Hospitalist Midwife

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Does anyone know how common this role has become? This type of work would be very appealing to me. I love working one on one with patients in the labour, birth, and triage settings. The "office visit" part is not for me. I have an MSN and worked with a CNM and WHNP in the clinic setting for about 200 hours total as part of my required rotations. It was so rushed. Yes the hospital can be rushed too, but I really like that type of work. Right now I have a job with almost no patient care and find myself longing for the bedside. I did M/B and L/D for many years. I felt I would like to increase my skills and considered midwifery. At the time, I was not in a position to travel and do clinicals while I had a 5 day a week job and teenagers at home. I have a CNS certificate, but mostly I am now doing admin work. If I found a CNS job where I was physically caring for patients, I would like that too. Any input would be greatly appreciated. I am turning 50 in March and have been an RN for almost 28 years. I wish I wasn't so damn restless!

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That is EXACTLY what I want to do if/when I become a midwife. At least in the beginning until my children get a little older and then venture into homebirth. Around where I live however, I think a position like that would have to be created through some networking, and not actually posted as an open position

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Specializes in Nurse Leader specializing in Labor & Delivery.

The facility I work for has a practice of about 25 midwives. A few of those ONLY work inpatient (maybe 2 or 3?). We have one or two who ONLY work clinic. The rest do a combination of clinic and inpatient (and "inpatient" might be triage, L&D, or postpartum, which are three separate roles).

I think most midwifery practices will expect that you do both clinic and inpatient. I think that you would not be a very well-rounded clinician if you never did Gyn or antepartum care. There is WAY more to women's health than just delivery of the baby.

If you just want to be there for L&D, then why not be an L&D nurse? Why midwifery?

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Thanks. I was an L&D nurse for 18 years. I honestly would like to do some of the diagnosing, ordering, ultrasounds,more detailed exams and deliveries. I like AP pts and I wouldn't mind doing GYN exams for the ED as needed. I just hate that 10-15 min per pt one after the other routine. I was like an assembly line. It was fun to learn to do the spec exams and paps, etc. Just as you got to talk to a pt., it was time to hurry up, chart, and move on to the next. I guess I am wondering if the hosptlalist type of position is something which we will see more of for CNM's as we are for physicians. I know triage can be crazy because I have done it. Many times, you are able to touch back with the triage patients after initial assessment if you keep them for OBS, etc. I just do not like the office/clinic environment. I know many of the docs I worked with loved the office and couldn't wait to get out of the hospital.

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Specializes in OB.

I think we will see an increase in both midwives and OBs working for hospitals, as opposed to private practices, personally. However, that does not mean that there will be an increase in laborist-only positions (it also doesn't mean it won't, but I'm just guessing based on my experience).

In our group, there are 14 midwives. We all do an equal combination of clinic and L&D, although our clinic isn't quite as rushed as you describe--usually about 10-15 patients per day--and it's a mix of new and revisit OB patients, postpartum visits, and family planning/annual GYN. In our sister hospital across town, there are about 20 midwives, two of whom only do clinic, and two of whom only do L&D. All four of those midwives worked out that schedule after many years of experience doing both.

I'm sure it's possible to find the job you desire but it might not be possible in your desired geographical area.

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Specializes in critical care.
Does anyone know how common this role has become? This type of work would be very appealing to me. I love working one on one with patients in the labour, birth, and triage settings. The "office visit" part is not for me. I have an MSN and worked with a CNM and WHNP in the clinic setting for about 200 hours total as part of my required rotations. It was so rushed. Yes the hospital can be rushed too, but I really like that type of work. Right now I have a job with almost no patient care and find myself longing for the bedside. I did M/B and L/D for many years. I felt I would like to increase my skills and considered midwifery. At the time, I was not in a position to travel and do clinicals while I had a 5 day a week job and teenagers at home. I have a CNS certificate, but mostly I am now doing admin work. If I found a CNS job where I was physically caring for patients, I would like that too. Any input would be greatly appreciated. I am turning 50 in March and have been an RN for almost 28 years. I wish I wasn't so damn restless!

