 in the Nurse Midwifery Women's Health Nurse Practitioner programs. I teach in the first course that introduces birth skills to midwifery students. The midwifery students of cohort 20 and Professor Jean Jacob Witz and I are delighted to share our experiences in teaching and learning birth skills, knowledge, and critical thinking with our colleagues across the globe. This is the second annual Georgetown University Student Cafe. I am hopeful this will become a tradition with Georgetown Midwifery students. I want to provide a bit of follow-up on our first Student Cafe presentation in 2016. Last year's students presented on our inaugural visits to the United States Senators and Congress members as they learned political advocacy skills on Capitol Hill in Washington, D.C. Since that time we have made a total of 166 visits to our federal legislators and had our voices heard on important healthcare legislation. The students presenting to you today participated in our fourth trip to Capitol Hill yesterday and if you're following the news you'll know that it was quite an exciting day to be on Capitol Hill in the United States where healthcare issues were being debated. But nevertheless, midwives must learn to speak their truth to power regardless of the outcome. We still have to speak our truth as we are often advocating for the most vulnerable among us. For our presentation today on first birth experiences of Midwifery students, I want to call your attention to the photo in this title page slide. This is a photograph of a Georgetown student conducting one of her first births. You will notice that her preceptor's hands are over hers, guiding placement and pressure as this baby's head emerges slowly. Students need to feel safe and supported as they learn the skills, knowledge and professional behaviors needed to welcome new life into their hands. Such a timeless and sacred trust is given to us as midwives. Lifelong learning is our responsibility and obligation to honor this trust. This is a picture of me. Here I am. A prime directive for midwife educators is to transmit to their students Midwifery's unique body of knowledge, skills, philosophy and hallmarks of care that guide midwifery practice. Beginning students then develop confidence over time to maintain the unique aspects of midwifery practice in cultures where the routine use of intervention prevails, such as in the technologic and innovative medical culture common in many areas in the United States. The safe conduct of birth is the signature clinical skill of midwives around the globe. Student midwives approach their first births in the clinical setting with hopes and fears regarding their own abilities to master the required competencies and professional behaviors of the midwife. At Georgetown University, we acknowledge these hopes and fears in our opening session at our on-campus simulation learning of birth skills. This lovely photo shows the engaged and enthusiastic cohort 20 students who will be presenting their first birth experiences today. They are each holding a onesie that says a Georgetown midwife helped me out. Students are given these onesies at the end of their on-campus session and asked to present this gift to honor the first woman whose baby they caught as a midwife student. Why should we worry about hopes and fears? They are, after all, fleeting emotions that come and go throughout our lives. Hopes help us aim for our goals and set our expectations. Hopes enable students to approach problems with a focus on success, thereby increasing the probability that they will persist in attaining their goals. Hopes are motivators to learning. On the other hand, fears can be a barrier to learning. In small amounts, fears are instructive. They warn of potential danger ahead. For example, in the academic setting, fear of exam or assignment failure should lead to effective study habits to address and reduce this fear. In the clinical setting, high levels of fear can lead to cognitive and behavioral freezing. It is critical to address fears as all midwives will, at times, be called to action under conditions that create fear. A shoulder dystocia, a postpartum hemorrhage, a limp and unresponsive newborn, these are time-sensitive emergencies that demand cool, quick, effective action from the midwife even as she feels fear. It is a hopeful sign for the profession of midwifery when new midwives embark upon near-careers with high levels of confidence or performing key hallmark behaviors such as non-intervention in the absence of complications and therapeutic presence during labor. The development of student confidence is needed so that they will persist in the practice of these midwifery hallmark behaviors, particularly under cultural conditions that undermine these practices. First births for students can be quick and easy or long and difficult, resulting in outcomes ranging from excellent to poor. Students need to develop emotional resilience to celebrate the successful laborers and the miraculous births as well as to sustain themselves through difficult laborers and traumatic births. This slide shows the collective birth experiences of this cohort of students during their first three-month clinical rotations in hospitals and birth centers in the United States. The students sharing their experiences with you today named their hopes and fears during our on-campus time together. Now at the end of the term, we have asked them to share aspects of their journey related to these hopes and fears. Were your hopes realized? Were your fears lessened? How has your confidence developed to practice midwifery in this early part of your midwifery journey? What learning goals do you set for yourself as you face your final term in your midwifery education? What advice would you give to those midwife students around the globe who are listening to us now? And I actually see another attendant, so welcome, Ruth Joan. I would now like to invite our students to share their reflections on their first birth experiences with you. And this is Miss Lauren. Hello, my name is Lauren Coronado. I am from El Paso but currently living in Fort Worth. I'm a 26-year-old. I have been a labor and delivery nurse for a little over four years and I'm a semester away from completing Georgetown's Midwifery Women's Health Nurse Practitioner Program. I am currently doing clinicals at an urban Fort Worth hospital, which also happens to be where I learned how to be an RN. I am learning under seven