Eleanor Ruth Flinders was welcomed into our family on November 17th. That’s a big name for a little baby, I know- We call her “Ellie”. My labor was amazing. At 7:00 p.m., I called my midwife to let her know that my contractions were in a pattern and that they weren’t going away. I called her back at 7:15 to tell her she may not want to drive all the way home from the office. By 7:30, I called her AGAIN to tell her I was heading to the hospital. I got checked/ checked in by 8:30 (was 8-9 cm/0 station). In just one hour, at 9:31, it was all over! She weighed 5 pounds, 15 ounces at birth, and was 19 ½ inches long. Ellie looks just like her brothers, who love her dearly.

When the business of coursework was done we would occasionally wander off on other topics.

One of my favorites was Carol's telling me of a butterfly farm that she visited in her travels. It was wonderful to hear about the butterflies. I told her that we had one on the Umpqua River , but I had not had the opportunity to visit. I emailed Carol one day to tell her about the dragonflies at a creek where my dog and I hung out. The dragon flies were juveniles and would land on my dog and me as soon as we settled outselves in. There were many sizes and colors. Some would just watch us, some would land on my hands and knees and sunbathe. They would let me get my hand close and study them. Some would land on my dog's back and sunbathe. This was my daily break from studies in the summer. Carol wrote back, I could hear her voice telling me: the young ones were not bound with the fears like the adult dragonflies were, not unlike people. Then she wrote that she thought I was a strong women to have the strength to leave the dragonflies and creek to go back and ..... study. If she only knew.......

Suzan Ulrich was one of the guest speakers at the 25th anniversary of the North Shore Birth Center on Friday November 4, 2005. The gala anniversary celebration was a memorable evening. The NSBC is the longest running hospital owned birth center in the United States. Suzan was the director of the North Shore Birth Center from 1992 until 2000.

To Read Suzan's entire speach click here

The gala evening began with a string quartet playing softly while old friends arrived and greeted one another. There were beautiful tables with fall flowers. Newspaper clippings from the past 25 years were displayed along with notes from colleagues who could not attend, but sent their good wishes and congratulations.

Linda Anne L’Abbe, CNM, current Director of the NSBC, hosted the festivities. She welcomed everyone and introduced Dr. Henry Ramini who shared his heartfelt words about the loving process of giving birth to the NSBC in 1980. Dr. Leo Sorger, a pioneer for out of hospital birth in Massachusetts, and a great supporter of midwifery spoke next about his work with vaginal breech births and vaginal births after cesarean section. Suzan Ulrich, DrPH, CNM followed with a comparison of the state of midwifery and birth centers in 1980 with today. She saluted the NSBC for touching the lives of many women and their families for the past 25 years. (For Suzan’s complete remarks click here)

Linda Anne presented gifts of silver frames to the birth center founders Dr. Ramini, Dottie Kuell, RN, and Joan Richards, CNM. Silver baby spoons were given to Dr. Emspak for over 10 years of service as the second medical director and to Suzan Ulrich for direction of the NSBC throughout the 1990s. She also presented vibrant rainbow scarves with sperm and eggs on them to the current midwives at the NSBC. The program ended with a slide show of special moments at the NSBC from 1980 to today.

It was joyful celebrating the silver anniversary of the NSBC, which was in the vanguard of the birth center movement. The strong commitment by physicians, midwives, nurses, hospital administrators, and women and their families has contributed to the center’s longevity and will continue this special care for women and their families for many more years.

I am so happy to be here with you celebrating the 25th anniversary for the North Shore Birth Center. The North Shore Birth Center has been a blessing in my life.

First as a student nurse midwife from Georgetown University I came to the NSBC for my integration experience in 1983 and learned the art of midwifery from Joan, Debbie, and Fran.

I was privileged to work at the NSBC for almost 10 years.

In addition, the midwives of the BC took very good care of me when I was pregnant with my daughter Eve at the ripe old age of 40. She was born into the loving hands of Joan at the hospital with Dr. Emspak keeping vigil.

So I want to share some thought with you about the legacy of birth centers the NSBC.

It is interesting to note that births centers continue to be a blessing in my life because the development of the CNEP program at Frontier resulted from the growth of birth centers….because there was a need to educate more midwives to staff birth centers and an acute need to educate midwives in out of hospital births since all other midwifery programs were in tertiary settings. So working for Frontier still keeps me close to birth centers…and all my students do a business proposal for a birth center in their community.

The North Shore Birth Center and its sister centers around the nation and the world have experienced astounding growth and development in the past 25 years….and the future is bright for birth centers.

Why is the future bright for birth centers when there is chaos in the health care business?

Because of the young nurses I see applying to our program.

They are energetic and passionate about birth. They believe and trust in birth just as we have for the past 25 years at the NSBC. They want to offer women options for care and give women power to make decisions about their care.

One of my recent applicants had her baby at the North Shore Birth Center…she told me why she was becoming a midwife. She stated,

The first time I saw a birth I was 16 and did not have much sense about pregnancy and birth. The birth was a midwife attended birth and it blew me away. I was fascinated. At that point I became interested in midwifery. I had my first child at the age 21 at the North Shore Birth Center with midwives. I realized other women did not know about anything but hospital births. I wanted to give them choices. So I went to nursing school and had 2 more children. Now I am applying to midwifery school so I can work with women in an underserved area and offer them the choice of a birth center.

The legacy of the North Shore Birth Center lives on in the lives of the women and families who were cared for so lovingly by the midwives, nurses, office staff, and physicians here.

