Freestanding birth center vs. hospital and the future of my career

[RunBabyRN]

My long-term goal is to be a CNM. Years ago I worked at a freestanding birth center as a cleaner just to be in that environment (and I loved it!). I made a great connection with the then-owner (and founder; a CNM, not a licensed midwife). Fast forward to yesterday when I saw that they are hiring a RN! The former owner is still connected with the birth center, and I got in touch with her (and she's rooting for me and saying something when she's there tomorrow).

I am still figuring out my long term goal, as far as the direction in which I'd like to go as a midwife, and I'm sure it'll change over time. It used to be that my goal was to either own this birth center or open one similar to it. Now I don't know for sure, and I probably won't until I am closer to pursuing that part of my career. However, I still have interest in working in L&D at a hospital. How would this experience look on my resume to a hospital? Of course I know it will vary some from place to place, but any input is appreciated. I recognize it is NOT the same as acute care experience/hospital L&D. However, would this experience make hospitals more reluctant to hire me?

[klone, MSN, RN]

Are you an RN now? Do you have hospital L&D experience (I'm confused by your posts, I see you have women's health/OB experience, but am uncertain if that's as a nurse or in some other capacity).

I work primarily with CNMs, and I've seen some that came to us from several years in private practice and community hospitals, and some whose only experience was at FSBCs. The learning curve for the latter group is pretty steep, because all they have ever seen was non-medicated, low-risk pregnancies/deliveries. I imagine that would be similar for an RN. I do not think that it would HURT your chances of getting hired by a hospital, especially if you spin it as "I have extensive experience in non-pharmaceutical pain management and labor support". But I think working in an environment that sees the entire spectrum of OB/L&D experiences does make one a more well-rounded care provider.

[RunBabyRN]

I am a new grad RN (licensed in June of this year). I worked in women's health in the Navy (in addition to other departments), and have worked as a lactation specialist since working at this birth center here and there. I have a little RN experience, but not in this specialty yet. I'm thinking that it would be good to try to do this AND get a per diem hospital position if at all possible (dreamland, I know).

The learning curve and bias some in the more medical side of birth can have against FSBC providers (I've seen some of these) are why I ask this question. I did my senior preceptorship at the high-risk mother baby unit where this BC has privileges. I was supposed to get hired there, but the hospital had some political stuff going on and they wouldn't let the manager hire me (or any other new grads that weren't post-licensure).

[queenanneslace, ADN, MSN, APRN, CNM]

I had OOH birth experience prior to becoming a nurse. It's hard to describe my "labor and delivery" experience - because I couldn't say "I have **RN** L&D experience." And many nurses and OB managers had no clue that births were occurring anywhere but in a hospital on an OB unit. So to say that I had experience with birth, but this experience was not in a hospital is often very confusing for them.

I don't know how it will look on a resume. I know I've listed my OOH experience on a resume - but it always requires some explaining. After nurses work with me, they see that I have 'experience' because of my demeanor around birth and my understanding of the physiologic process.

I'd list on my resume the skills I gained through OOH experience, such as: maternal vital signs, intermittent auscultation of FHR, labor support, newborn vital signs, postpartum vital signs and fundal checks. This seemed to provide some information about the skills I have in relationship to labor and birth.

[RunBabyRN]

Luckily, around here, people know what a FSBC is, and they're familiar with this facility. It's been around for a long time. Knowing and having experience with nonpharmacological methods of pain management would be good as well. Knowing how to recognize stages of labor, the progress, and what's normal and what's not would be skills I'd be picking up, I'd think. I precepted at the hospital where this FSBC has privileges.

[cayenne06, MSN, CNM]

I think that the experience you get in out of hospital birth is priceless. It is all too easy to forget "normal" when you work at a hospital. I became a CPM in 2006 and did home and birth center births. Now I am an LDRP RN and a student CNM at a large tertiary hospital, and I am SOOOOOO grateful for my foundation in physiologic birth. It has helped me keep perspective that many RNs, OBs, and even CNMs sometimes lack.

When things go wrong in childbirth, they go really really really wrong, and it doesn't do anyone any favors to pretend otherwise. But it is equally as inappropriate to treat all labors as trainwrecks waiting to happen.

[RunBabyRN]

So true! Hospitals sometimes forget that birth is a normal process, not an illness. It seems like hospital feel the need to intervene in SOME way, and as minor as it may seem to the staff, it can affect the way Mom feels about the experience. This is part of why I prefer the CNM approach over the OB approach. Most births are actually uncomplicated, but we're so in "fix it" mode that we step in too often.

[klone, MSN, RN]

I think I must just be lucky, because at two of the three hospitals I've worked in L&D, they've been VERY holistic, hands off (when appropriate and desired) and I've been able to witness amazing natural births with midwives in the hospital setting (I'm talking about waterbirths, IA, birthing chairs, no IV access, aromatherapy and hypnobirthing.

A few of the midwives I've worked with pride themselves in being able to go through many entire births without once doing an SVE.

[cayenne06, MSN, CNM]

A few of the midwives I've worked with pride themselves in being able to go through many entire births without once doing an SVE.

I just had a birth the other night (i'm a student CNM) where we didn't do a SVE to confirm full dilation. She was unmedicated, her outward s/s were very clear, and it was just not necessary. Still, it was a Big Enough Deal that the nurses brought it up afterwards, and my preceptor commented on how rare it was. When I did home birth, we kept our hands out of there as much as possible. It's an interesting difference!

[RunBabyRN]

I think I must just be lucky, because at two of the three hospitals I've worked in L&D, they've been VERY holistic, hands off (when appropriate and desired) and I've been able to witness amazing natural births with midwives in the hospital setting (I'm talking about waterbirths, IA, birthing chairs, no IV access, aromatherapy and hypnobirthing.

A few of the midwives I've worked with pride themselves in being able to go through many entire births without once doing an SVE.

We're seeing more of this around here as well. There's a new hospital that just opened (well, moved locations to a new building), and they have two portable tubs. A lot of aromatherapy in the hospitals in all units, which is good. I haven't seen birthing chairs in the hospital yet.

I LOVE that providers recognize that SVEs aren't always necessary. It makes me CRINGE when we treat someone like a finger puppet. I have seen horrible uterine infections as a result of too many SVEs, including one that led to dehiscence of a c-section incision, and one that led to C-diff. Talk about birth trauma!! When I had my son, I refused them as much as I could, but of course, so many hospital providers refuse to "let" you push until you're fully dilated.