Hello Midwives-to-be,

Like many of you, I became a nurse with the intent of becoming a midwife. I really had no interest in nursing, just read and made (what I thought) was a wise decision to become a CNM vs an LM. Well anyway, I'm finishing my ASN, which was much more difficult than I thought it would be and have unexpectedly really enjoyed my program. I know that I want to apply to Frontier because of their excellent reputation and because there are no other CNM programs in my area. This is a second career for me, so, I'm in my mid 30's and will probably officially be a CNM when I'm close to 40. I whole-heartedly want to have my own birth center but will I feel prepared to do so when I finish my program? I'm almost an RN and feel like I can not be own for a while and I'm afraid that the same will happen when I finish my CNM program. My question/concern is how long did it take you to feel confident to practice on your own? I don't want to wait 5-10 years gaining experience but then again, I do want to feel like a competent CNM and make good decisions.

I'd appreciate anyones words of wisdom.

I'm still a SNM so I can't offer a concrete answer to your question but maybe some perspective.

So when you become a CNM and might look for work at a birth center, how much experience would you hope the midwife running the center has? What about if you were a patient of the center?

I think it's great that you have a big ambition and are willing to put in the effort to accomplish those goals. It takes more experience, in my opinion, to safely work out-of-hospital than within since providers are removed from the backup support and resources available in the hospital setting. In addition, having a leadership role in a birth center would also involve writing policies and procedures and being a resource for other clinicians. That being said, the American Association of Birth Centers offers some great resources including a workshop called "How to Start a Birth Center" which was offered to students at my program so maybe there is something behind growing new midwives in birth center ready mindset. Check out their website and the best of lucky to you!

birthcenter.org

You are absolutely right! I wouldn't want me as a midwife with no experience so I don't know what I was thinking. I just wasn't too excited about working in a hospital so long but that's where I'm going to gain the experience so I guess I should get used to the idea. Since there aren't any CNM run birth centers in my area the hospital is where I'll have to be for the time being. Perhaps I can wiggle my way into a DEM run birth center but I'm not sure if they'll be open to that.

Thanks for your response

I started as an apprentice - and I was thrown into sink-or-swim situations too many times. I did not feel comfortable! Often I did not have skills and I was asked to do things - and expected to do things that I had not learned - because I was the warm body that was present during these births. It was not ideal. At all.

I learned to accept that I would be asked to act on the fly - and I would get a little more comfortable - though there never seemed to be a shortage of new situations where I was put into more uncomfortable situations.

I just completed my RN - I did my preceptorship in L&D - what's nice about L&D is that you are never working alone. Never. Ever. There was a new nurse talking about how scared she was that she was almost done with her training (months) and was scared to be on her own. I think that fear is healthy - because in L&D (and midwifery) you need to be sharp and alert and you have to be on your toes. And lives will be in your hands. But to me, the fear of working on my own on an L&D unit is much, much less than when I was an apprentice in a rural farmhouse in the middle of nowhere, during a snowstorm, waiting for the midwife to arrive and knowing if she didn't get there for the birth and the baby needed resuscitating, or the mom hemorrhaged - or some other unexpected thing happened - that it would be ALL ME to get the situation under control. Yeah, you can call 911, but there's the 20 minutes or more that it would take to get there. Not ideal. Maybe not even ethical. But that's the reality of home birth.

I prefer the team method. I'm very comfortable monitoring labor in the hospital. I'm very comfortable assessing women in labor and providing support. Where I need to improve my skills is communicating with the OBs who are off-sight. And I saw a few EFM strips that made my hair curl. And did a LOT of asking about how the RN would document in those situations. But in the hospital I never felt like the lives of two people would ever, ever be in my hands alone - like when I was in a remote area, far from advanced assistance - I was in that situation too many times as an apprentice at homebirths. THAT is daunting.

That said - attending births at home with a midwife might put some of your reservations in perspective. Being thrown into situations where you're taking on more responsibility than your really should (I'm talking of myself, as a green apprentice) is a good way to get used to being in those situations. I can't ever say I was "comfortable. Maybe just more prepared for the unexpected.

I did A LOT of drills in my head - dystocia, resuscitation, steps for managing hemorrhage, etc - on my way to births. I think that helped. Study. Study a lot. Lots of resources out there.

Thank you so much for your response. You've really made some excellent points. I just started my L&D rotation at the hospital and I am loving every second but I see what you mean about not feeling like it's all on you. At the hospital, you always have someone there helping and someone to ask if you're unsure. I can not imagine what you were subjected to as an apprentice and having the possibility of something going wrong all on you. I'm not sure if I'd be able to make the right call in that type of situation and that's a situation that you have to be sure of, not wishy-washy.