You have touched the hearts of many at the intimate moment of birth and your caring influence extends well beyond the confines of the NSBC and Beverly Hospital…like the ripples of a pebble thrown into the sea.

I salute you all on this special occasion for you have been in the vanguard of the national birth center movement and have changed maternity care in the nation. As Margaret Mead said…Never doubt that a few dedicated people can change the world…indeed it is the only thing that ever has.

Thank you.

On August 23, 2005, my husband Pat and I celebrated our 25th wedding anniversary. Since August 23 also marked the first day of Frontier Bound for class 47, I decided that rather than spend our silver anniversary apart, I would bring Pat along with me to Bound (even though I have been driving to KY for 15 years, he had never been there or seen the school). What I learned during those days was that Frontier really is my second family, and that Hyden (and the FSMFN) really is my special home away from home.

We spent the night of the 22nd at a beautiful Inn, on the banks of the Ohio River, just outside of Cincinnati. I awoke early in the morning, put on a pot of coffee, and went to watch the sun come up, sitting on a bench that overlooked the river. As the new day began to dawn, I realized that Pat might also want to share in the beauty, so I ran inside to wake him up and invited him to join me for a cup of coffee. He shook the cobwebs off, as we walked back to our bench. As we sat in the dewy silence, he asked if I would do it all over again – knowing then what I know now, would I still marry him. I responded with a resounding “Yes – absolutely”. At that point, he pulled from his pocket, the diamond ring that we were unable to afford 25 years ago, and handed it to me. As my tears began to flow, a little old lady walking her dog strolled by – and he turned to her and said “she said YES!” She stopped, and congratulated us. I was too speechless to tell her that this was the second time I had said yes – that we had already enjoyed 25 wonderful years together. But all of that wouldn’t have mattered anyway – it was a wonderful moment for all of us.

We spent the next several hours driving into Hyden. I was so excited to share the beauty of southeastern Kentucky with him – and then repeat the history of the school (he has heard it many times) as we neared School Street. Then I had the pleasure of introducing him to all the wonderful folks at the school whom he has heard so much about over the years. Our Anniversary dinner was prepared by Betty, and shared with all the incoming students (vegetable soup and sandwiches?). As we headed down the hill to the Barn – my excitement grew as I anticipated him hearing our history as told by Jean and Kitty (and no surprise – they didn’t let me down – their stories were as rich as ever). Once the story telling was over, Pat got to experience his first Frontier Circle-Up. Finally, he was able to feel what I have been trying to share with him over the years – the power of nurses, coming together, to bring outstanding care to women and families.

As we walked up the hill, I stopped in the dorm to grab the key to the chapel in preparation for the surprise that I had planned for him. As we headed down the road, I stopped the car at the chapel. We walked through the still mountain air and I let us into the chapel, lit the two candles on the alter, and pulled our wedding vows from my pocket (Pat wrote our vows, and I had grabbed the copy that remains in my cedar chest as we left Wisconsin two days earlier). In the quiet and peaceful comfort of St. Christopher’s Chapel, we read our vows to one another – just as we had 25 years ago – alternating line after line. I think we both shed more tears that evening than we did, what seems now to be, a lifetime ago. When we were done, we enjoyed the silence, and then he turned and said “you know, we really have been true to these vows”, and we both wondered, how it was that so long ago, we knew what we wanted in our partnership. We realized that how that happened doesn’t matter. What does matter is that we truly have enjoyed our partnership – in parenting, and living and loving each other.

So…. I would like to thank all the folks who helped make our anniversary so special. You probably didn’t know you were doing it – so I wanted to share this with you now. That place, and all the magic of Frontier helped make a memory for us that will last a life-time, and that we will always treasure.

The midwifery faculty practice has been growing over the last several months. We said goodbye to Debi Karsnitz, who is transferring to a full time academic faculty position, Debi lives in Louisville now and will continue to help us out occassionally.

We are very excited to have welcomed two new CNMs to the practice.

Sharon Adams, CNM, MSN, joined us in October. She is a CNEP graduate, Class 30. She previously had a private practice in Prestonburg, Kentucky.

In January, Nikki Demetriou CNM, FNP, MSN also joined the practice. She is a graduate of Vanderbilt University and comes to us from Chicago via St Croix in the Virgin Islands.

The Faculty Practice is also busy planning the reopening of the Mary Breckinridge Hospital Maternity Services, but will not have an official statement until after the Board Meeting in late January.

November 3, 2005 thru November 6, 2005 I attended the annual induction ceremony and conference for the National Health corpss Scholar program. Starting last January, I began the arduous task of gathering information and applying for a National Health Service corpss Scholarship to help fund my graduate degree. While searching for possible scholarships, I came across the NHSC site and liked what I saw. Their mission statement is, “assisting the Nation's underserved by uniting communities in need with caring health professionals and supporting communities’ efforts to build better systems of care.” Simply stated, serving the underserved.

I received a very hefty application packet in the mail, and came very close to pitching it in the trash after looking at how detailed it was, and seeing that if awarded a scholarship, I would “owe” the NHSC a minimum of two years of working in a high-need area. Long story short, I filled it out and mailed it back, thus beginning a long journey from then until being seated at the ceremony in November.

During the waiting period, I had the chance to speak at length with Julie Marfell, ND, CS, FNP who serves as a local Ambassador for the NHSC. She encouraged me through the application, interview, and waiting period. I finally received notice that I had been chosen for a face-to-face interview, which would take place in May, the week following Frontier Bound. While at Frontier Bound, during our dinner at Wendover, I took advantage of being able to visit with a local practitioner, Kathryn Lauderdale, MSN, FNP. She had been a recipient of this award and I was able to network with her and get advice on my upcoming interview.

