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First CNM job- birth center or hospital?

Hello all,

I recently graduated from my master's program in nurse midwifery and am beginning to look for jobs. I have always wanted to work in a birth center, and I believe that working in a birth center would be my ideal job for many reasons including more personalized care and lower intervention care. However, I also realize that out-of-hospital CNMs take much more call than most hospital CNMs and I'm not sure that I would always be able to work the schedule that a birth center requires (when I start a family, etc). My questions is this- if I took my first job as a new graduate in a birth center, would it be difficult to transition to hospital midwifery in the future? Does anyone know if a hospital practice would even hire a CNM who has only worked in a birth center? Or should I try to get a hospital job now and transition to a birth center later? Thank you very much in advance!

Benefits of hospital midwifery: the hospital provides the nurses, there are usually on-call OB's and pediatricians/neonatologists for back-up in emergency situations, it might be a bigger practice with less on/call requirements and more of a balanced life.

klone specializes in Women's Health/OB Leadership.

I'm not a midwife, but I work with them. In my experience/observations, it's harder to go from birth center to hospital, than from hospital to birth center.

LibraSunCNM specializes in OB.

I agree with klone. Better to get that initial experience in a higher volume/potentially higher risk environment, and transition to a slower pace with only low-risk patients, than vice versa. It's certainly not impossible to go from birth center to hospital, I worked with a midwife who had done so. But I think she felt like a fish out of water for a long time.

klone specializes in Women's Health/OB Leadership.

I agree with klone. Better to get that initial experience in a higher volume/potentially higher risk environment, and transition to a slower pace with only low-risk patients, than vice versa. It's certainly not impossible to go from birth center to hospital, I worked with a midwife who had done so. But I think she felt like a fish out of water for a long time.

Exactly this. I was on my phone when I posted my earlier post, so I was going for brevity. But I've worked with both types of midwives, and my observation is that the midwives who start at a birth center have a more difficult time with the higher acuity and higher volume at a hospital.

Also, depending on the facility, a hospital-based CNM will probably have clinic time, which means well-woman/gyn in addition to OB. That will certainly make the midwife more well-rounded and knowledgeable in women's health, being able to see the entire spectrum of women's care, rather than just one small segment of it.

I just think you will be able to see more, do more, and just be a better practitioner by spending time as a hospital-based midwife.

Because I have 2 young daughters and I know we are not done with our family when I do eventually become a midwife my plan is to work at a hospital first until my children get older and then transition to homebirth /birth center practice

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