xt7kpr7mqt8p https://exploreuk.uky.edu/dips/xt7kpr7mqt8p/data/mets.xml The Frontier Nursing Service, Inc. 2006 bulletins  English The Frontier Nursing Service, Inc. Contact the Special Collections Research Center for information regarding rights and use of this collection. Frontier Nursing Service Quarterly Bulletins Frontier Nursing Service, Vol. 81, No. 3, Spring/March 2006 text Frontier Nursing Service, Vol. 81, No. 3, Spring/March 2006 2006 2014 true xt7kpr7mqt8p section xt7kpr7mqt8p UITIC Number 3 _  ¤· ¤%
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 US ISSN 0016-2116 h ·
Introduction to FNS 1 `
The Journey "Continuing to Build" - W.W. Hall, Jr. 2
Field Notes 4
Beyond the Mountains 8
The Courier Program — Susan Weller 9
FSMFN News — Dr. Susan Stone 12
Mary Breckinridge Home Health Agency — Susan Weller 15
Memoirs of an FNP - Heidi Froemke, FNP 17
Reaching "Wide Neighborhoods" — Suzan Ulrich 19
In Memoriam 22
Urgent Needs 32
Frontier Nursing Sewicc Quarterly Bulletin is published at the end of each
quarter. Subscription Price $5.00 a year for Donors/$15.00 for Institutions. _
Periodicals postage paid at Wendover, Kentucky 41775 and at additional
mailing offices. POSTMASTER: Send address changes to FNS, Inc. 132
FNS Drive, Wendover, Kentucky, 606-672-2317. Copyright FNS/Inc. .
2000 All Rights Reserved. The Frontier Nursing Service does not
share its donor mailing list. _.

. Introduction to Frontier Nursing Service
4 Bom in 1881 into a prominent American family, Mary Breckinridge
· spent her early years in many parts ofthe world - Russia, France,
Switzerland and the British Isles. After the death of her two chil-
dren, she abandoned the homebound life expected of women of
her class to devote herself to the service of others, particularly
mothers and children.
Mrs. Breckinridge established the Frontier Nursing Service (FNS)
in Leslie County, Kentucky in 1925, as a private charitable organi-
zation serving an area of 700 square miles. It was the first organi-
zation in America to use nurses trained as midwives under the
direction of a single medical doctor/obstetrician, based at their
small hospital in Hyden. Originally the staff was composed of
nurse-midwives trained in England. They traveled on horseback
and on foot to provide quality prenatal and childbirth care in the
client’s own homes. The service charged $2.00 per year for fam-
ily medical care and $5.00 for prenatal care and delivery, payable
in eggs, meat, service, or cash. No one was ever turned away.
Today, Mrs. Breckinridge’s legacy extends far beyond eastem
Kentucky. FNS, Inc., is the parent holding company for Mary
Breckinridge Healthcare, Inc., Frontier Nursing Healthcare, Inc.,
which includes six rural healthcare clinics; Mary Breckinridge
Home Health Agency and for the Frontier School of Midwifery
and Family Nursing which offers a Master of Science in Nursing
degree with tracks as a Nurse-Midwife, Family Nurse Practitio-
ner and Women’s Healthcare Nurse Practitioner.
Mary Breckinridge’s home, The Big House, located at Wendover,
was designated a National Historic Landmark in 1991 and is a
licensed Bed & Breakfast Inn. For more information or reserva-
tions, call 606-672-2317 or e-rnail fnstours@yahoo.com. You can
l also access our website: www.frontiernursing.org.

_ The Journey - “C0ntinuing to Build" I
W W Hall, Jr., President & CEO h
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  ·*»-•~{»»_;,_;Ey¢*¤=r¤,  “ I
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I am so pleased to carry the news of stability and strength at the  
FNS. Many thanks to our Board, staff and supporters, for this  
allows the opportunity to build and plan for a very bright future. I
Our Development Team, located at Wendover, has successfully  
added new foundations as strong supporters believing in our mis-  
sion. Individual donor giving has also seen a marked increase as  
we celebrated our 80th Anniversary last year.  
To encourage patient use of our hospital and clinics, many im- i
provements to our facilities have now been completed. Significant  
projects are now in the final planning phase to enhance our mater- I
nity service and to expand services in Clay County where we I
have long maintained a presence.
The key at FNS remains the quality of our providers. New addi-  
tions to key positions have provided extremely positive results from I
a patient satisfaction standpoint and our financial stability. {
Thanks to you, our faithful supporters, for ensuring that our care-  
fully considered plans for a very bright future are successful.  
I .