In August, 2005 I received the news that I had been chosen as a recipient for the NHSC scholarship which would include full payment of tuition and fees, along with a monthly stipend while in school full-time. I remember being overcome with joy…and then immediately being overcome with a sense of fear...worrying about where they might send me to fulfill my two-year obligation after graduation. What about our new house, what about my husband’s job, etc. I remember discussing these fears with my husband and him telling me not to worry about it, that everything happens for a reason, and that I would end up serving where I was supposed to, and that we would just deal with it. We then went out and celebrated with a nice dinner.

For those of you who have followed my story, you know that in September my life was turned upside down when my husband died very suddenly. I could not have ever foreseen that, but I do know that his encouraging me all along to pursue the scholarship, when I was weary of all the red tape and waiting, resulted in my being able to survive and stay in school following his death. My teenage son, Elijah, was able to attend the induction ceremony banquet with me in Baltimore in November. It was bittersweet, but I knew it was all part of a bigger plan.

While in Baltimore, I had the honor of meeting the Director of the National Health Service corpss, Jennifer Burks. She came over to personally introduce herself to Elijah and me, because she had heard about the loss of my husband. She was gracious and very much an inspiration. She told me that they had received over 3000 applications from medical students, D.O. students, midwifery students, FNP students, physician assistant students, and dental students. She told me that they had only funded 135 awards and that I was sitting amongst those 135.

While at the conference, I had the opportunity to learn exactly what it meant to be in the National Health Service corpss, and what my obligation would consist of. I was able to network with representatives from all over the nation, and before I left, I had more business cards with locations trying to recruit me than I knew what to do with.

Incidentally, our first day of the conference, they showed us the very first episode of “Northern Exposure.” It was a good ice-breaker, no pun intended, as the physician in Northern Exposure ended up in rural Alaska, paying back his debt to the government for funding his medical school education.

I would like to encourage other Frontier students to apply for the upcoming season. The deadline is the end of March. You can access the organization at http://nhsc.bhpr.hrsa.gov. On the site, you can learn more about the corps, and download or request an application. For those of you who may have applied last year and were not chosen, do not give up. Resubmit for this coming year and give it another chance. If you have any questions about the scholarship or application process, feel free to contact me. I am happy to assist you. I know for many, the prospect of having to go “wherever they send you” is scary. At the conference, I learned that we are given the ability to request locations, and that more than 90% of the time, scholars are placed in their first or second choice of location…so don’t let that frighten you.

There is also a loan repayment program from the National Health Service corps that you may want to research if you are not interested in the scholarship program.

I am currently working on Level 2 of my FNP program at Frontier and very much looking forward to finding out what is in store for my children and me. Without a doubt, I know that there is a plan, and that in due time, I will become privy to it, and will end up serving where I am supposed to serve.

I am working at J C Blair Memorial Hospital. The practice was formerly known as Birth and Beyond but has not been renamed. I have one partner and there are two consulting physicians on staff. Our practice consists of mostly teenagers and women who are financially needy. I work one day a week in the office with call that night and the next day off, and call every weekend. My L & D experience has been helpful at times but also has provided me with challenges. I have pretty much worked at level three facilities and am use to a certain way of doing things especially with preterm patients. This is a level one facility so we stabilize and transfer as necessary.

One of my greatest challenges has been dealing with my role as a novice CNM and some of the L & D staff. It is like riding a wave. I doubt myself and my abilities and then God sends me a message. For instance, I saw a patient for a repeat Pap smear. She was very uncomfortable with the exam. In the back of my mind I am thinking possible abuse. She then confided in me that she was raped in college. I spent a lot time discussing things with her and she is receiving counseling at this time. She has come to the practice for a number of years and never shared this with anyone. Another day I had my first catch come in for her postpartum follow-up. I had gotten her a gift for her son and shared with her and her husband. She said " I just want to let you know that you did a great job. You have great bedside manner. You were very personable. I would have another baby with you anytime."  Of course, I cried, thanked her and told her how much I appreciated her kind words.

Looking back on this past 20 years, I would never have guessed that I would become a successful sole proprietor of a birth center. Of the several birth centers in our two county area, only ours has survived the many changes in health care that impact birth centers.

When I graduated from the Frontier Midwifery Program in 1983, there were no nurse-midwives in my community. Kitty Ernst advised that I talk to Dr. Ormsby in Riverside CA. He had just opened a birth center and may be interested in a nurse-midwife. Her words of encouragement still ring in my ear.

When I returned to Redlands, I interviewed with several physicians for a position as a nurse-midwife in their practices, including Dr. Ormsby. It was not encouraging.  None were interested. I then visited the nurse-midwives in San Diego and Studio City, CA where I became inspired and re-energized and set to work on describing midwifery care through the development of practice Policies and Procedures. I sent them to all the physicians with whom I had interviewed but received no response or very negative responses like;, “There is NO place on planet earth for nurse-midwives.”  Then a surprising call came from Dr. Ormsby to tell me that after reading my policies and procedures, he learned what nurse-midwives were all about and he was impressed. He offered to become my first consulting physician and provided the opportunity to attend my births in his birth center. Thus began Inland Midwife Services and my career as the first certified nurse-midwife in private practice in San Bernardino County.

My first office was the shared space of a pediatrician friend. That was a good arrangement, because he then saw all of the babies I delivered at home. It was about a year before it became apparent that a freestanding birth center was needed in our county. The birth center opened in Loma Linda in 1985 and moved to Redlands in 1988. We have birthed over 1250 babies, some of whom are now second generation and some who have traveled from great distances including Alaska and Tahiti.  In 1999, Baby-Friendly USA, the UNICEF baby-friendly hospital initiative, recognized Inland Midwife Services, the Birth Center as the 18th baby-friendly birth facility in the United States.

