your role in a hospital with OBGYNs

  1. 0
    Hello all,

    I am a junior in my undergraduate nursing program, and thinking about my future as far as going to school to become a certified nurse midwife.
    I know that it is possible to be employed by a hospital, but I was wondering what your role encompasses if this is so. Wouldn't the patients already have an OBGYN that is delivering their baby? So do you end up assisting the OBGYN, or is your role pretty much autonomous in birthing the child? If you do end up working pretty much solo, how is this possible, again due to woman usually having a doctor?
    I got the impression if you are employed by a hospital, you are not following a woman all throughout her pregnancy, correct?

    Thank you so much for all your help!!
  2. Get our hottest nursing topics delivered to your inbox.

  3. 1,181 Visits
    Find Similar Topics
  4. 4 Comments so far...

  5. 1
    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.
    Eeyore_fan likes this.
  6. 0
    That was very helpful!! Thank you very much for taking the time to make such a clear answer on all my questions. I was unaware that there were clinic hours while working for a hospital, and had the impression as a midwife you would just be up on the floors sort of waiting for the deliveries to get down to your work; and thought that if you started up your own practice you would follow someone all throughout their pregnancy.

    Correct me if I am wrong: if you are working for a hospital, you get your patient load through the clinics or referalls (thereby, the hospital takes care of most of getting the caseload), versus if you have your own practice, you have to attract your own clientele?

    Thank you again!
  7. 0
    Think about it as any provider, such as a doctor. If you are hired, you are probably getting a fixed salary and seeing existing patients of that practice.

    Remember, however, that there are many variations to what I've identified. For example I know a few hospitals which do hire mw's a laborists - only working on the deliveries. It's never all set in stone. Sometimes MD's are your bosses and expect you work strictly under them. It depends on you what you are willing to do. Many people are unaware that we are autonomous, therefore, working strictly under a doctor's guidance means that you have to be responsible for management that you may not agree with. But you have been authorized by your state to make independent decisions, so if something goes awry, you take the blame. It can get complicated. The ACNM is the best place to go for guidelines.
  8. 0
    Gotcha!! Again, thank you so much, you have been very helpful!


Top