Hi! I am a senior BSN student at Saginaw Valley State University. I entered nursing because I was really interested in women's issues, especially pregnancy. I love the concept of midwifery and empowering women during pregnancy and birth. However, I find myself so frustrated with the medical system of OB. I am working as a nurse extern in OB right now and I hate it! I feel like the beauty of pregnancy and birth is overshadowed by the schedules, the meds, the aggressiveness of the doctors who are so quick to slice open women to fit their schedules. It's a rare moment when I actually see through the depressing medical shroud and actually see childbirth for what it is.
So my question to you is-what are the options for a BSN to work with mothers through the midwife model of care? I live in Michigan and there is only one free standing birth center here. I have seen a lot of CNM's who act just like medical doctors, and that is also depressing! I know that I hate hospitals, and don't want to work as a hospital nurse. So does anyone have any advice? I am seriously considering dropping out of nursing because I hate the healthcare system and I don't know how I could get involved, as a nurse, in working with women in pregnancy outside of a hospital setting. Those of you who know how I feel, PLEASE give me any advice, resources, websites, someone to just talk to to share my concerns...I am so depressed about my future because I hate the hospital so much and what it does to women...
I am currently working on getting into a BSN program and my plan is to become a CNM eventually. I have a question based upon my own birthing experience. I am strep B positive (I think that's what it is called) and my OB gave me an IV for this. Do CNMs follow that as well? I always wanted a birth free of IVs, etc, and although that has yet to happen, I still dream that I will one day deliver naturally. Is this an issue that will always make my dream impossible? Or is this just an example of defensive medicine?
BTW- I'm not looking for medical advice on my situation, so please don't misread my post this way. I'm actually just using my own experience as an example of a question I have regarding the basic philosophy of CNMs vs. OBs. I hope I'm making sense.
I offer testing for GBS. Most women accept testing. I do believe that all women have the right to decline testing if they desire. I follow the CDC guidelines for GBS pretty religiously. There are a lot of providers (especially OBs) out there that do not, which irritates me, because usually they are overtreating and contributing to overuse of antibiotics. If someone declines GBS testing, I treat her as "unknown" per the CDC guidelines, which basically means no antibiotics unless there are risk factors (fever, prolonged ROM, or prematurity). If someone tests positive, I do give antibiotics in labor. That means being hooked up to the IV every 4 hours or so (depends on abx given), the rest of the time, she can have a heplock only. IV antibiotics for GBS is not a reason to have a continously running IV.
There are midwives who will do a homebirth with a GBS positive woman. Some midwives have the ability to do intermittent IV antibiotics at home - it depends on the laws in each state and what type of midwife it is if that is possible or not. Many homebirthing women, I would bet, don't bother testing in the first place.
And, FYI, the CDC guidelines also state that being GBS positive in one pregnancy does not mean a woman should be treated as automatically positive in the next pregnancy. I have seen women test positive in one pregnancy and negative in the next.
beckinben, CNM
189 Posts
I offer testing for GBS. Most women accept testing. I do believe that all women have the right to decline testing if they desire. I follow the CDC guidelines for GBS pretty religiously. There are a lot of providers (especially OBs) out there that do not, which irritates me, because usually they are overtreating and contributing to overuse of antibiotics. If someone declines GBS testing, I treat her as "unknown" per the CDC guidelines, which basically means no antibiotics unless there are risk factors (fever, prolonged ROM, or prematurity). If someone tests positive, I do give antibiotics in labor. That means being hooked up to the IV every 4 hours or so (depends on abx given), the rest of the time, she can have a heplock only. IV antibiotics for GBS is not a reason to have a continously running IV.
There are midwives who will do a homebirth with a GBS positive woman. Some midwives have the ability to do intermittent IV antibiotics at home - it depends on the laws in each state and what type of midwife it is if that is possible or not. Many homebirthing women, I would bet, don't bother testing in the first place.
And, FYI, the CDC guidelines also state that being GBS positive in one pregnancy does not mean a woman should be treated as automatically positive in the next pregnancy. I have seen women test positive in one pregnancy and negative in the next.