Believing that educating people about nurse-midwives and birth alternatives is an important part of establishing childbirth as an empowering experience for women, we invite nursing schools to send their students to learn about birth alternatives. I am thrilled that some of these students and a few of our clients have made the decision to become midwives. We are a clinical site for nurse-midwifery and nurse practitioner students and foreign visitors wanting information on birth centers. I guess this is one way we can "birth the future".

This year we celebrated 20 years of service to our community with a Picnic in the Park for the families and all our supporters. It has never been a large practice and there have been times when we have feared that we would not be able to pay our bills. But I would not trade the joy that my practice has brought to my life and the lives of the families we serve for anything. 

Leonette Clayson, CNM, FNP  is the owner and director of Inland Midwife Services (Redlands, CA) and a graduate of FSMFN

I woke up the morning of Tuesday, November 8 to prepare the lunch that I was taking to the birth center staff in appreciation of my training experience there. I was in the bathroom at around 8am when I felt a small gush of fluid. I was not sure at first, but a couple of hours later it became very clear that my water had broken as fluid gushed out with each step I took. I went ahead and finished preparing lunch, both excited and nervous that the time was near. I had a non-stress test while I was at the birth center. Everything looked fine, but I was not having regular contractions yet. So I went home, got some castor oil on the way in case I needed it, and took a nap. My husband and I had already scheduled to have some belly photos taken Tuesday night, and since I was not contracting, that’s how we spent our evening. It was a nice way to start labor!

Wednesday
I woke up to the morning sun, surprised that I had slept through the night without labor starting. I called the midwife at 8am to check in. I was already on the schedule for a 10am return OB appointment, so she told me to keep it and come on in. The two proud grandmothers had arrived the night before and they accompanied me to my appointment, while my husband anxiously attended classes at school. When Maureen, who had also been my preceptor, checked me, she told me I was 5-6 cm. We were both very surprised since I had not really been contracting. I thought that maybe I would be one of those fortunate primips with a multip labor. Why in the world did I think that??

I went into the birth center that evening at around 8pm. I was 7-8 cm/80/-2. Then Maureen said that I had a big bulging bag of water. Shortly after that my water broke . . . again. Big gushes of fluid went flowing. Labor slowed down whenever I laid down, so I walked for a while. I eventually got into the tub and things were pretty intense, so much so that Maureen told my husband to go ahead and call the grandmothers at home to come to the birth center. I later got out of the tub because the water was too warm . . . then things slowed down. So to bed I went to rest with plans to stimulate things in the morning if needed.

Thursday
I again awoke to the morning sun . . . much to my disappointment. I was certain that I would be having a sunrise baby . . . complete with chirping birds and breakfast in bed!! I walked around again to get things going . . . which they did. Maureen checked me and I was still 7-8cm. So she sent me to eat breakfast with plans to start blue and black cohosh after that. So until around 2pm, I cohoshed, walked, rocked, bounced, and nipple stimmed myself to a resounding 7-8 cm!!! I wanted to cry . . . in fact I did. Things were pretty intense for a while. During one contraction, I looked up to see the famous Frontier photo of the baby in the saddlebag. The rooms had been redecorated since I was a student there, and seeing that picture gave me an inner strength that I will always appreciate. However, things once again slowed down. Maureen then kicked my husband and the nurse out of the room and we had a “heart-to-heart”. She asked me about fears, worries, abuse, etc. She even asked me if I was okay with being with her in labor. I told her there was nothing that I could think of. In fact, I had looked forward to being taken care of by the very midwives who had taught me to be one. I especially looked forward to Maureen’s back and foot rubs!! So she took my face in her hands, looked me in the eye, told me to forget that I was a midwife and that right now I was a mother in labor and that I could do this. She held me while I sobbed away my frustrations. She told me that I could go home and wait some more for things to pick up or go to the hospital for pitocin. I chose to go home after Sher, my other preceptor, came down and evaluated the situation also. Maureen told me to call her at 8pm to check-in. So back home we went . . . .

I ate a late lunch and tucked myself into my own bed. At around 4pm, I woke up to pretty strong contractions about every 6-7 minutes. I walked around my room and this time I meant business (not that I did not before, but my “deadline” was soon approaching). I prayed, I squatted, I walked. I chanted phrases like “My cervix will open and my baby will come.” In between contractions I told them to “come on.” When they were starting I would say “stronger, stronger” until I had to begin moaning. I called Maureen at 8pm with contractions every 5-6 minutes. She told me to call her back when they were every 3 minutes and were that way for an hour. After that, I cried every time I had a contraction that was more than 3 minutes after the last one! At around 9:30 pm I decided it was time to go.

We arrived at around 10:30pm, I was checked . . . 9cm/100%/+2. Finally!! I went to the shower and squatted and moaned through very intense contractions and pressure. I laid down for a little while and Maureen massaged my back and feet. The contractions did not slow down this time!! I could not believe that I had wanted to get to this point . . . . what I wanted was a break. By 1:30am I had made my way to the toilet and was pushing involuntarily. Maureen checked me again and I had an anterior lip. I could not believe that I had finally made it!! I heard Maureen say, “Let’s have a baby!!” The nurse and grandmothers were called to the room as baby made its decent.