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- Field Notes V V
At Wendover during December, the retaining wall along Pig Alley ·
from the Blacksmith Shop to the Big House, was replaced. The `
original wall had been built approximately 30 years ago and was  
cracking and falling due to the shifting ofthe mountain. i
During December, Wendover was finally connected to the City  
Sewer System — a wonderful improvement. Also during Decem—  
ber, the floor in The Big House Twin Room was replaced due to  
water damage from the heating unit in the attic.  
During January, new water lines were installed at Wendover due  
to underground leaks from the shifting ofthe mountain. I
Guests at Wendover from December l — March 1, including over- i
night, lunch/dinner or special functions were 524. {
The Mary Breckinridge Hospital Emergency Room recently re-  
ceived two Datascope bedside Cardiac Monitors through a grant  
from HRSA (Health Resources and Services Administration).  
Dr. Andrew Krasuski, OB/GYN, Board Certified, will begin work  
at Mary Breckinridge Healthcare March l. Dr. Krasuski worked |
at Mary Breckinridge Hospital during 2001 and we welcome him  
back with open arms!  
The Mary Breckinridge Home Health Agency recently had a com- i
puter conversion where laptop computers will be used for patient 1
care documentation. {
An Employee Fundraising Drive at Mary Breckinridge Hospital 5
resulted in the refurbishing of several patient rooms on the Medi- E
cal Unit. Improvements included new flooring, paint, tiles and l
molding, Hillrom beds, over bed tables, bedside tables, visitor seating  
and sleeper chairs. Thanks to the employees for their enthusiasm

  while they continue their fundraising efforts. Also, special thanks
to two local businesses, Hyden Citizens Bank and Begley Lumber
, Company, for contributions for the room renovations.
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Newly Renovated Patient R00n1
A A Fast Track process will soon be implemented in the Mary A
Breckinridge Hospital Emergency Room. The purpose ofthe Fast
T Track is to move the less serious patients in and out in a more
efficient manner. ln addition to physicians, an FNP will be placed
in the Emergency Room. Kathy Lauderdale, FNP, will begin work
T in the Emergency Room March l. Kathy worked at the Beech
Fork Nursing Center for two years as a National Health Service
Corp placement.
Y Recent renovations at Mary Breckinridge Hospital included The
i Scott House, located adjacent to the Mary Breckinridge Hospital,
: R which was remodeled as a Physicians Speciality Clinic and The
 , Anne Wasson Center, located inside the Hospital which
A received minor renovations. Renovations will soon begin on the

· Duplex - home ofthe Mary Breckinridge Home Health Agency §·
which is located adjacent to the Mary Breckinridge Hospital.  
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The Duplex - Home Health Building  T

  February 9, Mr. Trey Grayson, Kentucky Secretary of State, and
S Ms. Donna McClure, Field Representative for Senator Mitch
~ McConnell, visited Wendover.
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Donna McClure, Trey Grayson and Michael Claussen
(FNS Tour Guide)
Frontier Nursing Service — www.frontiernursing.org
l FSMFN Community Based Nurse Midwifery Education Program
 , (CNEP) - www.midwives.org
_ l
_ FSMFN Community Based Nurse Practitioner Program (CFNP)
_ - www.frontierfnp.org