midwives at a practice that averages about 100 to 120 births a month. At the beginning of the semester, I was terrified, probably more than terrified to actually deliver a baby, especially after being on Georgetown's campus and practicing for three days. I was worried that the delivery would go too fast and that I wouldn't put my hands in the right place and goodness forbid, drop the baby. My biggest hope was to have a bonding moment with the parents and not let my midwife and preceptor down. So on my first day of clinicals, the CNM was coming off that morning, texting me to hurry that there's a lady five centimeters and she was going fast. As I'm driving down the freeway about to exit, the song Final Countdown came on the radio, as if I wasn't already nervous enough. I got into the hospital's doors and just as I was about to go into the lounge to put my backpack down, I received a text message from the midwife saying come to room 10 fast. She's getting pushy. The laboring woman had only had one prenatal care visit with us and had tested positive for methamphetamine. She was screaming out in pain beside herself after two milligrams of state all and was completely naked. She was completely alone besides the nurse and the midwife in the room. When I walked in, I put on gloves and a gown and stood at the end of the bed opposite my midwife. The woman would kick us every time she would have a contraction and attempts to resist the urge to push. When the baby's head appeared, the woman clamped her knees shut tight and refused to open them or to continue pushing her baby out. After what seemed like an eternity but was only probably about 30 seconds, she pushed the rest of the baby out so quickly, I almost missed him coming out. Thankfully, I caught him, clamped and cut the cord and handed him off to the NICU team that was awaiting for an assessment. The baby was then handed back to the mother and we delivered the placenta and assessed her perineum. The next day, during postpartum rounds, we were notified that the impet would be removed from her care, as were her other two children due to drug abuse. Well, I can say that this was not how I pictured my first delivery. She and her son will always remain in the back of my mind. In the United States, we are seeing more women who are struggling with addiction to drugs and give birth. We need to treat them with compassion and kindness and not punishment. I did not feel that this was the power that I was able to affect on this woman because of the way I ended with her, but I hope here on out going forward, I would like to advocate for loving and humane treatment for these women that are struggling with addiction and for getting rehabilitation services so that mothers and babies do not have to be separated. There are three months later and 31 births down and my nerves and fears are calmed with a small amount of confidence that has peaked through. The best, most memorable birth was actually birth number 31. A lot has changed and I have grown through the last 13 weeks. I have learned many techniques and what works best as far as sitting versus standing and how to position my hand. The biggest thing is my stomach no longer feels like it is twisted in 10 knots. My learning goal for the final semester is to work on suturing because that remains the most complicated thing to overcome in the free school. My advice to students is to trust your instincts, your preceptor and your education. Goal has been the best thing I have ever done in my life and I know that this is exactly what I want to be doing as I continue to grow up. I think... Hello, my name is Amy Estes and I live in a small town called Ulaga, Oklahoma, which is just north of Tulsa, Oklahoma. Edwifery in Oklahoma is not predominant. There are about 60 midwives in our state. They're not as well accepted as well accepted by the physicians. Most of the certified nurse midwives in my state work in hospitals. My clinical site is called Cherokee Nation Hastings Hospital. It is the largest tribally owned healthcare system and provides care for all of Native Americans. At the beginning of the term, my biggest hope was to learn lots, gain experience in education and gain confidence as a student midwife. My biggest fear was not being able to perform skills correctly, not remembering information, not living into the reputation of my school at Georgetown University and letting myself and others down. I had the experience with a first time mom that was 24 years old. Her birth plan included wanting a birth that consisted of no to low intervention. She did not want to use any pain medication. She wanted intermittent monitoring and she wanted to be able to move around. She was going to exclusively breastfeed. She asked for delayed quirk clamping and she wanted to keep her placenta. These are the exciting births. At my clinical site, many of our moms are wanting to be induced, get epidurals, and so we medically manage them more than we would like to. When she arrived at the labor and delivery unit, she was contracting with her bag of water broke. On exams, she was 2 centimeters, 80 percenting faced and was at a minus 2 station. Her husband was there for her support. She labored well, walked around her room, had good breathing with her contractions. Her labor progressed well and quickly for a first time mom. She was in control for the majority of her labor. But around 8 to 9 centimeters, she began to lose some control. She was having a really hard time dealing with the increased pain and pressure that she was feeling. My preceptor looked at me and said, go in there, help her through this, you'll be a midwife. Her words made me smile. I went to her and worked with her and helped her through her transition period. I finally got to use all those tricks and tips that we've read about, learned about, and practiced. And then when you got to see your actions really make a difference to witness your patient benefit from what you did, what a feeling that was to know that I did that, that I was able to help a patient. Help her experience the labor that she desired to encourage her and to help her see that she is strong and in control. What an amazing feeling. About 8 hours after her arrival, she was completely dilated and fully effaced. Again, she began to lose some control. The pain was overwhelming her and she started screaming almost uncontrollable. My preceptor and I worked with her to help her find her control and focus on what she