I can still hear the cheers of all those who surrounded me. I can still see myself looking at the photo of the baby in the saddlebag. I remember how intently I listened to every word that Maureen said as if I had never said those same words to other women. I remember touching the soft folds of my baby’s scalp as he inched closer to joining the world outside my womb. I remember the echoes of my own screams as the head crowned and I felt that “ring of fire” that I have told so many women about. All of those things got me through to the end . . .

As soon as I felt the release of pressure of the head being born, I looked down. As soon as those shoulders were out, I reached down to welcome my baby. My husband and the grandmothers were already crying. As I held him up to bring him to me, we could see that he was all wrapped in his membranes. I sobbed and sobbed. I was so happy to see him and hear his cry!! I chose not to have an ultrasound during my pregnancy, so I spent a good deal of my pregnancy wondering if he would be “normal”. After he was dried off, I lifted him up and inspected every inch of his perfect little body. Everything was in its proper place!!!

So at 2:14 am on Friday, Nov. 11, after a 45 minute 2nd stage, Kyle Joseph Janjay Harris was born (Janjay means “God’s gift” in my husband’s native Liberian dialect). I nursed, peed, ate, and settled in to sleep with my newly expanded family. I awoke 2 hours later and just stared at him, sobbing at various intervals while my exhausted husband snored beside us. We finally got up to eat breakfast and to prepare for discharge. Suddenly, my cell phone rang. My husband answered and to everyone’s great surprise, it was no other than Kitty Ernst, midwife pioneer, grandmother of the birth center movement, and founding faculty member of my midwifery program!!!!! She was calling to ask us to take pictures of our baby’s birth to put on the Banyan Tree. We informed her that the birth had already taken place, but reassured her that there were plenty of pictures! She was tickled. We also got a call from my college roommate, also student a midwife, who said that she was just thinking about me and decided to give us a call!

Between delivering at the birth center where I had learned how to be a midwife, the photo on the wall of the Frontier baby in the saddlebag, and phone calls from Kitty Ernst (representing the history of nurse-midwifery) and my college roommate (representing the future of midwifery), my on again, off again labor was a full circle moment for me, and my baby is a Frontier baby in more ways than one!! I would not trade it for anything . . . . and I thank God for all of it. I could not have done it without the patience and confidence of Maureen, who, towards the end, had more faith in me than I had in myself. I also thank Kyle, who was very nice to his mama and kept my fluid clear, had a steady heart rate throughout, and left me with only a small tear that did not need stitches! The journey, as long as it was, was well worth the effort and I am very thankful that there were no major complications. I am also VERY happy that the journey to getting him here is over . . . . and that it ended at the birth center.

WHAT? She can't retire. Who is going to keep us in stitches with the jokes rolling on the forums. I demand that you find a replacement with a humorous side. Otherwise, no deal!!!!

I think the greatest thing about Carol is that when we met her at Bound, we were all a little afraid....couldn't quite put a handle on what to make of her. She seemed so, so, well, "cranky" isn't the right word...."eccentric" didn't fit, not "mean" but not your joyous, bubbling over effervescent personality either. We were all, and I think I can speak for the majority of us, BLOWN AWAY when we started reading the forums and Carol's insane humor. I LOVE her and can't imagine opening the forums ever so often to find a long list of hysterically funny witticisms....you gotta love it!

When is this so-called "retirement" (the one we're not quite sure we'll let happen????)

My most memorable moment of Carol dealt with her response to my accidentally submitting a case study assignment to her in Decision-Making, in color--not the typical black and white typewritten paper format. Carol, e-mailed me with this little note at the top of my case study saying something to the effect of "BTW, weren't we supposed to be starting this in black ink, with the rainbow beginning with my replies back to you?" I was mortified. What Carol didn't know was that I'm an adult ADHD----I learn in color----that's how I do ALL my assignments, for ALL my classes (& have for years), but prior to submitting anything, I just highlight and change it all to black to accommodate my teacher's preferences. When I (most embarrassingly) explained, apologized, and said I'd immediately re-submit it in the correct color ink--Carol didn't bat an eye--she just went right ahead and kept my colors, and started her own new color--and said something to the effect "that we'll just keep the color, and have a REAL rainbow", and told me to "feel free to submit in color anytime". I laughed, and then I cried--because I've always had a challenge "learning how to learn"--and years ago figured out what worked best for me--but just never got caught at it :) I loved her all the more for being able to accommodate to my way of learning--it never bothered her, or cramped her style. At least I never knew if it did. Please, if this is used, don't post my name with it--I just felt she needed to receive recognition for the awesome, wonderful teacher she is!! I've gleaned so-o much from her. She'll never begin to know the difference she's made in the view I have of many things involving life--but especially of myself. She challenged me, encouraged me, corrected me, and has invested in me. I'll NEVER forget her!!!

Consumer Reports has named cesarean section number three on its list of “12 Surgeries You May Be Better Off Without.” The recommendation, based on research at the non-profit Rand Corporation, encourages consumers to “check out safer alternatives” before having any of the 12 listed “invasive procedures.”

(PRWEB) December 29, 2005 -- Consumer Reports has named cesarean section number three on its list of “12 Surgeries You May Be Better Off Without.” The recommendation, based on research at the non-profit Rand Corporation, encourages consumers to “check out safer alternatives” before having any of the 12 listed “invasive procedures.” See www.consumerreports.org/mg/free-highlights/manage-your-health/needless_surgeries.htm

The number three ranking of cesarean surgery appears just above episiotomy (#4) and hysterectomy (#5) and below angiography (#1) and angioplasty (#2). The recommendation from Consumer Reports Medical Guide comes on the heels of the Centers for Disease Control report showing that the primary cesarean rate in the United States has reached a historical high of 20.6 percent and an overall rate at 29.1 percent in 2004. The latest overall rate reported in Canada is 22.6 percent.

