CNM with no L&D experience

MariannaCNMstudent, ADN, BSN · Jul 3, 2021

You know, your question is more difficult as it seems. The most practiced approach to birth in hospitals is the opposite of how midwives view and manage it. Practicing as a L&D nurse may be a valuable and may be a harmful experience. In a hospital, you may go a long time seeing many births, but not even one physiological and without mama and baby being traumatized. There are wonderful hospitals out there, but they may not be in your area. If I were you I would get a doula certificate and go from time to time to home births. You can offer such a service at low cost or even free as a student and for sure will get clients. Make connections with homebirth midwives in your location. Good luck!

MariannaCNMstudent, ADN, BSN · Jul 3, 2021

And yes, I was admitted without such an experience. I decided against it for the reasons I wrote above. I start the program this August.

Specialscar, BSN, RN, EMT-B · Sep 30, 2021

I’m in a CNM program with no nursing experience whatsoever. I tried getting a job as soon as I was licensed in July and even though it’s a pandemic I never got a call. I cannot work because of my program in January I found out so I’ll be delivering babies for the first time in residency. But I’m confident, and have my own kids so that counts towards something at least! I think nursing is such a tough job most people will feel very emotionally charged and even threatened when someone doesn’t put in their time. Like anything, if this is your passion and drive you’ll be wonderful!

MaryWal · Jan 16, 2022

Hello! I was wondering which program you were in currently? I am looking to apply once I complete my BSN in August and due to my age (43) I was hoping to not have to wait a year.

Thanks and good luck to all!

Ohm108, MSN, NP, CNM · Jan 17, 2022

Here is my two cents:

Yes, you can get a job after CNM school without any L&D experience but there are a few caveats as follows:

a. There will be hospitals or institutions that will reject you as a candidate solely because you don't have any L&D experience prior to becoming a CNM; that can and does happen. This is also dependent on the person who is reviewing your application and whether they feel L&D experience is necessary for the role and whether a hospital system or practice prefers a new grad CNM to have prior L&D experience before hiring them. You will just have to keep applying until you find a place that values what you bring to the table. If they do, they will at least be willing to extend you an interview where you can make your case.

b. Each individual person's life circumstances are different. If you can't leave a certain geographical after midwifery school because of (a partner's job, family, children, or you just like a certain geographical area) then the candidate will need to factor this into their job search timeline based upon how receptive their area is to new grad CNMs without L&D experience. As a new grad, you will have more opportunities if you are willing to relocate after graduation. Some geographical locations are more open to having new grad CNMs without any L&D experience and they are generally near schools that have direct entry midwifery programs. If a candidate is unable to move, this might mean that they will have to lay the groundwork early on in their area of interest even before you are admitted to midwifery school or establish personal relationships with your local birth centers and hospitals so that they know you are interested in working for them after graduation. Joining your local ACNM chapter or joining your local doula collective can help you build relationships and put you in touch with the people that are making hiring decisions

OP - you mentioned that your area is receptive to midwifery care and has a midwifery program so this might not be an issue for you

c. After you land your first CNM role and have worked for 2-3 years, whether you have any prior L&D experience becomes moot because your current CNM experience trumps your lack of L&D experience. Put another way and to put a more positive spin on it, it means you just need one institution to say yes and to see what value you bring to their midwifery practice!

d. There are many direct-entry midwifery programs and many of their graduates have been successful in obtaining jobs as new grad CNMs without any prior experience in L&D

e. Integration does help to make you feel more prepared for your first full-time midwifery position and it is something that is unique to our specialty that the other specialties (FNP, PNP, AGPCNP etc) do not get to experience since it is a requirement for us to graduate from our programs. The other specialties normally gain this experience through a new grad residency or fellowship after graduation. I had a great experience as an SNM during integration and as my preceptors became more confident in my abilities they let me become more independent during births and clinic. By the end of my integration, I saw the majority of the clinic patients in my preceptor's panel, if my preceptor agreed with my assessment and plan, they would only come in to talk to the patient to double-check if I missed anything then we would put in orders together. As I become more competent, my preceptors expected me to manage the majority of the birth myself and they would only come into the room once the baby's head was crowning. If I had any issues they were outside of the room just a call away. I learned a lot during my integration. In your interviews, you can speak to these experiences and how those experiences are an asset to the job you are applying to.

