Question for the midwives....

katwoman7755 · Aug 13, 2005

We have similar goals, and I've had to make that same decision, and I am a few steps ahead of you. I can share with you what I did, and why, and you can take it for what it is and help you make your decision.
The most important question for me was my end goal. CNM's (at least in NY) do different things - and some end up just doing delivery, and some just Woman' Health. A CNM is just as much a Woman's Health Practitioner as she is a midwife. To me, delivering would be a part of my practice. I just graduated BSN and am entering a CNM program in September. For the first year, I will be working and taking about 2 courses a semester. In the beginning of next year, I will quit my job and go fulltime into the clinical CNM setting.
But I chose not to be in L&D for this one year experience, for these reasons:
1. Patient (general health) assessment is so challenging, and I badly need that experience, even more than delivery experience. Inversely, if I had delivery experience, and no health assessment, I would be worst of at the end of year, and don't know how I would catch up. L&D's assessments are narrowed down to women who are in labor, not the entire spectrum of pregnancy.
2. The hospitals in my area - they are literally swimming in pitocin. That's exactly what I don't want to learn. I am not an extreme, non-intervention type of person, but I think pitocin should be used only when a woman can no longer do without it. In addition, at the drop of a hat, a woman is wheeled into surgery, or vacummed. So I ask myself, after one year of witnessing this, now how am I going to build confidence in the woman's own power? With that, I decided it would actually be detrimental for me to do L&D as my initial work experience.
I don't really know what I'd be doing. I have an ICU offer, but I don't know if I'd stay there too long - I feel like a low level ER would be the best place to hone my assessment skills. But what I do would be very goal orientated to be in a good place when I finally get my CNM.
So, if I had one advice, it would be for you to ask yourself where you want to be. If you want to be delivering a hospital for the rest of your life, and you'd be happy as clam doing that, I say L&D is where you should be. But I'm headed off a different direction. I want to work in primary health care as well, and the delivery I would be doing would be healthy births. So here I am for better or worse. I wouldn't be suprised if there are flaws in my plan, but I have faith it'll work out in the end. Even if I was compelled to do L&D in order to get into CNM schools, it's not the end of world. There's always something to learn.
Good luck.

Thank you for your reply....I too want to be involved in the entire spectrum of women's care. I enjoyed your perspective in that you are CHOSING not to be an L&D nurse. I agree with you re:need to have good assessment skills/critical thinking skills....and those things seem to come from experience. I wish you the best...keep in touch...your journey sounds like it will be very interesting.

Kathryn

katwoman7755 · Aug 13, 2005

One of our 5 CNM's was NOT a nurse before becoming a midwife. She is exceptional. However, I think she is the exception. I still feel that those with previous nursing experience as well as some L&D background do far better (in a far shorter period of time) in midwifery. Just their assessment skills alone are far superior to thjose who ahve ot had a nursing background.
The last student midwife we had recently didn't make it: mostly because her assessment skills were so weak. She was one of those go through and become a nurse in a year masters candidates and her lack of background was so obvious. I'm sorry but I think that those "fast track" programs (and I am talking about programs like Yale) do their students a terrific disservice in this arena.

I agree re: the fast track programs....I guess there is alot of hesistancy re: the use of DEM's....so some are getting the nursing degree for the sake of being CNM's instead of DEM's. I also agree that it probably depends on the person...that's what my friend the OB-GYN said...just varies from person to person...and of course, the more experience you get, the better you get....no one is really great and totally comfortable with it first day on their own...I guess that is probably the reasoning behind recommending previous L&D experience.

Kathryn

fergus51 · Aug 13, 2005

Kathryn, there will always be exceptions to any rule and it may be you or it may not be you. It doesn't matter what anyone else thinks, we're just telling you our experience. It doesn't matter if some CNMs are great with previous L&D experience and it doesn't matter that some fail because of a lack of experience. This one is just about YOU. Only you can know what course is right for you. Just because I wouldn't want to go for my CNM without previous experience in L&D (and antepartum/postpartum which are really being neglected when talking about previous experience) doesn't mean someone else couldn't.

midwifemama · Aug 13, 2005

Just found this site and this thread and thought I'd chime in.

I happen to be one of the CNMs who jumped into midwifery. I completed one of the RN/MSN programs and contrary to what other people have said on this post, was offered a job before graduating and began working the day after I sat for boards! It also wasn't a crap job, but really my dream job, at a freestanding birth center. I will also say that I graduated with about 20 others (all without nursing experience) who all were working within 4 months of completing boards, as midwives. The few people who worked as nurses, did so by choice, mainly because the pay is higher and the hours less strenuous. So it CAN be done.