“Women need to be selective consumers and study their birth options,” said Tonya Jamois, president of the International Cesarean Awareness Network (ICAN). “The priority should be to avoid that first cesarean, and if you have a scar on your uterus, educate yourself about vaginal birth after cesarean (VBAC). Twenty years of research shows VBAC to be safer for mother and baby than repeat cesarean surgery.”

According to Consumer Reports Medical Guide, most cesareans are performed because labor is progressing too slowly. The Guide notes that a number of less invasive procedures may be enough to stimulate labor. Consumer Reports encourages women to ask “what percentage of normal deliveries as well as births following a prior cesarean the physician delivers by C-section. Ideally, look for rates below 15 percent in women who haven’t had the procedure and about 60 percent in those who have.”

The guide also states that physicians perform cesareans in the vast majority of women who have already had one. But ACOG, the American College of Obstetricians and Gynecologists (as well as SOGC, the Society of Obstetricians and Gynaecologists of Canada) has published research showing most women could safely try for a VBAC, which would succeed about 70 to 80 percent of the time; and if it does not, a cesarean can take place. Unfortunately, cost concerns and fears over liability have led some physicians and hospitals to ban VBAC and require repeat cesarean.

Consumer Reports also recommends women consider giving birth in a hospital with a certified nurse-midwife, if available, since their births have lower cesarean rates than births with obstetricians.

“Giving birth in a free-standing birth center or at home with a midwife is another option that women should consider," Jamois said. "Midwifery care has been proven to be a safe alternative for most pregnant women. Countries where the majority of babies are born into the hands of midwives, such as The Netherlands, have cesarean rates below 10 percent, and they boast the best maternal and infant health outcomes in the world.”

Those who seek information about preventing a cesarean, or support in recovering from a cesarean, can visit www.ican-online.org for more information. In addition to more than 70 local chapters across North America, ICAN hosts an active online discussion group that can serve as a resource for mothers.

About Cesareans: ICAN recognizes that when a cesarean is medically necessary, it can be a lifesaving technique for both mother and baby, and worth the risks involved. Potential risks to babies include: low birth weight; prematurity; respiratory problems; and lacerations. Potential risks to women include: hemorrhage; infection; hysterectomy; surgical mistakes; re-hospitalization; dangerous placental abnormalities in future pregnancies; unexplained stillbirth in future pregnancies and increased rate of maternal death.

Mission statement: ICAN is a nonprofit organization whose mission is to improve maternal-child health by preventing unnecessary cesareans through education, providing support for cesarean recovery and promoting vaginal birth after cesarean.

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The faculty practice continues to be very busy working in the community as well as seeing our patients. The FNPs are continuing their monthly health education sessions in the Leslie County Elementary Schools to help address the problem of obesity. Wildcat Way to Wellness has been very successful in bringing various community groups together to help promote the health and wellness of Leslie County youth. We are working on developing this program in Clay County. A FNP will be attending the Kentucky Association of School Based Health Centers (SBHC) to begin to develop the foundation of bringing SBHCs to Clay County. This is a project that is sure to keep us busy and we will keep you updated.

As of January 2006, the post-baccalaureate nurse-midwifery certificate will no longer be offered at FSMFN. This decision was made by the FSMFN Board of Directors at the October 2005 Board Meeting for several reasons. One was that given the structure of CNEP (students need to only complete 6 more credits to obtain the MSN) and the added value of the MSN degree, it only makes sense that students should complete the MSN and not only receive a post baccalaureate certificate. Second, the faculty strongly feel that students need to complete the two additional MSN courses in the suggested sequence (Theories in Level I and Research in Level II) in order to use the information in the remainder of their program. Last, the Board of Directors and the faculty believed that nurse-midwives should be educated at the graduate degree level. This decision is in congruence with the December 2005 position statement published by the American College of Nurse-Midwives which stated that all CNMs should be educated at the at the graduate degree level, and that as of 2010 completion of the Master's or Doctoral degree shall be required for entry into clinical practice (http://www.midwife.org/display.cfm?id=458). This decision will have no effect on the Post Masters Certificate option for Nurse-Midwifery education. Students who enrolled in the post-baccalaureate certificate program prior to January 1, 2006 will be allowed to finish that program, if they desire, but are encouraged to complete the MSN Program.

There are always many exciting discussions happening at the Frontier School of Midwifery and Family Nursing.  The topics at the top of the list for the administrative team and faculty are ways to increase the number of students who graduate and complete the program within the established time frame. Attrition rates for distance education are typically higher than in traditional programs.  Our attrition rate at Frontier continues to be lower than most distance based programs but it has increased in the past year.  In an effort to address this issue, the administrative team and the faculty have been discussing and reading the literature to improve our school's processes and student support services.

The administrative team held a retreat in January in Hyden to review the Annual Strategic Plan for the school, and to discuss the issues of student retention and graduation rates.  Here are a few of the ideas that were discussed by the administrative team and faculty. These are the first of a series of improvements that you will be seeing in the up coming months.

Interactivity in the courses has been a hot topic.  In all distance-based programs, faculty members are trying different approaches to deliver course content. Here at Frontier, we are looking for ways to address each of the different learning styles in the delivery of our course content. Videos and chats have already been added to some of the courses.  Each Course Coordinator has a goal this year of adding more interaction to their courses.

We have also been looking at how we can provide better support to our students.  Availability through an increase in posted office hours is one way.  Increased availability of faculty members will be accomplished by having each full-time faculty member post 20 office hours per week. Please call us for questions, comments or just to talk if you are feeling isolated. 