needed to do and what her body was naturally telling her to do. We coached her through and how to redirect her screams and how to use that energy to assist the delivery of her baby. After about an hour and 20 minutes of pushing, I had the pleasure of catching her beautiful baby and helping her meet her new son. Every baby that I've had the pleasure of catching gives me that same feeling that is not easily to put into words. Knowing that I am helping these women bring new life, becoming new moms is just an incredible feeling. Each delivery reminds me of why I'm becoming a midwife and knowing that this is my passion and I am doing what I'm called to do. Going into my last and final term, my learning goals include continuing to gain experience, increase my competencies and improve my self-confidence. My advice for midwifery students facing their first burst is to enjoy it, take a deep breath, remember to breathe, do what you know to do and take every experience as a learning opportunity. Thank you and happy International Day of the Midlife. Hello, I'm Katherine Kruppnick and I live in New Hampshire which is in the northeastern part of the United States. This is a picture of me moments after my first birth just prior to handing out my onesie. In the beginning of the term, I was really focused on being able to apply what I've learned and really just hoping that I would be good at it. And my fear was of course not being able to awaken the midwife inside me and failing myself in some way. What I didn't realize was how much different the birth would look and feel when I managed it as a midwife. Women centered believing in the power and strength of a mother and putting faith in physiologic process of birth. My first birth I was able to manage was one that the woman wanted no medications, no interventions and she actually sought midwifery care. My midwife preceptor encouraged me to be in with this mom during her labor and I just focused on this one patient. And from our discussion she gave me permission to follow this women centered midwifery care that I had learned. I had the pleasure of being present for this woman as she and her husband became first time parents. I helped her husband and family provide support measures that I had learned like the hip squeeze, the reboso, numerous position changes, the willful tub, positive affirmations and the safe environment and space that she needed. It was amazing to watch her transform through each phase of the labor. And she did it as I was taught and watching her then have control, lose control and then gain it back again when she was supported to find strength. I don't know how I even noticed how I didn't notice it before but I could actually tell from how she was acting in her labor just by watching her. I didn't need to do a cervical exam. Encouraging to push in different positions also seemed empowering to her. I never had experienced the intense eye contact and need for help that I felt from her as she tried every suggestion that I gave. Most of the births I'd seen as a nurse were in the lithotomy position and now I learned that this could be detrimental to the natural process of birth. I believed in the concepts that I was learning but I had never actually seen midwifery in action. When she became tired she found the knee chest position. When she became tired in the knee chest position she found the left lateral to be a good recovery position and she actually began to crown. And this was exciting to me because I had been told that this was a great position for birth. So as she crowned I was tempted to give the perineal massage and stretching that I had seen previously as a nurse but again I wanted to see what a hands-off approach would look like. So as the hedge emerged I only applied light pressure and maintained flexion and gently supported the perineum as she used physiologic pushing. No counting, no holding glass, it was the quietest most relaxing birth I had ever seen. Then guiding her baby out, her and I locked eyes and it was the quietest, I'm sorry, I locked eyes and my preceptor was actually whispering in my ears how amazing I was doing. I had a hard time holding back my own tears. I lost track of my hand maneuvers which was one of the things that I was fearing but the baby still came and I handed her off to her mother and my heart had to be as full as hers. We were both connected and fulfilled. Her position and control helped her perineum to maintain its integrity. She only had a small labial tear which my preceptor guided me through repairing. For my final term I wanted to continue to see how midwifery care, to help women to seek midwifery care and help them know that we're always looking to care for them how they want to be treated and providing them with interventions that they ask for and show them how having faith and birth can help things happen physiologically and safely. And my hopes for applying what I have learned throughout the semester were encouraged and accomplished with the help of my preceptor and my fears are a work in progress but they're getting less every day. I'm learning that the inner midwife in me will never let me down as long as I'm quiet enough to hear her. I have to be in the moment, encourage you all to be in the moment and promote the serenity of birth and above all trust birth. And happy International Day of Midlife. Hi, my name is Amy Leiland and I am a Washington DC native and student at Georgetown University and currently living in South Carolina. My clinicals have been in the neighboring state of North Carolina at a small town hospital that does approximately 60 births a month. My background is that I have been a state licensed midwife for over 20 years and a birth center owner for 17 years with a birth volume of about 100 deliveries a year. So I might self I've delivered about 2000 babies, but that's been in an out of hospital setting, which is very different than the in hospital setting. My hopes during my masters in the real free education have been to learn the management of complicated pregnancies and to improve my knowledge of pharmacotherapy and to learn the hospital culture of birthing. My fears have been the management of women with an epidural on board or narcotic pain relief because I am accustomed to the full presence and participation in mobility of my patients. So the thought of a sedated or a mobile patient has been the area of unknown that has been on my mind. So in my clinical rotation, I had a