Schedule for CNM

Allison T · Jan 1, 2018

I too was the pioneering CNM at a hospital. I was on call virtually 24/7. My plan was to gradually persuade management to hire another CNM. I did ultimately succeed with that. However, our service got shut down by the CEO a short time after we hired the 2nd CNM.

I am an experienced midwife (and state affiliate leader) who has heard many, many sad and abusive stories from midwives who started midwifery services at hospitals. One thing to do is really thoroughly research the hospital, the CEO, and the OBs. For example, I have seen hospitals hire a CNM to start a service, then fire the CNM when the local OBs get threatened. Then a few years later, with the OBs complaining about the workload, the same hospital again hires a CNM (who is unaware of the history). You may learn some helpful things from the state ACNM affiliate members and/or other APRNs such as NPs. If I had done my research, and seen how the hospital treated NPs (like they were disposable), I wouldn't have gone there.

It is essential that the office staff understands you and midwifery. If the person answering the phone says "Do you want to see the doctor or just a midwife?" it is not good.

Another tricky thing is that you are not really a midwifery service if you aren't 24/7. How will your patients feel if they come to a midwife for prenatal care and get a non-midwife at their birth? When you are the sole midwife at a hospital, it is inevitable that this will happen.

Many, many hospital administrations do not understand that midwives labor sit. I would get phone calls asking, "Can't the nurse or the monitor watch the patient?" In fact, I was trying to get to the place that the nurses would be at the bedside (or birth ball side, LOL) with the patients so that I could stay in office a bit longer, but I lacked the support of administration with this. There was no nurse training unless I provided it, uncompensated, and with no one stepping in to help with my other other duties. And this in a state that provided nurse training in Lamaze childbirth techniques, lactation, and other relevant topics at a huge discount for nurses.

So make sure that admin understands this about you (if indeed you do plan to practice "real midwifery" and be with your patients in labor). You have to be willing to either reschedule people's prenatal or GYN visits, or have your office colleague (MD/DO or whoever else you are working with) see the pts if you are at a labor/birth.

I do recommend monthly team meetings (CNMs/CMs, head L & D nurses, OBs, CEO or maternity service leader) to ensure everyone is on the same page. We had these, but because the CEO was essentially off his rocker, they didn't work well. However, in general they seem a helpful concept.

Good luck, and I hope you do your research.

**LibraSunCNM, BSN, MSN, CNM** · Jan 2, 2018

I too was the pioneering CNM at a hospital. I was on call virtually 24/7. My plan was to gradually persuade management to hire another CNM. I did ultimately succeed with that. However, our service got shut down by the CEO a short time after we hired the 2nd CNM.
I am an experienced midwife (and state affiliate leader) who has heard many, many sad and abusive stories from midwives who started midwifery services at hospitals. One thing to do is really thoroughly research the hospital, the CEO, and the OBs. For example, I have seen hospitals hire a CNM to start a service, then fire the CNM when the local OBs get threatened. Then a few years later, with the OBs complaining about the workload, the same hospital again hires a CNM (who is unaware of the history). You may learn some helpful things from the state ACNM affiliate members and/or other APRNs such as NPs. If I had done my research, and seen how the hospital treated NPs (like they were disposable), I wouldn't have gone there.
It is essential that the office staff understands you and midwifery. If the person answering the phone says "Do you want to see the doctor or just a midwife?" it is not good.
Another tricky thing is that you are not really a midwifery service if you aren't 24/7. How will your patients feel if they come to a midwife for prenatal care and get a non-midwife at their birth? When you are the sole midwife at a hospital, it is inevitable that this will happen.
Many, many hospital administrations do not understand that midwives labor sit. I would get phone calls asking, "Can't the nurse or the monitor watch the patient?" In fact, I was trying to get to the place that the nurses would be at the bedside (or birth ball side, LOL) with the patients so that I could stay in office a bit longer, but I lacked the support of administration with this. There was no nurse training unless I provided it, uncompensated, and with no one stepping in to help with my other other duties. And this in a state that provided nurse training in Lamaze childbirth techniques, lactation, and other relevant topics at a huge discount for nurses.
So make sure that admin understands this about you (if indeed you do plan to practice "real midwifery" and be with your patients in labor). You have to be willing to either reschedule people's prenatal or GYN visits, or have your office colleague (MD/DO or whoever else you are working with) see the pts if you are at a labor/birth.
I do recommend monthly team meetings (CNMs/CMs, head L & D nurses, OBs, CEO or maternity service leader) to ensure everyone is on the same page. We had these, but because the CEO was essentially off his rocker, they didn't work well. However, in general they seem a helpful concept.
Good luck, and I hope you do your research.

Thank you so much for sharing your valuable experience. I haven't been that pioneering midwife before, but I suspected that a lot of the issues you described are what the OP might come up against, I just didn't know how to reply that! I hope you are in a better situation now, and my hat is off to all of you who fight the fight to get midwifery care into places where it's never been.