Growing up in a bilingual household has given me a unique cultural perspective that enhances your empathy and understanding of diverse patient backgrounds. This is invaluable in nursing, where cultural competence is crucial for effective patient care. My mother wanted my sibling and I to work hard on our education families and placed a high value on education as a means to improve opportunities. Growing up, she working everything from being a cook, janitor, pizza delivery driver, and fast food restaurant employee to make ends meet. My mother's hard work pushed me to strive for academic excellence and pursue further studies in nursing. My mother also provides strong emotional and practical support, encouraging me through challenges and celebrating me achievements. There have been times where I have struggled and my mother mothers encouragement and prayers have helped me push through hard situations while studying to be a nurse and during the early days of my nursing residency. This kind of support is crucial in demanding fields like nursing to persevere thorough difficult days. As a Mexican-American person and child of an immigrant, I feel a sense of responsibility to give back to my community, especially if I’ve seen health disparities firsthand. Most importantly, if I have Spanish-speaking patients, I try to speak to them in our shared language as not every provider or nurse can fluently speak Spanish. Being bilingual enhances my communication skills with Spanish-speaking patients, making me a more effective and compassionate caregiver to those who would otherwise have to speak through an interpreter or be misunderstood due to a language barrier. If they expressed a need for resources in the community, I can also reference them to places with bilingual or Spanish-speaking staff to help them get access to the care or resources they need. This inspires me to focus on serving underrepresented populations in your nursing career and help fill a need for more inclusive and culturally competent care. Exposure to the healthcare experiences of family and community members has shaped my interests within nursing, to maternal and child health with a focus on community health and outreach. Taking healthcare to the people in their communities fill a very large healthcare gap and I look forward to earning a Masters in Nursing Education to help learn effective ways to reach communities at risk. All these influences are shaping my life and career goals, whether that’s working in a community health setting, specializing in certain areas, or advocating for health policy changes that benefit marginalized groups.

Nursing is as much of a calling as it is a career path for me. I am an older adult returning to school for a career change and have met some amazing nurses in my life, both as friends and professionally. What struck me was their ability to actively make a difference daily in someone's life as a nurse and how they can constantly learn and adapt to new situations easily and effortlessly. Nurses are often the people that patients interact with the most, so a nurse has the ability to make the biggest impact on a patient’s experience. I hope to learn the essential skills in my schooling and internship to positively affect my patients' lives and make their hospital stay as pleasant and healing as possible when under my care. I dream of becoming a midwife in my predominantly ethnic community of San Antonio. Access to midwifery care here is limited, and even more so, having a fully bilingual midwife for home or birth center births is rare, even with the diverse population of the San Antonio community. I dream of becoming a nurse midwife in my predominantly ethnic community of San Antonio. Access to midwifery care here is limited, and even more so, having a fully bilingual midwife for home or birth center births is rare, even with the diverse population of the San Antonio community. Maternal mortality and morbidity affect all families who choose to have a baby. Some families have a higher incidence of death and injury just because they are black, indigenous, or people of color (BIPOC). Many BIPOC families face prejudices in healthcare even when seeking maternity care with community midwives. The birthing justice framework must recognize that midwives and other birth workers have implicit biases. Implicit bias is not limited to race, as biases can exist for characteristics such as gender, age, sexual orientation, gender identity, disability, and physical appearances such as height, weight, or body structure. Many Latinx Texan families have faced generations of not being American enough due to the color of their skin, speaking primarily Spanish in their homes or workplaces, and not becoming more “American” by conforming to white American ideals of beauty, English monolingualism, and other dominant societal standards. Midwifery care helps improve Latinx and BIPOC birth outcomes in my community. Barriers remain in access to bilingual midwives, limited Latinx midwives in practice, and lack of insurance or Medicaid coverage for community birth in Texas. BIPOC birthing families can benefit from increased birth options at birth centers and planned home births attended by a midwife and a doula for continuous support. Measures to remove barriers to managing labor and delivery by midwives in community birth in Texas should be encouraged to allow out-of-hospital birth options to BIPOC families who only have hospitals as an option due to a lack of insurance coverage for home and birth center options. Regardless of where women give birth (hospital, birth center, or home), access to a doula or midwife can provide additional support to women and potentially reduce C-section rates that put women and infants at risk. Midwives and other healthcare professionals should also strive to have culturally inclusive prenatal and/or bilingual programs to promote breastfeeding, healthy lifestyles, and proper infant feeding habits among Latinx. I hope to be part of the change by not only being a care provider to BIPOC families but also being their advocate for improving birth outcomes in my community and across the metropolitan San Antonio area.

The United States is growing in population and increasing the diversity of cultures and religions within our communities. With increased diversity, we also need to diversify our healthcare practices to address the various needs of different ethnic, cultural, and historically underserved populations. As a bilingual Latina, I hope to partner with other nurses to increase diversity in nursing and continue to learn about diverse cultures to provide all my patients with culturally competent care. Ensuring equitable care in healthcare is vital in promoting positive health outcomes for all communities. Diversity in nursing is crucial due to the close relationships nurses create with their patients and the personal nature of the care nurses provide. Healthcare providers and nurses that serve diverse populations sometimes do not have a similar culture, ethnicity, or socio-economic status to their population. This lack of diversity can leave many patients feeling disconnected from a system that does not reflect their culture or may not put effort into understanding their specific needs. There is evidence that when patients see healthcare providers of similar language or culture, patients participate and engage more with their healthcare provider (Why We Need More Diversity in Nursing, 2021). Diversity in nursing and healthcare can also enable nurses to learn from one another to understand better different backgrounds, life experiences, and cultural influences. This peer-to-peer learning can enhance the quality of healthcare nurses provide. Research published in the Journal of the National Medical Association also found that a more diverse healthcare team was linked to improved patient care quality and cost savings (Gomez & Bernet, 2019). Improving the diversity of the nursing field can help alleviate health inequities in growing immigrant and historically underserved communities while enabling better access to more personalized care for all. Learning about cultural competency has been an ongoing experience for me as an adult learner transitioning into a new career with ever-evolving challenges. Living in a highly diverse community like San Antonio has allowed me to see that nurses in this area must learn to care for various people from different countries, cultures, and religions. Knowing that we do not have a monoculture of people means that I need to continue to learn about other cultures and take each patient with dignity and respect regardless of their differences from my culture and beliefs. Just because someone does not look or have a similar background as mine does not mean they do not deserve healthcare with compassion, integrity, honesty, and equitable care. Nurses need to adapt to changing the mindset to be more inclusive of diverse cultures and become more accessible to a different variety of people. Continuing to learn about the communities I will serve will help me as a nurse understand the difficulties some people face and have not had the privileges I have had. More importantly, the most significant way to learn about my client's needs is to discuss their beliefs, desired outcomes, and any cultural aspects that will affect their care plan. Continuing the journey with our peers and patients will help teach the next generation of nurses to give equitable and individualized care to decrease disparities created by systemic racism or prejudices against immigrant populations. Growth is essential in our society and healthcare for positive health equity and justice changes. The more diverse and culturally competent we as nurses can be, the better we can address institutional prejudices and deconstruct our healthcare system for improved health equity.

Nursing is a challenging but fulfilling career. Nursing is as much of a calling as it is a career path. I am an older adult returning back to school for a career change and have met some amazing nurses in my life, both as friends and professionally. What struck me was their ability to actively make a difference daily in someone's life as a nurse and how they can constantly learn and adapt to new situations easily and effortlessly. Nurses are often the person that patients interact with the most, so a nurse has the ability to make the biggest impact on a patient’s experience. I hope to learn the essential skills in my schooling and internship to positively affect my patients' lives and have their hospital stay be as pleasant and healing as it can be under my care. It is also important to note that nurses are always needed, and the stability of a job is important. As a mother of four children, I have gone through layoffs in my previous career, and it was stressful not being able to provide for my family and struggle. As a nurse, the wide variety of specialties allows for cross-training to nearly every specialty in the medical field for ever-evolving job opportunities and ways to grow as a nurse. I also appreciate the holistic approach of nursing to treat the person as a whole and not just the symptoms of their disease or illness. For instance, a patient may have appendicitis and need surgery. A high-quality nurse would not just see they need surgery and some antibiotics but also ask how they feel about missing work or school and any stress this may add to their personal or professional life. Nurses look beyond the presenting issue much deeper to help their patients heal more effectively. Many times, I have seen nurses reach their patients far deeper than others in the healthcare team to find out if they need resources for food insecurity, medication assistance programs, or other social services needs to decrease the stressors in life that contribute to health issues and that can enhance the healing of their patients. If we treated only the symptoms, most people would not recover as well as they would without a nurse that gives compassionate care. Nurses also play an integral role in sharing care and information with other healthcare professionals to allow necessary referrals and interdisciplinary care to occur for those patients that need it. Nurses can have strong organizational and critical thinking skills to ensure their recommendation affects the overall care plan to improve their patient's lives. Nurses are so much more than medical care providers. Nurses can make a real difference in someone's life. We, as an industry, can offer hope to people, sometimes during the most difficult times of their life. Nurses often counsel patients and families after a devastating diagnosis, educate patients on the choices they can make to enhance their health, celebrate with them during improved health outcomes, offer therapeutic care during difficult times, and become trusted allies in a patient's life.