Beyond the Mountains  
January 20th, Kevin Cook, Operating Room Head Nurse and ·
Region 10 Bioterriorism Director, attended a Pandemic Flu Sum- J
mit in Frankfort, Kentucky. This Summit allowed a glimpse into a
pandemic flu episode and discussion of procedures if this arises in _
the State of Kentucky. i
January 23 - 26th, Kevin Cook attended a Perioperative Nurse 1
Conference in Brentwood, Tennessee as part of an ongoing leaming i
experience for managers and nurses in the area of operative care. p
February l0th, Mallie Noble attended the Kentucky Hospital As- l
sociation Cumberland District Meeting in London, Kentucky. Topics I
included certificate of need, Medicaid, provider tax and medical
Larissa Maggard Pack, PA, attended a Kentucky Hospital Asso-
ciation Meeting in Louisville regarding Quality Improvement.
March 18th, Mrs. Breckinridge will be inducted into the Medical
Mission Hall of Fame at the Medical University of Ohio in Toledo.
Mr. Bill Hall, FNS, Inc., CEO & President, Barb Gibson, Assis-
tant to CEO, Michael Claussen, FNS Tour Guide and FSMFN I
Alumni Joan Moon, plan to attend the ceremony. We consider this I
a great honor. An update will be provided in the June Quarterly

  The Courier Program
by Susan Weller, Courier
' Life as a Courier for the Frontier Nursing Service has changed
since the "early years". Originally, modeled after the use of girl
j chauffeurs for the CARD Motor Corps in war—tom France, after
i World War I the Courier position first focused on transport. "Trans-
J port was the backbone of the work in the American Committee
E for Devastated France, even as it is in the work of the Frontier
  Nursing Service. And such transpor“t"! ON ide Neighborhoods, page
, 272). Mrs. Breckinridge wrote in her biography, Wide Neighbor-
    about the notoriously rugged Eastern Kentucky Appala-
  chian landscape and the role of the Courier in conquering it.
  The first male and female Couriers were Brooke Alexander and
T Marvin Breckinridge. ln their days, duties more closely resembled
the true meaning of a "Courier" - coordinating travel on horse-
back between Wendover, the Hyden Hospital, and the outlying
l clinics, as well as Hazard, 20 miles away.
p A long line of prominent Couriers followed Brooke and Marvin,
including the original "resident Courier," Jean Hollins, Kate Ire-
land and former Courier, now FNS Board Chairman, Jane Leigh
r Powell. The Couriers were selected carefully, for as Mrs.
T Breckinridge explained in Wide Neighborhoods, “Kentucky moun-
tain transport, depending as it did in its early days entirely on horses
and mules, called for girls who had more than horsemanship to
J offer - although that had to be good enough for them to travel icy
trails, swim swollen rivers, carry sick babies on the pommels of
, saddles and escort nervous guest." (page 272 Wide Neighbor-
Y  ).
While today’s Couriers at FNS have a different array of duties
and opportunities, a weekly washing ofthe FNS Tracker does pay
E homage to the former days of grooming horses. And while shad-
owing nurses, midwives, doctors, and teachers and pursuing vol-
unteer opportunities in the community diverges from the original

Courier tasks, the Program continues to allow for a relative out- ‘*·
c sider to the community to experience rural life and to see FNS in `
action. This evolution which Mrs. Breckinridge saw in her time,
as the Courier Program expanded beyond close family and ac- "
quaintances to include an array of college students. y
Previous Couriers needed a large knowledge of animal husbandry  
and local landscape. Today, when the 20 minute drive to Hazard  
can seem long I need only to imagine the 20 miles on horseback  
regularly crossed by Couriers to wonder if I have gone soft. Yet I
today’s Courier Program, assisted by the staff, past and present,  
here at Wendover and the generous outreach of FNPs, midwives, i
and former Courier, invites the expression of a new form of "Cou— I
rier" travel — not of miles underfoot but miles underway towards I
personal, professional, organizational and community goals.  
My Courier Experience I
by Susan We/[er, Courier I
Life as a Courier at FNS has proved   I ul`. H r — Y ,  
to be a rich and varied experience.   I A      Hm; I
During my first month in Kentucky   ’ ,L_~ E   I
I have had the opportunity to shadow     _.-,,   __  
a number of FNS healthcare pro-        
viders and to interact with several of      
them after their work hours. Thank  II ·     M  
you to the numerous people who     I    Y V  I '  ,  V  
have reached out with kindness and        
welcoming words! ~ l
So far, I have shadowed providers at the Beech Fork, Christian  
Family Healthcare and Dr. Anne Wasson Centers. At all three 1
centers, the providers I followed - FNPs Heidi, Janessa and Sa- I
rah; Drs. Begum and Varghesse; and PA Larissa - graciously I
allowed me to observe their skilled interactions with patients and I
took time out of their busy days to explain diagnoses and tech- I
niques. I also particularly enjoyed spending two days on Home  

