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CNM or OB-GYN?

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Hello! I am currently a junior in college forced to make a tough decision. I have to decide to fully pursue my dream of becoming an OB-GYN or to give up my dream and become a nurse-midwife instead.

A little background: My passion is in women's health. I know without a doubt that I have to work within the field in order to be happy. However, my GPA is currently a 3.1. My adviser said that it is tough, but doable if I get 4.0 every semester until I graduate and possibly go an extra year in order to spread out the rest of my classes. That would mean that would be applying for med school when I am 24. I know in the scheme of things, that isn't that old, but I want a ton of kids, which just isn't realistic if I wait until I am done training after I am 32. With that being said, I feel like I could also be happy as a midwife. My understanding is that they basically do everything that an OB-GYN would do expect for surgery.

Part of me feels like this is the smart choice. I could be done with my training by the time I am 25 and have a career and a large family. The other part of me is heartbroken for giving up my dream so easily and fears that the limited abilities of a nurse-midwife would not be enough for me.

I don't know what to do, and I am in a tough situation, as I have to decide within the next day as classes start and I have to switch from pre-med requirements to pre-nursing.

So here is where you come in: I need help. Midwives out there-did you ever consider going to med school? If so, do you regret your decision? Is there a respect level within your career, and do doctors take you seriously? Are you satisfied with the limited scope of your practice? How is your family life?

Thank you for your time and responses. I truly appreciate it.

duskyjewel

Specializes in hospice.

If you truly want to serve women and improve maternity care in this country, the midwifery model of care is the way to go.

Jolie, BSN

Specializes in Maternal - Child Health. Has 35 years experience.

You mention being fearful that the "limited abilities" of a midwife might not be satisfying for you.

I would encourage you to research the practice of both OB-GYN medicine & midwifery so that you are clear on the similarities & differences.

duskyjewel

Specializes in hospice.

The surgical capabilities of OB/GYNs are being rampantly abused in this country, to the detriment of women and their babies. Why would you want be part of that? Be part of the solution!

queenanneslace, ADN, MSN, APRN, CNM

Specializes in Nurse-Midwife.

This is an odd choice of boards to ask your question "Should I give up my dream and become a nurse-midwife instead?"

I have only wanted to be a midwife, and becoming a midwife didn't mean I gave up my real dream to become anything else.

Not only should you learn more about the medical field, obstetrics and gynecology, you should learn about the profession of midwifery and understand that it is not a second-rate profession for individuals who didn't have high enough GPAs to get into med school.

Please, become a midwife only because it is your dream to become a midwife, to be with women, and because you are passionate about the midwifery model of care.

If becoming an OB/GYN is your dream, please pursue that dream, and don't substitute it for midwifery because you haven't worked hard enough to make your real dream come true.

I'm sorry if I offended you with my question. That was not my intent. I think very highly of midwives. Please do not think otherwise. If I didn't think I could be happy in the profession, then I wouldn't even have a doubt in my mind about continuing on to med school. I appreciate the fact that your dream was to become a midwife. I feel like because of that you should appreciate the fact that I had a different dream. That in no way diminishes yours, nor am I in any way saying that your dream was not good enough. Maybe I didn't phrase my question right and for that I am sorry.

I feel like your comment was unnecessarily harsh. I am a young adult who is thinking of replacing a dream with something that is very similar, if not better suited for me in many ways. If I decided that becoming an OB-GYN was for sure the right direction for me, then I would definitely go in that direction. I wouldn't even be here asking the question. However, I am doubting if it is the right career for me. This is not because I CAN'T get there. If that is what I truly wanted I could do it. I am doubting because they have a very different lifestyle and scope of practice. Excuse for me questioning whether it would make me happy or not and reaching out to midwives for their life experiences. I don't know if the lack of surgery or not getting to have more complicated pregnancies would bother me. That is why I am asking YOU. You are midwives who should be able to tell me "yes, there are some points that I wish I could perform a c-section" or "no, I love my job and everything that pertains to it". That is all I wanted. Again, I am sorry if I offended you or made it seem like midwifery is second best. It isn't. It just isn't right for everyone and I was hoping to get some insight to decide if it was right for me.

Also, I am sorry for the wording "limited abilities". I didn't mean skill. Rather, I meant ability to perform surgeries and take care of higher risk pregnancies. I have done a ton of research on the differences between midwives and OB-GYNs, so your comment really wasn't helpful.

duskyjewel

Specializes in hospice.

I get really tired of these reactions where if the responses aren't all sweetness and light, these very young posters get upset and start calling people harsh. Read your initial post, OP. You directly tie your lower, less competitive GPA to the possibility of choosing midwifery over OB/GYN, and yet you can't understand why queenanneslace might be offended. All she's saying is that the two professions are different, and you should choose one based on wanting to be in that profession, not as some kind of consolation prize.

There are days I feel like my family yells too much, but honestly, at least I know my kids won't crumble under the tiniest indication of non-positivity.

duskyjewel

Specializes in hospice.

