A day in the life..."birth sitting"

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    As I move closer towards nursing school, I have these feelings of panic now and then that I might not be making the best decision for ME. I have had a long standing debate whether or not to pursue CNM or DEM (this seems to change weekly). It's like my heart tells me to do DEM, but my mind tells me to go to nursing school. I really want to be in a position of offering continuity of care to laboring women and I'm conserned that as a nurse or CNM, I won't really be able to do that optimally. I am curious what a day in the life of a L&D nurse or CNM looks like as far as how many patient you are caring for at a time and how much time to get to spend being "with women" during labor. I also have a hard time imagining myself walking away from a laboring women when my shift is over. I also worry about physician/midwife relations in "managing" birth. How do the nurses and midwives out there handle these challenges? I just finished a book called Giving Birth: A Journey into the World of Mothers and Midwives by Catherine Taylor which presented a lot of the challenges that CNM's face. It kind of made me feel like maybe pursuing DEM is more fitting for me personally, yet I'm afraid of making the wrong decision. 10 years down the road I don't want to kick myself in the pants for not going through nursing school! Any and all feedback is much appreciated! Thanks in advance!
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    As a labor and delivery nurse, I spend most of my time charting, usually at the bedside. So, I do spend time with my patients, but not sure about quality time. We usually have 2 patients at a time...AWHONN staffing guidelines are way too expensive for our hospital to follow according to management. I spend my day running between 2 laboring moms, monitoring and charting heart tones, and charting all the interventions I do. I thought I would get to know my patients and a little about them going from post partum to labor and delivery, but in order to keep up with all the paperwork and charting, it isn't much better. I hit the ground running from the time I step on the unit. I will say, I love what I do, I love the deliveries and the patients, I just hate the charting. I would not want to work in any other area. Hope this helps. Spend a day shadowing a nurse and midwife if you can. I did, and I knew what I was getting into.
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    I one was in your same position, trying to figure out whether DEM or CNM was better. What ultimately won me over was the fact that CNMs are legal across the country (DEMs vary by state laws--in some states they can be considered practicing medicine without a license). Also, the route to becoming a DEM was a bit too flexible for me. That is to say, some DEMs are educated at the college level and receive a bachelors or masters in midwifery (but this is the minority of DEMs). The majority receive their education through apprenticeship. This leads to lack of standards. There certainly are DEMs who are well education, well trained, and are fully knowledgeable on what they are doing. But these lax regulations mean that there are a lot of DEMs taking on women that should not be birthing at home. If you are interested in reading more about this, you should check out the blog midwifeology. She was going to be a CPM, and after a lot of soul searching, she decided on CNM.

    Finally, I am interested in doing general well-women care, which CNMs practice, whereas DEMs typically only deal with women during pregnancy, labor, delivery, and a short postpartum period. Also, I realized that my philosophy on birth and women's health care would not change no matter the type of midwife I was. Also, the amount of time you spend with a laboring woman depends on the type of practice you work for. Some have midwives stick with their patient throughout their whole pregnancy, labor and delivery. Others have on-call, which as you mentioned, means you would leave at the end of your shift. CNMs do do home births, though. They are in the minority of CNMs, but they are out there.

    Just my 2 cents...

    GOOD LUCK!!
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    Thank you for this information! Yes, there are a lot of factors to consider and being able to practice in all states is a big one! They say that there's something in the water here in Portlan, OR that breeds midwives, doulas and massage therapists It's really competetive to find work and there is a lot of saturation in the job market. It would be nice to have more options available as to where I can practice and it's true that I could always still attend homebirths down the road. Thanks again for the info, it was helpful!
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    What does dem stand for
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    direct entry midwife
    from midwives alliance of north america
    "a direct-entry midwife is an independent practitioner educated in the discipline of midwifery through self-study, apprenticeship, a midwifery school, or a college- or university-based program distinct from the discipline of nursing. a direct-entry midwife is trained to provide the midwives model of care to healthy women and newborns throughout the childbearing cycle primarily in out-of-hospital settings."
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    I've chosen to do the CNM route because I want the ability to have hospital privileges and be able to use things like pitocin, etc., for home-births--which in a lot of states DEMs are very restricted in regards to anything "medical" they're allowed to do.


    It's not only whether you choose CNM or DEM, it's where you want to practice. Home birth midwives don't have shift changes--unless they're part of a group that chooses to operate that way. Birth centers can vary wildly, but some of them will let you stay with a client past your scheduled shift.


    For me, it's important to get to know mothers personally and be available for their labor and birth, so I plan on having a solo home birth practice of three to four births a month, with a back-up CNM in case I have two mothers that are in labor at the same time or something unforeseen happens.
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    Direct entry midwifery. I would be attending a college that grants a BS in midwifery.
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    I am a DEM/CPM (former Florida LM). It's a great job, but the pay is abysmal and the lifestyle is rough. Most DEMs are self employed. Many are solo practitioners and as such are on call 24/7. I loved the autonomy of home birth midwifery, and I loved that I had the time to develop close relationships with clients. I was lucky to work in a birth center/home birth practice with two other midwives, so my call hours were limited. The pay was not very good, but I would have kept the job had my daughter not developed a very serious disorder that necessitated me leaving the work force for a time. Anyway. . .

    I am back in school to become a CNM. Half of my CPM graduating class returned to school to get their CNM credential. I will always keep my CPM credential and plan to return to it once I "retire," but a CNM license allows much more flexibility in both location and job opportunities. I highly recommend doing at least your BSN, and then deciding between CNM and CPM.
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    Thank you for the feedback; it's nice to hear from a DEM. I have actually heard that time and time again about homebirth midwives heading back to school after a few years of practice for numerous reasons. I am 31 and have already done 4 years of college (going on five) plus 1.5 years in massage school and I'd like to head down the right path now and preferably not end up back in school in another 10 years if I can avoid it I only have a couple of more prerequisites for nursing school to go.
    It definitely does seem like becoming a CNM would offer the best security and flexibility. I know that someday way down the road I could head off into a homebirth practice if I so choose. In this day and age it is good to have options! Thanks again for sharing and good luck with your education!


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