’·· Health visits with CNAs Kim and Samatha, who impressed me
with their compassionate care and the critical roles they serve in
the lives of their patients.
p Currently, I volunteer one moming a week at the Adult Leaming
1 Center in Hyden, a rewarding and inspiring experience as the
  Center serves people committed to furthering their education. In
  addition, one day each week I help in the office at Wendover and
  on another day each week I help in the office at the Kate Ireland
  Healthcare Center in Clay County. Thanks to the Wendover crew
  and to Angie Mitchell for putting me to use. This month I attended
i the monthly Animal Shelter Committee meeting, the local food
l drive and the local blood drive - all great opportunities to see dif-
  ferent areas of community participation in Hyden. Thanks also to
  Anna Carey, former Courier, and Michael Claussen, Courier Co-
  ordinator, for helping me get connected.
In the remaining two months of my time here I plan to continue
Q my current volunteer and office commitments; to shadow a nurse
  midwife, in the ER and at Community Health Center; to observe
r in the Leslie County Schools and to train and volunteer with the
i Rape Crisis Center. Once again, a huge "thank you” to everyone
l here. You have made being a Courier a wonderful experience for
  me so far.
  Former Courier News
  Karen T homisee, Atlanta, Georgia (‘96, Courier Coordinator) —
i wrote that she finally made it to nursing school and it would never
  have happened if it wasn’t for her years at FNS. Karen was
  awarded a full fellowship to Emory University School of Nursing
  and is in her first semester of a dual BSN/MSN program with a
I masters speciality of Family Nurse—Midwife. Karen renewed her
interest in nursing after a medical mission trip to Haiti which led
I I her to quit her job as a Photojoumalist to spend more time on
V healthcare initiatives in Haiti.

Frontier School of Midwifery and Family Nursing Update *‘
` — Dr. Susan Stone, President and Dean l
FSMFN Developing an ADN-MSN Progrum A
A goal ofthe Frontier School of Midwifery  H
and Family Nursing ( FSMF N) faculty and  
Board of Directors is to establish an ADN—   " f°'’‘·i` ? `—~  li p
MSN Bridge Program. This bridge option   _   E''     .  {
will be designed to offer registered nurses       trz f 
who hold an Associate Degree in Nursing   g in P
and have a desire to become a nurse—mid-
wife or nurse practitioner, the opportunity to complete the required
course work and bridge directly into the MSN Program. Students I
will not complete a bachelor’s degree.
Many ofthose sending inquiries to our Program hold an ADN. A
recent survey of inquiries revealed that ofthe 205 respondents, 92
(43%) currently hold an ADN and would be interested in entering Q
a bridge option at FSMFN ifit were available. Results ofa similar
survey of current students at FSMFN revealed the following:
Of the 150 respondents to the survey, 53% started their nursing A
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 the FSMFN. 80% ofrespondents believe there is I
a need for an ADN-MSN Program at FSMFN. A
During the summer of2005, the Curriculum Committee designed y
the bridge plan. The plan includes completion of six courses worth I
20 credits. Students will be required to complete all courses in l2
months. Upon successful completion ofthe courses, they will be
eligible to start the MSN curriculum.

» Curriculum Overview Bridge Year
. The objective of the F SMF N Bridge Year is to provide the oppor-
‘ tunity for students to meet the baccalaureate nurse competen-
Didactic-Clinical Credits
j N400 Physical Assessment 2-l
A N404 Statistics 3-0
N405 Communication 3-0
N406 Leadership 3-0
N407 Theories and Research 3-0
N408 Community Health 3-2
Total 17-3
This Bridge Plan 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
and was approved. The Plan was submitted to the Kentucky Coun-
cil on Post Secondary Education in November of 2005 and was
added to the FSMFN state licensure in December 2005. The pro-
posal and curriculum were submitted to Southern Association of
Colleges and Schools, Commission on Colleges (SACSCOC) in
December of 2005. We received approval from the Southern
Association ofColleges (SACS) in January. The next step will be
T to submit the plan to the National League of Nursing Accrediting
Commission (NLNAC) and the American College ofNurse—Mid-
A wifery Division of Accreditation (ACNM/DOA). Assuming ap-
proval, 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 educating more midwives and nurse practitio-