PS a decent midwife knows how to PREVENT 90% or more of cesareans. The problem with obstetricians is that they seem to be looking for excuses to do them. Look at the rate climb over the last 15 years and tell me I'm wrong.....

queenanneslace, ADN, MSN, APRN, CNM

Specializes in Nurse-Midwife.

"Midwives out there-did you ever consider going to med school?"

I did. But medicine and medical school had little appeal to me. I was not focused and driven to "make money." And the medical field did not appeal to my personal philosophical approach to people as individuals who have a right to autonomy and decision-making in their health care.

It was empty. It was presented to me as an option to "make lots of money." And I needed to pursue a career that was more in line with making a difference in people's lives.

I also don't care for surgery. I don't get jazzed about surgery. I'd rather not do it. I understand that people need surgery, and surgeons. I'm not anti-surgery at all. I'd rather not do it myself.

But, working in a OB unit, I find myself down in the OR quite a bit. I just don't have my hands in open cavities.

"If so, do you regret your decision?"

Nope. Becoming a physician was never my dream. And it is still not my dream. No regrets at all.

"Is there a respect level within your career, and do doctors take you seriously?"

This implies that doctors are at the top of the hierarchy and are the ones who make the decisions regarding which professionals are worthy or not worthy in health care. Any reasonable physician will understand that nurses, nurses aides, techs, scrubs, housekeepers, pharmacists, clinical nurse specialists, NPs, CNMs, PAs, etc, etc, etc all play vital and RESPECTABLE roles in providing safe and effective care to patients. Any physician who does not respect non-physician colleagues and co-workers is deceiving him or herself. Healthcare is not a single-provider endeavor.

That said - sometimes CNMs are caught in no-mans-land between nurse and provider. And there are struggles to be seen as "more than a nurse" but "not really a doctor". The reason midwives should be committed to midwifery is because it is likely that you will have to fight to practice midwifery every day of your career. And you'd better believe in midwifery, otherwise you won't be willing to endure it. Or you'll be used to provide cheap OB/GYN services in the health system where you work. True, this is allowed by license, but this is not really midwifery care.

I come back to this question: do you want to be a midwife, and to practice the discipline of midwifery, or are you looking for something that will accommodate the other goals in your life?

"Are you satisfied with the limited scope of your practice?"

I don't see midwifery as "limited in scope." It is midwifery, practiced to the full scope of the profession. That's how I'm going to answer that question.

"How is your family life?"

ANY career - in health care or not - is going to require a sacrifice. Work-family balance is challenging. It is challenging for bus drivers, cafeteria workers, teachers, insurance agents, fast-food workers, actors, reporters, and [insert ANY career you can think of here].

A career in health care - particularly as a provider - as an advanced practice nurse or physician - requires dedication and commitment. DO WHAT YOU LOVE. Because your career will take you away from spending with your family. It needs to be worth it. It needs to be your dream. It needs to feed your soul. Being away from your family for DAYS is difficult - and it is a reality for many healthcare workers. Working nights on end sucks - but people need health care at 3am just like they need it at 10am. You need to believe in what you do, and what you do needs to satisfy you as much as your children do, because you will be trading time with your family to perform your job.

Here are a few points to think about:

1. A 3.1 GPA is low for either NP school or medical school. The good NP schools are very competitive for admissions.

2. Midwifery is a different philosophy of care than medicine. Research which fits your personality best.

3. Being a mother of a big family is a very full-time job, even if you hire nannies. Childcare for infants can be over $1000 a month. Being pregnant is usually 9 month stint where you are physically taxed by growing a fetus. Then you take time off work to nurse and bond with your child. Which career will best fit your desire to mother in the way you wish?

4. Are you planning to be the primary breadwinner or do you wish to work part-time?

ixchel

Specializes in critical care.

I would highly suggest shadowing a midwife for a few days. If you're able, find a CNM who does hospital and home births. Then, again if you are able, shadow an OB.

Another thing... I see that your life plan includes kids in your mid 20s. Honestly, these days, 32 isn't really that old to get started.

Midwifery believes that women are fully capable of carrying and birthing babies without intervention. They are also trained to know when intervention becomes necessary. In other countries, midwives are the primary providers in pregnancy and birth, and OBs are specialists that midwives refer to.

OBs practice based on the medical model, typically looking at pregnancies as though things are on the verge of going wrong always. Yes, that is anecdote. It's just different.

If you google "nurse practice act" followed by the name of your state, you should see what exactly is in a midwife's scope of practice in your state. In my state, physician collaboration is required, and home births can only be attended by CNMs. There also needs to be a plan in place for emergency transport for home birth.

Your GPA may be an issue no matter what direction you go. Also, for CNM, many, if not most, programs require 1-2 years working as an RN in L&D before they'll accept you. Be sure to consider this in your plan. Even if you find a program that allows direct entry, most people here would probably highly recommend getting that experience anyway. There is so, SO much to learn that experience teaches.

As previous posters have said, your ultimate decision should be based on what route you think will fill your dreams the best. In my opinion, the best place to start is learning more about the difference between CNM and OB ideology and practice. I have a feeling this will lead you to your answer.

Jolie, BSN

Specializes in Maternal - Child Health. Has 35 years experience.

