Nurse Midwife vs Labor and Delivery RN. Can't Decide

Tacomaboy3 · Sep 22, 2017

There's definitely been a combative tone to your posts.

Really? Combative?

I simply dislike the spread of misinformation.

Here.I.Stand, BSN, RN · Sep 26, 2017

I wouldn't pursue nursing if L&D is your only acceptable practice setting. Everyone and their sister wants to get into L&D... there are scads of new grads who can't even find a hospital position, let alone an L&D position.

For what it's worth, as some of the others have said, I would never EVER trust someone with zero experience. (And unless you get an RN job and work as an RN during the MSN portion, you WILL graduate with zero experience. To argue otherwise is to argue that ALL nursing school grads are experienced, by virtue of having done clinicals. Clinicals are not nursing experience.) My life and my babies' lives are not worth it.

A CNM who was an L&D nurse has experienced OB emergencies, have learned cultural nuances of her client population (Nursing school/textbook content about culturally competent care is embarrassingly simplistic.), have managed a variety of normal and high risk deliveries (let's face it -- womens' uteri have not read the textbook!, have become tuned to the small changes that indicate an impending emergency.........

A new grad has not.

Are you familiar with Benner's novice to expert theory? With no experience one is a novice, and cannot be considered expert , i.e. the A in APRN

secondtimer14 · Oct 1, 2017

I'm in same shoes as OP (currently taking prereqs, career changer, deciding between ABSN and direct-entry CNM programs).

To back OP, the schools with direct-entry CNM programs are among the most prestigious nursing schools in the country for midwifery (Yale, Vanderbilt, UCSF, Penn, etc). These programs are 3-4 years in length; the first year is the traditional ABSN curriculum, the remaining years are the masters in midwifery, with thousands of clinical hours built in.

I 100% get that it's super helpful and relevant to have L&D experience before coming a midwife. That said, you wouldn't expect a future OBGYN to spend years doing L&D work before going to medical school, or call them "unqualified and dangerous" when they graduated from an accredited medical school. The point of school is to teach and train you for the job.

If I were young I'd be very open to the L&D nurse-first route because why not spend a few years getting that extra experience; but I also trust that Yale etc wouldn't have direct entry CNM programs if it doesn't fully prepare you to be a highly skilled practicioner. And as I'm in my 30s with two kids, I don't necessarily want to draw out the nursing part of the degree for years when I know with certainty that I want to be a midwife.

Tprofitt, BSN · Oct 1, 2017

I'm in same shoes as OP (currently taking prereqs, career changer, deciding between ABSN and direct-entry CNM programs).
To back OP, the schools with direct-entry CNM programs are among the most prestigious nursing schools in the country for midwifery (Yale, Vanderbilt, UCSF, Penn, etc). These programs are 3-4 years in length; the first year is the traditional ABSN curriculum, the remaining years are the masters in midwifery, with thousands of clinical hours built in.
I 100% get that it's super helpful and relevant to have L&D experience before coming a midwife. That said, you wouldn't expect a future OBGYN to spend years doing L&D work before going to medical school, or call them "unqualified and dangerous" when they graduated from an accredited medical school. The point of school is to teach and train you for the job.
If I were young I'd be very open to the L&D nurse-first route because why not spend a few years getting that extra experience; but I also trust that Yale etc wouldn't have direct entry CNM programs if it doesn't fully prepare you to be a highly skilled practicioner. And as I'm in my 30s with two kids, I don't necessarily want to draw out the nursing part of the degree for years when I know with certainty that I want to be a midwife.

The OBGYN's go through years of residency before they are practicing on their own. I understand time may be of the essence but who is going to hire a Nurse Midwife, with no experience as a Nurse at all? Its a gamble and an expensive one.