My goodness, what an impressive CV!!! I wanted to share only that my hospital is currently hiring a MW hospitalist. I this its a major advantage to do so, financially. MWs are now reimbursed the same rate as OBs for lady partsl births.

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Specializes in Nurse-Midwife.

I'm getting the impression that more hospital systems are looking at CNM hospitalists as a way to cut costs. I think this type of position will become more prevalent in the near future.

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I'm getting the impression that more hospital systems are looking at CNM hospitalists as a way to cut costs. I think this type of position will become more prevalent in the near future.

Exactly what I'm thinking, midwives in many states (or just some, don't remember) get reimbursed the same or close to the same and physicians by insurance. Therefore having a midwife and an OB saves a lot more than 2 OBs.

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Specializes in Nurse-Midwife.
Therefore having a midwife and an OB saves a lot more than 2 OBs.

Right. So this is a way to market midwives to a hospital system. A potential drawback (and not an insignificant one) is that midwives will be utilized to provide cost-efficient *obstetrical* care and not midwifery care. I try to imagine this model and wonder if the hospitalist midwife will be expected to act as an OB (often) does on the labor unit: AROM everyone. Actively manage everyone with Pit. At the bedside for all of 10 minutes to catch a baby, the placenta and suture any tears - then on to the next patient.

What would be an ideal hospitalist midwife position? How could a midwife negotiate the role to *not* be the low-cost version of an OB for laboring and lady partsl birth patients? But to actually *be* a midwife? Thoughts?

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Specializes in critical care.
Right. So this is a way to market midwives to a hospital system. A potential drawback (and not an insignificant one) is that midwives will be utilized to provide cost-efficient *obstetrical* care and not midwifery care. I try to imagine this model and wonder if the hospitalist midwife will be expected to act as an OB (often) does on the labor unit: AROM everyone. Actively manage everyone with Pit. At the bedside for all of 10 minutes to catch a baby, the placenta and suture any tears - then on to the next patient.

What would be an ideal hospitalist midwife position? How could a midwife negotiate the role to *not* be the low-cost version of an OB for laboring and lady partsl birth patients? But to actually *be* a midwife? Thoughts?

The way a midwife approaches birth is individual to the midwife. I don't believe she would change her practice based on setting. If her practice is guided by EBP, she'll steer away from intervention when it is not indicated or asked for by the patient.

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Specializes in OB.
The way a midwife approaches birth is individual to the midwife. I don't believe she would change her practice based on setting. If her practice is guided by EBP, she'll steer away from intervention when it is not indicated or asked for by the patient.

Certainly in an ideal world, a midwife would not change his/her practice based on setting. BUT queenanneslace brings up a very salient point that an institution could start hiring midwives as laborists for financial reasons, and then could possibly place a lot of pressure on the midwife to conform to that institution's way of practicing. Which might possibly be non-evidence based, or basically, not the midwifery model of care. A lot of negotiating/gentle pushes for change might be necessary by the midwife, and that is very difficult. I have learned since becoming a midwife how often midwives have to be subtle and politic in order to "play the game" to effect change.

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Certainly in an ideal world, a midwife would not change his/her practice based on setting. BUT queenanneslace brings up a very salient point that an institution could start hiring midwives as laborists for financial reasons, and then could possibly place a lot of pressure on the midwife to conform to that institution's way of practicing. Which might possibly be non-evidence based, or basically, not the midwifery model of care. A lot of negotiating/gentle pushes for change might be necessary by the midwife, and that is very difficult. I have learned since becoming a midwife how often midwives have to be subtle and politic in order to "play the game" to effect change.

That is likely my biggest fear of actually becoming a midwife in a hospital setting, treading that fine line between conforming enough to policies to preserve my job yet helping to effect change. Having experienced and worked at places that encourages EBP, I fear getting emotionally worn out, especially since I suspect that most of the hospitals in my area aren't all that progressive.

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