[LuvsOB]

Hi everyone,
I am interested in becoming a CNM but we don't have any where I work. I was just wondering how they are treated and utilized at other places. Are they respected by docs and mangement? We had a FHNP in a clinic where I worked and she was not utilized like she should have been. Also not very respected by management or docs. She got fed up and left. I really want to be a midwife but I would like to check out the climate before I spend all that time and money. Any info would be greatly appreciated.
Thanks

[dreamon]

I would also like to hear about how midwives are being treated. I hear some OB docs are threatened by them...is this true?

[SmilingBluEyes]

OH boy there are some great books out there about midwifery practice in an Obstretric environment...
It just depends


some places, I have seen them treated VERY well by OB's that back them up...

others, I have seen them treated LESS than well by the OB's.....there is definately an "us versus them" mentality there in some places.

I think there is ROOM FOR BOTH------

Women should have a choice.....and midwives are PERFECT for low risk prenatal care for families. They are superb teachers, listeners and care-givers.

It just depends on the place. I worked two where midwives have been employed. In one,they were treated VERY well...the other...they were not and eventually left the practice.

Good luck to both of you!

[moondancer]

In the hospital I work at we have a full time staff of about 10 OB's and 15-16 CNM's. Our model is set up so that our midwives see their patients during clinic hours and also take a 24hr "shift" on L&D. The midwives do 90% of the deliveries. They do not handle high risk Ob pt's, anyone under 36wks, or anyone specifically requesting an MD. There is always an OB doc on the unit w/the CNM's, 24hr/day.
I love this model, many of the CNM's are former RN's from our unit. The RN's and CNM's work side by side, in fact some of the really good ones help with actual nursing care (as opposed to waiting for the RN to do something for the pt).
We have a very unique model, and unfortuneately, I haven't seen it duplicated many other places. I, myself, would love to advance as a CNM, but I would only work at my current hospital, b/c anywhere else in this city the CNM's aren't treated very well!

[SmilingBluEyes]

moondancer, that sounds ideal!!

[mother/babyRN]

I am with Smiling Blue Eyes here...They have to prove their skill just as any delivery nurse does....The one we work with is pretty good, and we do attempt to work with her....That includes working with her idiosyncrocies as well......But, we can talk about it and she is approachable. Since she was a nurse first, she also understands where we are coming from AND she is affiliated with an all Woman practice, which I believe does help in her case. She is not opposed to working WITH the nurses vs against them, and that makes us want to work with her as much as possible, especialy since she does not take un neccessary or inappropriate chances and calls the doc as soon as one is needed...That is a big plus considering we have had some that do not do that...

[BETSRN]

We love our CNM's where I work. We have 5 in one all female OB practice. Their OB's are very supportive and try to encourage all patients to be midwife patients. There are a few, however, who want to be "MD only" patients and that is their choice. Our CNM's have delivery priviliges but are not allowed to use forceps or vacuums. Some insurances are mandating that the OB be in the room (for reimbursement purposes) but when that is the case, the OB keeps her hands off unless she is needed (as it would be in any case).
I have been at my hospital for almost 15 years now and I was there before midwives. The midwifery influence has been very positive. We work very hard to keep unnecessary interventions (like scalp electrodes and IUPC's) to a minimum and I do think that the midwifery model of care has rubbed off on all of our docs.

With midwives, comes a lot of autonomy for us nurses (with all the docs). I'd have a hard time in another L&D unit where I couldn't ahve to hands on and autonomy that I have where I am now.

[Dave ARNP]

There are three midwives at my Ob/Gyn clinic where my wife works. She values their imput, and the do just as many deliveries at the hospital where we work, as the Ob/Gyn's do.

They are very well respected, and personally, I call one of them should I need to refer a PT for Ob/Gyn needs. Ofcourse, I do avoid MD referrals, NP's to Np's!

Best wishes in your career!

David Adams, ARNP
-ACNP, FNP