Specialscar, BSN, RN, EMT-B · Jan 18, 2022

On 1/16/2022 at 9:11 AM, MaryWal said:

Hello! I was wondering which program you were in currently? I am looking to apply once I complete my BSN in August and due to my age (43) I was hoping to not have to wait a year.

Thanks and good luck to all!

I'm not sure if this question was directed at me, but I'll go ahead and answer it anyway haha. I'm currently at Georgetown University - some of the best universities in the nation accept RN's into CNM programs without experience - Yale, Vanderbilt, Georgetown to name a few. . .so in my mind that speaks to the open possibilities one has with this less popular route. I am currently 43 like you, and my passion has been midwifery for 20 years, but life happens as they say (and raising 3 kids as an impoverished single parent happens!). . .I struggled a LOT with the weight of working a year in med-surg as the masses would have you believe in the only way, or trying at least to get some hospital experience versus jumping into grad school (I absolutely stand by my jumping in head first decision!). I still struggle with it a bit - I only have 6 months in a covid vaccine mega site and I'm currently a PT pediatric home health nurse (read: not much experience). BUT! I'm not the only RN in this situation in my program, and GU has been exceptionally wonderful in supporting me in every way. For me, my goal is to work in underserved areas, particularly with Indian Health Services, which isn't exactly on everyone's top ten places to work list. I am also a nursing corps scholar, so I will have a service obligation after licensing, in an underserved area, which works out for me since I totally want to move (NJ is hella expensive, even with a good salary), and totally open to working in areas no one else really wants to. I've done it plenty in other capacities. I also saw the same anxiety with my covid BSN cohort (an accelerated program that became 100% virtual only 6 weeks after starting because of covid) - people were so worried that no one would hire us because several of our clinicals were virtual - including obstetrics ? but lo and behold, our cohort was hired straight into ICU's and ED's and oncology and trauma and everywhere in-between! One woman is already training to be a flight nurse (she had zero experience!) - GO FIGURE!! Make sure to make connections with everyone, and volunteer where you can. That's my plan at least. And just believe you're where you need to be - best of luck (and maybe see you at GU - oh, it's typically a PT online program which has been fantastic so far!)

rac1, ASN, BSN, RN · Mar 7, 2022

You got great advice (especially from @Ohm108) - just wanted to chime in with one little thing: Think of all the OB/GYNs that started out as OB's without L&D experience.

Not that we want to be like OBs. My point is - being a labor and delivery nurse is something completely different than being a CNM. There are skills and experience that are all helpful, but you will learn them as a CNM just like OBs learned them without L&D experience. No one questions their lack of L&D nursing experience (maybe they should, ha - kidding).

Specialscar, BSN, RN, EMT-B · Mar 7, 2022

28 minutes ago, rac1 said:

You got great advice (especially from @Ohm108) - just wanted to chime in with one little thing: Think of all the OB/GYNs that started out as OB's without L&D experience.

Not that we want to be like OBs. My point is - being a labor and delivery nurse is something completely different than being a CNM. There are skills and experience that are all helpful, but you will learn them as a CNM just like OBs learned them without L&D experience. No one questions there lack of L&D nursing experience (maybe they should, ha - kidding).

Thank you! I feel there is this unspoken (or sometimes quite loudly spoken) resentment at APN's who go straight through, in all fields. . .like they should have their time in the nursing trenches. . .There are all kinds of arguments on both sides, and for me I can honestly say that I know I would have been a HORRIBLE nurse if I went to school at 18-22. . .I was a WILD young woman in my early 20's, there's no way I would have the empathy and patience and sacrifice needed to be a good nurse - not until I was maybe 30! But having 4 kids and being a poor single mom for 10 years, dealing with so much personal trauma and my own health crises and those of my kids. . .moving all over the country, being a live-in caregiver for my grandma with severe Alzheimer's, have a grad degree in education, volunteering as a doula - these very real experiences that I will bring to my practice, even though they don't include official roles as an RN. . .I dealt with people as a server for 20 years, which is one of the most stressful jobs out there, and least respected. It just hurts to have judgement from nurses, or displaced anger. I realize nurses do SO much (I am a working nurse right now!) but each person has their own strengths and gifts and passions. Like I said, I couldn't imagine myself being just an RN at 22, but I accept that there are some wonderful and mature people out there who are able to be that. . .In my opinion I'd rather have a woman whose had 4 births of wild variety (homebirth, hospital, induction, high-risk, hemorrhage) and multiple miscarriages and a lifetime of experience with less clinical experience then a 29 year old midwife without any personal experience but 5 years of nursing experience. . .but again, that is MY opinion, and I know I'll be appreciated once I'm out there. . .I just won't mention to many others that I didn't put my 'time' in to the trenches.