"I don't know what to do, and I am in a tough situation, as I have to decide within the next day as classes start and I have to switch from pre-med requirements to pre-nursing."

Please also understand that when you come to an anonymous website and ask for immediate information because a life-altering problem must be solved today or tomorrow, it is more than a little difficult for thoughtful, experienced members here to offer any ideas or opinions that will be satisfactory to you.

I understand that to a 20-something year old, it can seem that everything in life demands an immediate answer. As you gain experience and maturity, you will come to understand that is not the case, and that making hurried, rushed, poorly informed decisions does far more harm than good.

If OB-GYN is truly your passion, and you are willing to consider your advisor's plan to add a year to your college studies in order to improve your grades and chances of med school admission, then jumping ship tomorrow to pre-nursing classes is not necessary. Furthermore, many pre-med and pre-nursing classes are very similar. It seems likely that you could meet with an advisor and try to re-work your fall semester to take classes that would meet requirements for both possible tracks. That would buy you time to seek information on both professions and make an informed decision on which one to pursue.

SCSTxRN

Specializes in Psych.

I am going to sound so negative - it is not my intent - and I promise to answer something to your question at the end.

If you have a 3.1 now, unless you've already got bioethics and organic chemistry under your belt, a 4.0 isn't going to be likely. If you've been working as hard as you can for that 3.1, it's less so..

Nursing classes are, for most people, harder than regular undergrad classes.

Competitive MSN programs are looking 3.7 and higher, plus experience, plus PASSION for the field.

I think if your dream is to sign, M.D. after your name - CNM is never going to cut it for you. If your goal is to support women through healthy pregnancies and catch babies.. then M.D. might not have been your thing.

A large family is a HUGE commitment. Delivering babies is a time suck. You need to seriously consider how you're going to deal when your 6 month old is crying with a low grade temp and your mom is delivering and you have to GO.

15 years ago, I had just finished premed and been accepted into one of my top choices for MD, and I kind of lost my mind. Had I known then that NP was a thing - even a possibility... I never EVER would have chosen ANYTHING except NP.

I'm almost done with school now (not CNM - my kids are too demanding for me to deal with pregnant women).. and I can't imagine being satisfied doing anything else.

Also getting a nursing degree does not preclude you from applying to medical school down the road. It gives you an in to a healthcare related position. I've worked with several residents that were nurses first. I've been a L&D RN for 15 years and just got into a CNM program. Both obstetrics and midwifery are demanding and difficult callings. Working in a hospital alongside physicians made me realize that I really did not want to be one - for many reasons - but my family was one of them and my birthing philosophy and the time that I like to spend with patients was another. I am lucky to work with fabulous midwives and doctors. They do very different things and are appropriate for different kinds of patients. Have you worked in healthcare before? Have you worked nights and weekends and holidays. As far as MD's go, OB's have some of the worst call. If you want a lot of children are you comfortable with a nanny or daycare spending far more time with them than you will? These are decisions that are too difficult to make in a short period of time. Even if you do want to pursue a medical degree, a nursing undergrad is a good vehicle for this. I know many OB residents that did not get into school the first time they applied. Working as a RN in L&D gives you insight into the birthing process and providers role in that process that no other experience will. In addition, it's a hell of a lot more marketable than a biology degree or whatever premed course of study you might take. There are so many premeds that lack the grades to get into medical school and have a difficult time finding jobs with their degrees. You can take the premed track science classes while pursuing a BSN and working in a hospital will give you a lot more insight in whether you have the dedication and drive that it takes. I realized while going to school that I wasn't willing to put in the 80-100 hour work weeks at that stage of my life. OB residency is fairly brutal, a midwifery call schedule can be killer as well. Good luck with your decision and future.

cayenne06, MSN, CNM

Specializes in Reproductive & Public Health. Has 10 years experience.

I also wanted to echo the previous posters. I chose midwifery because I wanted to practice midwifery, not obstetrics. I struggled with the CNM vs OBGYN thing too, and in the end it was clear to me that my passion lay in public health. Improving birth outcomes both individually and systemically. This is the purview of midwives.

Midwives are not mini-obstetricians. Midwives are experts in physiologic childbirth. Obstetricians are not. I am both a CPM and a student CNM, and our physician colleagues consult with us for OUR expertise, just like we consult with them.

CNMs can do first assist in c/sections. They can do circumcisions, colposcopies, aspirations for missed ABs, and many other advanced procedures. And depending on the practice, many CNMs care for higher risk patients and do vacuum extractions and other more traditional OB skills. Almost all states currently prohibit non-physician providers from doing abortions, but medical and surgical terminations are well within the skill set of CNMs and will become part of our scope when the physician-only regs are inevitably changed. I love blood and guts and all that stuff, so being able to perform advanced procedures was important to me too.

ETA I have a 4.0 undergrad GPA and a very impressive C.V. Med school is hard to get into but I am very confident I could have made it work. So never was this a case of me "settling." But I WILL say that the lifestyle of a resident was a factor in my decision to not be an OB. I have two kids, and a decent work/life balance is a big consideration for me.

Edited by cayenne06

I'm curious what you ended up choosing to do.