Midwives hired at a local previously OB-only practice

[ixchel]

I'm a student now, working on my RN, and I'll be moving on to my masters after that. Midwifery is my passion, and I'm very committed to the idea of evidence based care practice, within the context that my patients deserve full autonomy, including fully informed consent and refusal.

So, I live in an area that is very much opposed to that kind of care. My first two births were micromanaged poorly and I was scolded for learning from books and the internet, and I was laughed at for having a birth plan, and when it came to the births themselves, they wouldn't stop pushing me until I finally caved in, laid on the bed, and enjoyed my IV with my CFM straps. I've since experienced a third birth that was exactly as it should have been, with respect from my care providers, but I had to travel for this an hour each direction. I was okay with that-- it was absolutely worth it, to never have to have those care providers I had with my first two births again.

I admittedly hold onto a lot of emotion from those first two births. I'm nervous about doing clinical rotations for my RN because I know I'll be on L/D with those doctors. I've doula'd for births where other women were treated just as poorly. The c/s rate is well over 40%, and the epidural rate is roughly 95% and they prefer to keep it that way. I have a lot of disdain for the way that birth is approached here. And, if women hope for a better experience, they have to drive an hour away like I did. There is only one hospital here, and there is only one practice offering OB services.

Today I heard that that practice has hired 2 midwives. Imagine my surprise!!!! Could they be moving in the right direction???? Could they be hoping to offer a more autonomous experience for their patients???? My god I hope so!

But now I'm thinking forward to my own future and plans and I'm realizing... if they are changing their approach, and if they are allowing these midwives to practice holistic care, with evidence based practice at the core of their practice, what if I could complete my preceptorship locally? What if I could actually hope for a job locally?

Is it possible I could be hoping for too much? How do I even assess this situation from the outside to know if it's even worth doing research on? And how can I push aside my personal experiences and feelings to approach this clear-headedly professionally? Goodness, when I'm working on my masters, I've had it in my mind this whole time that I would have to just let go of two hours out of every day just driving to clinicals. When you're working full time with kids and you are in school, those two hours a day are SACRED! Not to mention the impending move after I've been employed.

Any thoughts? For those who have BDTD, is it possible to have such a drastic change in ideology as a practice? They have had a change in staff with their OBs as well, but the ones who have joined their staff are ones who used to be in private practice and they're not all that much better, by what I've heard. How do I learn if their ideology HAS moved toward a more supportive one? What questions can I ask them without completely offending them or ruining my chances of maybe having a future with them?

[mommy2boysaz]

I'm a student now, working on my RN, and I'll be moving on to my masters after that. Midwifery is my passion, and I'm very committed to the idea of evidence based care practice, within the context that my patients deserve full autonomy, including fully informed consent and refusal.

So, I live in an area that is very much opposed to that kind of care. My first two births were micromanaged poorly and I was scolded for learning from books and the internet, and I was laughed at for having a birth plan, and when it came to the births themselves, they wouldn't stop pushing me until I finally caved in, laid on the bed, and enjoyed my IV with my CFM straps. I've since experienced a third birth that was exactly as it should have been, with respect from my care providers, but I had to travel for this an hour each direction. I was okay with that-- it was absolutely worth it, to never have to have those care providers I had with my first two births again.

I admittedly hold onto a lot of emotion from those first two births. I'm nervous about doing clinical rotations for my RN because I know I'll be on L/D with those doctors. I've doula'd for births where other women were treated just as poorly. The c/s rate is well over 40%, and the epidural rate is roughly 95% and they prefer to keep it that way. I have a lot of disdain for the way that birth is approached here. And, if women hope for a better experience, they have to drive an hour away like I did. There is only one hospital here, and there is only one practice offering OB services.

Today I heard that that practice has hired 2 midwives. Imagine my surprise!!!! Could they be moving in the right direction???? Could they be hoping to offer a more autonomous experience for their patients???? My god I hope so!

But now I'm thinking forward to my own future and plans and I'm realizing... if they are changing their approach, and if they are allowing these midwives to practice holistic care, with evidence based practice at the core of their practice, what if I could complete my preceptorship locally? What if I could actually hope for a job locally?

Is it possible I could be hoping for too much? How do I even assess this situation from the outside to know if it's even worth doing research on? And how can I push aside my personal experiences and feelings to approach this clear-headedly professionally? Goodness, when I'm working on my masters, I've had it in my mind this whole time that I would have to just let go of two hours out of every day just driving to clinicals. When you're working full time with kids and you are in school, those two hours a day are SACRED! Not to mention the impending move after I've been employed.

Any thoughts? For those who have BDTD, is it possible to have such a drastic change in ideology as a practice? They have had a change in staff with their OBs as well, but the ones who have joined their staff are ones who used to be in private practice and they're not all that much better, by what I've heard. How do I learn if their ideology HAS moved toward a more supportive one? What questions can I ask them without completely offending them or ruining my chances of maybe having a future with them?[/Q

Sounds like you still have plenty of time before you'd be ready to look for a preceptor for midwifery clinicals. In the mean time, I would ask around to patients of these new midwives and maybe some of the OB staff (if you know anyone), to find out if these are truly CNMs that practice with a midwifery philosophy. Change really can happen and I hope it has, in your community.

Also, you could certainly set up an appt with one of the midwives for just a yearly Pap and ask about their pregnancy, labor, and birth philosophies. You could likely get a good feel for them that way.

Best wishes to you in the future. Sounds like you would make a great midwife someday!

[ixchel]

Thank you so much for your thoughts and encouragement. As it turns out, it was too good to be true. I've learned today from a pregnant friend that she's met with the practice in question and that the midwives have not been granted hospital privileges. The cheif of obstetrics actually works out of this office that hired the midwives, so I'm just baffled. It feels to me like they've hired cheaper labor to do their dirty work, while they can micromanage L/D, and give the appearance of supportive care. So, so sad I hope that they don't mislead women into believing they'll be given the ability to labor and birth without intervention, because those misled women are going to be very, very distraught to learn that it doesn't happen without a very dedicated fight in between contractions. My friend said that it's at least a step in the right direction, but I feel like it is almost a step backwards.

Onward and upward. At least I don't have "what if?" floating around in my head anymore.