I dream of becoming a midwife in my predominantly ethnic community of San Antonio. Access to midwifery care here is limited, and even more so, having a fully bilingual midwife for home or birth center births is rare, even with the diverse population of the San Antonio community. Maternal mortality and morbidity affect all families who choose to have a baby. Some families have a higher incidence of death and injury just because they are black, indigenous, or people of color (BIPOC). Many BIPOC families face prejudices in healthcare even when seeking maternity care with community midwives. The birthing justice framework must recognize that midwives and other birth workers have implicit biases. Implicit bias is not limited to race, as biases can exist for characteristics such as gender, age, sexual orientation, gender identity, disability, and physical appearances such as height, weight, or body structure. Many Latinx Texan families have faced generations of not being American enough due to the color of their skin, speaking primarily Spanish in their homes or workplaces, and not becoming more “American” by conforming to white American ideals of beauty, English monolingualism, and other dominant societal standards. Midwifery care helps improve Latinx and BIPOC birth outcomes in my community. Barriers remain in access to bilingual midwives, limited Latinx midwives in practice, and lack of insurance or Medicaid coverage for community birth in Texas. BIPOC birthing families can benefit from increased birth options at birth centers and planned home births attended by a midwife and a doula for continuous support. Measures to remove barriers to managing labor and delivery by midwives in community birth in Texas should be encouraged to allow out-of-hospital birth options to BIPOC families who only have hospitals as an option due to a lack of insurance coverage for home and birth center options. Regardless of where women give birth (hospital, birth center, or home), access to a doula or midwife can provide additional support to women and potentially reduce C-section rates that put women and infants at risk. Midwives and other healthcare professionals should also strive to have culturally inclusive prenatal and/or bilingual programs to promote breastfeeding, healthy lifestyles, and proper infant feeding habits among Latinx. Once racism and prejudice are considered, public policy and program solutions must be developed to dismantle it with culturally competent midwifery stimulating a lasting impact on health outcomes for Latinix birthing families. I hope to be part of the change by not only being a care provider to BIPOC families but also being their advocate for improving birth outcomes in my community and across the metropolitan San Antonio area.

This past year has been very formative in my growth as an individual and as well as growing as a future nurse. I have just completed my first year of nursing school, so I have gained much book knowledge on proper nursing care for patients. The biggest portion of my nursing experience has been through my clinical experiences to develop my interpersonal skills further to treat patients with compassion as well as give them fully informed nursing care with an emphasis on patient-centered care to allow them to be in control of the care they receive from their medical team. In my clinical experiences, I have seen patients with serious health disorders or traumatic events. Much of my nursing care ensures they feel comfortable in their environment with the team treating their needs. Often, a difficult patient is only anxious from not knowing what is happening or what will occur next in their care. Acknowledging a patient's concerns or fears when I enter the room makes sure that they feel heard and, if appropriate, provides answers to some of their questions. If I cannot answer their concerns, I let them know I will further investigate or refer them to the appropriate healthcare provider to ensure they get the necessary information to know more about their medical care. We are no longer the day of "doctor knows best" for the patient, so giving the patient autonomy to make decisions in their healthcare is important with the proper knowledge to make these decisions. Before, I never thought giving background information about how treatments or medications would affect a patient's anxiety or frustration with the medical process. For example, if a blood sample were taken from a patient, the patient would often not know how long it would take to get the results or even what the result are. After learning about patient-informed care, letting the patient know a laboratory test takes several hours to run and be verified by the health care provider eases some of the fear of the unknown of why it takes time to find a diagnosis or if a prescribed treatment is effective. Likewise, having frequent conversations between the patient and the nurse helps increase trust and the growth of a professional relationship between the nurse and the patient. The more I work at improving my communication skills ensures that I give my patient appropriate care and also lets my team of nurses know the patients that we sharing in caring for is getting the quality of care they are giving as well.

I plan on working in Labor and delivery or postpartum for a year or two after graduation and then pursuing a degree in midwifery. My dreams of midwifery started during my pregnancy with my third child. My best friend was pregnant at the same time and was going through some difficult personal situations. She chose a midwifery team as her care provider. She talked so much about the great care she received and the many resources they offered her as she was living in a relatively new area without family or friend support. I learned from her more about midwifery and also doula services. I was so impressed by the support that she received that I trained as a birth doula and served many families in the San Antonio area. Later, I sought some midwifery training to become a Certified Professional Midwife. Still, so many experiences pushed me to support families in a hospital setting than the birth center and home birth settings I preferred. Birthing and postpartum families need excellent care in all birth settings, and many families choose to give birth in hospitals. Caring and supportive nurses who perform evidence-based care can help improve birth outcomes and patient satisfaction. Many families may come with the fear of being in the hospital and may lack knowledge about childbirth or the immediate postpartum experience. Having a nurse available who can acknowledge their concerns and provide patient care can greatly decrease the new parent's stress and improve their ability to care for their newborn. While in nursing school, I have learned that every patient is unique and that providing the same care is not the best option for providing patient-centered care. Every care provider should listen to the patients, adjust care as needed to address their concerns and individual health issues, and be respectful of their cultural or ethnic practices. Knowing that we do not have a monoculture of people means that I need to continue to learn about other cultures and take each patient with dignity and respect regardless of their differences from my culture and beliefs. Just because someone does not look or have a similar background as mine does not mean they do not deserve healthcare with compassion, integrity, honesty, and equitable care. Nurses must adapt to changing the mindset to be more inclusive of diverse cultures and become more accessible to various people. For positive health equity and justice changes, growth is essential in our society and healthcare. The more diverse and culturally competent we as nurses can be, the better we can address institutional prejudices and deconstruct our healthcare system for improved health equity for everyone, especially at the start of one's life outside the womb.

I plan on becoming a nurse midwife as women and birthing families need to have options to birth where they feel most comfortable if they are healthy and low-risk. Hospitals are great placing for birth if someone chooses this or needs it for medical reasons of the mother or a high-risk pregnancy, but most pregnant people may not want to birth there. Hospitals are usually associated with illness, and pregnancy is not an illness but a temporary state of life. Offering community birth options allow families to give birth they feel most comfortable and lowers the amount of stress that inhibits the birthing process. Outside of birthing situations, nurse midwifery also offers patient-centered well-women care and usually has providers that have also personally gone through similar situations as most midwives are women. A provider who has gone through similar personal journeys can help improve the patient-client relationship and give real-life feedback about situations along with their expert knowledge gained from nursing and midwifery education. I did not initially want to be a nurse midwife until I had personal experiences with midwives during my pregnancies and appreciated the midwifery model of care. It was far more personal and directed care on a patient-by-patient basis rather than offering every woman similar care despite their differences. I have also worked with excellent nurses in my prior neurodiagnostic career and saw how many times patients reported the greatest and most effective care given in their hospital experiences was from their nurses. Many nurses I worked with have been great advocates for their patients, sometimes even having to stand up to providers. One nurse, Patty, had a patient anesthetized and then had a group of OB/GYN residents enters the operating suite requesting vaginal exams on the patient. Since this patient was not an OB/GYN patient, Patty denied the residents from doing an unconsented vaginal exam on a patient who would not be aware that this invasive exam was being performed while asleep. I was very proud of her for standing up for her patient, who would have been unaware of the violation of their body. As I return to school to start a second career, I face the financial burden of budgeting to feed my four children while paying off my monthly tuition expenses. I am working a lower-paying position that is flexible for my nursing classes at this time. I also have only a limited amount of Stafford loans for my tuition expenses. My oldest son is also in college, so affording two college careers is a difficult task that has made our family drastically adjust our budget and decrease our spending on extras like eating out and visiting family in other areas of the country. In continuing my nursing education, I want to be a bilingual care provider in a community with a large Hispanic population. Many local care providers have limited Spanish-speaking abilities. Being a Spanish-speaking provider will allow patients to connect more fully with me as a nurse and decrease miscommunications and barriers to their health education. My experiences with high-quality nurses have encouraged me to return to school in my forties to give patients excellent care as they did. I hope my life experiences with these amazing nurses and the evidence-based care I am currently learning in nursing school will help me be the best nurse midwife I can be for my patients.

