For CNMs: How to get through hospital L&D experience needed for grad school?

[exactlywatt]

I am a second degree/career student who garduated with her BSN in December. I returned to school specifically and soley to pursue a career as a CNM/FNP. I feel a strong calling and passion for midwifery and primary/well care. I know I need at least one year of experience before I can even apply to grad school (and realistically need to work and pay off some student loans) but am nervous about working in the L&D hospital setting. My 12 week L&D preceptorship was hard for me, as the hospital I worked in was not mother-baby centered and my coworkers did not have an innate trust in women's bodies. Unfortunately, I live in Las Vegas and that is the norm and my family is stuck here for the next few years.

Having said that, I understand that my views are my own and talking to a woman in labor about natural/gentler options is not the right time. I have no problem finding ways to support a laboring mama being induced, epidural, etc. I do find it personally heartbreaking to see some of these mamas ending up with traumatic c-sections when providers fail to listen to the natural rhythms of labor and push too hard. Do you think this attitude and the knowledge that it won't be forever will be enough to get me through a few years as an L&D nurse? Are there other options for gaining experience that I am overlooking that will allow me to pay some bills?

Luckily, I had a baby in March so still have several months to think about things before returning to work in the fall. I'm just so worried about burning out before I even make it to grad school.

Thanks so much,

Kim

[klone, MSN, RN]

Not all programs require L&D experience. I would suggest looking for one of those programs, rather than forcing yourself to work in a unit you don't like.

[StarrySkies]

Well, I am in the exact same boat, but I have been working as an L&D nurse for a year. I am finally starting the process to apply to grad school. I was a homebirther/ doula long before nursing school. There are a lot of things that I have done to make this year a good one. First off, not everyone WANTS the midwifery experience. A lot of people are terrified of pain and want to not feel anything during labor. My job as a doula was to give women the birth that THEY wanted, not the birth that I wanted them to have. Also, once you are outside of your preceptorship, you can decide what kind of nursing practice you want. You don't have to do things like everyone else on the unit! You can advocate for you patients, you can ask for ambulation orders, for intermittent monitoring orders, for food and liquid orders. You can go to the docs with research in hand! AWHONN has a great book for about $35 that I have highlighted and dog eared. I show it to docs all the time to get the orders that I prefer.

If you pick a busy hospital, you will see things that you might not get to see in 10yrs of homebirth practice. I KNOW what PIH looks like, I KNOW what an abruption pattern looks like, I KNOW how to resuscitate a baby, how to manage a seizure, how to deliver a demise, and how to do tons of things that I would of never learned in years of practice. I might secretly know that the nurse 4 doors down unintentionally caused her pt to end up in the OR because she was pushing her on her back for 3 hours, but it isn't my place to fix her pt. I manage my own pts and I get them delivered while giving them a sense of empowerment and that they were well cared for. I encourage them to wait for the pain medicine. I rub backs, make hot packs, and sit them on birth balls. I use my skills as a doula everyday in my job. Is it ideal? No. I would rather of spent the last year at a birth center, but I knew it was necessary to get into grad school.

[arabianeyez83]

I got accepted a CNM program and I only have ER experience....I always wanted to become a CNM and still decided to do ER...I wanted to get more of a broad base experience...and I Love it. I had my baby March 20, how about you?

[allthemadmen]

Critical care experience, especially a very busy SICU or MICU, should be carte blanche for just about any program, but you may not like that kind of intensity. If you work L/D you can at least improve the experience for people, but you do need to be careful that you are helping them to experience *their* birth to the fullest, not the birth you would like for yourself. I agree that experience with high-risk patients and poor outcomes/complications can only help you, not only in terms of getting into grad school but in caring for your patients and understanding the real consequences of primary care responsibilities. (You may also find it less emotionally upsetting once your own baby is a little older.)

[Little_Babycatcher]

I also wanted to add that I was accepted into a Midwifery program (Frontier) without any L&D experience. I would have liked some, but unfortunately I wasn't able to find a position as a new grad RN.

I think most programs just want a year's RN experience. Med-Surg should qualify for just about anything IMHO

[joyrochelle]

hmmm-- well, its all a part of the same process, and no matter what type of midwife you want to be (home birth practice, hospital or birthing center) being exposed to as many laboring women, their partners/ support systems, and yes, even the nastiness of a hospital unit, will all be a benefit to you in the long run. every labor is different, women will come to you late in pregnancy as well, so finding tried and true but efficient ways to support and get them thru is an art form- so just because you haven't been with this woman for the 7 or 9 mths prenatally does not mean you can't learn effective labor support measures. Consider it an elective in sociology if nothing else.

Also being in the hospital can really help to fortify your beliefs about what kind of labor attendant you want to be, and what does and doesnt work. Of course there are nasty nurses out there, but there are also those that have been there thru thick and thin-- and for probably 20 years that can help you with tricks of the trade, fetal monitor strip interpretation, position changes, emergency interventions that I would have rather been exposed to in the hospital than while flying solo on my own as a baby catcher-- cord prolapses, abruptions, shoulder dystocias, floppy/apneic babies..... postpartum hemorrhages.... and if that doesn't help you appreciate your time there, just be thankful of how much more wonderful life will be WHEN you are done with your requisite (and I'll say it again- valuable) time on a hospital L&D unit and in a midwifery capacity. Hope is very healing, exciting stuff.

You wont be there forever, and there may be a time (or 12) when you look back wishing you werent the one managing it all. :)

it's all good. Soak it up.

[midwife228]

I agree with Joyrochelle - it's better to experience some of those bad things that can happen in labor while you're in a hospital where you have a support team (of sorts, at least) before you are out there on your own. When I went (over a weekend) from working as an RN to working as a CNM it was scary enough even with many years of experience. I know some good midwives who never had prior L&D experience but I have always been grateful for the years of experience I had.