Quote from midwife sarah
Thanks for your reply. Great to hear you have CNMs working in your hospital. What do they do and what sort of hours do they work? Do you know anything about their malpractice insurance
. I heard that is a problem as it is so expensive. Do they promote normal birth within the unit? How do the nurses feel about them and do they work in collaboration? Would love to hear your point of view on this. Thanks again........
I am going to school to be a CNM also (BSN program now)... I know that there are also CNM's in Ft. Myers, Tampa, Gainesville, Miami, Jacksonville, Orlando and Stuart.. I'm assuming they are in most bigger areas at least. I'm in a rural county where they have been effectively banned from delivering by the physicians in town. They are apparently too threatened by the thought. Among other things, they made a rule that CNM's can't deliver without a physician present and they can't make rounds. I've heard that we have a couple of CNM's employed at our health department, but they just do well checks, etc.
Jennie Joseph is a midwife in Orlando that I met at a conference several years ago, she was trained in England, she is CPM (not nurse-midwife), her website: http://www.orlandomidwife.com/staff.htm
She may be able to discuss a lot of this with you.
What you say about malpractice is true, but sometimes is paid by the practice you are employed with. Most CNM's here are in practice with OB/GYN physicians, although some are in private practice, birth center practice, etc. (all must have a physician affiliation for back ups for transfers/emergencies of course). Some practices have had to close because of the malpractice problems. The ACNM lobbies for better midwife compensation from medicare, etc.. but it is hard to fight other bigger entities.
CNM's here provide well-woman care (PAP smears, exams, etc.) as well as pregnancy/birth care. Some become qualified to do more technical gynecological procedures (can't remember which ones they may do at the moment), some also perform as first assists in surgery with the physicians for c-sections.
Hospitals vary widely in how much they support normal birth, I would say. It also varies widely from nurse to nurse within a unit. But you should have a good amount of freedom to be supportive with your own patient (anyone correct me if I'm wrong there).
It is the goal and philosophy to support normal and non-interventionist births, however some CNM's here have become more interventionist under pressure from patients and/or their practice (i.e. patient demands to be induced, or you have 20 patients waiting back in the office/time constraints, etc...). Some are being called "medwives".
There is a lot of information at www.acnm.org
, the U.S.'s professional organization for CNM's. Best wishes!