What happened in my situation was prior to my midwifery program, I participated in a home birth course and did some doula-ing. Once I got my RN, I did start working part time as a nurse while completing my MSN, but not in L & D. Frankly, I have had 3 L & D jobs and they were truly awful. It was very difficult for me to work in medicalized environments as a nurse, when I knew how differently I would practice as a midwife. I would come home so angry and really was unable to deal with the hospital. I did work in a postpartum and high risk antepartum unit - both helpful. I really think having some nursing experience is valuable, no matter what area you choose. Like now, I work in a birth center - you have to be able to think quickly and do things like start IVs, give injections, suction, etc. Nursing things, not necessarily L & D things. As the previous poster said, I think an ER or ICU setting would be a great place to hone your nursing skills. Really, it depends on your personality, your confidence, how you learn, your goals, etc etc. I always knew I wanted to practice out of hospital and made that my number one goal. When I interviewed for the job, they really wanted to know my comfort level with being truly independent - you can be a nurse with loads of L & D experience but be used to being in a setting with lots of help for things like resusitation and feel lost in a home or birth center. Anyway, I got lost with all the info in the thread but I'd be happy to talk to anyone further or answer questions as a CNM with just a tad of nursing experience.

katwoman7755 · Aug 13, 2005

Just found this site and this thread and thought I'd chime in.
I happen to be one of the CNMs who jumped into midwifery. I completed one of the RN/MSN programs and contrary to what other people have said on this post, was offered a job before graduating and began working the day after I sat for boards! It also wasn't a crap job, but really my dream job, at a freestanding birth center. I will also say that I graduated with about 20 others (all without nursing experience) who all were working within 4 months of completing boards, as midwives. The few people who worked as nurses, did so by choice, mainly because the pay is higher and the hours less strenuous. So it CAN be done.
What happened in my situation was prior to my midwifery program, I participated in a home birth course and did some doula-ing. Once I got my RN, I did start working part time as a nurse while completing my MSN, but not in L & D. Frankly, I have had 3 L & D jobs and they were truly awful. It was very difficult for me to work in medicalized environments as a nurse, when I knew how differently I would practice as a midwife. I would come home so angry and really was unable to deal with the hospital. I did work in a postpartum and high risk antepartum unit - both helpful. I really think having some nursing experience is valuable, no matter what area you choose. Like now, I work in a birth center - you have to be able to think quickly and do things like start IVs, give injections, suction, etc. Nursing things, not necessarily L & D things. As the previous poster said, I think an ER or ICU setting would be a great place to hone your nursing skills. Really, it depends on your personality, your confidence, how you learn, your goals, etc etc. I always knew I wanted to practice out of hospital and made that my number one goal. When I interviewed for the job, they really wanted to know my comfort level with being truly independent - you can be a nurse with loads of L & D experience but be used to being in a setting with lots of help for things like resusitation and feel lost in a home or birth center. Anyway, I got lost with all the info in the thread but I'd be happy to talk to anyone further or answer questions as a CNM with just a tad of nursing experience.

Thank you for your reply....nice to hear another point of view.

I have been a nurse for several years...so I definitely have nursing experience under my belt...just not necessarily anything pertaining to L&D or postpartum. I am glad to hear that you had a successful experience...and that others also had success without previous L&D experience. I would definitely have alot to learn, but nursing itself (assessment, critical thinking,etc) would not be new for me.

Kathryn

fergus51 · Aug 14, 2005

Also Kathryn, you might want to consider just taking some breastfeeding courses. No L&D job required there and it may be valuable to you.

katwoman7755 · Aug 14, 2005

Also Kathryn, you might want to consider just taking some breastfeeding courses. No L&D job required there and it may be valuable to you.

That's a good idea...thanks

Kathryn

midwife2b · Aug 16, 2005

My limited experience on this issue: The SCHOOLS will educate you. Not a problem. The issue is after school, when your resume and experience are evaluated for a job, no L&D experience may be a detriment.

When I was doing my IP rotation last fall I worked with a RN who had completed the StonyBrook CNM program and passed boards. She interviewed with 3 different practices and they all told her they wanted her to have at least 2 years L&D experience. So she was working as a L&D nurse (had oodles of NICU and NBN experience, which is also a plus to a CNM) but that didn't count. She couldn't relocate... so she is making the best of a difficult situation.

I met a young lady at ACNM convention who has to complete one year of L&D and THEN she can have a job. She took the position because it is the kind of practice she wants to be in (hospital based care for unassigned women and clinics).

I'm sure this isn't common everywhere. A critical care nurse can become a FNP in 2 years and no one thinks for a moment that she can't perform well because she doesn't have "primary care experience". I think the litigious climate we are in is, in part, why nursing experience is valued by a lot of doctors and other nurse midwives.

Ponder this: Your midwife has no relevant L&D experience, she's brand new, and met the minimum requirements for graduation from her program. How many births do you think she has to do to become credentialed? ACNM only requires 20 births and 20 labor managements. Some programs require more, but only like 30 or 40. I am glad I have a lot of experience; my soon to be backup docs just about DIED when they found out 20 births was the minimum. Fortunately over the years I have caught enough babies that they are comfortable with ME.

fergus51 · Aug 16, 2005

I'm shocked that 20 is the minimum!!!

futureTMA · Aug 17, 2005

katwoman, I was just trying to point you to different opinions which I thought is what you were looking for. Thanks for this additional thread on the subject, there is a lot of good information. I can see both sides of the issue, but I think I will wait until I get more school behind me and most importantly, clinical rotations, before I decide.

texas-rn-fnp · Apr 10, 2006

Haing L&D experience is definitely helpful. The L&D nurse not only has all the delivery and triage experience, but is comfortable with the settings and situations. The CNM is an extentional to a higher level of what the L&D nurse is already doing. That doesn't mean you can't be a great CNM without being an L&D nurse first, but it sure makes life easier and hopefully better.