By Stephanie Tillman, CNM, MSN
I have come to believe
that one of the hallmarks of a great midwifery practice is ability to integrate
new midwives. As a recent graduate, I was thankful for the six weeks of
outpatient orientation and ten births my new practice required before the
experienced midwives “cut the cord” and sent me out on my own. Despite feeling
adequately supported clinically, the warmth and kindness I had found in my
classmates while in midwifery school did not carry over into the midwifery
world at my practice. I longed for the “fuzziness” offered to some of my fellow
graduates, welcomed with a celebratory party, a formal introduction to the
group, or even a complete orientation schedule. There is a way to welcome new
midwives with needed clinical support and extended knowledge, grace, and love.
And, of course, there is a way to toss them in. The great midwife practices
likely utilize a mix of all of these methods for any new hire, but the best do
so with special care and encouragement for recent graduates.
I continue to be amazed
at how few job postings are open to new grads; how many explicitly advertise
for “experienced” midwives only. What assumptions compel that purposeful
exclusion? Is a lack of ability perceived in the most recently certified
midwives? Is an absence of faith in the current midwifery educational system making
us doubt that graduates are adequately equipped to begin independent practice?
Perhaps this concern stems
from the harrowing emotional transition many new graduates, myself included, endure,
and the time required to fully support that process. The initial anxiety, self
doubt, stressful repetitive verification of evidence-informed care...we new
grads run ourselves through the ringer to ensure adequacy when we first enter
practice independently. Shouldn’t experienced midwives foster that? Shouldn’t
they see that investment as developing a way of practice that would be
beneficial for their patient population? Isn’t there enough patience to
encourage and support and respect the process of a new graduate entering her
work? Isn’t there enough time to show her how to care for women as you do?
I also remember the lack
of confidence women had in my abilities during my student clinical rotations.
When I walked into a room and introduced myself, “Hi, I’m Stephanie, I’m the
student midwife working with you today,” women would look over my shoulder for
the “real” midwife. It was as if they allowed me to bide my time and ask a few
questions, but didn’t consider it an actual visit until the “real” midwife
appeared. I assumed that was partly to do with my age, but I’m not much older
today, and women never look over my shoulder now. “Hi, I’m Stephanie. I’m the
midwife.” That shoulder-look reflected my feelings of personal and professional
responsibility to the patients. I never felt wholly responsible for the care of
the women assigned to me, because, then, they were only ever partially so. There
is a responsibility gradient that is crossed very quickly as a new graduate:
confidence must be backed-up with correct care. This gradient requires time and
attention from others in the practice; great patient care includes support by
each other regardless of experience.
When does the “new
midwife” label pass? Is it when the new midwife starts to discuss others
removing that label, or when others slowly forget to connect her hire date to
her graduation year? When do days added to months equal a timeframe and an
assumed level of exposure that make “new” or “recent” disappear? When is it
appropriate for a midwife to think that about herself? When has one proved
I do not have these
answers. I am only 8 months into my own practice, and feel at a crossroads.
Certain days I feel incredibly confident, like experience and education are
catching up with the needs of the women I serve. Other days, I feel completely
lost, not sure that anything has stuck in my brain, unsure if I can walk into a
room confidently as a “real” midwife. Perhaps this feeling never goes away.
Maybe all midwives continue to be surprised by the wonders of women,
healthcare, and birth.
Ideally, I would hope that
I and all midwives continue to learn throughout our careers. That we will
continue to be recent graduates of each new experience when we conquer it and
take note of each new experience when we stumble over it. If we recognize that
in ourselves, then a label of “new” midwife indicates an opportunity to guide
and be with each other. I hope all practices truly consider hiring a new
graduate: consider the opportunity for the practice as well as for the midwife
herself to be welcomed into midwifery, to enter into this profession with a
feeling of being wanted and respected and believed-in. To fully be “midwifed”
into the profession. We can all fit a little more midwifing into our daily practice,
especially for a member of our own profession, our own mantra, and our own
life’s work. Let us be the best midwives we can, especially for each other.
Stephanie Tillman is a
recently-graduated Nurse-Midwife now practicing full-scope midwifery in the
urban United States, at a Federally Qualified Health Center (FQHC) and as a
member of the National Health Service Corps (NHSC). With a background in global
health and experience in international clinical care, the impact of public
health and the broader profession of midwifery are present in all her thoughts
and works. Stephanie's blog, Feminist
Midwife, discusses issues related to women, health, and care. Find out
more at www.feministmidwife.com and follow her on Twitter at @feministmidwife.