couple of epidural patients that went very smoothly. I thought, wow, this is okay. But then I had a patient that was laboring well and she had an epidural placed at about seven centimeters and the baby instantly reacted and braided down into the 80s. I went straight into the room and called for the epidural to be discontinued. I repositioned the mother to sideline with considerable effort because her legs had already gone numb and very heavy. This did not resolve the heart tone. So we tried the other side, which didn't work either. And then we hoisted her to her hands and knees, which took great effort, and this resolved the baby's heart tones. For me, that was a high intensity moment because I'm used to a mother being able to move herself. And so this was the very thing that I was really seeking to understand and learn and know that when these things happen with an epidural on board, that you really can still straighten them out with repositioning, which is the best way to sort out heart tones initially if you're trying to have a baby recover. The other thing I faced was a state all-patient that was very sleepy due to her medication, and it was difficult to elicit her cooperation and effort in second stage. But after she finally delivered, she was also very out of it, so she couldn't hold her baby. And when she proceeded to hemorrhage, it was difficult to ascertain her well-being because I'm accustomed to very lucid patients. So her bleeding was controlled well with IV pitocin and rectal side attack with a blood loss of approximately 700 cc. So it forced me in a good way to utilize the medical management that I needed to learn with additional tools that are available at the hospital that we don't have in the birth center setting in South Carolina to rely on vitals and medications and not just the patient's responses. I couldn't well answer the question of what, you know, my hopes and fears of delivering my very first catch, because I did that 25 years ago. But what I would say from what I've seen students around me experience is there are so many elements that you're having to keep track of when you're catching a baby. There's so many little details, and it's oftentimes we'll focus on one thing. Oh, I got the baby out. Great. But the baby's not breathing. You've got to get that going, too. And it's hard to integrate all those little pieces all at once, and you're not going to get it all at once because, you know, when you're first doing it, you can't. But it will come. And eventually each little piece will start to become a part of your, you know, just autopilot knowledge where it just, it falls into place, and you do it, and you'll do it, and you'll do it. And baby after baby after baby, each little piece will start to become a part of the fabric of your memory, your body memory, your muscle memory. So if you're afraid now, don't worry, because it will come together. And before you know it, you'll be able to be that calm midwife, get that shoulder dystocia, get that hemorrhage, keep the room calm, stay, keep everybody not knowing that anything really went on. And happy international day to midwife. My name is Cindy Lomba, and I live in Ocala, Florida. The facility where I do my clinical rotation is a level one hospital that does approximately 100 deliveries a month. They also have the busiest obitriage in Seminole County. Midwifery is quickly becoming acceptable and accessible in the central Florida area. A large percentage of women in this area will have their pregnancy monitored by a nurse midwife and subsequently delivered by one. My hopes during my midwifery education would gain confidence with my environment and with my role as a midwife and women's health provider. Each woman comes with her own set of fears and expectations during pregnancy and delivery. And knowing how to navigate each woman's needs and provide the education for each individual patient is a huge challenge. My fears during my midwifery education were associated with emergency situations and my own ability to navigate through them successfully. I was very afraid of suturing for the first time because of all those instruments that I wasn't familiar with and identifying the layers of tissue all had me worried. Regarding emergency situations, my preceptor and I managed a situation of postpartum hemorrhage. It hadn't been our delivery, but we heard the newly delivered mom call out for help. Upon entering the room, it was a hemorrhage. This mom had a history of a hemorrhage with her prior delivery. And so on expecting the uterus, I discovered a large piece of routine placenta. My heart was pounding as the blood continued to flow and even through this, though, because of all my studying and rehearsing the situation over and over in my head, I did remember to call for the hemorrhage pack and check that methadone had been given and that pitocin was running and that a second IV line had been placed. I also learned that cytotech giving buccal works miracles. So at the time it was over and a firm uterus obtained and there was a measured blood loss of approximately 1600 mils. A hemoglobin was drawn after the third unit of packed reds was completed and her hemoglobin was 10 and I was elated. I still remember my first perineal tear. I felt the tear occur as the baby's head exited. I felt so guilty that I hadn't done a better job of protecting a perineum. It was a second degree in my first repair and thankfully this patient had an epidural so I was able to take my time matching all the layers of tissues and identifying whether a repair needed to occur. I still get nervous doing a repair but I've always been told that it gets easier with practice. There will always be a difference in philosophies and approaches to the birthing process within the midwifery as well as the medical communities. All of us as students are facing this dilemma and all I can say is this is an amazing opportunity to define ourselves and identify who we want to be as a provider of women's health. My goals for being a provider to women is to continually gain knowledge that can be imparted to my patients and contribute to their optimal health. Whether that's in pregnancy, labor or menopause, I want them to be able to feel empowered by the care they receive. My education however has elated most of my fears. We were able to practice these emergent situations in a non-emergent environment and I'm learning to ask questions and I'm able to rehearse these scenarios over and