Re: Talking to a CNM
I have had 3 very different employment experiences and I will try to share them briefly. I am certainly willing to share more details by PM if you want; I have not tried that from this site either but am willing to.
My first midwifery position was in a private practice that was physician-owned. I was scheduled for 32 hours a week in the office (add about 1/2 to 1 hour per day for going over lab results, returning phone calls, etc.) and a 24-hour call, as well as 1 in 3 weekends on call. The other midwife and I also did 1 in 2 call for women who wanted a midwife specifically for their birth (this was a practice that offered the option of physician or midwife for delivery). I also on occasion made private arrangements with clients to be available for their birth. I "lived" in a call room at the hospital whenever I was on call, as I lived 45 minutes away. Fortunately, my children were grown adults by that time.
My second midwifery job was in a small community hospital, closer to home, in a hospital-owned practice. This was my "dream job" - at the hospital I had always wanted to work in - but turned out to be otherwise. I was hired to what was going to be a 4-provider practice, 2 docs and 2 midwives. One of the docs was finishing her residency so the other midwife (who I absolutely loved working with) and I offered to split the call until the second doc came; then it was to be 1 in 4 call. Between the time we signed our contracts and the time I started, the 1 physician had taken another job and the hospital quick hired a women physician who, it turned out, did not want to work with midwives although that is NOT what she told them when they hired her. She undermined us personally and professionally every day. When the 2nd doctor came, the on-call schedule never changed. They never would agree to take call, other than to back us up, and the hospital Administration never made them do it. The other midwife left after about a year of this; I stayed about another year and a half after she left (call me stubborn, I guess, but I really wanted it to work out).
My current job is as a staff midwife at a large teaching hospital (where I worked as a L&D nurse for many years). I do triage and "manage labor" until the docs decide to breeze in and catch babies. Once in a long while I get to catch a baby if a doctor isn't going to get there in time. I also help to teach resident physicians, hopefully teaching them a more midwifery model of care. I do feel that I have a collegial relationship with physicians here, although that is probably partially because they have known me for many years and respect my judgment. I also feel that I am paid appropriately here but I have to qualify that by saying that there is a Union at this hospital and a large part of my appropriate pay is because I have worked here for many years. I do not feel I was ever paid appropriately in private practice and I used salary.com in negotiations with little effect. Private practice midwifery jobs are few and far between in my area because the malpractice insurance has gone through the roof - in the 9 years that I have been a midwife it has gone up 100% and there is no provision for part-time midwifery. Most practices who have midwives only have them work as practitioners in the office.
I never would have thought that I would be in this position at this relatively early point in my midwifery career. Under more favorable circumstances I would have happily continued being on-call for several more years. However, we have to do what we have to do and so, while I miss births and the relationships I had with my clients enormously, I comfort myself with knowing that I am (hopefully) contributing to the next generation of providers who will have been taught another way of doing things and with the fact that I work three 12-hour shifts now and am never on call so I have lots of time to spend with my grandchildren. Speaking of which, you asked about job/family time conflicts. I would suggest that if you have a young family you should look for a large group practice to limit your on-call time. My children were grown when I went back to school but I would think it would be nearly impossible to be on the schedules I have been on if they had been younger.
I'm sorry, this is a very long post. Hope it has been helpful and not just rambling. I will be glad to try to PM if you want. I hope to hear back from you and good luck with your midwifery career!
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