I'm getting ready to change careers; after 20+ years as a labor and delivery RN I am going to practice as a CNM in the same hospital where I work now. I'm excited, psyched, scared... all kinds of emotions.
I believe that the nurse MUST be your ally in order for successful hospital midwifery practice, so I'd like those of you who have worked with midwives to give me some "tips" for working well with the labor nurses. I already know that I get frustrated when the nurse midwife gives my patient a herbal preparation and she won't tell me what it is, and that my coworkers get frustrated when they don't understand the management that is going on with each patient, and I hope to fix that.
By the way, this is a level III hospital, over 3,000 births per year, 27% C-birth rate, and an epidural rate of at least 85%... so lots of intervention and lots of staff! I will have good physician backup; a few of the docs have actually started using some of my 'tricks" for difficult labors, so I am not really worried about the doctors interfering in my management plans.
Thanks for your help and advice. My coworkers are excited about my new role, and I would like to improve our credibility and reputation if possible.
I'll second what smileing said and add some thoughts of my own. Try not to become to medicalized. As I said in a previous post I work with allot of great midwives. They have good skills and make smart decisions. The only thing I could wish for with them is that they more closely followed the midwife model of care.
We have a group of hospital based midwives and their practice is aimed toward low income/underserved population. Their practice is structured in a way that gives these women excellent care but doesn't allow for consistency of care or a strong supportive relationship and that is kind of sad. However most of the patients they care for don't have the expectation of a midwife that some private patients do.
We have 2 CNM's that are in practice with a group of OB's. Often I find myself feeling bad for their patients. These are patients that choose a midwife over an OB because they wanted the midwife model of care. In my opinion they don't use the midwife model of care. They practice allot like our OB's do. We just call them for delivery. They don't give their patients enough education. I don't know how many times I've explained things to their patients that I would have expected them to learn from the midwife. Often their patients ask "is my midwife going to come and labor with me?" Now when an OB patient asks me this I think it's silly but a midwife should be there at least part of the time because that is the model of care.
One of the private midwives really surprised me the otherday. I was taking care of her patient who was unmedicated and GBS positive, it was 3 AM and the midwife came in. The patient had been in the hospital from 12:00 I had given her amp for GBS at 12:30. She was now 6 cm and doing very well with breathing and positioning. The midwife was upset "I thought she would have been complete by now or I wouldn't have come in, I should go break her bag". It was a little surprising to hear her say that because the patient wasn't the interventional type. I reminded her that recommendations are for 2 doses of amp/pcn and at least 4 hours. She really wanted to get the patient delivered and go home so she went in and told the patient that she wanted to break her bag and get things moving. I told the patient about the recommendation and was really surprised that the CNM seemed perturbed by this. I wasn't that upset that the CNM suggested AROM (because the risk isn't all that great) I was however bothered that she didn't give this patient informed consent. I'm used to having to police OB's and make sure they don't walk over patients but I am troubled by a CNM who needs to be watched.
This is the point that bothers me, that patient had chosen a CNM because she wanted a low intervention birth. Now I'm not anti intervention, I participate in them everyday but on patients that choose that type of care. To me it is one thing to break a bag or start pit on a patient that desires medical care and isn't concerned about natural labor or birth experience but wholly another thing to do it for a patient that desires natural/ low interventional birth.
As for a midwife giving an herbal treatment and refusing to tell the nurse what was in it, this wouldn't fly with me for a minute. I would have had a private talk with that midwife and let her know that it was unacceptable. After all it's my patient too.
Remember why patients choose midwives over OB's and try to honor that for them. After all, if you act like an OB they might as well have gone to an OB.
Last edit by Dayray on Jun 23, '05