over again to help build the knowledge base for when the real emergency does happen. Midwifery education teaches the practitioner to trust in the process to be ever watchable and have the ability to react when necessary. I've also learned that becoming a midwife is never ending quest. You never finish learning. It's lifelong. My advice to other midwifery students is to become devoted to learning. Solid evidence-based practice goes a long way towards being a truly qualified midwife. Happy International Day of the Midwife. Hi everyone. My name is Katie McDevitt. I'm originally from California but I currently reside in Washington, D.C. My husband is in the Coast Guard and brings us to many different places currently just in the U.S. I have two children, two and a half year old boy and a three month old girl. In D.C. it's a really unique practice environment because it is a full scope of practice and full prescriptive authority. It's been an amazing place to learn my basic skills and to have the guidance of the amazing midwives who have pioneered such regulations. At the beginning of my interpartum semester my biggest hope was to catch babies but I was afraid that I wouldn't connect with the patients. I was working at a high volume hospital and I wasn't seeing the patients during their prenatal care. I didn't want to just walk in and be more of a midwife than a midwife. Throughout the semester I managed to find ways to connect with the patients whether it's just stopping by to learn more frequently or just making time to really hear the concerns. My biggest fear was suturing. As you've heard before it's a common theme. I just wanted to have things go together and make sure the muscles look good. My most significant birth experience is also the scariest one for me is one that was really stuck with me throughout my training and it happened to be my fourth birth. It had just come on shift and I had a 30-year-old G2 P1001 at 39 and 6 weeks and she presented to triage at 8.30 in the morning. At that point she was 4.75 and minus 3. She reported strong contractions but denied leakage of fluid vaginal bleeding or decreased fluid movement. On monitoring she was a Category 1 and she was rechecked at 9.30 at which time she was 5.80 minus 2 with continued regular contractions. Her abdomen was non-tender and relaxed between contractions and she continued to have a Category 1 tracing. Her prenatal care was only significant for hyperthyroidism. Once on labor and delivery she received an epidural, continuous external field monitoring and she had regular vital sign evaluation which continued to be normal. The epidural helped alleviate the pain but her labor continued to progress rapidly. Around 11 o'clock my preceptor broke a water and it would be found thick pea suit and a conium. But after that we stayed in the room and the tracing continued to be Category 1. There were no accelerations but there were no decelerations at this time. About a half hour later she felt the urge to push. We checked her. She had an anterior lip and she also had a late decel at this time. Replaced an FSE, moved her to right lateral, she received fluids and oxygen and a fetus recovered. About 10 minutes later she again had a strong urge to push. An anterior lip was still noted and she really wanted to push. So we called for the pediatric team due to the conium and we prepared for delivery. But another deceleration started. So we decided to continue with the pushing and have her push beyond that anterior lip. I had my preceptor at my left and the OBGYN was by the door due to the deceleration with instruments ready if needed. We told the mom it was really important for her to push. Now her baby really needed it. She pushed very effectively and the baby was delivered in less than four minutes at 11.45. The head delivered and she had a tight nipple cord times two and a left compound hand. We delivered the anterior shoulder with gentle traction, the posterior shoulder followed, and my preceptor immediately clamped the cord and I moved the baby to the warmer. And the NICU team immediately started resuscitation. The baby's Apguards were 0, 3, and 5. At that moment I saw the baby deliver the Apguards 0. I knew the baby was in the NICU's hands and I just immediately redirected myself to focusing on the woman. My job at that point as a student was to help deliver the placenta and remain calm so the woman could focus on delivering the afterbirth and recovering so she could be there for her baby. It was a very hard moment to not just look at the baby and try to see what was going on. And I did everything in my mind to redirect towards the baby and just keep in mind that what I needed to do was make sure that she didn't hemorrhage and that she was safe. The baby was transferred to the NICU and they did cooling and many studies revealed a hypoxic injury. I checked on the baby that night and it's still on cooling and they noted multi-organ system failure. I was away from the medical center for about a week and was just very anxious about what had happened to this baby. I was very relieved to find out and receive a text that the mom and baby went home healthy a week later. It was a birth that had stuck with me. It instilled a little bit of fear in natural birth. How could something that seems so normal with no complications turn out this way? Could I ever trust an out-of-hospital birth setting? Could I trust myself in that situation? And I learned to trust the team. It was a high volume center and I had 40 births later. I feel I've restored a lot of my faith in births but I am entering my final semester at a birth center and doing home births. I do have some fear going into this so my hope for the semester is that I restore my trust in normal physiologic birth and that I don't jump to transferring or to interventions based on this experience. My advice for midwifery students facing their first birth is to trust yourself in your training. You're supposed to be there. Don't doubt yourself and you are not alone in the journey. Thank you for your time and happy International Day of the Midlife. Hi, my name is Nicole Quintero and I live in York, PA. I just finished a clinical rotation at a trauma center in York and will be starting my integration semester in the Poconos at a similarly large and busy medical center. In Pennsylvania midwives work in collaboration with physicians. Naturally my hopes and fears have evolved as the program has progressed. Currently my