A student services website is currently under construction.  This web will have resources available for students needing help with exam taking, writing skills and other student support issues. 

We have also been working on ways to help new students come into the program better prepared to be in a community-based classroom.  This includes having a better idea of their schedules prior to Frontier Bound that will help them structure an actual schedule for “class time” when they come home from Bound.  We are recommending that they have their office space/classroom setup and the books for the first three courses waiting for them when they come home as well.  We want the new students to be able to start class as soon as the return home from Frontier Bound.

Another focus for new students is to improve their preparation to be community-based/distance learners. There is a plan in place to have a course that is completed by students before they come to Frontier Bound to assist with this process.  This will include more information on becoming a life-long learner and ways to address common issues encountered in learning at a distance.

The faculty is meeting in March to continue these discussions.  We are also looking for ways to refine our curriculum.  We will be discussing ways to make the course instructions clearer, the content and the readings not as bulky, while continuing to deliver an excellent curriculum. 

The ideas of our students and alumni are very important as we go through this process of improvement.  We need you to complete the course evaluations and the graduate surveys to let us know what we can do to improve our program.  We also welcome suggestions and comments that will continue to help us make more nurse practitioners and nurse-midwives. 

Stay tuned for more information.  We encourage you to read the Strategic Plan and President's Report.  Please stay in touch and let us know what you think.

I was in the forums the other day and found a student asking if we offered a Women’s Health Care Nurse Practitioner track that was separate from the nurse-midwifery track. It seems that we have added so many new options in the last two years that there is confusion. I thought I would do a review of the line up of our programs in an effort to decrease the confusion. .

FSMFN offers a Master of Science in Nursing Program with three different tracks. Students can choose to take the nurse-midwifery track (CNEP), the family nurse-practitioner track (CFNP), or the women’s health nurse practitioner track (CWHCNP). The Community-based Women’s Health Nurse Practitioner track is the newest option at Frontier. While CNEP graduates have been able to add one clinical course (4 credit hours) to make them eligible to sit for the WHCNP certification exam since 1998, we have not had a separate WHCNP specialty option until March of 2005. This was added at the request of many of our inquiries to Frontier. The curriculum plan can be accessed in the Frontier catalog at http://www.midwives.org/catalog/DeptMidwifery.shtm. We currently have five students enrolled in this track option. We are continuing to offer the one additional clinical course to our CNEP graduates who are interested in dual certification as both a nurse-midwife and a nurse practitioner.

Students who already have a Master of Science in Nursing can now choose to do a post-masters certificate in any of the three specialties. This is especially convenient for those who are already clinicians in one specialty and who want to add a second specialty. For example, this could include nurse-practitioners returning to add nurse-midwifery or nurse-midwives who want to add family nurse practitioner skills. We now have several graduates who have completed both the nurse-midwifery and family nurse practitioner certifications.

We are no longer admitting students to the post-baccalaureate certificate nurse-midwifery program. There is another article in this newsletter explaining that decision. We do still have students enrolled in that option. Once they finish, that option will end.

We are currently in the process of developing an ADN-MSN program option. That program is described more fully in another article in this newsletter. We are hoping to enroll the first students into that program in September 2006.

I hope this helps to clarify what programs we have to offer here at Frontier in 2006. If you have any questions, please feel free to write to me at sstone@midwives.org.

A goal of the FSMFN faculty and Board of Directors is to establish an ADN-MSN Bridge at Frontier. This bridge option will be designed to offer registered nurses who hold an Associate Degree in Nursing and have a desire to become a nurse-midwife or nurse practitioner, the opportunity to complete the required course work and bridge directly into the MSN program. Students will not complete a bachelor’s degree.

Many of the inquiries to our program hold an ADN. A recent survey of inquiries revealed that of the 205 respondents, 92 (43 %) currently hold an ADN and would be interested in entering a bridge option at FSMFN if it were available. Results of a similar survey of current students at FSMFN revealed the following:

• Of the 150 respondents to the survey, 53% started their nursing career with an ADN.
• Of those starting with an ADN, 75% of those would have been interested in the ADN-MSN option if it were offered at Frontier.
• Of the 150 student respondents, 80% believe there is a need for an ADN -MSN program at Frontier.

During the summer of 2005, the curriculum committee designed the bridge plan. The plan includes completion of six courses worth 20 credits. Students will be required to complete all courses in 12 months. Upon successful completion of the courses, they will be eligible to start the MSN curriculum.

Curriculum Overview
Bridge Year

This bridge year of courses was approved by the Faculty at the October 2005 faculty meeting. A proposal was brought forward to the Board of Directors (BOD) at the October Board Meeting. The BOD approved the proposal. The plan was submitted to the Kentucky Council on Post Secondary Education in November of 2005 and was added to the FSMFN state licensure in December 2005. The proposal and curriculum were submitted to SACSCOC in December of 2005. We received approval from SACS in January. The next step will be to submit the plan to NLNAC and ACNM/DOA. Assuming approval, a pilot class will be admitted to the ADN-MSN bridge in September of 2006. We will keep everyone updated on the progress of this option for making more midwives and nurse practitioners.

As I sit here at the end of my last clinical day, I pause and take a moment to reflect over the past 16 months of my life…

It was a beautiful summer day in August 2004 in the mountains of Kentucky.  Not quite as hot as what I was used to in Texas.  I found myself surrounded by a classroom full of strangers from all over the United States, with so many different experiences and stories to tell.  I couldn’t help but feel a little homesick and wonder to myself, “what have I gotten myself into this time.”  However, I knew my purpose for being in the hills of Kentucky that summer…I was going to be a MIDWIFE!