I am changing careers in my midlife and seeking to become a nurse midwife to allow more families options at birth. Midwives can work in hospitals, birth centers, and in-home birth settings. Most pregnancies and births are allowed risk, so families should have options in where they choose to birth as birth is not an illness. As a bilingual midwife, I will also be able to offer families options to birth in Spanish, allowing for more culturally cognizant care in the language they feel most comfortable with. We live in an ever-expanding multicultural world. A monocultural community is starting to become rare, so even in the nonprofessional world, we must become used to different languages and cultures in the people we meet daily. As a nurse and midwife in a very diverse metropolitan area, it is also important to know that my clients will not have the same lived experiences as I do. I must open my eyes to see that others may not live with my privileges and may have different goals than I do. I must also open my ears to listen to my clients to their specific goals and expectations so I can adapt care to their specific needs. As a health care provider, it is important to build a relationship of trust with my clients, and that starts with centering my care around the client's needs rather than what I want. It is good to start every patient interaction by thanking them for sharing information and asking questions about their health care. This enhances the relationship and allows for even better communication with each interaction. Being nonjudgmental and respecting their cultural influences also helps build trust and give the patient a culturally cognizant setting where we can advocate for our clients without pushing our worldview on them. In both scenarios, a nurse could offer her personal opinion but would likely close lines of communication by not listening to the cultural practices and backgrounds that affect the patient's decision-making for their health. Transcultural care involves the nurse recognizing cultural values, beliefs, and customs differences and accommodating healthcare around an individual's cultural needs. Being a nurse midwife who realizes every client is unique allows for personalized care that decreases the risk of harm and stress to the client. Stereotypes and prejudice should no longer be allowed in a patient-provider relationship. When prejudices emerge, I should immediately address my ignorance and be open to learning more about what my client believes or needs. The more we can be open to learning, the more we can better address our client's needs to improve their health outcomes.

Life is a path of hard work for most minority women. The intersectionality of being a person of color and a woman can sometimes put roadblocks in your path to success. Growing up, my family was a working-class Mexican-American family that struggled to get by some months and had to use food programs at times to ensure we had enough to feed a family of seven. My parents worked hard but could not afford to send my brothers and me to college after high school. Those who did go to college either had to work to save enough money before starting classes, take out high amounts of student loans, or do both. Having a high amount of loans to repay after schooling can be very difficult for someone entering the workforce as an entry level employee and having paid off student loans before, it can take many years to repay while trying to afford housing and a growing family. As I return to school to start a second career, I face the financial burden of budgeting to feed my four children while making sure I can pay off my monthly tuition expenses. At this time, I am working a lower-paying position that is flexible for my nursing classes, but it does decrease the amount of money available to provide for my family. I have only a limited amount of Stafford loans available, so every month, I must make a payment to my school for the remainder of my tuition expenses. My oldest son is also in college, so affording two college careers at this same time is proving to be a difficult task that has made our family drastically adjust our budget and decrease our spending on extras like eating out and visiting family in other areas of the country. I want to continue with my nursing schooling as I want to be a bilingual care provider in a community with a large Hispanic population. Many care providers have limited Spanish-speaking abilities, so it really affects communication with patients. Being a Spanish-speaking provider will allow patients to connect more fully with me as a nurse and decrease miscommunications and barriers to their health education. I also plan on continuing my nursing career in nurse-midwifery to also allow birthing families' care in a culturally competent setting. Many midwives in my area are not fluent in Spanish, so having an additional midwife who understands the language and cultural customs will also help put patients at ease and give them access to a care provider who shares similar life experiences.

I have worked in the medical field for over fifteen years and have worked with many wonderful nurses. Many have been great advocates for their patients, sometimes even having to stand up to providers. One nurse, Patty, had the situation of having a patient anesthetized and then had a group of OB/GYN residents enter the operating suite requesting to do vaginal exams on the patient. Since this patient was not an OB/GYN patient, Patty denied the residents from doing an unconsented vaginal exam on a patient who would not be aware that this invasive exam was being performed while asleep. I was very proud of her standing up for her patient would, who would have been unaware of the violation of their body. Many other nurses have also had a great impact on my life. Most of my hospital experiences are in the operating room, so I have seen many other nurse advocates for the patient and keep the staff safe. Especially during the pandemic, the operating room nurse was the prior person who would advocate for appropriate droplet, contact, or airborne precautions and supplies for all members in the operating room, from the medical representative to the operating surgeon, to ensure we all would remain from infectious diseases we knew little about with the emerging COVID infections. Many times, N95 masks were in short supply, so they would have to go to other sectors of the hospital to make sure everyone in the operating room would have a mask available. One of my favorite nurses was Linda, and she often started the day with our operating pre-brief with the phrase "see something, say something." She enlisted all the team to watch out for one another to ensure everything went well for each patient. All patients were VIPs in her eyes and deserving of the highest quality of care. We would not call the patient back to the operating room until all personnel and supplies were in the room and everything was checked to ensure they were in working order. Not every nurse would do that, and there have been times that other nurses would have to call out during an operation for supplies, delaying care. At the end of the operation, Linda would always check in with the anesthesiologist, the surgeon, the scrub technician, and any other medical personnel if everything was going well and would include any suggestions to improve the next surgery, if necessary. My experiences with high-quality nurses have encouraged me to return to school in my forties to give patients excellent care as they did. I hope that my life experiences with these amazing nurses, as well as the evidence-based care I am currently learning in nursing school, will help me to be the best nurse I can be for my patients.

I am currently working as a patient care technician while I am in nursing school to help afford my college education until I can become a registered nurse. I am also taking out Stafford loans to assist with financing my college education and plan on paying these loans once I get hired as a labor and delivery nurse. I have applied to several other college scholarships as well to attempt to make my education more affordable. My future nursing career is very important to me, but it is a financial burden on my family. I have four children and currently, my husband is the only person working full-time to provide for our family. With six people living off one income, our budget is tight and extra expenses are difficult to cover. Also, my oldest son is going to college at UTSA, so we are trying to provide covering the tuition expenses that his student loans do not cover as well. I have been taking classes at Hallmark since June 2022 and have maintained a high average in all my courses. I have also tried to assist my classmates often sharing notes and online resources so we all can do our best in our courses. Just yesterday, I was helping a classmate with our pediatric medication calculations work after class and created Quizlet flashcards for exam reviews for our nursing classes that I have shared with my cohort and other students at Hallmark University. I also recently received a Character with Distinction awarded from Hallmark University I greatly appreciated the recognition of all the hard work I have done for the past year. Our nation needs nursing but college and university expenses can make this dream to be out of reach for many. Loans can be helpful but the amount of debt many take on can be overwhelming to pay off for many years after they graduate. Currently, I am financing my education with Stafford loans and the remainder with our savings, but this past year has been expensive with the increased cost of living and the added expense of a longer commute to the new Hallmark university campus further away from my home. As expenses have gone up, our savings have now been drained and I find myself with the possibility of taking a leave of absence to work during that break to continue to afford the nursing program. I do not qualify for a Pell grant currently and have been applying for other scholarship opportunities, but I do not have any other financial options at this time to support my nursing education. Scholarships and grants would help me immensely but I do plan on paying off any debt I do accrue as needed by working full-time as a nurse and strict budgeting until my student loans are taken care of.

My best tip is to get organized a few days before the start of each semester. Getting books, notepads, and essential supplies are necessary to have the first day of classes go well. If you have online access early to your classes, it is also best to check the syllabus and due dates for assignments to make a plan on when they are due and how soon you should start working on these items. It is also good to get in touch with your classmates early in the semester so you can share helpful videos or flashcards to help prepare for important quizzes and exams. My current nursing cohort has a group chat created so when someone finds a great source that will help us do well in class, we share it with everyone. Every little bit helps us all achieve our dreams of becoming nurses and we are learning to support one another now, which will be essential when we enter the workforce as registered nurses.

My family's cultural identity is an immigrant identity. My mother came to the U.S from Mexico, worked as a seamstress, and learned English after living here with her nephew in Los Angeles. My father was born in the U.S. but was born to a Mexican immigrant mother and Filipino immigrant father who was in the U.S. Navy. My father did not learn English until he started school as a child. My parent moved to Texas a little over two years before I was born, so they did not know much about Texas when they moved here. Growing up, we spoke Spanish at home but only English in school as it was not accepted at the time to speak Spanish in school unless you were in the ESL program. At times, I felt I was not Mexican enough to hang out with the Mexican kids and was not American enough to hang out with the dominant culture kids. It was also hard to fit in many times as our family was low-income for many years, so we did not get the popular toys other kids got nor had name-brand clothes that other children would wear. Many do not remember the years when Academy or Wal-Mart did not carry name-brand clothes, but only off-brand clothes and shoes for a discount price, but those were our go-to school stores. Despite this, my family did raise us to respect others, especially our elders, wait for our turn to speak, and not interrupt others when speaking as that was extremely rude. Due to this, I find it hard not to get annoyed when conversations are constantly interrupted. As a student nurse, I am learning the skills to help act and react in a helpful manner to my patients and compassionate care for the whole person, not just their ailment. Treating people with respect is one of the smallest but greatest things we can do for anyone, regardless of their culture, background, or social status. So many times in healthcare, people feel they are treated as lesser because the care provider is on a different level than they are when it is all not true. Whether rich or poorer, educated or ignorant, all people deserve respect and informed care. People like Mother Teresa served the people of the lowest and poorest caste but did not cringe away from serving those who were undesirable. It did make her rich but kept her humble as she saw the poor can be just as intelligent, honest, creative, and positive makers of change as anyone of higher classes. As a nurse, I will meet people of all types, so I do my best to ensure my patients get excellent care without bias. Many of us not in the dominant culture also need to feel heard and respected. As a student nurse, I want to become a care provider who listens to her patients and lets them know their concerns are important. I also plan on becoming a nurse midwife to allow more families to have birth options in my area. Many obstetricians and midwives in my area do not speak Spanish, so I hope to be one who can communicate with her clients in English and Spanish, giving them options to communicate in a language they are most comfortable with freely.

