Tell me what you like and dislike about nurse midwives

Specialties CNM

Published

I'm getting ready to change careers; after 20+ years as a labor and delivery RN I am going to practice as a CNM in the same hospital where I work now. I'm excited, psyched, scared... all kinds of emotions.

I believe that the nurse MUST be your ally in order for successful hospital midwifery practice, so I'd like those of you who have worked with midwives to give me some "tips" for working well with the labor nurses. I already know that I get frustrated when the nurse midwife gives my patient a herbal preparation and she won't tell me what it is, and that my coworkers get frustrated when they don't understand the management that is going on with each patient, and I hope to fix that.

By the way, this is a level III hospital, over 3,000 births per year, 27% C-birth rate, and an epidural rate of at least 85%... so lots of intervention and lots of staff! I will have good physician backup; a few of the docs have actually started using some of my 'tricks" for difficult labors, so I am not really worried about the doctors interfering in my management plans.

Thanks for your help and advice. My coworkers are excited about my new role, and I would like to improve our credibility and reputation if possible.

Wow, in our small LDRP, we have maybe a 5-10% epidural rate!!! Because the docs have to do them!!! ...so we do a lot of comfort interventions! Our moms generally do great without, but I admit I kind of miss them from working a unit with a higher rate 70% maybe... it was wonderful to have a patient sleep through part of labor and wake up refreshed and ready to push. Here we often push with exhausted moms :(.

What's your c-section rate?

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Specializes in Med/Surg, Geriatrics.

I don't work in L&D so I have never worked with a CNM, however my first child was delivered with midwives. It was interesting because during the first half of my pregnancy I was being seen at a teaching hospital(military) so I saw doctors. Near the end, I moved away and I chose midwives to finish my pregnancy. I was diagnosed with pre-eclampsia but I decided to continue to see them.

They were wonderful. They followed me very closely, admitting me to the hospital a few days before I delivered and they stayed with me all day through the 12 hour labor and delivery.

For my second child, I had a traditional OB. Needless to say, he sucked. I arrived at the hospital 9 cm so my hard labor started very soon after that. My nurse managed the entire labor and he waited outside until I crowned. In other words, the nurses did all the work.

My childbearing days are over, but if I was going to have another one there is no doubt about who I would choose.

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I appreciate everyones comments. I took the ACNM exam today and passed. I am so excited! Thanks to everyone for sharing there stories with me!

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Specializes in CV Surgery Step-down.

Yippeeee!!!:balloons: Well Done!!!

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Specializes in Case Mgmt; Mat/Child, Critical Care.
I appreciate everyones comments. I took the ACNM exam today and passed. I am so excited! Thanks to everyone for sharing there stories with me!

:Melody: :balloons:

Congratulations! What a great achievement! I'm sure you will do great! You have so much L&D experience...just remember (as time goes by) that you were once a practicing L&D nurse. Now you are "advanced practice". Remember the things that really are your pet peeves w/the medical and midwifery models, learn from that, practice from that. And how true that the RN can be your best ally....as you well know!

Keep true to your reasons for becoming a midwife (vs an OB) and you will do great! :)

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Specializes in Lactation Ed, Pp, MS, Hospice, Agency.

Please don't ever model the "Medical Model of Care"... you are Holistic!

B/c as a CNM moms will look to you to model this Model. I admire you & can't wait for the day that I am in your postition. I am hoping to be working at a Freestanding Birth Center by then.

Congrats on passing... if you need more great examples: read Ina May Gaskins books (if you haven't already). I'd advise beginning w/her newest one though. It applies more to today's standards & is more realistic.

Here a link for amazon and the books:

http://www.amazon.com/exec/obidos/search-handle-form/102-5775332-8779304

:balloons:

Now go out there & change the world! (one mom at a time, lol)

~MJ

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Specializes in OB, lactation.
I appreciate everyones comments. I took the ACNM exam today and passed. I am so excited! Thanks to everyone for sharing there stories with me!

Congrats!! Woohoo!

I'm still a student but there were a good number of midwives in my OB rotation. I want to be a CNM and I am familiar with the different models of care, etc... but my clinical instructor wasn't (she is a psych NP) and so the best part for me was to have my instructor in with me as baby back up during a CNM delivery (one that is able to do her own thing and do mw model of care completely, she does home births too) and be able to see my instructor realize the difference after seeing a typical OB birth the day before - I think she really got to appreciate the difference in those 2 practitioners and now she will be able to pass that on in her instruction. The CNM was so nice, she talked through/explained a lot of the things she did (to mom &/or us, with rationales).

So please advocate for CNM's via students and instructors!!!!!

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I personally love working with the midwives and patients that are more involved in their labors. I work at a hospital that is high risk and most of the OBs are very interventionist minded. I do find it difficult to work with though when a midwife will choose not to follow the hospital protocol, putting the hospital and the nurse in the position of the bad guy. Example: we have one midwife that will call light meconium clear fluid so he doesn't have to call in NICU and Neonatology since this is our protocol. Or telling a patient that they don't have to have an IV and then when they get to the hospital they find out from the nurse they are GBS +. We all know the protocols and things that have to be followed in the hospital environment even if we don't agree with them. I think there are some you can work around and some you have to abide by.

While writing this I am realizing that this trait is not exclusive to midwives. Though the midwife patients are generally looking for a more natural birth so I feel like I come across it a little more.

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