Quote from queenanneslace
One of the hardest things about 'having the heart of a midwife' and working in OB/GYN practices (even OB/GYN practices with CNMs) is that .... oh .... so much of the 'heart of midwifery' is sucked out of it. I struggle with the kind of care I participate in providing. There are days where I feel like I make a different to an individual patient. But there are other days where I feel like a very tiny cog in a big huge baby-birthing industry.
OMG, so much this. I have been a CPM since 2006 and will be graduating from CNM school (knock on wood) next May. This is a real and ongoing struggle for midwives who work in mainstream obstetrics. I am also an LDRP nurse in a tiny community hospital with terrible, backwards protocols and I *hate* being complicit in care that I feel is directly HARMFUL to the wellbeing of mothers and infants.
BUT! I am doing my integration at a hospital with a birthing unit that is entirely run by midwives. They set the protocols and see ALL the patients- the physicians are only involved when medically necessary. Their epidural rate is below 60% (amazing for a hospital), they do uninterrupted skin to skin for at least one hour, delayed cord clamping, waterbirths, etc. The rooms are set up to encourage women to move and stay out of bed, and all the nurses are on board with this model of care.
So it is possible to practice real midwifery in a hospital setting, it really is.
Midwifery has always been my profession. Even when I was burnt out from the 24/7 lifestyle of OOH midwifery, I knew I needed to stay in the field. What drove me back for my CNM was, first and foremost, a better income potential. CPMs make a shameful salary. SHAMEFUL. The other major factor was that when I lived in FL, I was able to accept medicaid reimbursement. CPMs in my current state are not regulated and can't get insurance/medicaid reimbursement, and IMO the women who have the wherewithall to seek out OOH midwives and who can afford to pay out of pocket for a homebirth are often NOT the women who could benefit most from midwifery care.
As a student CNM, I get to take care of women inmates, women who have substance abuse issues, and women who come from all socioeconomic backgrounds. Also, as a CNM I can provide a level of GYN care that I was not qualified to do as a CPM. I ADORE GYN. Love it. I have aspirations to provide expanded sexual/reproductive health services someday too, including abortion services when the silly physician-only laws inevitably get changed.
I still keep my CPM certification and probably always will. But I am glad I went back for my CNM. I think if you truly feel that midwifery is your profession, it is a good career choice. Even if you don't want to go on catching babies, there is so much more to midwifery than that.