Frontier School of Midwifery & Family Nursing ·»
Update - C0n’t ‘
The Annual President’s Report for 2005 has been published. You I"
may read the report by going to http://www.midwives.org/
PresidentsAnnualReport/pres2006.pdf. lf you would like a print
copy of the Report, you may call Shelley Aldridge at 859-253-
Enrollment is up at the FSMFN. We enrolled 34% more students
in 2005 when compared to 2004. This growth is especially appar-
ent in the Family Nurse Practitioner Program. While nurse-mid-
wifery is stable, enrollment in the Family Nurse Practitioner Pro-
gram more than doubled. Interest in the new Women’s Health
Nurse Practitioner Program is garnering increased interest. Class
47, admitted in November of 2005, was the largest class that has
been admitted to FSMFN in over ten years. We will be enrolling
five students in that Program in the March 2006 class. It appears
that offering the MSN has had a tremendously positive effect.
. *"  ’   » . I   r      
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Class 47

rt Mary Breckinridge Home Health Agency -
One Perspective
. —Susan Weller, Courier
As a Courier, I recently shadowed two Mary Breckinridge Home
Health Agency providers. The Certified Nurse Assistants (CNA’s)
I observed, Kim and Samantha, impressed me with the impor-
tance and quality of the physical care they provide and the warm
and personal relationships they maintain with their clients.
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  Nursing Assistants Kimberly Short and Samantha Canada
  Services provided by the Home Health providers include personal
, bathing and hygiene, taking vitals, light housekeeping, and social
A interaction, including asking specific questions to assess health
status. Home Health providers deliver personal care to vulnerable
j individuals who are disabled in some fomi. Without Home Health
care these individuals would have a difficult, if not impossible,
ly time meeting basic personal needs in their homes. Home Health
A providers serve a person’s basic physical needs in his or her own
environment and thus with an intimate perspective not afforded in
· a general doctor’s office.

For this reason, Home Health provider-patient relationships truly t
extend beyond the meeting of physical needs. ln many cases, ‘
these providers hear the latest updates in their clients’ lives. In
one household, a client professed loyalty to "her" provider, stat- ’
ing she would ‘send anyone else bacl<.’ In another household, a
client described her provider with heartfelt compliments and in-
vited her to drop by and share a meal. For the client, these pro-
viders are the caring "1"aces” of FNS. They are a consistent help-
ing hand in many lives and earn the honest appreciation of those
they serve, several of whom personally remember Mary
Breckinridge. Indeed the original intent of Mrs. Breckinridge was
to provide home-based care to those unable to access such ser-
vices. The sense ofappreciation with which this help is received,
I imagine, remains precisely the same today as in her time.
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Willa M0rris, Director 0 the Mar
Breckinridge Home Health Agency

· Memoirs of an FNP - A Week in the Clinic
by Heidi Froemke, ARNP
j Driving home from an outlying clinic last week, I was thinking that
probably, in my almost 13 years here, I’d seen just about every-
thing. I never learn. Thus began my week as an FNP at the Dr.
Anne Wasson Rural Health Clinic. I returned that aftemoon to
find a child who had pushed "something" (its true nature uncer-
tain) up his nose. A fishing expedition ensued. I took a call from
the radiologist to tell me the CT scan on a "dizzy" patient revealed
brain metastases — its original source unknown. I visited a patient
in the hospital and we mapped out a plan for her care at home
upon discharge. Numerous phone calls later there was oxygen at
her home. Papers were faxed to and from to obtain a motorized
wheelchair, only to be informed that, after all, I didn’t have the
correct fonns. I began again.
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Heidi F roemke with patient Ashleigh Baker

