For L&D RNs who are future CNMs: Coping with different model of care??

Hello folks! I am pre-CNM and will *try* to get a L&D position to gain some much needed experience before trying to find a CNM position...

I was wondering how those of you who are working in L&D are coping with the different model of care as you are (mostly, I assume) working under OB/GYNs in the hospital setting? As I read through the different posts (ie: lichotomy positions, enemas etc.) I keep imagining how hard that would be to have to perform as RN who might not believe in all the interventions...

Is this something that actually crosses your minds, or are you really too busy to think about it? What advice can you give to someone who is worried about having to administer so many routine procedures that totally go against what they're working toward?

Thanks!

I have worked L&D for many years. I have never given an enema, and the delivering woman can deliver in the position of her choosing, baring any complications. Try to find a job in L&D where there are midwives.

Most doctors do not like midwives, because they take money out of their pockets.

I'm in a direct entry program right now so this is only my point of view from that perspective but I will share my plan. I will be doing my OB rotation wherever the school tells me to, but my last semester I get to provide input as to the location where I want to be. I plan to chose a hospital with a birthing center. There are quite a few of them around here. Then when I get a job I will try to do the same. I plan to work for 4-5 years before finishing my CNM. Or finish it but not work as a CNM for at least a few years. It's my opinion that the critical decision making skills will only come with time.

I think it boils down to this for me- if I work somewhere I do not like I will consider it experience and a chance to learn what I don't want to do. And maybe I can be that granola girl who all the birth plan bradley people get sent to.

Also, since my school is highly rated in midwifery and the faculty are really super I expect my OB clinicals and education to be in line with their philosphy since they will be teaching the class.

Thanks folks, the idea about looking for L&D with a birth center in hospital is a great idea! And of course looking for one where there are midwives is a plus too!

Often anyplace that has midwife deliveries can be a great place to start......Just be aware many CNMs practice in a more medical model than others. Learn from and emulate those you admire and respect the most.

Most doctors do not like midwives, because they take money out of their pockets.

Which is ridiculous. Midwives make nothing compared to Ob's and in my opinion work harder. Midwives were here long before Ob's got here! They have been delivering since the Old Testiment................

Just a bit off topic....

I have a couple of GREAT recommended readings/books about the history of midwifery in the USA and the "Grannie Midwives" of the South. The fabric of midwifery and its history in the USA is so very rich and fascinating.

Just a bit off topic....

I have a couple of GREAT recommended readings/books about the history of midwifery in the USA and the "Grannie Midwives" of the South. The fabric of midwifery and its history in the USA is so very rich and fascinating.

I'd love your recommendations. Are they listed on the sticky thread? I am especially interested in the way the southern midwives practiced. It was really a way of life and a totally different philosophy on life and birth.

http://search.barnesandnoble.com/booksearch/isbnInquiry.asp?z=y&isbn=0913990973&itm=4

Why Not Me?: The Story of Gladys Milton, Midwife

Wendy Bovard

http://search.barnesandnoble.com/booksearch/isbnInquiry.asp?z=y&isbn=0385335512&itm=5

The Midwife's Tale

Gretchen Moran Laskas

http://search.barnesandnoble.com/booksearch/isbnInquiry.asp?z=y&isbn=1570873631&itm=6

Etta “Granny” Nichols: Last of the Old-Timey Midwives

http://search.barnesandnoble.com/booksearch/isbnInquiry.asp?z=y&isbn=0912670134&TXT=Y&itm=1

Witches, Midwives, and Nurses: A History of Women Healers

Barbara Ehrenreich, Deirdre English

http://search.barnesandnoble.com/booksearch/isbnInquiry.asp?z=y&isbn=080785378X&itm=6

Working Cures: Healing, Health, and Power on Southern Slave Plantations

Sharla M. Fett, Sharla Fett

there, that is a start. I have quite a few books I have read regarding midwifery and childbirth. I am a true birth junkie who has a lot to learn. ENJOY!!

I'm glad to hear that I have company here... my L&D experience has been so negative that I've been planning to do med-surg, rather than L&D, before I go for CNM. (Some schools won't accept an RN without L&D, I know, but others will.) None of the L&D preceptorships available for my school are "alternative" in any way. Lately I've been realizing, though, that I REALLY WANT to do L&D, even if it's not perfect... a wise classmate has pointed out that within the confines of a standard L&D unit, I can still be a caring nurse--and who needs a caring nurse more than the women who don't realize they have options?

I'd love your recommendations. Are they listed on the sticky thread? I am especially interested in the way the southern midwives practiced. It was really a way of life and a totally different philosophy on life and birth.

Check out "Motherwit" by Onnie Lee Logan. She was a black granny southern lay midwife, one from whom CNMs could learn a thing or two. Fabulous book.

Peggy Vincent writes about her experiences in the SFBA as a homebirth midwife in "Babycatcher." (I worked in her hospital for a few years before grad school .... the most alternative birth friendly hospital I've ever worked in, and it had high risk, high volume deliveries, so it can be done.)

A thought on working with midwives in hospital: yes, it can be great, you can learn a lot from them -- I did when I lived in CA and was reinspired to try midwifery again. But when I lived in the large city in the midwest, the midwives I worked with were like residents, nothing particularly "midwifey" about them and I didn't learn anything -- in fact was discouraged. Try to not work in a teaching hospital -- meaning, no residents around 24/7 doing everything for the patients. In nonteaching hospitals you, as the RN, will be managing the care of patients, which will be invaluable experience for midwifery practice. With midwife patients, you may be doing very little in way of assessment, exams, management, &c (unless they are like the docs and basically just come in to catch the kid). You can actually wind up developing more skills working with OBs as you are more likely to manage their patients for them.

I'm glad to hear that I have company here... my L&D experience has been so negative that I've been planning to do med-surg, rather than L&D, before I go for CNM. (Some schools won't accept an RN without L&D, I know, but others will.) None of the L&D preceptorships available for my school are "alternative" in any way. Lately I've been realizing, though, that I REALLY WANT to do L&D, even if it's not perfect... a wise classmate has pointed out that within the confines of a standard L&D unit, I can still be a caring nurse--and who needs a caring nurse more than the women who don't realize they have options?

Sure you can be an amazing nurse within the confines of the LDRP unit of a hospital. I know many of them and I happen to think I am not too bad, myself. Your caring attitude will come through to your patients and you will learn a LOT, even if some of it IS negative. I would say go for it.

Here's more on African American midwives, many of whom practiced in the south:

http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=34416

Anacostia Museum in the Washington DC area has an exhibit on AA midwives until August 6th, "Reclaiming Midwives: Pillars of Community Support"

http://anacostia.si.edu/exhibits/exhibits.htm

And I'm sure you know about Mary Breckenridge, who brought the English style of educated midwifery to the USA in the 1920s, helping form the nurse-midwifery profession. She lived and practiced in Appalacian Kentucky, and founded the Frontier Nursing Service.

http://www.midwives.org/whoweare/fnshistory.shtm