In this journey in midwifery, it has been a struggle with the transition of becoming an adult student, reflecting on who I am, and who I plan on becoming as a midwife. Since the second tenet of the Midwifery Model of care states, “providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support” we as student midwives are learning to see and treat our clients as individuals who need individualized care. Native Americans and women of color have largely had inadequate care that lacks cultural competence from largely white providers. While it will take time to increase the number of providers of color, the current professional midwives must also adapt to changing the mindset to be more inclusive of diverse cultures and become more accessible to a different variety of people. Since women of color have had a life of prolonged exposure to systemic racism, we as midwives must be compassionate care providers who acknowledged the historic trauma many people face. Becoming trained in trauma-informed care is a good component of care to introduce into midwifery to address these historic traumas as well as the many personal traumas, all birthing families face from exposure to family violence or traumatic experiences. As a midwife, I would prefer to work with the communities that would most benefit from the midwifery model of care. San Antonio is a diverse community due to its ties to many military bases around the city and it also has a large population of families of low socioeconomic status. At times midwifery, home birth, birth centers, and your right to choose those things have come under fire in the Texas Legislature. My goal is to advocate for the Texas legislature to have Medicaid pay for midwifery services, similar to how New Mexico has for many years. Ensuring Medicaid families have access to a range of maternity providers promotes patient choice and individualized care, especially for lower-income women who largely have limited choices in their birth options. I would also eventually low to open a birthing center modeled after the JJ Way so families who otherwise could not afford out-of-pocket payments for midwifery (The JJ Way). Along with eventually having Medicaid coverage, the JJ Way model also keeps other costs low for birthing families by addressing health disparities due to cultural and socioeconomic reasons and giving birthing families essential support during the antenatal and postnatal periods. Every family wants a healthy birth and every family deserves one. Engaging parents while identifying their racial disparities for low-income people and people of color is important to lower rates of preterm labor and low birth weight. Disparities in birth for people of color could be improved if midwives were accessible and available to those who would most benefit from high-quality midwifery care. Continuing the journey together with other culturally competent midwives who teach the next generation about equity and individualized care is paramount. Growth is essential for our society for positive changes in equity, compassion, and justice. The more diverse the field of midwifery and healthcare as a whole, the better we can begin to address some of the institutional prejudices and hopefully, dismantle them from within.

I have always tried to live by the motto, "live within your means" to make sure I can afford what I need in life without over extended myself. This wasn't always the case in my life as I did accumulate a lot of student loans and credit card debit in my early twenties. It did take over a decade to pay off my debt and I no longer want to be at the point where I gave more debt than I can pay for. Many loan or credit card companies will approve people for much more than they can afford so people need to be aware that these options are loaned money that carries interest. This adds up as debt increases and many people end up paying for more than they owed because it took so long to pay their debt with the accumulating interest. As a mother of four children, we often have to cut back on our expenses to make sure our family can afford our home, food, and utilities. This means we are not driving the newest car nor going out to eat every day. It can be frustrating on days when I rather not cook meals after a long day but every meal at home saves us so much more money to be able to afford necessary items like clothes and school supplies that we otherwise would have to put on a credit card. Staying within a reasonable budget is essential when having a large family while I am in school and we are on one income for our household. College is expensive as both I and my oldest child are currently in college. Neither currently have any grants or scholarships so our education is being financed largely out of pocket and with Stafford loans.

Legacy is not what you leave in monetary items on earth but the change you instill in your community to positively affect those around you. For example, people like Mother Teresa of Calcutta treated those in the lowest caste of society with dignity and helped them with basic necessities of life. Her legacy is that generations of families have survived and gone on to sometimes break out of their caste to go on to provide for themselves and others. The ripple effect of a good deed is what our legacy should be based on. Many times, we see small deeds and cars of kindness as insignificant. One open door or buying a friend a meal is seen as no big deal. That one open door for someone may have changed their mood for the day and helped them be productive. That one meal could have helped that person last for one more day until their paycheck comes in. So much of what we do does not have to be a million-dollar donation or thousands of personal goods donated but just the one small action that enables others to also give. We hear about the bystander effect when someone is injured and no one responds to help them as they all think someone will eventually. That one bystander who does respond can sometimes bring the greatest change and enroll others to help when otherwise everyone would continue to pass by. The sooner we can be the bystander who responds, the more people tend to respond as well to do good things. My legacy is to be an early responder. As a student nurse, I am learning the skills to help act and react in a helpful manner to my patients and compassionate care for the whole person, not just their ailment. Treating people with respect is one of the smallest but greatest things we can do for anyone regardless of their culture, background, or social status. So many times in healthcare, people feel they are treated as lesser because the care provider is on a different level than they are when it is all not true. Regardless of whether we are rich or poorer, educated or ignorant, all people deserve respect and informed care. People like Mother Teresa served the people of the lowest and poorest caste but did not cringe away from serving those who were undesirable. It did make her rich but kept her humble as she saw the poor can be just as intelligent, honest, creative, and positive makers of change as anyone of higher classes. As a nurse, I will meet people of all types so I do my best to ensure my patients get excellent care without bias.

I have always tried to live by the motto, "live within your means" to make sure I can afford what I need in life without over extended myself. This wasn't always the case in my life as I did accumulate a lot of student loans and credit card debit in my early twenties. It did take over a decade to pay off my debt and I no longer want to be at the point where I gave more debt than I can pay for. Many loan or credit card companies will approve people for much more than they can afford so people need to be aware that these options are loaned money that carries interest. This adds up as debt increases and many people end up paying for more than they owed because it took so long to pay their debt with the accumulating interest. As a mother of four children, we often have to cut back on our expenses to make sure our family can afford our home, food, and utilities. This means we are not driving the newest car nor going out to eat every day. It can be frustrating on days when I rather not cook meals after a long day but every meal at home saves us so much more money to be able to afford necessary items like clothes and school supplies that we otherwise would have to put on a credit card. Staying within a reasonable budget is essential when having a large family while I am in school and we are on one income for our household. College is expensive as both I and my oldest child are currently in college. Neither currently have any grants or scholarships so our education is being financed largely out of pocket and with Stafford loans.

I also thought scientific advancements based on serendipity were also very interesting. Sir Arthur Fleming never expected that a contaminated petri dish would yield an entire field of medicine called antibiotics. The story behind this discovery was also based on another accidental contamination of a petri dish when Fleming accidentally shed a tear into a bacterial sample and noted that the spot where the tear landed was free of the bacteria that grew all around it. After conducting tests he concluded that tears contain an enzyme, lysozyme, that can fight off minor bacterial growth. Years later, Fleming remembered the tear he shed that inhibited bacterial growth and hypothesized his contaminated Staphylococcus bacterium sample with a blue-green mold inhibiting the Staph growth could be something that may help treat bacterial infections. He and other scientists identified and isolated the mold to create penicillin which was the very antibiotic of many generations of antibiotics we now use to treat many types of bacterial infections. Fleming was once quoted as saying, “but for the previous experience I would have thrown the plates away as many bacteriologists have done before.” We sometimes think a mistake is something we must throw away and start over. If Fleming had thrown away his contaminated petri dish, he would have never discovered one of the world's first antibiotics and likely it could have taken him or another scientist to find penicillin that has saved many lives. Sometimes, we need to see our mistakes or unexpected outcome as a way to learn and grow instead of a point to go restart and try again. Serendipity can bring out a new way of thinking and change the world because of it.

September 3, 2019, was my daughter's 13th birthday, my first day of midwifery school, and also the day my father passed away. Without my father dying, it was already a stressful day as I was returning to college after being out of school for several years and I was having to relearn to study again and do assignments. My daughter also reached a milestone birthday as her first day of being a teenager so we also wanted the day to be special. I woke to the news my father passed as I was getting my children ready for school and I was waiting for them to get out of the house so I could plan my semester and get online for my first class sessions of the day. It was a tough day that was spent trying to check my new class schedule while calling family members to inform them of my father's passing. I know that getting behind on the first day and week would not be easy to get past so I did what assignment I could between phone calls and visits to the mortuary to help plan the funeral. I was fortunate that the funeral attendant was an old classmate so he knows my family well and understood many factors that would be important o our family while we grieved. I also contacted my instructors that I was doing my assignments to the best of my ability but I obviously was distracted from my classes being my primary focus for this week due to our family's loss. It was a hard semester but I made it through thanks to the help of my family and spouse who supported me when I needed time away to be by myself for self-care or just a couple of hours to write an essay that was due the next day. I realized over the next year that the current program I wasn't in wasn't the best fit for my life goals so I exited the program and had to grieve the loss of the advancements I made in the program. I spent a month grieving this loss but was able to find a new school to become a nurse and eventually a nurse midwife. My father was a father to 5 children so he knew well the long process of pregnancy, birth, and postpartum with supporting my mother. I hope to bring the life experience of hearing his stories of raising myself and my 4 brothers in my career as a nurse and midwife in the future when I graduate less than 2 years from now.