Here.I.Stand, BSN, RN · Oct 1, 2017

I'm in same shoes as OP (currently taking prereqs, career changer, deciding between ABSN and direct-entry CNM programs).
To back OP, the schools with direct-entry CNM programs are among the most prestigious nursing schools in the country for midwifery (Yale, Vanderbilt, UCSF, Penn, etc). These programs are 3-4 years in length; the first year is the traditional ABSN curriculum, the remaining years are the masters in midwifery, with thousands of clinical hours built in.
I 100% get that it's super helpful and relevant to have L&D experience before coming a midwife. That said, you wouldn't expect a future OBGYN to spend years doing L&D work before going to medical school, or call them "unqualified and dangerous" when they graduated from an accredited medical school. The point of school is to teach and train you for the job.
If I were young I'd be very open to the L&D nurse-first route because why not spend a few years getting that extra experience; but I also trust that Yale etc wouldn't have direct entry CNM programs if it doesn't fully prepare you to be a highly skilled practicioner. And as I'm in my 30s with two kids, I don't necessarily want to draw out the nursing part of the degree for years when I know with certainty that I want to be a midwife.

Again, the ABSN program does not equate with nursing experience. As an ADN nursing student, we got exactly two shifts in OB -- that included postpartum and well-baby nursery. Half of us didn't even see a delivery. (In my BSN completion program, we didn't even learn about maternity.)

Prestigious nursing schools are great; I wholeheartedly agree that education should be rigorous. BUT -- and you would have no way of knowing this as a pre-nursing student -- classroom/book knowledge is only a start. It goes hand-in-hand with experience -- it is nowhere near a substitute for experience.

Yet again, the reason that new grads are not considered experience is that that they ARE. School clinicals are NOT experience.

The comparison to OB-GYNs is not applicable. Direct entry CNMs are spending what, 2-3 years learning midwifery. That time is further divided between classroom and practicum.

An OB-GYN physican has completed his/her 4 yrs of med school, and THEN spends another 4 yrs in residency during which s/he works with staff/attending physicians. I've worked in two teaching hospitals, and the residents do call the more senior physician when they need their expertise. As a CNM, you're it.

secondtimer14 · Oct 1, 2017

How are clinicals during an MSN NOT experience? L&D nurses aren't performing the same role as midwives. Yes, you'll get strong experience checking for dilation, observing the process, etc, but there's a lot of things that only midwives are allowed to handle.

Yes, OBs go through residency, but OBs are also surgeons. They're learning to perform c-section, hysterectomies, etc. They also handle high risk patients, patients which midwives are not allowed to supervise. I guarantee that first year OB residents are handling lots of solo low risk births. Not to mention, med students have gone through a 12 week Ob rotation and taken a class or two during the four years of medical school. MSN students are spending 100% of their focus on the midwifery speciality after the first year of BSN coursework.

Tprofitt, BSN · Oct 3, 2017

secondtimer, I understand what you're trying to say; however, schooling and actual day-to-day experience do not equate. When you start your BSN you will go through fundamentals where they are going to explain the various levels on competency. They are called the Benner's stages and they start from novice and move upto to expert. As an MSN student that focuses 100% of their time in midwifery, yes you will be learning, but you aren't practicing independently. As a matter of fact, it isn't even practicing at all because you don;'t have a license or even a permit to practice. Which puts students in the category or novice because all they are doing is watching.

Here.I.Stand, BSN, RN · Oct 3, 2017

How are clinicals during an MSN NOT experience?[/Quote]
Because it isn't -- it is learning.
Every single pre-licensure nursing student goes to facilities to practice assessments, nursing procedures like starting IVs, med administration etc. When they graduate, they are inexperienced -- not inexperienced as in six months as a floor nurse; inexperienced as in zero.
It's the same with non-midwifery entry level MSN students; unless they worked as an RN while in the MSN portion, when they graduate they are still inexperienced novice nurses. If a staff nurse position requires any minimum of experience, this new grad MSN does not qualify for this position.
L&D nurses know SO much more than how to check for dilatation and observe the process. That that was your reasoning for the argument that experience isn't necessary, that clearly shows that you don't know what you don't know.
Consider this for a moment: on this thread are different opinions. Say the experienced, professional nurses here are correct and the pre-nursing students are wrong. Don't you want to do the absolute best you can for your future patients and their babies, and do everything in your power to be that provider for them? Even if you were correct, wouldn't it be better to err on the side of caution? L&D experience would not detract from your ability as a CNM, but it may just save lives... so why WOULDN'T you get experience first?
If your mind is made up though, make sure you get good malpractice insurance. Obstetrics is a very litigated specialty.
(Side note: my opinion has nothing to do with the "I paid my dues, so you have to pay yours" mentality. I am an ICU nurse; I never have, never will work in L&D. My only dog in this fight is patient safety.)