biggest hope is to become the best midwife and women's health nurse practitioner that I can become and simply my biggest fear is not providing women with great care. The experience that I will describe with my first birth, it could not have been more perfect. I saw Mom in the office for several of her antipartum visits and we built a relationship. She was a G4 P3 who went into spontaneous labor and was 8 centimeters upon admitt to L&D. She was excited to have me there which helped to ease a lot of my worries. She delivered a beautiful baby boy vaginally and she and her husband couldn't have been more thrilled. I was nervous but my preceptor did a wonderful job guiding me through the delivery. I then got to see her for her six week postpartum visit and she was doing wonderfully. At Georgetown we were given onesies that we could give to the first baby that we helped enter the world as Dr. Farley explained. I love that I gave my onesie to her son. It definitely made me eager to deliver more babies. Sadly after roughly five births I lost my clinical site in the middle of the intrapartum semester but was fortunate enough to be placed quickly at a hospital very close to my home. There I was definitely exposed to a very different environment than the one I started in despite the first site being much smaller with less acute patients. It was more progressive in a midwifery sense, practicing delayed cord clamping, skin to skin and providing more individualized close support to mothers. The hospital I finished at performed roughly 1200 births a year, was much faster paced and cared for more acute patients. It would be dishonest of me to say that my confidence level did not wax and mean a lot during the IP semester. Definitely more at the second site but while I wonder if my confidence level would have been higher at the end of the semester if I had finished out at the first site, I am glad to have seen what midwifery looks like in different settings. I am hopeful that my integration semester will help me work through the uncertainties I was left with. That being said, delivering babies is an exciting yet scary thing entering the IP semester but remember many of us chose this path for this very time in our programs. Being a midwife will not be easy. Consider your passion for women's health while going through the ups and downs of being in school and at clinical. So good luck to everyone. During my final term, I have many learning goals which include working on hand skills, suturing, and further developing differential diagnoses and treatment plans. Basically, I'd like to start putting all the puzzle pieces together and develop a sense of independence. Thank you for your time and happy international day of the midlife. Hello, my name is Sierra Shank and I live in Columbus, Ohio. Midwifery in Ohio is slowly uprising and one of the contributing factors of midwives in Ohio is helping to decrease the infant, the high infant mortality rates. I had the opportunity to gain midwifery experience in my interpartum rotation in Claremore, Oklahoma, which is located in the middle of the United States. It was in a small government hospital that provides care to Native Americans and it's managed by midwives with an average number of 30 deliveries per month. And they don't manage complex interpartum or newborn care. My biggest hopes for interpartum, I had a lot of them and I wasn't sure where to begin with all my hopes because I was so overwhelmed with so many fears. But I was able to condense my feelings into one. I wanted to be great at what I did. I wanted to be an awesome learner and confident in my own ability to learn at my own pace with the foundation Georgetown DSU and be confident in my new role as a midwife. My biggest fears, again, I had so many fears and was overwhelmed when I started. I found my fears so interesting and very different from my peers. It was not my lack of skills or even management that scared me. Rather it was my personal confidence that was my biggest fear since I had not been a labor and delivery nurse. I was certain that I would have a difficult time adjusting to the environment and learning to communicate with staff. My second fear was management in acute care situations. I knew skills and maneuvers were a matter of muscle memory and that practice makes perfect. But I wanted to be sure that I was a safe practicing midwife. My clinical side gave me autonomy and management, which gave me the opportunity to use my foundation for management. I had a woman who was a G2P1 that had an uncomplicated labor with a Category 1 tracing. The youth continued with fetal monitoring during the first and second stage. During second stage, there was a prolonged fetal heart rate deceleration into the 80s that lasted for five minutes without returning to baseline. As I watched the fetal heart rate drop initially to 90 without recovery, I wasn't sure if my preceptor was stepping at that moment. But I decided to manage this complication. I started with oxygen and repositioning. There was still no recovery to baseline by three minutes and my heart rate dropped or then the heart rate dropped to 80. And my adrenaline kicked in. I then decided to attach a pseudo-scop electrode and I could visually see the baby rotating from an OP to OT position. But had difficulty delivering the head because of the tight perineum. I made the decision to perform an apesiatomy to expedite the delivery. My preceptor continued to provide me calming reassurance through this process. The newborn was born within 60 seconds of the apesiatomy without any complications. Even though the time from fetal heart rate deceleration to delivery was approximately nine minutes, it felt like an hour had gone by. The outcome of the delivery was just what I had hoped for, a healthy mother and a healthy baby. At that moment, I realized that it was not my perception of the lack of labor and delivery experience. But it was that the intermittent wife and me had finally survived. My learning goal was to continue to ask questions of my pyramid-wise OBGYNs and other labor and delivery nurses that I would be working with. I found that there are so many things to learn and to apply and ask some questions and to apply to my practice. And asking questions to someone to help make sense of things or even talking about is reassuring and at times feedback for growth and competency use. My advice to future midwives is to be an open slave for knowledge. Never stop learning and