Thriving elderly populations in the community are a sign of a good community. A community that takes care of its residents regardless of their age is a community that respects the wisdom of those that came before us and respects life across a spectrum from birth to death. I recently started my nursing clinical experiences and we have been assisting residents of a long-term facility. Many of these individuals are older and some have physical or cognitive decline that comes with advanced age. They appreciate being cared for by people that respect them and allow them to do daily activities within their level of functioning. Respectfully asking if they need help or being available if they ask for help is what many desire in this facility. Many older adults also appreciate being talked to rather than talked about as many still want input into their care plans and to be updated on how they are doing. Even small actions like reporting what their blood pressure is or reminding them of what day it is ls they know what activities are happening during the day is something small we all can do.

I have created several Quizlets for my classes. I have found they help me describe each concept or term I need to learn in my own terms. It is also helpful for reviewing later when I have breaks in my day to review my Quizlet flashcards without carrying a stack of cards that can get lost or damaged. My classmates also have benefited from studying for our exams as I have shared my classes and Quizlets. It is an excellent tool for studying and reviewing.

I am motivated to continue my education due to my children and the community around me. As an older student, I do want to show my children that we can continue to learn and follow our path to our dream career regardless of age. At this time, my oldest child and I are both in college studying for our bachelor's degree so it also helps me be a positive example of a committed student for my child. As a student nurse and eventually midwife, I hope to collaborate with my peers and instructors to learn to incorporate the Midwifery Model of Care (https://mana.org/about-midwives/midwifery-model) into my life path. I have connected with local midwifery students and my local midwifery organization to establish connections and learn more from my peers and mentors. I plan on opening a community birth center that is open to all clients with Medicaid and major medical insurance plans. I will run my midwifery practice with compassionate care and evidence-based practices for all birthing families and people who need gynecological care. I am an advocate for improving access to midwifery care for all families by pushing for more health insurance and reimbursement for birth centers and home birth. In my birth center, I will strive to serve all people and create a community of caring birth professionals. As a midwife, I would prefer to work with the communities that would most benefit from the Midwifery Model of Care. San Antonio is a diverse community due to its ties to many military bases around the city and it also has a large population of families of low socioeconomic status. At times midwifery, home birth, birth centers, and your right to choose those things have come under fire in the Texas Legislature. My goal is to advocate the Texas legislature to have Medicaid pay for midwifery services, similar to how New Mexico has for many years. Ensuring Medicaid families have access to a range of maternity providers promotes patient choice and individualized care. I would also eventually low to open a birthing center modeled after the JJ Way so families who otherwise could not afford out-of-pocket payment for midwifery (The JJ Way- https://commonsensechildbirth.org/jjway/). Along with having eventually having Medicaid coverage, the JJ Way model also keeps other costs low for birthing families by addressing health disparities due to cultural and socioeconomic reasons and giving birthing families essential support during the antenatal and postnatal periods. Every family wants a healthy birth and every family deserves one. Engaging parents while identifying their racial disparities for low-income people and people of color is important to lower rates of preterm labor and low birth weight. Disparities in birth for people of color could be improved if midwives were accessible and available to those who would most benefit from high-quality midwifery care.

A thousand dollars would benefit right now as myself and my oldest son are both currently in college and I have three other children to take care of. We have been blessed more than others but neither I nor my son has scholarships due to our higher earnings prior to me returning to school full time in the past year. We have been fortunate to carry on normally due to the Child Tax Credit disbursements but a new year brings on new challenges for our family. Our vehicles are older with many mileages so maintenance and repairs are needed. My husband and I are due to dental and medical visits which cost us more than we expect since my husband has long-term dental issues. I was diagnosed with a disorder in January that required semi-annual lab work and checkups to make sure it does not progress into a serious issue. These labs are only partially covered by our insurance so it is an unexpected cost to our budget. Our children also are growing so there is always the possibility of needing new clothes, school supplies, or illness. This scholarship opportunity would go straight to my monthly tuition. This amount would be a little over two months of my payment plan. We are lucky but it is always a fear that one major financial setback will cause my family to choose whether we should pay for college or a house repair, car repair, or medical bill.

I am currently in nursing school and wish to become a midwife. As an advanced practice nurse and midwife, I hope to offer evidence-based care from a nurturing approach that can give culturally competent care for people of various cultures and ethnicities. Many people think that only obstetricians can deliver a baby, but midwives and the field of midwifery have been around since Biblical days. Many midwives practice in various hospitals birth centers and attend births in people's own homes. The option of midwifery for pregnancy and postpartum care gives clients opportunities for families to meet their new baby wherever they feel more comfortable to birth. Having body autonomy in birth is very important in helping a family have a normal physiologic birth. I hope to finish my nursing schooling and then a midwifery degree to offer many families options for the delivery of their baby and well-woman care with a more holistic approach to caring for bodies, mind, and soul.

Wanna see how I live with bravery and boldness? See my Facebook page at: https://www.facebook.com/Gisellethegeekygal/

I love the discovery of the DNA double helix by Rosalind Franklin. Though her colleague Watson and Crick are often given the distinction of the discovery of the structure of DNA, her photographs were absolutely essential for them all the understand the structure. Without her, the structure of the most vital element to all life would have likely been years later. It has been exciting to see how over the years more and more people have learned about her contribution to science and pushed to elevate her name to the level of Watson and Crick as pioneers in understanding DNA and the basic structure of life. This showed girls and women that even if they are currently not being considered an essential part of the development of science, times can change and we can learn from past experiences that even small contributions can lead to amazing discoveries. Those who want to learn from the history of our sciences do usually uncover the true pioneers like Franklin and other men or women like her who didn't get the recognition they deserve.

I am motivated to continue my education due to my children and the community around me. As an older student, I do want to show my children that we can continue to learn and follow our path to our dream career regardless of age. At this time, my oldest child and I are both in college studying for our bachelor's degree so it also helps me be a positive example of a committed student for my child. As a student nurse and eventually midwife, I hope to collaborate with my peers and instructors to learn to incorporate the Midwifery Model of Care into my life path. I have connected with local midwifery students and my local midwifery organization to establish connections and learn more from my peers and mentors. I plan on opening a community birth center that is open to all clients with Medicaid and major medical insurance plans. I will run my midwifery practice with compassionate care and evidence-based practices for all birthing families and people who need gynecological care. I am an advocate for improving access to midwifery care for all families by pushing for more health insurance and reimbursement for birth centers and home birth. In my birth center, I will strive to serve all people and create a community of caring birth professionals. As a midwife, I would prefer to work with the communities that would most benefit from the midwifery model of care. San Antonio is a diverse community due to its ties to many military bases around the city and it also has a large population of families of low socioeconomic status. At times midwifery, home birth, birth centers, and your right to choose those things have come under fire in the Texas Legislature. My goal is to advocate the Texas legislature to have Medicaid pay for midwifery services, similar to how New Mexico has for many years. Ensuring Medicaid families have access to a range of maternity providers promotes patient choice and individualized care. I would also eventually low to open a birthing center modeled after the JJ Way so families who otherwise could not afford out-of-pocket payment for midwifery (The JJ Way). Along with having eventually having Medicaid coverage, the JJ Way model also keeps other costs low for birthing families by addressing health disparities due to cultural and socioeconomic reasons and giving birthing families essential support during the antenatal and postnatal periods. Every family wants a healthy birth and every family deserves one. Engaging parents while identifying their racial disparities for low-income people and people of color is important to lower rates of preterm labor and low birth weight. Disparities in birth for people of color could be improved if midwives were accessible and available to those who would most benefit from high-quality midwifery care.

I am motivated daily by my children. As a mother of four children, I have a responsibility to show that they and I can do anything we put our effort into. As a mature student, I have to struggle to learn to study again and keep up with much youngest students with higher energy levels than mine. Studying nightly while making dinner or folding laundry shows my family that even if you have other tasks that are important, we can still apply ourselves to our education. Age is not a disqualifier for starting a new career or getting an education. Whether my children immediately decide to go to college after high school or decide to go later on in life, they will see that it is possible, even with a family and other adult priorities.

I do small things to show other than I care and love them. Sometimes, just sharing a stick of gum with friends after lunch can be something that will get them through the next hour in class when the post-lunch tiredness hits. Sharing a handful of microwave popcorn with a hungry friend during a short break can help someone from being too hungry when they return to work afterward. Letting an obviously very rushed driver in your lane will prevent them from more anxiety or stress from being late to work, school, or any important appointment. Sometimes, even just listening to someone vent for a little extra time helps a friend relieve their stress even more than if I replied with my advice they likely didn't ask for or maybe didn't even want. Small acts of kindness have a ripple effect on those around us.

1. I am a mom for 4 children who left her career to go back to school to become a nurse and eventually a nurse-midwife. It is a financial struggle going to one income and also having our oldest child in college as well. 2. We do have some wonderful birth centers here but none take Medicaid so it does restrict access to mostly only those with employer provider insurance and those who can pay out of pocket for out-of-hospital care. Just because someone cannot pay thousands out of pocket for a midwife, it shouldn't restrict their birth options. 3. My first professional job involved commuting around ninety miles each way to train as an intraoperative neuromonitoring clinician. I spent over a year and a half commuting each way to train and work with neurosurgeons. It also involved two different training sessions in Michigan for two weeks at a time during the first six months of my training. My son was a year old and my husband just started his career too so it was difficult to be training, newlyweds, and raising our oldest child while not being around one another often. We are now married for nearly twenty years now so we learned how to work on our relationships.

