CNM without catching babies?

Ohm108, MSN, NP, CNM · Feb 27, 2023

Yes, there are midwives that only work OP but generally, they have been a midwife and have taken call for a number of years. They usually have decided that they don't want to take call anymore and want a more regular and set schedule.

It would be difficult for a new midwife to only have an OP schedule. The main reason most practices will hire a midwife and not a WHNP is to take a portion of the call and to catch babies in the IP setting.

If you really love women's health and only want OP work, you can go back to school and become a WHNP, they only work in the OP setting and perhaps round PP on patients in the hospital depending on the setting but will not catch babies.

LittleWing21, RN · Feb 27, 2023

Thanks for sharing that, it definitely makes sense. I have considered Women's Health, but I just don't know how much I would use my IBCLC. I absolutely love working with postpartum dyads and I feel like newborn care and education is a huge strength of mine.

I've also considered FNP, but I'm middle-aged with two kiddos and honestly, I just don't want to waste time and $ on areas that I have no interest in. Also, CNM seems to be the only APRN that doesn't involve a good amount of prescribing. And I get so excited thinking about the curriculum! I haven't worked night shifts in many years, perhaps I could tolerate them better now ?

Ohm108, MSN, NP, CNM · Feb 28, 2023

Yes, if OB/GYN is your area of interest then don't go down the FNP route. A lot of people do the FNP route to be more marketable or have an easier time finding a job because you can see pts across the lifespan. But what I remind most people who are trying to make this decision is that CNM/WHNP is a specialty while FNP is a generalist role and it is a specialty because we have very deep knowledge of the subject matter within this sphere. If you want to be a specialist then as a provider then you need to specialize. If you go down the FNP route, you will end up learning things that are not of interest to you though you might find it useful. At the end of the day, I am still a primary care provider though I still stay mainly within the OB/GYN world like WWV and WCC. But I have had to send the occasional neb or take a look at an earache or a rash but not very often; that might be when FNP knowledge will come in handy.

There are some FNPs that do want to specialize in women's health but they either 1) have to go and specifically find more women's health sites during their clinical rotation, 2) find a fellowship after graduation, or 3) find a good mentor who comes from or works in women's health. My experience with FNPs who want to go into WH after graduating is that their skill set in the area is lacking and that they have a lot of catching up to do because they never received the same training that we received in school and when they did complete a WH rotation it was very short. They eventually gain the skills they need but will need more time and support to do so.

In my facility, most of the IBCLC counseling is done by my very capable nurses who are IBCLC certified. I still plan on obtaining my IBCLC but more so to have another skill in my pocket and to just learn more in general and when I am rounding on pts PP who need some help with lactation or when I am older and don't want to take call anymore and want a more 9-5 role like as a lactation consultant at a large hospital.

CNMs prescribe a lot of medications especially BCP, STD medications, and medications for morning sickness, prenatal vitamins, HB medications. If you are also MAT trained you can also prescribe suboxone. We can also prescribe nebs and inhalers if they need a refill while they are pregnant and are seeing you as their PCP. There are also MH medications that I use to stabilize a pt before I send them to a PMHNP or BH specialist. There is a long list of medications I prescribe every day for my patients.

I truly love my job and the subject matter especially. Though I will say that the job is very demanding both emotionally and physically but ultimately very rewarding. You need to establish appropriate boundaries and know when to say no, when to push back, and when you need to take a break so you can be an effective midwife to both your current AND future patients and babies.

**LibraSunCNM, BSN, MSN, CNM** · Mar 1, 2023

Yes, there are CNMs who solely work outpatient but as the poster above recommended, it sounds like you'd be more suited to the WHNP role.