stay encouraged. Be kind to yourself and find support, rest, and never forget the joy of midwifery on those challenging days. Because it honestly is the greatest gift that you can ever give to a woman. And happy International Day of Midwife. Hello, my name is Amanda Snyder. I'm also a midwifery student at Georgetown University. Prior to entering the program, I worked as a labor and delivery nurse at hospitals in the Midwest as well as in California. I'm currently living in Northern California and completing my clinicals in Southern California. About high school, I knew I wanted to be a labor and delivery nurse. However, I found to the midwifery thing a little unexpectedly. I grew up in an area that wasn't super abundant with midwives and I really didn't know much about who they were or what they did. As I got waist deep as a labor and delivery nurse, I started to become bothered by the way the labor women were being treated at the huge university hospital that I worked at. They were not being heard, decisions were being made for them and not with them, and they were being labeled non-compliant if they questioned or deferred a procedure or medication. When I started to speak out about this, my manager told me to, quote, stop acting like a midwife. I found this amusing and took this to heart and started reading everything I could on midwifery. Soon after, I came to the realization that I was built for this profession. That's for a few years and this brings us to my first interpartum clinical rotation. Going into the rotation, my main goal was to catch some babies and my biggest fear was suturing, like most of the students. I was placed at a birth center in Southern California with two certified nurse midwives as preceptors. One patient in particular shines through in my memory when I look back on the semester. It was my first birth that I attended that semester. It was my first ever home birth and it was also my first ever water birth. So my blood was really pumping with excitement that day. All morning while she was in early labor, I was practicing my hand maneuvers and suturing techniques. I reviewed the birth center's policy and procedures, refreshed on labor support, massage, counter pressure, and other ways to provide comfort during labor. I was ready and very excited to put forth what I learned into practice. When I arrived at her home, the room was dark, lit only with a few candles and was almost completely silent aside from the woman deep breathing every two to three minutes and the calming swish of the water as she swayed her body back and forth in the tub. As I mentioned, my background is in hospital labor and delivery. My days were filled with many tasks and assessments and due to the high volume and high risk population I dealt with, it was very rare that I got the chance to sit with a woman for hours and just witness her labor. As a midwife, I was ready to share words of support, provide counter pressure, try that verbose thing or the 50,000 other midwifery tricks that we learned in school. I was ready and willing to do just about anything to help her through this labor. But she didn't want to be touched and she didn't want anyone to talk and she didn't want any noise to be made, specifically from her husband. She requested that we just stand by. I found myself in a very confusing place and it was in this place where I really and truly learned the definition of physiologic birth. Nothing that I read compared to witnessing this woman progress through her labor. It was beautiful, powerful and magnificent to watch. She truly trusted her body with every ounce of her being and she taught me to trust her body. I approached that situation from the wrong angle. I was ready to help her give birth and I was somehow under the impression that she needed me and my midwifery tool bag to make that happen. But she taught me that though some women do need that type of support, I need to be giving the support I need to be giving is supporting the natural process and trusting in the power of her as a woman and her uterus and empowering that. Even as I say these words, I realize that I've heard them said to me many times in class from professors and scattered through readings that the deeper understanding of what this means didn't resonate with me until that day. Quite frankly, I don't remember much else from that birth. Delivery was a bore and I swear my eyes never left her paring me the whole time she was pushing. She delivered a beautiful healthy baby boy. Before we left, she pulled me aside and said, Thank you for being here. Your support gave me so much strength. I left that birth of the new sense of what my purpose was as a midwife and what it means to be supportive. I learned in a real raw way what trusting and supporting physiologic birth means and how sometimes doing nothing but being present is the best way to support a woman and it says to her, I trust and believe in your ability to do this. I put Animes quote on my slide because though it is funny, it brings true. There is no other organ quite like the uterus. If men had such an organ they would brag about it, so should we. My advice for midwifery students facing their first term is this. Though all the technical stuff and hand maneuvers and suturing are extremely important and obviously essential, don't forget to take a minute, breathe, and acknowledge the amazing act of strength that is happening before your eyes. It is truly immaculate. Thank you. Hello, my name is Michelle Wright. I am originally from Long Beach, New York. I was bride with a dappled gray Arabian horse to give being a southern girl a try and relocated to a little town called Rail Georgia. Midwifery is not common in the rural areas in Georgia. But it is in larger cities like Atlanta, Savannah, and Athens, the site of my next location. When the time for interpartum came to say I was anxious to be a monumental understatement. We gathered together as faculty and classmates to discuss fears and hopes. I'm almost never comfortable sharing in large groups and had more fears flooding my mind than I could enumerate or even articulate. I had the largest lump in my throat and hanging in my chest. What if I wasn't good enough? What if I loved Midwifery only to find out that the art itself would not love me in return? What if the still never found its way into my hands? I remembered my days as playing competition classical piano and the all-encompassing calm that flooded me when I could