There was the woman with asthma who needed medications, but  
‘ no money to pay for them. I did what any Frontier provider does I
almost daily ......,.. improvise (how much can be accomplished in _
the clinic alone), scrounge (who has the medication samples needed It
and how long will it take to get them) and make do (okay. . .it’s not
ideal, but it’s the best that can be done under the circumstances).
There was the gentleman with severe weight loss, fatigue and
frightfully abnormal lab values. A quick consult with Dr. Begum
and he’s sent for further diagnostic testing. There was the patient
with scoliosis needing a photograph of her deformed back for the
medical record. (Okay, where’s the camera?). There is another
suspicious CT scan of the chest —lung cancer? The I3- year—old
whose parents want to take him out of public school for home I
schooling because of health reasons and .... what do I think? The (
gentleman with a massive infection of a finger occurring only 48
hours after clipping his tingemails . . . A briefsearch and his blood I
sugar is found to be 4 times the limits of normal and, at the age of I
82, now a newly-diagnosed diabetic. Today, we start the process
of teaching him how to live with this disease. A trip to a grade
school to discuss first-aid with 4"I and 5"‘ graders. Their enthusi-
asm and energy are wonderful. I left the elastic bandage with I
them to practice wrapping wrists and ankles. ( “No, this bandage
cannot be wrapped around so1neone’s neck!"). Oh, yes .... .Dr. I
Tan and I shared recipes for Mediterranean cooking. That was I
my week. Yours'? (

~~ Reaching "Wide Neighb0rh00ds"
Suzan Ulrich, DrPH, CNM
. Frontier School ofMidwy’e1y and Family Nursing
`“ Chair ofMidwifery and Women ’s Health
“We have grown like the banyan tree...with branches yielding
shade and jiuit to wide neighborhoods of men. " Mary
Breckinridge (1 952)
Mrs. Breckinridge believed the work ofthe Frontier Nursing Ser-
vice would spread far and wide. Her vision of reaching wide neigh-
borhoods is being fulfilled by a special tradition the midwifery stu-
T dents at the Frontier School of Midwifery and Family Nursing
, (FSMFN) have developed.
i J ust prior to the clinical component of their education, the student
S midwives are on campus in Hyden for two weeks of intensive
skills training. The week culminates with a formal dinner at
Wendover. After dinner, there is a special ceremony where the
» faculty members of the FSMF N present the students with beauti-
l fully knitted baby hats.
, These baby hats have a long tradition at Frontier. They were knit-
l ted by the Daughters of Colonial Wars and were placed on the
r heads of all babies bom into the hands ofthe nurses on horseback
y of the FNS. The creation of the Cornmurrity-based Nurse-mid-
  wifery Education Program (CNEP) presented another way to use
I these special hats. Because the CNEP students do not attend births
» at FNS, but rather return to their own community, the spirit of
FNS is extended throughout the United States.
. When the students retum to their community, they give this spe-
cial hat to the first baby that is born into their hands and tell the
U parents the story of Mary Breckinridge and the FNS. They also
` recount this story to their classmates and faculty by posting their
"Lost My Hat" story on the Banyan Tree which is the electronic
<— bulletin board system of the FSMFN. Faculty members and stu-
dents avidly read the "Lost My Hat" stories.

I had the privilege of doing a qualitative research study on these
I stories to analyze how the midwifery students were intemalizing `
the midwifery model of care that is part of the tradition of nurse- —
midwives at FNS. This study was published in the J oumal of Mid-
wifery and Women’s Health in 2004. Major themes emerged re-
peatedly in these stories that showed the midwifery students ,
had a strong belief in the midwifery model of care. r
One ofthe major themes was facilitating bonding between mother,  
infant and family immediately after birth. Many stories recounted l
how the student presented the infant to the mother. "The baby  
went straight to mom’s awaiting hands and arms. I watched in  
amazement as this family met their baby." Students are very aware  
of how important it is for the mother to hold her newborn right  
after birth to promote attachment of this new family member.  
Another aspect of the midwifery model of family centered care  
that was evident in these “Lost My Hat" stories was helping the  
woman draw on her own strength to give birth and how the stu- r
dent was there to serve the mother in her hard work of giving  
birth. "She was so powerful and hardly said a thing. The baby  
steadily moved down with every push. With one push the baby  
rounded the comer, crowned and was on his way out. I gloved,  
together with my 1nentor’s hands we caught the slippery big guy  
and mom brought him up to her abdomen. A most awesome woman.  
I really felt this was all her show and I was just there for a bit of I
assistance, so honored to be able to share it with her."  
The preceptor mentoring the student during their first birth was  
also a major