L & D Experience

HammockBound · May 22, 2015

Working as a doula would be very hard if you are working a regular job. You need to be on call like 2 weeks before and 2 weeks after delivery date. You go to the labor when the family calls. You may go in at anytime. 2am 6pm no one knows. I guess if you can just not go in to work for a few days you would be able to do it. But it is not the same experience you get as a nurse.

queenanneslace, ADN, MSN, APRN, CNM · May 22, 2015

Have you tried searching these the posts here on AN?

Many discussions and good input here:

https://allnurses.com/gsearch.php?cx=partner-pub-9350112648257122%3Avaz70l-mgo9&cof=FORID%3A10&ie=UTF-8&q=L+%26+D+CNM

1) you can become a CNM with no L&D experience - there are a number of programs that will admit students with no L&D experience and some with no nursing experience

2) if you have never worked in L&D, how sure are you that you want to become a CNM?

3) The CNMs that I know who graduated without nursing experience (or minimal working experience as a nurse), ended up relocating to another part of the country to get a job. Is this a possibility for you? It IS harder to get a job without RN L&D experience. It just is.

4) My opinion - take it for what it's worth. The reason CNM programs don't require L&D experience for admission is because they are not hiring you to work as a nurse - they are GETTING MONEY FROM YOU to be enrolled in their program. If you appear likely to excel at classes, homework and do fine in clinicals and pass your boards, you will be admitted. You will be paying tuition for every credit. As a student, you are INCOME to them. Just something to think about.

Do a little reading and searching on AN - lots of helpful information and comments on this very topic.

DreamerMW · May 22, 2015

I can't tell you anything from personal experience, but I know of several programs that don't require L&D experience or even nursing experience. Sure, graduates of those programs might have a steeper learning curve, but it is totally doable.

hopefulfnp · May 22, 2015

Thank you very much! This is very helpful.

Simplyroses · May 22, 2015

Go to the ACNM website and search the job boards. American College of Nurse-Midwives

The majority of the job postings require 2 years of CNM experience but will consider a new grad IF you have significant L&D experience. Getting into school and passing boards is not the same as being employable.

hopefulfnp · May 22, 2015

Thank you, all. I feel like this is the best, most honest advice I've received yet.

Katie71275 · May 26, 2015

From what I have observed most employers want the cnm they hire to have labor and delivery experience. It is very helpful! I just saw a cnm student ask about how to read fetal monitoring strips. That's just one example where the experience would be helpful.

CNMidwife2Be · May 27, 2015

I feel that midwifery is a separate and unique profession from L&D nursing. Naturally all birth experience is valuable and some non-L&D nurses may have a steeper learning curve in some areas. For me, electronic fetal monitoring is an area that I'm largely inexperienced in...But L&D nurses do not have an advantage in all areas. They will have no experience in antepartum care (an essential part of midwifery) and they may have little to no experience supporting physiological birth. I realized my calling to midwifery 5 years ago, became a doula and started taking prereqs for an ABSN. I finished my degree and applied to and was accepted into Frontier. No L&D, no nursing. Before making my decision I spoke with many CNMs and asked if a.) L&D was necessary and b.) any nursing was necessary. A couple (both LONG time L&D nurses) said absolutely, minimum 5 years...but the vast majority of CNMs said no to both. They all said the same thing- any nursing experience is valuable and will support your future practice, but it's a very different role and it's not necessary. In fact, L&D nurses often struggle w switching into the provider role and some may pick up bad (medicalized) habits. Seeing birth as a normal physiological process (and not preemptively pathological) is an important part of the profession. In the UK, most midwives have a 3 year bachelors, and do not train as nurses. There are also 'graduate-entry programs' at many highly ranked schools in the US (Yale, OHSU, SFSU, UPenn) that offer an accelerated BSN followed by a two year masters in nurse-midwifery. Those students also go directly into the profession, without L&D or any nursing. I don't agree that the schools that admit students without L&D are only considering the money. I believe it is an acknowledgement that midwifery is a unique profession. I have not found my lack of L&D to be a detriment in the program.