My core beliefs are that God enables us to do good works and follow the two Great Commandments but we sometimes get bogged down into what our world wants rather than what will fulfill our duty to God and our brethren on earth. As a nursing student, part of my profession is to serve others, be compassionate to our patients, and do no harm to even those who I may not want to serve. I will have to serve those that I may think are undeserving due to their violence, neglect, or whatever it may be but I must always look to God to give compassion and care to even those who I do not see as worthy. We are all unworthy to some extent in the eyes of the Lord so I should still treat others with dignity and compassion regardless of my personal feelings. Excellence is pursuing your goals, accomplishing them, and continuing to strive to become a better version of ourselves every day. There will be obstacles in our way and sometimes we get detoured from our path but we always must continue on with the strength through Christ we have to continue on. Job from the Old Testament struggled even with being a just and righteous man so we also must realize that even the faithful can still struggle with obstacles and adversity when we pursue following our Lord and the goals we want to achieve. Pray is an excellent tool that I will continue to use daily to continue my relationship with the Lord and to know that I always have Christ supporting me and giving me strength to continue in the path that I have chosen to best serve Him and the people around me. I do plan on eventually doing mission work in Haiti along with Mother-Baby Haiti along with some community midwives to serve the impoverished people of Haiti. This will give me an opportunity to help people outside my privileged American society and be thankful for all the Lord has given me. Sharing my skills, abilities, and knowledge with others is the least I can do to thank the Lord for giving me the opportunity to learn to be a nurse. When I do become a nurse and eventually a nurse-midwife, I will be thankful to my Lord for giving me this life that allows me to pursue my dream of serving pregnant and birthing families in one of the biggest life transitions. I will also thank my classmate who has supported me, studied with me, and shared in the struggle of long days and difficult clinical days. We will only make it through nursing school by supporting one another. I will also thank my family as they have had to make adjustments for my ever-changing clinical and class schedule. My husband and children have had to adjust their lives and have had to deal with me not being around as much. They have also taken on the burden of needing to be more independent to continue on with their work and school while also supporting one another on the days that I cannot be at their school events. I am very thankful for all the support I have from the people around me. I can do all things through Christ who strengthens me and Christ has given to me abundantly with the love of my family, friends, and classmates.

I lost my father on the first day of classes in 2019 for my midwifery program at Midwives College of Utah. It also happened to be my daughter's 13th birthday as well. We had just visited with my parents over the weekend and had seen my father right before we left my hometown for my home in another city. It was a very confusing and stressful day with wanting to grieve my father, wanting to get a good start to the school year, and also wanting to have a good day for my daughter as she enters her teenage years. The morning was spent with calling family and grieving over the phone with many and contacting the funeral home to start making plans. The afternoon was full of doing what I can for my online classes and was fortunately very light in assignments so I wouldn't get too behind with being out of town for the majority of the next two weeks. The evening was spent with family celebrating my daughter and sharing a good time. This was a good reminder that with every life that goes on and it celebrated, there is another life at the end. I did continue on with this midwifery program for the next year that also included many other life changes like my husband's layoff and other family deaths. It was a difficult year, aside from the COVID pandemic changes plans for all of us, but I had a great support system from my family and local friends who also helped support me when I thought about just giving upon everything. During this year, it turned out that midwifery wasn't what I needed to be studying so I have changed to another college, Hallmark University, to pursue a nursing degree. This has shown me that life sometimes goes on unexpectedly. I did not expect to wake up to the news of my father's passing nor did I expect to drop from one program and go into another program within the same year. Despite this, I have to keep moving on regardless of the obstacles and grieve that we all deal with from time to time. Many other students have also lost friends or family during my time as a student and my experience has helped me to speak with them with empathy and make sure they have support. Support from my family and friends has helped me get through the hardest days of my life so I also must respond in kind to those around me that are also dealing with difficult times.

In this journey in midwifery, it has been a struggle with the transition of becoming an adult student, reflecting on who I am, and who I plan on becoming as a midwife. Since the second tenet of the Midwifery Model of care states, “providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support” we as student midwives are learning to see and treat our clients as individuals who need individualized care. Native Americans and people of color have largely had inadequate care that lacks cultural competence from largely white providers. While it will take time to increase the number of providers of color, the current professional midwives must also adapt to changing the mindset to be more inclusive of diverse cultures and become more accessible to a different variety of people. Since people of color have had a life of prolonged exposure to systemic racism, we as midwives must be compassionate care providers who acknowledged the historic trauma many people face. Becoming trained on trauma-informed care is a good component of care to introduce into midwifery to address these historic traumas as well as the many personal traumas, all birthing families face from exposure to family violence or traumatic experiences. Luckily, two local birth professional organizations have trauma-informed care training sessions that I plan to attend to help become a better care provider that will be able to identify trauma and seek to educate and assist in not creating more trauma. Since I have a current doula client with a history of sexual trauma, it will be imperative to make sure she is given the support that is promoting healing and recovery with retraumatization. Trauma-informed care training is important to deliver holistic patient care while being sensitive to live experiences that may relate to a person’s current mental and physical health. Lastly, live in an area where the "minorities" are no longer the minority but many care providers are still non-Hispanic whites and about half are male. There have been small changes with the growth of midwifery here but it also does remain primarily for more wealthy, white families as well. As I learn more about the Midwifery Model of Care, I hope to understand better methods to care for birthing families to decrease trauma and improve informed consent for families having babies. Just because someone may not look like I do nor come from my background, that does not mean they do not deserve health care without compassion, integrity, and equitable care. Continuing the journey together with other culturally competent midwives who teach the next generation about equity and individualized care is paramount. Growth is essential for our society for positive changes in equity, compassion, and justice. The more diverse the field of midwifery and healthcare as a whole, the better we can begin to address some of the institutional prejudices and hopefully, dismantle them from within.

I am pursuing my dream of becoming a midwife to help others have the opportunity for culturally competent community birth options. I live in a large Hispanic/Latinx community that lacks any midwifery representation for Spanish-speaking birth centers and home birth options. As a midwife, I would prefer to work with the communities that would most benefit from the midwifery model of care. San Antonio is a diverse community due to its ties to many military bases around the city and it also has a large population of families of low socioeconomic status. At times midwifery, home birth, birth centers, and your right to choose those things have come under fire in the Texas Legislature. My goal is to advocate the Texas legislature to have Medicaid pay for midwifery services, similar to how New Mexico has for many years. Ensuring Medicaid families have access to a range of maternity providers promotes patient choice and individualized care. I would also eventually low to open a birthing center modeled after the JJ Way so families who otherwise could not afford out-of-pocket payment for midwifery (The JJ Way). Along with having eventually having Medicaid coverage, the JJ Way model also keeps other costs low for birthing families by addressing health disparities due to cultural and socioeconomic reasons and giving birthing families essential support during the antenatal and postnatal periods. Every family wants a healthy birth and every family deserves one. Engaging parents while identifying their racial disparities for low-income people and people of color is important to lower rates of preterm labor and low birth weight. Disparities in birth for people of color could be improved if midwives were accessible and available to those who would most benefit from high-quality midwifery care.

The meaning of my life is serving others When we serve, we lead by example. We get rewarded by the good we have done and by spreading the love we have within us with others. This usually also sparks others to find their way to serve as well. This sparks a fire that spreads from every good deed we do so those around us share their gifts and help out our community and all those in need around us.

I love early morning walking after dropping up my children at school. The cool mornings of fall have been a refreshing time to exercise and reconnect with nature before I start my day. It may just be a walk around my neighborhood or a nearby park but it has been one of the best ways I can take care of myself to be a better person with everyone I meet throughout the day.

I want my legacy to be a legacy of helping others grow and share their knowledge with others. As an older student returning to school, it has been interesting to see younger students struggle in class as they haven't yet learned to study in a college environment. I also struggled when I was a young adult in my early college career and hard to learn the hard way to study but getting low grades and trying different methods of learning to retain knowledge better. My current class of nursing students has banded together to learn from one another and share tips with each other on how we have learned some of the more difficult information we need to know for our exams. I usually contribute by creating a Quizlet from our study guide as well as sharing any online resources like Khan Academy or Crash Course web-based lessons so we all can have different sources to adapt our learning style to. Over time, we have created a group chat to share our resources as well as meet before class to study for quizzes and exams. This has been a great learning experience to pool our knowledge together and learn together as a team when the information was difficult. Though we may not continue to be in the same courses, we have learned some great learning methods that we will individually use to continue our path to becoming registered nurses and can use them as well in our professional career when we have to learn new or emerging methods of patient care.

"I did then what I knew how to do. Now that I know better, I do better."- Maya Angelou This quote shows that we try our best to do what is right in the world. We may not always do things correctly or well but we learn with experience over our lifetime. Sometimes, we learn by making mistakes and learn the correct way to do things by not repeating those mistakes. When we know better methods or just learn better techniques from reading or advice from someone more knowledgable than ourselves, it helps us become a better person at our job or in our home life. Wisdom doesn't come all at once. We learn little bits every day of our life. Sharing what we have learned also helps other gain wisdom and the ability to do better as well.

