Wouldn't the patients already have an OBGYN that is delivering their baby?
- As a midwife, you can have your own patients because you are a licensed practitioner. You sign your name on the documents, so you better be the one managing. Yes, you actually see patients in the clinic, manage their pregnancy, and then manage their labor.
So do you end up assisting the OBGYN, or is your role pretty much autonomous in birthing the child?
- Generally speaking, a midwife is not assisting an OB. She is managing her own patients. She (or he) consults with the attending when she has to, for example when the patient develops pre-eclampsia. How much and when a midwife has to consult depends largely on hospital protocol. There are many models of midwifery care in hospitals depending on where you are, whether it's a teaching hospital, whether the midwife is involved in teaching. In many hospitals, especially in the West Coast, midwives actually run the labor floor, with attending available for consult. That's actually the most desirable setting for many midwives.
If you do end up working pretty much solo, how is this possible, again due to woman usually having a doctor?
- Many women seek midwifery care rather than a doctor. Whether in a hospital or in a private practice, midwives have collaborative agreements with MD's so that we can consult in high risk cases. What is considered high risk has to be outlined in the collaborative agreement, although most collaborative agreements are pretty much the same. The ACNM, our proffesional organization, is against the need for collaborative agreements required by the state legislation. This is because we are autonomous in our roles. For example, if primary care doctors can make independent decisions to refer a patient to a specialist, we should be able to do the same. All health care proffesionals practice within their scope, even MD's. Our scope is defined as management of normal deliveries.
I got the impression if you are employed by a hospital, you are not following a woman all throughout her pregnancy, correct?
- Yes, you do follow a woman throughout her pregnancy, but in a hospital, this is usually done as a group of midwives. You have clinic hours as well as Labor and Delivery hours.
I hope this has been helpful. My advise is for you to start perusing the ACNM (The American College of Nurse Midwives) website, where you will get a better understanding of what we do. Also remember again that hospitals differ vastly in midwivery models they implement, and that your license is governed by the state in which you work. When you do your OB rotation as a nurse, maybe you'll be lucky to observe some midwifery practice. Good luck.