Running header: REFLECTIONS ON PRIMARY UNDER SUPERVISION EXPERIENCES 1

Reflections on Primary Under Supervision Experiences

CLNC 3040 & 3060
Katlyn Carter
April 13, 2020
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CHALLENGES

This term I have had a few challenges. The first was finding a good balance between

feeling like my primary clients, were in fact, my clients and then taking a mental step back and

remembering that these are my preceptor’s clients. There are things that I will want to do a little

differently, but that, for now, I just need sit with. I haven’t wanted to question or argue although

my preceptor is always wonderful about answering questions and talking through things. I have

learned to listen, ask questions, and then keep some thoughts to myself on occasion. I am feeling

like I know I still have more to learn, but am finding I have my own thoughts and opinions, too.

Is this the “teenage” stage of midwifery. Needing and wanting to fly but not, quite there yet??

Maybe I should be more specific. I think my preceptor is wonderful and that her clients

get great care. Sometimes I think I would want to suture when she doesn’t think it’s necessary or

I’d like to see the client a little sooner than my preceptor schedules for. Small things like that. I

think these things will work themselves out once I’m practicing and getting into my own groove.

The second challenge had been taking care of my body. I dislocated a rib while catching

a baby in an awkward position a couple months ago. I have come home from several births and

found my body to be sore and aching the following day. I am trying to have more awareness of

my body especially while the client in in second stage. In the event that baby needs some

assistance, I know I won’t have awareness of my own body in that moment, so I’m trying to take

a minute to think about it before birth is eminent!

COMPLICATIONS, TRANSFERS OUT OF CARE, EMERGENCY TRANSPORTS

Thankfully, I haven’t had any major complications this term. We had a client with ICP

but with supplementation, her labs allowed her to stay in care and have a beautiful waterbirth
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after a home-induction. We actually have another client who described the s/s of ICP much

earlier in gestation at 23+3 wks. She was also diagnosed with GDM at 28 weeks. I am getting the

opportunity to have lots of good conversations about diet and supplementation with her… and

hoping she can make it until June (her EDD). It will be really hard to transfer her if she ends up

requiring that. She is a 20 yo, G1P0 who is really excited about homebirth. I hope she gets it!

I have had several very precipitous births this term which can be a little tricky to fully

understand what’s going on. For example, I had a COC client looking like she was transitioning,

but was adamant that she wanted a VE. Due to position, I had to check her with my left hand

while she was hands and knees. I didn’t think what I was feeling was accurate and had my

preceptor assess the next contraction. I had felt she was 2cm. My preceptor said 3cm. This client

was holding her baby within 4 minutes of these exams. I was so glad to have had the

confirmation from my preceptor or I would never have believed my assessment!

I had one sticky baby that was born without complication after 2 maneuvers. I had

experienced this a couple times in previous terms, but felt like this time I had more confidence to

do what needed to be done and not step back to let my preceptor take over. This time it felt like I

wasn’t overthinking things, merely trying the next thing. That felt good.

Just yesterday, I had nuchal hand that I didn’t quite know how to hold resulting in the

elbow “popping” and the client had a deep second-degree laceration. I’m always learning and

hoping to help the next client a little better.

I haven’t needed to transfer any clients nor have I had any emergency transports. I have

my SBAR ready, should I need it!

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All-in-all, I feel like I have managed my own stress quite well. I feel like I have the tools

(sometimes tools are on speed dial!), to help me manage my stress and take care of my own

needs as I serve others.

CLINICAL LEARNING PROCESS

I think as an earlier student, I was more likely to directly ask my preceptor all the

questions about anything that came up in clinic. She was very gracious and always was happy to

explain things. However, as I have neared the end of my time in clinic, I find myself asking

myself the question and doing some reading whether it is from my own PG’s or doing a quick

search online before discussing it with my preceptor. I keep thinking that I’m going to be

practicing on my own soon and want to have a general plan in my head. I then talk through my

plan with my preceptor to ensure I have all the information and that my plan is appropriate.

IMPROVED COMMUNICATION SKILLS

I think this is something that I’m still working on. I have a hard time asking/telling

people what I need/want them to do. Part of my still feels like the rookie in the room who

shouldn’t be asking anyone for anything. Again, I don’t have much experience with transfers, but

always have SBAR in my head and feel that would quickly come to the forefront of my mind.

Professional introduction, SBAR, approximate time of arrival-that is my general transfer plan

verbiage.

CHART REVIEW

We hold a weekly chart review meeting with all those included in the birth team (this has

changed slightly in the midst of COVID-19). Typically, we all gather at 8:30am on Wednesdays

before the clinic day starts. This allows us to discuss any recent births, developments with
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currently clients, and personal updates. This facilitates the opportunity to discuss on-going

challenging situation, follow-up on labs, etc. I really enjoy these chart review sessions as it is one

of the few times we can all be together outside of births! It makes the team feel more cohesive

and up-to-date. This will definitely continue to do in my practice!

CONCLUSION

As I come to the end of my journey through midwifery school, I find myself with my

emotions including, first and foremost, gratitude for my preceptors and our clients. I have had the

opportunity to work with two amazing women over the last 4 years and many clients and

families who have welcomed me into their care and homes. My current preceptor and I have

recently reviewed my Skills Competency Form of which she stated, "Katlyn is ready for exams

& beginning to practice! She particularly excels at labor support and with education and

counseling skills."  Hearing those words… “She is ready” have been really amazing to hear. I

recently attended the birth of a return client with my first preceptor. I was able to primary that

birth and managed a PPH including a catheterization. Yesterday at the 3-5 day visit, the client

commented on how much I had grown as a student in the 2 years between her babies. She said I

was “really a midwife now.” Those simple words brought me to tears.

I know that I have so much left to learn and things to experience, but, really, I hope to

always continue learning. There will always be new research, new testing methods, and topics to

revisit! In the meantime, it is really nice to feel like I’m getting there!