As far as nurses getting upset that others just want to rush through school to make more money, that seems moot currently - travel nurses are making more than some doctors right now! I wish I could travel but I just can't.

Thanks again - that comparison is what I often think about - MD's go straight from BS typically to med school some of them never working any job at all! My best friend only did phlebotomy for about 6 months her entire life before graduating med school and doing residency. . .that was ALL the experience she had

Ohm108, MSN, NP, CNM · Mar 7, 2022

1 hour ago, rac1 said:

You got great advice (especially from @Ohm108) - just wanted to chime in with one little thing: Think of all the OB/GYNs that started out as OB's without L&D experience.

Not that we want to be like OBs. My point is - being a labor and delivery nurse is something completely different than being a CNM. There are skills and experience that are all helpful, but you will learn them as a CNM just like OBs learned them without L&D experience. No one questions their lack of L&D nursing experience (maybe they should, ha - kidding).

I just wanted to add to what @rac1 said about OBs. I agree that the reason why I didn't want to pursue medical school was because I didn't want to practice like an OBGYN. When I was on clinical rotation, I saw how they are trained in terms of management of issues that arise with their patients. There were certain times when I felt that medicine took precedence over the humanity of working with a patient. I understand why this is the case in part because their training makes birth a medical event vs a normal physiological process, the legal and litigious environment we work in especially in obstetrics, and the pressure residents face while they are in training.

BUT that being said, I also was able to rotate with residents during my clinical rotations and I learned a lot from them especially the art of suturing. They have a lot more experience with hands-on skills than what we receive as midwifery students in midwifery school. They are efficient and with so much more experience they have a better grasp of how to approximate a tear and to bring back the tissue to best help with the healing process.

What I wanted to say which is slightly off-topic is that yes midwives and OBGYNs have different approaches and the relationship can be contentious at times especially when it is one of our patients and while I do not want to be like them, if we are able to learn from each other it is only to the patient's benefit in terms of their care. So I value what my OBGYN residents and attendings have taught me and I hope that they also learn from us and value the fact that normal and healthy physiological birth requires very little intervention, only a bit of patience and time. As I have always told my patients, there is very little that I can guarantee in life but I can guarantee that a baby is always born and labor will end.

ashleybrooke91 · Aug 15, 2023

Specialscar said:

I'm not sure if this question was directed at me, but I'll go ahead and answer it anyway haha. I'm currently at Georgetown University - some of the best universities in the nation accept RN's into CNM programs without experience - Yale, Vanderbilt, Georgetown to name a few. . .so in my mind that speaks to the open possibilities one has with this less popular route. I am currently 43 like you, and my passion has been midwifery for 20 years, but life happens as they say (and raising 3 kids as an impoverished single parent happens!). . .I struggled a LOT with the weight of working a year in med-surg as the masses would have you believe in the only way, or trying at least to get some hospital experience versus jumping into grad school (I absolutely stand by my jumping in head first decision!). I still struggle with it a bit - I only have 6 months in a covid vaccine mega site and I'm currently a PT pediatric home health nurse (read: not much experience). BUT! I'm not the only RN in this situation in my program, and GU has been exceptionally wonderful in supporting me in every way. For me, my goal is to work in underserved areas, particularly with Indian Health Services, which isn't exactly on everyone's top ten places to work list. I am also a nursing corps scholar, so I will have a service obligation after licensing, in an underserved area, which works out for me since I totally want to move (NJ is hella expensive, even with a good salary), and totally open to working in areas no one else really wants to. I've done it plenty in other capacities. I also saw the same anxiety with my covid BSN cohort (an accelerated program that became 100% virtual only 6 weeks after starting because of covid) - people were so worried that no one would hire us because several of our clinicals were virtual - including obstetrics ? but lo and behold, our cohort was hired straight into ICU's and ED's and oncology and trauma and everywhere in-between! One woman is already training to be a flight nurse (she had zero experience!) - GO FIGURE!! Make sure to make connections with everyone, and volunteer where you can. That's my plan at least. And just believe you're where you need to be - best of luck (and maybe see you at GU - oh, it's typically a PT online program which has been fantastic so far!)

This is an older thread but I'm considering applying to Georgetown CNM, I graduate with my BSN in May. Would you mind sharing information about your experience there?