I agree with a previous poster that it would be challenging or logistically impossible to work and be an on call doula if you're scheduled for nursing shifts. However, I think it's incredibly valuable experience and worth doing if your work is flexible. I'd also recommend immersing yourself in the birth world as much as possible. Buy midwifery biographies and textbooks, attend workshops and conferences (Midwifery Today is fantastic) and do doula and CBE trainings - even if you don't end up working as one the information will be valuable. I am amazed how much I learned over the years just from my own study.

Also, I'd like to add that in terms of finding work as a CNM and L&D experience - it entirely depends on your area. In my area there's a residential program that has a masters entry program so many new grads have no nursing at all. If they're open to hiring new grads they don't care about L&D experience. I have many classmates who got jobs locally without any. That said, I know some areas really do require it. Maybe ask to attend a local ACNM affiliate meeting to get a sense of your area? Hope this helps!

queenanneslace, ADN, MSN, APRN, CNM · May 27, 2015

The bottom line is working in L&D won't hurt you. It will give you valuable experience working with laboring women. It will strengthen your admission to midwifery programs. It is paid learning.

As far as the drawbacks of 'learning bad habits' as an OB nurse, I'd like to know what those things are - specifically. Especially since I'd made that claim myself before becoming an RN.

Not sure what bad habits I'm picking up working as a nurse - but I know I've gained skills at reporting off to physicians, managing complicated patients, establishing rapport and trust with an actively laboring patient, interpreting EFM, titrating oxytocin during induction or augmentation, making accurate cervical assessments, providing labor support, acting as a patient advocate. I know my way around an OR, I manage Mag sulfate patients, pts with epidurals, pts with high epidurals, pt with crappy epidurals, hypotensive patients, hypertensive patients, hemorrhaging patients. Oh, and through all this I haven't forgotten how to be 'with women' and how to support a natural, physiologic labor. I actually haven't forgotten this at all!

The skills I gain as an OB nurse is going to make me a skilled and competent CNM. The CNM (and CM) credential has direct-entry pathways - this is true - but it does not negate the fact that a nurse-midwife, by training and education, is an advance practice nurse. The CNM credential was designed for those individuals who had considerable nursing experience prior to becoming a midwife. I think direct-entry students can do it - but there is A LOT to learn.

I've also developed **huge** respect for nurses, what they do, and what they put up with from providers. I won't ever take a good nurse for granted.

Maybe I feel l need to atone for my past opinions - that nursing wasn't necessary for one to become a midwife. But I now feel like we should not be discouraging the future CNMs from entering OB nursing.

Before I started midwifery school, a midwife friend of mine - a Frontier grad - STRONGLY encouraged me to get into L&D. As much as I cringed and cried and fretted about it (yes, I did all those things). It really IS phenomenal experience. I'm grateful I was pressed into doing this.

biggolp · May 28, 2015

Thank you, queenanneslace, for your honesty.

I've been lurking on these boards for a while now and have actually seen the shift in your perspective.

I seriously considered going the CM route (I have a prior bachelors degree and I live in NY), but after a lot of soul-searching I am now enrolled in a BSN program and going for the CNM credential.

As much as I originally hated the thought of going through nursing school just to get to midwifery, I am now looking forward to learning new things (even if they won't all be directly related to midwifery).

I do not yet know if I will go straight to midwifery (after my BSN) or I will get to work in L&D first, but I feel better about the nursing aspect now even though I am not a nurse at heart; I am a midwife at heart

MidwifeMinded · May 30, 2015

Not a CNM, but on the path myself... and am currently an active doula, so wanted to chime in there.

I actually would say go for the doula training! It shows you a totally different set of skills and a different aspect of birth that even midwives sometimes don't see (unless they do home birth). I love my doula experience and how much it has taught me about not just physiologically normal birth, but what it has taught me about my clients - how to listen to them, how to understand their needs, and how to learn to read birth and understand my client's boundaries. It is so humbling to be able to help them find their process. You have to learn to get out of their way and take your ego out of it.

It is actually NOT impossible to work full time and also be a doula. I know many doulas who do it. What they don't do is work alone. You may need to find another doula to partner with and establish a plan with that doula to make sure your clients are well taken care of. I know a handful of nurses who also work as doulas. Its just a function of finding out how it works for YOU and then making it work for the clients. I have 2 or 3 backups available to me at any given time... so I never worry that my clients will be taken care of.

You're welcome to reach out to me with doula questions!