Just this weekend, my family and my husband's long-time friend and his family got together for dinner and a movie. It had been a long time since we have gotten together due to our busy lives of working, school, and just recent COVID infections keeping us away from crowded settings. We ate good food, shared funny stories, and spent time watching a great movie in their home theatre room. At the end of the night, their daughter made a card for my son that said, "I will miss you." It made me appreciate the life-long friends we have made.

I am motivated to continue my self-betterment due to my children and the community around me. As an older student, I do want to show my children that we can continue to learn and follow our path to our dream career regardless of age. At this time, my oldest child and I are both in college studying for our bachelor's degree so it also helps me be a positive example of a committed student for my child. He sees me study and read my textbooks at home. He has also been active during projects and classwork at home so we have been motivating each other by example. I also have many friends who have changed careers and have gone back to school as adults. Many have similar family and financial situations as me so it has been nice to be able to reach out to others who have gone through a similar school journey as mine or are still studying as well. One of my classmates is also a working parent so we have supported one another by studying together and offering one another advice on how we manage our busy schedules. Likewise, a good friend and former coworker of mine has recently completed a Master's degree program while raising her three children and working in her own business during her studies. She has shared the ups and downs during her schooling and has provided a realistic view of being an adult learner. I appreciate my friends who are supporting my goal to become a nurse-midwife. The people around me motivate me to continue on with my schooling and goals to provide community birth services in my area with many current doula careers and eventually nurse-midwife certification.

My best skill is being an active learner and sharing my knowledge or tips for learning with my classmates. During my past two terms of nursing courses, I have been fortunate to have very supportive classmates that also have a spirit of sharing their knowledge with each other so we as a class have the best opportunities to do well in class. I am a visual learner so any time I find a high-quality video or online tutorial for the current subject we are learning, I will share it with my classmates. Our instructor also shares blueprints for each quiz or exam so I have used these to create several Quizlets that I have shared with my class as well. I enjoy creating the Quizlets as they help me to study by the simple fact I am reviewing the study material as I create them as well as having various images to share on the flashcards created to see the process of the item we are learning. Seeing the words together with the image help me understand the concept better. Sharing knowledge is essential as my classmates and I prepare for our nursing careers. As medical and scientific advances are made, we will have to learn new techniques or evidence-based care treatments. Sharing new protocols and methods will be essential to ensuring we provide proper care to our patients. Having an early foundation of knowledge-seeking and sharing will be an essential tool for my career as a nurse and nurse-midwife so my patients know I am giving the best care I can give.

Self-care is an essential part of every day of my life. I am busy as a wife, mother of four children, nursing student, and birth doula so having some time to myself to recalibrate my mood can sometimes be a difficult task. Many mornings after dropping off my children at school I do have time before classes or appointments to walk around my neighborhood or nearby park. This helps me start my day from a calm and centered place. I also can wash off the stressful thoughts from my walk in the shower afterwards to stay my busy day feeling fresh, renewed, and energized from having my heart and muscles having some exercise to get my blood flowing. I also do try to find some time to make a health meal for myself and family for dinner. This time for preparation is almost meditative as it takes my mind off the busy day I just have and brings me to thinking how to best nourish myself and my family. Due to school and work, dinner is the only time we have to sit together and talk about our day. On days where things don't go as planned, I do miss these dinner times and do feel they are essential with connected with my children and husband when we are otherwise mostly connected to work or school colleagues throughout the majority of our day. On weekends, we do usually have a lazy Saturday or Sunday at home. A busy week does leave us pretty tired by the end of the week so one day of unplanned relaxation is necessary for us to recharge for another week. We also usually go out at least once for a sweet treat so we can enjoy life at a slower pace on the weekends.

Friends are people who support you, love you, trust, and can be honest with you if they see you are in need of help or making wrong choices. True friends don't always need to be in touch every day and sometimes time can pass without contact for some long bouts of time. True friends can come back to a conversation days, weeks, months, or years later and speak with ease with each other. There have been difficult times in my life and even a tiny gift like a miniature cactus from my friend during a "prickly" patch in life or a random photo tag on social media from a high school friend has brightened my otherwise dark mood and day. I am a relatively private and introverted person so many new friends never came easy as a child or as am adult. I have cherished those who have patiently waited for my to come out of my shell of shyness to become my friend.

Patience is an important part of my personal and professional life. My personal life includes being the youngest of five children, wife, and mother of four of my own children. Patience is essential to taking turns for the bathroom, in the kitchen, and getting everyone ready to go to school. We have to practice patience on a daily basis as well with the nearby road construction and living near several school zones with slower speed limits that I appreciate when I am pressed for time. Professionally, I am a birth doula and birth never unfolds are people expect. I have been to births that have lasted from three hours long to over forty-three hours long. In both extreme instances, the parents especially are anxious to meet their new baby after many months of pregnancy. My job as their support person is to provide continuous emotional, physical, and informational support to mothers before, during, and after childbirth. Many times, families who choose natural, unmedicated birth hit the transition period of labor and it can very difficult to continue laboring after many hours of changing positions and contractions. Giving them an extra cheerleader in their corner as well as hands-on techniques like massage, sacral press, and even just offering a strong bear hug can get families through that last bit of difficult labor before they have their baby. Patience is something I will always work on as one day may be a good day and the next day may be one that wears my patience very thin. Every day is a day to renew my patience and learn new ways to help myself stay calm and collect plus hopefully be a good model for others.

Healthcare is a STEM career. It applies biology and chemistry to keep bodies healthy. I am in the process of becoming a nurse and eventually a nurse-midwife. People need compassionate and evidence-based care that is also culturally competent. I hope to become one of a very few Latina nurse-midwives in Texas so that English and Spanish speaking pregnant clients can have high-quality care in the language that suits them best to understand the care they are receiving and feel comfortable enough with me as a provider to ask questions when they need more information. I have been an intraoperative neuromonitoring clinician and a doula so I hope to apply my medical and ancillary training to the care I will offer as a nurse-midwife. I am an adult learner and older than most of my classmates but I also hope that my time in school shows many of my classmates it is never too late to learn and follow your path to your dream job.

I walk daily to start my morning with the best attitude and my blood flowing for the healthiest start to the day. I have been also trying to lessen my involvement with others who only seem to want to sow discord and division between people as I do not need their negative energy ruining an otherwise productive day. Spending my morning in mature also helps me reconnect with the world around me.

I loved the support of my midwife for the pregnancy, birth, and postpartum recovery of my youngest son. Every prenatal visit was relaxed in her birth center and I was able to ask several questions about my care and health without feeling rushed or talked down. Even though I had an emergent transfer of care into a hospital for cesarean birth, my midwife supported me during my labor, called the transferring hospital to allow for emergency transfer procedures for the admitting obstetrician and delivery staff. Even after discharge, my midwife did a home visit and brought extra resources to aid in my recovery. This great care had greatly impacted me and has to lead me to also enter birth work as a doula and enter into nursing school to eventually become a nurse-midwife.

I currently work for San Antonio Birth Doulas, an organization that offers childbirth education, labor, and postpartum support. Labor doulas like myself educate and empower pregnant women and their families so they can make informed decisions regarding their health care. Labor doulas also work with health care providers, insurance companies, hospitals, and politicians to implement evidence-based maternity care practices. A great need for birth advocacy exists with the cesarean rates in the U.S. at 33%, and women being denied access to choices such as VBAC, community birth with midwives, and waterbirth. Our organization not only attends to birthing families but we also support postpartum families with postpartum doulas, lactation consultants, and access to our boutique for gently used baby and maternity items for all clients for free if they need them. Due to increased funding, our organization has also been able to enroll some of our staff as Community Partners to help clients enroll in Medicare, CHIP, SNAP, and other state benefits if they need it. We have also trained some of our staff to be pregnancy testing advocates so clients who do not have a doctor can get a pregnancy test and a list of local resources to help them find support if they are pregnant. This has been a great help to many of our clients who are faced with an unexpected pregnancy and did not know they could use these programs to help them continue their pregnancy and have support for their medical needs and access to food or nutritional resources. Many clients do stay with our organization for their childbirth education needs, labor or postpartum doula support, and also postpartum counseling with a licensed therapist that has joined our staff. To truly be pro-life, supporting the parents during and after a baby is born is absolutely important. As a doula, it is a blessing to walk with a family as they physically and emotionally grow as people and learn ways to support their new baby.

I am Giselle Rackley (she/her/hers) and live in Universal City, Texas. I come into this midwifery journey by learning little by little over the past 17 years of having 4 children. My first child was unplanned and unexpected so I came into motherhood rather ignorant about pregnancy, labor, birth, and raising a family. I am the youngest of five children and my closest cousins were near the same age so I grew up not interacting with many babies until I was a teenager and a young adult. On my first pregnancy, I did what my doctors told me to do (i.e. read these books, take the clinic birth class, do the hospital tour, etc.) but really didn't know much about what my body would go through into pregnancy and labor outside of book and class knowledge. With my second birth, I had recently moved to a new city and choose a female OB/GYN group as I wanted to hear about birth and my concerns about postpartum from a woman's viewpoint as my prior provider was male, though very kind and compassionate. My third pregnancy coincided with my best friend's pregnancy and we both learned together about the option of having a midwife and doula at a birth. I loved to hear how she was supported during and after her birth so I sought out a doula training course to learn more and entered into my local birth community of doulas and midwives that I had previously did not know existed. My youngest childbirth was attended by my doula/friend and a midwife and, though it was an unexpected hospital transfer from home, it was my most supportive birth of all. I appreciate the great, compassionate, and professional care my doula and midwife provided. Over the past three years, I have noticed I have read more and more about birth, postpartum care, and the needs of women to have better access to trained birth providers that I finally listened to my heart plunge into the waters of midwifery.