close my eyes and play scenelessly knowing the notes were safely stored in my hands. Would these women, these sweet babies, ever be safe in the stills of these same hands? I thought all of this but simply said I was afraid that I would not learn everything I needed and hoped that I would learn enough to be competent and safe omitting the details that were haunting me. Little did I know, I was practicing from the very beginning one of the trademark traits of Midwifery, a calm exterior despite the possible raging of a storm within. My first completely solo birth was intense. A young woman was having her fourth baby. When I met her she was excited, yet calm, confident and sure in what she wanted. I loved that she had a plan that meant structure for the day. I could work with structure. For the first first that's what I wanted. Things progressed rapidly, so rapidly in the days so busy that she was unable to receive the epidural that she wanted. It came time to push and she was not tolerating the process very well and it was very hard as a student to keep order and control the room. The situation became more intense with the accelerations and the need to start pushing early. Later, despite her greatest efforts, the baby could not pass the nature to their son. I coached and coached and nervously watched the deceleration. I then encouraged her to stop pushing to allow the baby time to recover. This pattern went back and forth to what felt like an eternity. My consult was available but did not step in. I helped her change positions over and over until finally the baby passed and meets the pubic bone and emerged so very slowly. I reduced the very tight nuke report and caught for the first time a limp, grey baby. The mother began to cry asking why he was so quiet. She grasped my hand tightly and would not release it. I comforted her until she was comforted by his cry moments later. I found it so strange that she looked at me for comfort. If she had seen how I felt on the inside, she would have looked elsewhere. Even when I felt inadequate, what I had was enough for her, for her worries, for her fears, for her birth. Towards the end of the term, I attended another birth with a young girl with a detailed plan who was calm right until time to push. She looked at me with large questioning eyes and said, is this your first time too? I said, no, it isn't. You'll be magnificent and I'll help you. She said, oh good, and instantly relaxed. All she needed to know was that I had done it before and I could do it again. I told myself that every time after, I would be able to do it again and again. That day for the first time, my exterior genuinely mirrored my interior. I was not faking my calm. It was very real and it was just what she needed. My goal from this point onward and advice to other student midwives would be to reach a point where we trust ourselves to be enough for our patients. Enough in knowledge, skill, presence, support, and heart. Where the awe-inspiring and tremendously humbling birth experience motivates us to strive to forever be whatever it takes to be a nurse. Thank you and happy International Day at the Midway. Hello everyone. How beautiful are all these reflections from our students? My name is Jean Jacobs, and I've been a certified nurse midwife for over 20 years in the United States and joined the faculty at Georgetown University in January of 2013. My new role as an educator provides the opportunity for me to mentor the new generation of midwives, which is extraordinarily rewarding. I also appreciate how similar our students' hopes and fears are to my own hopes and fears so many years ago when I first began my midwifery education. We hope that the student reflections that have just been presented provide an understanding of the tremendous growth that takes place during the interpartum semester in the Georgetown Graduate Midwifery Program. Fears and frustrations are deflated during our clinical sharing times, with students helping each other problem-solve more than just clinical management. Issues such as understanding different preceptor styles, learning to manage a room, and finding the confidence to consult with a medical colleague are also explored. As midwifery educators, it's our responsibility to not just teach midwifery, but to also be a midwife to our students, encouraging self-confidence when they are the most vulnerable. It's not enough to provide the content, but also to support and gently encourage the students as they embrace this new role as a student midwife. After the midpoint in the semester, we see the reemergence of their passion for midwifery, coupled with the confidence that, yes, they may one day actually be a practicing midwife. Fear, insecurity, and exhaustion are soon replaced by the exhilaration of participating in birth. The students have finally come to the moment in their education that brought them to us, the desire to guide women and families in the beautiful journey of birth. We watch with delight as we observe each one embracing the culture of midwifery, advocating for women's health care rights, access to care, and the promotion of the family unit. We stand guard at the door, watching as our students spread their wings towards their final semester before joining the family of midwives. The fears have become smaller, the hopes rising exponentially. We are now open for any comments or questions from the audience who would love to hear stories of your first birth experiences. Thank you for your kind attention to our presentation today, and happy International Day of the Midwife. Hi Lorraine, this is Cindy, and I see we have a small current audience, but this will also be on recording. Yes, we do. Any questions from our audience? And if there are, no comments. No, well, thank you Lorraine. It's been a pleasure being with you this year. And you as well, and all your wonderful... Shall we see you again next year? I just want to make a comment. I hope so, I hope so. I just want to make sure you see this comment from Rose, because she was struggling with a lot of the fears that the students were talking about as well. And she said that she can relate a lot to the stories, a lovely for people to share them with other students on such a brilliant platform. So this is, I think, an important way to reach out to other students. Yes, thank you Lorraine. And will you let us know when the link is available for the recording? Indeed, I'm going to close the recording right now.