a tear, it was repaired using suture (stitches) that dissolve on their own over time and do not need to be removed.”
Yes, right there on the education. “Vaginas are amazing.” Let’s just give them a nod and some appreciation for what the vagina did. And then move onto what you can expect for healing. Simple, easy to follow, and honest.
I posted on the blog the exact template I use for basic postpartum discharges. Check out the post on the link for the template and feel free to copy, share and add to depending on your practice.
And please…let me know what you’re recommending to your mamas on discharge (classes, websites, haakaas).
Tip #17: Be The Calmest Person In The Room During Birth And Emergencies
It’s easier said than done. Your hands are trying to figure out when the constant flow of blood is coming from… the baby’s shoulders are stuck and you’re the one trying to figure them out…you get a page in the middle of the night because a mama got bit by a tick and now wonders what her chances of Lyme disease are… all normal days on the battlefield of midwifery. But most important, is how you take a deep breath, steady yourself, and keep your voice calm as you identify what’s wrong, how to fix it, what kind of help you need and then talk to your team and mama. These help me: I’ve found keeping your voice calm keeps everyone calmer (i.e. no shouting). Closed loop communication never fails. And calling for help as soon as you identify you need it (whether you need the peds team ASAP or your back in house for a placental abruption). Although midwifery can make you feel like a lonesome ranger some days, it’s a team sport. Next time your feel the butterflies or anxiety build, take a breath, stay calm, call for help and get to work.
Tip #18: Buy Back Some Time
Midwifery is all about serving others and often times we either put self-care last or neglect self-care completely. Self-care involves a lot of things, but ultimately it involves time. So today, give yourself permission to buy some time back! This may be something that takes a little extra time to set up, but will give you ten-fold of time back. Here are some examples…
*Hire a housekeeper for just a couple hours of cleaning in the main areas of your house.
*Hire someone to mow the lawn (even just every other week!).
*Sign up for a meal delivery service (HelloFresh, etc…).
*Buy pre-cut veggies or ready to go meals at a store so meal prep takes less time.
*See if your city offers car services (oil change, car detail, etc.) at your house so you don’t have to drive on a day off for service.
*Hire childcare help – full time, part time, a few hours a week – especially if you don’t live near family, this is important to help you recharge as a mama!
*Have groceries delivered to your house or do pick up at a store near you!
*Set up annual payments to be automated if possible so you don’t have to log on and pay annual fees every year (only when your credit card number changes…).
*Pay someone to do your taxes.
*Pet owners…get some help with pet exercise, grooming, etc. – there are some great businesses today that didn’t even exist 10 years ago!
Tip #19: Schedule Your Vacations FIRST
For most of us, we schedule work first and vacations last. I urge you to try and schedule it the other way! Taking time away from midwifery bolsters resilience, provides rest, and renews the spirit. It also prevents burnout. I find it’s easiest to schedule out vacations for the next year (i.e., beach in June for 1 week, family vacation in August for 2 weeks, family reunion in October…etc.). The long view planning usually helps your team balance only having certain providers on vacation at a time and helps to ensure you are taking your hard-earned time off. At my current job, if you don’t use your PTO in a year, you lose it! You bet I’m motivated to take some time off! Try scheduling your conferences too – see tip #1 – but definitely prioritize vacation over conference!
Tip #20: Take Notes At The Conferences You Attend!
I started doing this shortly after I graduated midwifery school. Really, it was a survival mechanism to try and remember the information shared at various lectures I attended. On the backside of midwifery school, your brain is a little worn out and concentration is hard as you navigate through boards, jobs and licenses.
What I didn’t realize was how often I would look back at those notes. I personally like to use Google Keep – it’s an electronic sticky note that has a great app/website. My notes are pretty simple – title of lecture, name of speaker and bullets about the takeaways from the presentation. The notes are also helpful when I go back to my team/colleagues and we’re discussing practice changes, evidence and current guidelines. Try it at your next conference or Grand Rounds and see what you think!
That’s the list so far! If you love the tips, let me know and I’ll keep the list going.
Stay tuned for the 20 Tips for Mamas next week – and a birth story from a dear friend who had a successful vaginal birth after cesarean section.
Hugs,
Jamie
1 year ago on the blog…Midwife Musings on Trends in Obstetric Practice During the COVID -19 Pandemic
2 years ago on the blog…What to do for back pain during pregnancy?
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