It has been hard to stay optimistic during these difficult times of pandemic and political polarization. I have been making sure I continue to do balance work and home life as well as making sure some self-care time is included in every day. Avoiding incendiary conversation has also been a part of improving my personal mood as some conversations are not worth putting effort and frustration into as they are usually not conversations worth having in the first place. Some people you can avoid that frustrate you but even if people can't be avoided, patience and politeness should be always shown to make sure a stressful situation isn't made worse by my personal bad attitude or growing frustration. Sometimes, asking for help can also lower these frustrations if a situation just might boil over or cause me to lose my temper. Taking a walk daily outside has been one of the key ways I either vent my frustration or even start my day on a calm path. If possible, everyone should connect with the outside for some time of the day to let the breeze blow away the stress, the movement of our body to relax our muscles, and the sunshine to invigorate our soul.

I love my constant desire to learn more about improving the health of the people around me and myself. I cannot be an advocate of improving health if I do not do it myself. With the pandemic, most people have put their health on hold to help others or handle stressful situations. To be able to help others, we also need to make sure we keep our bodies and minds in good health as well. As a nursing student, I am currently learning about our body systems, what causes dysfunctions, and how the system should work. We know how to do things better but we also sometimes do what works now because change is difficult and improvement does take time. I have personally been setting time aside to exercise and eat healthy afterwards. Time management in a busy life can greatly improve our health by making time to feed ourselves well and move our bodies to keep them strong and healthy. Sharing good health tips and education is also a great part of improving the health of others around me. As others learn healthy habits and methods to keep our bodies healthy and safe, the more we can collectively create a movement to improve health outcomes and lower morbidity rates due to bad health choices and unhealthy lifestyle habits.

Midwifery care helps improve Latinx birth outcomes but barriers remain in access to bilingual midwives, limited Latinx midwives in practice, and lack of insurance or Medicaid coverage for community birth in Texas. Latinx birthing families can benefit from increased birth options of birth centers and planned home births that are attended by a midwife and a doula for continuous support. Measures to remove barriers to the management of labor and delivery by midwives in community birth in Texas should be encouraged to allow out-of-hospital birth options to Latinx families who only have hospitals to choose from. Regardless of where women give birth (hospital, birth center, or home), access to a doula or midwife can provide additional support to women and potentially reduce C-section rates that put women and infants at risk. As a Latina working towards a nursing degree and eventually a nurse-midwifery degree, I hope to fill the gap of culturally competent care for the largely Latinx community that I like in.

My third pregnancy coincided with my best friend's pregnancy and we both learned together about the option of having a midwife and doula at a birth. I loved to hear how she was supported during and after her birth so I sought out a doula training course to learn more and entered into my local birth community of doulas and midwives that I had previously did not know I existed. My youngest childbirth was attended by my doula/friend and a midwife and, though it was an unexpected hospital transfer from home, it was my most supportive birth of all. I appreciate the great, compassionate, and professional care my doula and midwife provided. Over the past three years, I have noticed I have read more and more about birth, postpartum care, and the needs of women to have better access to trained birth providers that I finally listened to my heart plunge into the waters of midwifery. As a student nurse and eventually midwife, I hope to collaborate with my peers and instructors to learn to incorporate the Midwifery Model of Care into my life path. I have connected with local midwifery students and my local midwifery organization to establish connections and learn more from my peers and mentors. I plan on opening a community birth center that is open to all clients with Medicaid and major medical insurance plans. I will run my midwifery practice with compassionate care and evidence-based practices for all birthing families and people who need gynecological care. I am an advocate for improving access to midwifery care for all families by pushing for more health insurance and reimbursement for birth centers and home birth. In my birth center, I will strive to serve all people and create a community of caring birth professionals.

My classmates and I had our first in-person class together today. After a semester of online classes, it was amazing to speak face to face with friends that we have the only group chatted with or discussed information via our Zoom class. Since we are in an accelerated program, classmates shared their tips on studying for exams. I have been sharing my Quizlet flashcards with classmates, another classmate studies during her breaks being a Doordash delivery person, and we all share what great resources we find online with one another to make sure no one gets left behind. The team effort of our small class has helped lower our stress knowing that we have support and someone going along with us in the journey to becoming nurses. Then support and positive attitude has also helped me continue with my pregnancy and birth advocacy page, Geeky Gal Birth Advocate.

My dream life involves becoming a community-based nurse-midwife who attends a diverse community of families of many ethnicities and income levels. Community birth in a birth center or home should not only be available to those who have the luxury of being able to afford it. Currently, the state of Texas offers very lower reimbursement to nurse-midwives who attend to clients with Medicaid and a majority of major medical insurance companies offer little to no reimbursement or coverage. I plan to start advocacy for improved insurance coverage for community birth professionals so that birthing families have opportunities to have high-quality care available in a variety of birth settings. Hospital birth is appropriate for high-risk pregnant people but low-risk pregnant people should have the option for hospital, birth center, or home birth if a licensed medical professional can attend to their needs and provide medical care with the appropriate equipment and training. Nurse-midwifery can fill the gap that many people currently face during the pandemic by having a birth option that is safe from potentially infectious disease due to very volume hospital capacity and hospital staff that may unknowingly spread infectious diseases because they are having to cover more patients than normal during these trying times.

Empowering women begins at birth. Many women do not feel supported by their providers during their pregnancy and their body autonomy is not respected many times during labor and birth. I have worked the past several years as a birth doula and midwife assistant to help families feel respected, supported, and heard during birth. I am currently on my journey in nursing school at Hallmark University to get my Bachelor's in Nursing to become a Nurse Midwife. I come into this midwifery journey by learning little by little over the past 18 years of having 4 children. My first child was unplanned and unexpected so I came into motherhood rather ignorant about pregnancy, labor, birth, and raising a family. I am the youngest of five children and my closest cousins were near the same age so I grew up not interacting with many babies until I was a teenager and a young adult. On my first pregnancy, I did what my doctors told me to do (i.e. read these books, take the clinic birth class, do the hospital tour, etc.) but really didn't know much about what my body would go through into pregnancy and labor outside of book and class knowledge. With my second birth, I had recently moved to a new city and choose a female OB/GYN group as I wanted to hear about birth and my concerns about postpartum from a woman's viewpoint as my prior provider was male, though very kind and compassionate. My third pregnancy coincided with my best friend's pregnancy and we both learned together about the option of having a midwife and doula at a birth. I loved to hear how she was supported during and after her birth so I sought out a doula training course to learn more and entered into my local birth community of doulas and midwives that I had previously did not know existed. My youngest childbirth was attended by my doula/friend and a midwife and, though it was an unexpected hospital transfer from home, it was my most supportive birth of all. I appreciate the great, compassionate, and professional care my doula and midwife provided. Over the past four years, I have noticed I have read more and more about birth, postpartum care, and the needs of women to have better access to trained birth providers that I finally listened to my heart to plunge into the waters of nursing school and eventually a master's in midwifery.

I come into my educational journey to becoming a nurse midwife by learning little by little over the past 17 years of having 4 children. My first child was unplanned and unexpected so I came into motherhood rather ignorant about pregnancy, labor, birth, and raising a family. I am the youngest of five children and my closest cousins were near the same age so I grew up not interacting with many babies until I was a teenager and a young adult. On my first pregnancy, I did what my doctors told me to do (i.e. read these books, take the clinic birth class, do the hospital tour, etc.) but really didn't know much about what my body would go through into pregnancy and labor outside of book and class knowledge. With my second birth, I had recently moved to a new city and choose a female OB/GYN group as I wanted to hear about birth and my concerns about postpartum from a woman's viewpoint as my prior provider was male, though very kind and compassionate. My third pregnancy coincided with my best friend's pregnancy and we both learned together about the option of having a midwife and doula at a birth. I loved to hear how she was supported during and after her birth so I sought out a doula training course to learn more and entered into my local birth community of doulas and midwives that I had previously did not know existed. My youngest childbirth was attended by my doula/friend and a midwife and, though it was an unexpected hospital transfer from home, it was my most supportive birth of all. I appreciate the great, compassionate, and professional care my doula and midwife provided. Over the past three years, I have noticed I have read more and more about birth, postpartum care, and the needs of women to have better access to trained birth providers that I finally listened to my heart plunge into the waters of nursing and midwifery. I plan on finishing a BSN program in the next few years and work afterward while I pursue a Certified Nurse-Midwifery degree. I plan to provider culturally competent care as well as evidence-based care for all my clients when I become a Nurse and Nurse-Midwife.