As we all circled up at the end of Bound and said our goodbyes, we each went our own way, back to our lives.  Little did I know that my life would become a whirlwind of events over the next few months.  I proceeded with my studies and continued to work full time nights (supervisor) in Labor and Delivery.  There was so little time between being a mom of three, studying, and working full time. 

In October, my husband and I separated and sold our house. I felt as if my life was over, however, I continued to study.  The holidays came and went…on to Level 2.  In March, my husband and I began to work out our differences and piece our family back together. I continued to work and study.  In April, we decided to build a house and move to the city that I would eventually be working in.  During this time, I also had to have emergency surgery. Still, I continued to study! 

In June, we were moving and there was that huge Level 3 deadline to meet!  Lord, give me strength.  Now I was studying day and night.  Level 3 came and went in September.  I met a whole new group this time, including some friendships that I will keep for the rest of my life. 

It was finally time to quit work.  I was scared. Had I saved up enough money to sustain us for 6 months?  Time for clinicals, and to leave my family as I traveled 6 hours away to my site.  This had to have been the longest 7 weeks of my life as I sang my 5 year old to sleep over the phone at night, and then afterwards cried myself to sleep. 

Then came December and I got to come home.  Once again the holidays came and went, just a big blur.  January is here, and I can see the light and the end of the tunnel as I finish up numbers, hours, papers, and tests.  Oh the taste of victory is so sweet!

What have I learned or gained from this journey…

• Being a midwife is more than just a title. It’s a gift from the heart.
• I can do anything I put my mind to. I just have to dream big enough.
• Learning as you get older is more challenging, yet possibly more rewarding.
• Life is precious, make the most of it.

May God bless you and sustain you through your journey! 

Pamela Stubblefield, RNC, BSN, SNM

This is me holding one of the precious babies I got to catch while in Tahlequah, Oklahoma!

Click Here to view a special presentation for Carol
Click Here to read Cammie Hauser's My favorite Carol Moment
Click Here to read Katie McNeff's My favorite Carol Moment
Click Here to read an anonymous My favorite Carol Moment

Carol is a family nurse practitioner who came to Frontier from the Universality of Tennessee at a critical time with just the experience and talents needed to shepherd the school from a professional school with accredited programs of study in nurse-midwifery and family nursing to a full fledged, independent, degree granting. graduate school. She was seasoned and savvy about the world of graduate academia and the expectations of regional accreditation agencies. In short she had “been there and done that.” The requirements of three accrediting bodies had to be met almost simultaneously. The first step in the longer and more expensive process than any of us imagined was the “biggie”; regional accreditation by the Southern Association of Schools and Colleges. This was followed by the National League for Nursing and then, most familiar to us, the American College of Nurse Midwives. In all, it took over six years of continual work on curriculum, campus improvement, faculty credentialing and four library shelves of notebooks filled with documentation of our eligibility. Carol knew exactly how to present the details of every report – and it is true that ‘The Devil is in the Details” when it comes to meeting the requirement s of an accrediting agency.

We passed all reviews with flying colors. But savvy about the world of graduate academia and the expectations of accrediting agencies is not all that Carol Panatucci brought to Frontier. She is a strong, quiet woman who listens to all sides of the discussion of an issue. When she speaks, everyone listens for she is a genuine “sage femme” on issues involving curriculum, student affairs, faculty responsibilities and administrative details. She is a no nonsense gal who frequents on-line faculty discourse and occasionally puts forth a pithy remark that rings true to everyone.

Frontier has a relatively young faculty whose growth has been healthy in part because of the supportive nurturing of Carol Panicucci. Carol always dreamed of being a Frontier Nurse but retired thinking it would never be. All I can say is, “This was the right time for you to be here Carol.”

Staff News...

The cheery and friendly new voice that greets each caller is Susan Morgan the school's new receptionist/secretary.  Susan was hired in November and is doing a fabulous job.

Our Quality Assurance Coordinator, Billie Couch, has completed all of the pre-requisites for the BSN program she’s enrolled in.  This semester she is carrying 14 credit hours.  She has been awarded the Kentucky River Properties Scholarship, LLC Nursing Scholarship, and the Kentucky Educational Excellence Scholarship.  We are so proud of Billie!

Lonnie, Judy and Sherri have completed a little dorm project that Judy and Sherri have wanted to undertake for some time.  They tore all the old linoleum out of the Haggin dining room, and restored the original hardwood flooring.  All of the endless sanding, stripping and scrubbing was definitely worth the effort -- the floor looks great.

Our energetic tech squad is feverishly working on the new web conversion project, and they’re doing a wonderful job.  We have some very talented and dedicated techies!  Keep up the good work guys.  We do appreciate all you do.

Sarah Kehrberg delivered her first child with the help of a midwife, and when she got pregnant again, she wanted to repeat the very positive experience.  The full article will be available on the Web for a limited time:http://www.kentucky.com/mld/kentucky/living/13394585.htm(c) 2005 Lexington Herald-Leader and wire service sources. All Rights Reserved.

I have some news. A couple of months ago Carol Panicucci called me and told me that she wanted to retire. I tried to discourage her but after talking with her, I guess she really does deserve to work less (not totally retire though ). She really did not want to be the Coordinator of Graduate Education any longer. We did a national search and interviewed several very good applicants. But it seemed that the very best applicant of all was right here on the Frontier faculty already. I am pleased to announce that Francie Likis will be our new Coordinator of Graduate Education. I hope you will all join me in congratulating Francie on her new position.

Sincerely,
Sue Stone