L & D experience and CNM -- opinions!

Specialties CNM

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I know this has been asked before, but I need advice! Just applied to a CNM program. I have no L & D experience. I've talked to two midwives in my area non-CNM, who say that I shoudn't try to get a L & D job in the meantime, and one CNM who says the same -- background on her, she also went into her program without experience. I spoke to another CNM with 10 years experience, and she said I should definitely try to get some L&D in!

Here's my issue. My job right now is m-f daylight. I KNOW that I'm going to have to quit this job because it will be too difficult to schedule my precepting hours outside of this. So, I am either going to not work altogether, or I was thinking of applying to L & D, but with the mixed reviews, I'm not sure! I think it would really help -- but I guess what I'm worried about is spreading myself out too thin. I have 2 small children at home, and on top of that I would be trying to learn a new speciality (L&D) as well as learn midwifery course work and precepting. I'm just worried it might be too much, especially because my local L&D is at a women's hospital and most are high risk or have other medical problems. I would love any advice!

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Specializes in OB.

Only you can decide what is best for you. I just graduated from a midwifery program in May, and I had 5 years experience as a nurse, but chose not to do L&D. I worked for 2 years in med/surg and 3 years in mother/baby. I actually started the mother/baby job right before I was supposed to start clinicals, and ended up taking a year leave of absence from school, because starting a new specialty as well as clinicals was too much for me. I was learning so much new information and so many new skills, all applicable to midwifery, that I wanted to solely focus on that for awhile. I became a certified lactation counselor in that year off from school, which was immensely valuable. I think you are wise to recognize that if you do switch to L&D, it deserves its own period of time for learning.

In terms of L&D experience, I think it would have been helpful for me to have more experience being comfortable with FHR tracings. Otherwise I don't feel at a huge disadvantage, as the L&D unit at my hospital was extremely high-intervention, with a high C/S rate and no midwives, so I felt I would get discouraged/jaded working there. For what it's worth only 3 of my 9 classmates had L&D experience. I think having ANY nursing experience is an advantage, given how many direct-entry midwifery programs are out there now. I know a lot of those students have a much steeper learning curve, and in some areas, a harder time finding a job.

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Thank you for your input/advice! It is greatly appreciated. Did you find when you were interviewing that employers wanted you to have previous l&d experience?

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Specializes in OB.

I only interviewed at 2 hospitals and ended up taking a job at the first. Neither employer was bothered by the fact that I didn't have previous L&D experience. That being said, I am in NYC, which has a direct-entry CNM program at Columbia, and a direct-entry CM program at SUNY Downstate, so employers are more used to seeing new grad midwives without any nursing experience, much less L&D. I think it is very variable to your location and an individual employer's preference.

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Specializes in Nurse-Midwife.

I don't know how having L&D experience can hurt. I know quite a few CNMs who did not have prior L&D experience, and they are fine midwives. Not necessary, no. But what is the drawback?

I have a CNM friend who called her high risk L&D experience "awesome" ... "but not in a good way."

Meaning she saw all kinds of crazy things and high-risk situations that she does not see as a midwife... but that's she's grateful to have had those experiences before practicing on her own.

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Or, you can be like me, who has been trying to get hired in L&D for many years and just can not get hired. I really WANT to work as a RN in a specialty I want before getting my MSN in that area. Instead, I may just go for the CNM so that I can finally work in this area. So, yes, to answer your question. You are fine without experience. Even if you applied you may not get hired.

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You don't need L&D experience unless your program requires it. L&D experience does help but it's not essential. Any nursing experience will help but any inpatient experience is best. More importantly, you only have to work 3- 12 hour shifts a week to be full-time. Many units offer part-time once you have seniority which is great for when you start clinicals.

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Specializes in Reproductive & Public Health.

I am in CNM school. I am an LDRP nurse and a CPM with years of experience in home birth. I think working as an LDRP RN is not in any way necessary to becoming a proficient CNM. Yes, you can learn a lot as an RN in L&D. However, you also pick up a lot of non-evidence based practice, depending on the providers you work with, and letting go of your RN role can be very difficult when you move to the provider side of things.

I love my job in L&D but none of my classmates work in women's health, and 2 of them are brand new nurses just out of school. They are all doing very well in school and will be great midwives. Sometimes my extensive background can be a hindrance, because I could easily coast through school without a lick of studying, which sometimes leads me to put my schoolwork on the back burner. Not good.

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Hello All,

Your comments have been very helpful and appreciated. I too am considering CNM school. I have been a trauma nurse for 14yrs and immediate felt that i would have to switch jobs. Cayenne06 I definitely appreciate your comments. What schools have either of you attended if I may ask?

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I am planning to apply to Frontier. I completed my senior capstone in L&D but never worked as an RN in L&D. I was really nervous about having no experience but after reading the comments I feel like it might not be a negative thing.

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I am in CNM school. I am an LDRP nurse and a CPM with years of experience in home birth. I think working as an LDRP RN is not in any way necessary to becoming a proficient CNM. Yes, you can learn a lot as an RN in L&D. However, you also pick up a lot of non-evidence based practice, depending on the providers you work with, and letting go of your RN role can be very difficult when you move to the provider side of things.

I love my job in L&D but none of my classmates work in women's health, and 2 of them are brand new nurses just out of school. They are all doing very well in school and will be great midwives. Sometimes my extensive background can be a hindrance, because I could easily coast through school without a lick of studying, which sometimes leads me to put my schoolwork on the back burner. Not good.

Hi there cayenne06... I find it very interesting that you have your CPM and are now working towards a CNM. Unfortunately I am a few posts away from being able to PM you otherwise I would have. I would love to discuss your roles as both a CPM and a CNM. I am currently in nursing school working towards an RN and eventually a CNM. I have been volunteering with a few CPMs in their home birth practice and I find myself questioning more and more whether I should continue to pursue a CNM or switch gears to a CPM. Initially I figured that a CNM would be the better choice because I have the option of working in a hospital, I am not limited to which states I can practice, and I am already in nursing school. But, beyond those few things I am not sure if the CNM route is still the best option. I am curious as to why you went back to school for a CNM? Thanks for any advice you can part with. If it is easier here is my email: [email protected]

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Specializes in critical care.

Depending on how supportive your area is of midwifery, the idea of hospital birth and midwives is very politically charged. Midwives favor a more natural approach to birth, believing the body is quite capable without intervention (unless, of course, a situation requiring intervention arises). Hospital births tend to be highly managed via intervention. OBs will tell you this is necessary. Midwives will tell you this is increasing adverse outcomes. That's the summary of it, anyway.

Midwives who feel strongly about hospital births leading to more adverse outcomes will probably advocate for you NOT working as an LD nurse. You will be exposed to more medical intervention than if you were to skip that experience. The thing is, though, getting that hands on experience, whether highly medically intervened or not, is invaluable. There are subtle changes that you can read about in a textbook, but will you recognize them in a patient? If you have a patient that does require medical intervention, you will have experience in that.

I'm a person who believes in the "middle way". I believe strongly that birth is a natural process that should be left alone. But I also believe that we are very fortunate to have the ability to intervene when it is needed. If you become a home birth CNM, you may never need to use some of the skills you gained in LD, but you will be thankful that you know from experience what to expect, and what something going wrong looks like before it is too late. That's not to say those who go direct entry into their programs lack that ability - it's only to say that having experience can not hurt you. It can only help in the long run. I think you will ultimately end up thankful for it.

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