CNM or OB-GYN?

duskyjewel · Aug 29, 2014

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 · Aug 29, 2014

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 · Aug 29, 2014

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 · Aug 29, 2014

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.

Midwife or OB-GYN? · Aug 31, 2014

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.

Midwife or OB-GYN? · Aug 31, 2014

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 · Aug 31, 2014

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 · Aug 31, 2014

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 · Aug 31, 2014

"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.

Simplyroses · Aug 31, 2014

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 · Aug 31, 2014

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.