secondtimer14 · Oct 3, 2017

I don't necessarily have a dog in this fight; I am still open to both paths. What is "enough" L&D experience, in your opinion, to avoid be a danger as a new MSN? One year? 2? 3?

I just refuse to believe that Yale, Penn, UCSF, and various other top nursing schools would send dangerous and unqualified people into the profession and inflict them on real patients. It's not just one or two oddball schools that have this direct-entry track; most of the top schools for midwifery have this degree option. Clearly they feel they can adequately train a midwife in 4 years of intense schooling. I'm sorry but I trust their judgment over internet strangers with nursing experience. And my money is where my mouth is - a recent graduate of Yale's program delivered my second child. Not to mention, these programs are not new. If midwives were graduating from these programs and having poor patient outcomes (like the malpractice cases you mention), they'd shut the program down.

Of course experience is better than non-experience, but all midwives have to start off as unexperienced. It's unavoidable. I know nurses do more than check for dilation, but at the end of the day a L&D nurse and a midwife are two different roles with different responsibilities. An L&D nurse does not have midwifery experience; L&D nurses are not delivering babies; they're not stitching up a torn labia post-birth; they're not rounding in the office and making the decisions that come up in the first 8.5 months of a pregnancy. L&D nursing experience is relevant, but a L&D nurse who becomes a midwife is still going to be an inexperienced midwife walking out of the MSN program. A former nurse will have a leg up that first year or two, but I doubt you see much difference (if any) after that.

Tprofitt, BSN · Oct 5, 2017

I say go for it!!! If it is successful then you can get right into a midwifery position and bypass L&D. You also have a point about listening to strangers on the internet with experience. Worst case scenario, you will have to just take an L&D job and gain your experience. Best case, you will be right where you want to be upon graduation and passing of the boards. I wish you the best of luck with your endeavor.

Irish_Mist, BSN, RN · Oct 9, 2017

I don't necessarily have a dog in this fight; I am still open to both paths. What is "enough" L&D experience, in your opinion, to avoid be a danger as a new MSN? One year? 2? 3?
I just refuse to believe that Yale, Penn, UCSF, and various other top nursing schools would send dangerous and unqualified people into the profession and inflict them on real patients. It's not just one or two oddball schools that have this direct-entry track; most of the top schools for midwifery have this degree option. Clearly they feel they can adequately train a midwife in 4 years of intense schooling. I'm sorry but I trust their judgment over internet strangers with nursing experience. And my money is where my mouth is - a recent graduate of Yale's program delivered my second child. Not to mention, these programs are not new. If midwives were graduating from these programs and having poor patient outcomes (like the malpractice cases you mention), they'd shut the program down.
Of course experience is better than non-experience, but all midwives have to start off as unexperienced. It's unavoidable. I know nurses do more than check for dilation, but at the end of the day a L&D nurse and a midwife are two different roles with different responsibilities. An L&D nurse does not have midwifery experience; L&D nurses are not delivering babies; they're not stitching up a torn labia post-birth; they're not rounding in the office and making the decisions that come up in the first 8.5 months of a pregnancy. L&D nursing experience is relevant, but a L&D nurse who becomes a midwife is still going to be an inexperienced midwife walking out of the MSN program. A former nurse will have a leg up that first year or two, but I doubt you see much difference (if any) after that.

I don't know if I find your thinking you know it all as a pre-nursing student funny or scary. I'm leaning toward the latter. You don't know what you don't know.

secondtimer14 · Oct 9, 2017

I by no means think I know it all. Please, tell me what part of what I wrote is misinformed?