English Midwife

  1. Hi, I'm a midwife in the UK in the process of relocating to the US as my husband is American. I am also an RN and have a job lined up in ICU in San Fransisco.
    For those of you that dont know, a midwife here in the UK is an independent practitioner who cares for women with normal pregnancies in the antenatal, intrapartum and postnatal periods. Women with uncomplicated pregnancies are usually midwifery led, they do not see a doctor throughout their pregnancy and are cared for solely by midwives, who also deliver thier babies. In fact between 75-80% of all births in the UK are attended and delivered by midwives either in hospital or at home. The emphasis being very much on demedicalising the process of birth.
    Women and their babies are cared for by midwives from conception until 28 days after the birth. I love being a midwife here, I enjoy the autonomy and rewards that come with the job.
    I know the system over there is very different but would like to know what exactly is the role of a midwife or ob-gyn nurse. I have considered working in that role in the US, but get the impression I would be doing a very different job. Please enlighten me!!
  2. Visit Tanvi Tusti profile page

    About Tanvi Tusti

    Joined: Sep '06; Posts: 177; Likes: 4
    Nurse Practitioner
    Specialty: 20 year(s) of experience in ICU, midwifery, Nurse Practitioner

    12 Comments

  3. by   traumaRUs
    Hi and welcome. In the US, certified nurse midwives are advanced practice RN's - meaning they have at least a master's degree in nursing and several years of experience.

    The exact job duties are determined by the state in which you practice. I am an advanced practice nurse but in adult health so I'm sure there will be some CNM's come along who can describe their typical days.

    Just wanted to welcome you.
  4. by   JentheRN05
  5. by   Kelky
    Hi! I'm an English midwife working as an RN in L&D in GA. It's very different. I can give you details later, right now I'm rushing out to work.
  6. by   Tanvi Tusti
    Hi all, thanks for your replies. There are 2 routes to becoming a midwife in the UK. First, be an RN, get a few years experience, then do an 18 month-2 year specialist degree in midwifery, or direct entry, which is a degree 3-4 years in length, no prior experience needed.
    Id love to use my skills in a positve way in the US but do midwives do deliveries over there, do they have professional autonomy? Thanks in advance.:spin:
    xx
  7. by   rbytsdy
    Midwives here can operate under very different circumstances. Some work in an ob practice and are essentially "another pair of hands to catch babies." Typically, with ob practices, you are delivered by whomever is on call. My SIL had 3 obs and 1 midwife in her practice. She just happened to get the midwife.... on the day she went in for her induction. Obviously, they are no all holistically oriented! Others work with ob practices but maintain their own patients. I used a group of 3 midwives that practiced along with a large ob group. I decided to use the midwives b/c I was looking for a natural and more personal birth experience. Unfortunately, the midwife that was on call was very intervention happy and I ended up with a c-section. There is a midwife in that group whom I just love. She did her midwifery in England and has a much more natural approach to birth which is what I was looking for. She is an RN midwife - I don't think she has an MSN although most American midwives do. Unfortunately, I can't guarantee she'll be there for my next birth so I plan to switch to a practice of 2 independant midwives who do either home or hospital births. I'd love to do a home birth but it's illegal for a midwife to attend an hbac in my state (NJ).

    Laws vary widely by state. You can find state laws here: http://www.mana.org/ For instance, in NJ, some nurse midwives do just homebirths, some do just hospital births and some do both. Direct entry midwives are not allowed to attend births in hosipitals so they can only do homebirths or birthing center births. In Texas, midwives (nurse or direct entry) are prohibited from doing hospital births. In hospitals, midwives are somewhat restricted due to hospital protocol but some hospitals are more natural birth/ midwife friendly that others. In some states, midwives must have a doctor back up should something go wrong with their patients.

    If you are interested in demedicalized birth, there are definitely opportunities. I don't know about licensing, etc so I don't have advice there (I'm still in school) but some women search high and low for midwives that won't bombard them with testing and interventions.
  8. by   Tanvi Tusti
    Quote from rbytsdy
    Midwives here can operate under very different circumstances. Some work in an ob practice and are essentially "another pair of hands to catch babies." Typically, with ob practices, you are delivered by whomever is on call. My SIL had 3 obs and 1 midwife in her practice. She just happened to get the midwife.... on the day she went in for her induction. Obviously, they are no all holistically oriented! Others work with ob practices but maintain their own patients. I used a group of 3 midwives that practiced along with a large ob group. I decided to use the midwives b/c I was looking for a natural and more personal birth experience. Unfortunately, the midwife that was on call was very intervention happy and I ended up with a c-section. There is a midwife in that group whom I just love. She did her midwifery in England and has a much more natural approach to birth which is what I was looking for. She is an RN midwife - I don't think she has an MSN although most American midwives do. Unfortunately, I can't guarantee she'll be there for my next birth so I plan to switch to a practice of 2 independant midwives who do either home or hospital births. I'd love to do a home birth but it's illegal for a midwife to attend an hbac in my state (NJ).

    Laws vary widely by state. You can find state laws here: http://www.mana.org/ For instance, in NJ, some nurse midwives do just homebirths, some do just hospital births and some do both. Direct entry midwives are not allowed to attend births in hosipitals so they can only do homebirths or birthing center births. In Texas, midwives (nurse or direct entry) are prohibited from doing hospital births. In hospitals, midwives are somewhat restricted due to hospital protocol but some hospitals are more natural birth/ midwife friendly that others. In some states, midwives must have a doctor back up should something go wrong with their patients.

    If you are interested in demedicalized birth, there are definitely opportunities. I don't know about licensing, etc so I don't have advice there (I'm still in school) but some women search high and low for midwives that won't bombard them with testing and interventions.
    Thanks so much for all that info. I'll read through the link you gave me and have another think about things. I would love to go back to midwifery at some stage so I need all the help I can get. Thanks again and I hope you somehow get your home birth!
  9. by   CEG
    The American College of Nurse-Midwives (www.acnm.org) has a section for foriegn midwives who want to practice in the US. I think the minimum requirement for licensure is a Master's degree, except for those who were practicing prior to that requirement. I'm not positive though. Good luck to you!
  10. by   rbytsdy
    Quote from Tanvi Tusti
    Thanks so much for all that info. I'll read through the link you gave me and have another think about things. I would love to go back to midwifery at some stage so I need all the help I can get. Thanks again and I hope you somehow get your home birth!
    Did I mention that some midwives are "traveling midwives?" That's how some women get to have their homebirths.

    When you get here, you might want to check out groups that are very "natural" minded like La Leche League, Holistic Moms Network and the International Cesarean Awareness Network. Once you get licensed as a midwife here, that will be a great way to hook up with women who are interested in your approach to birth. Believe me, we need more midwives like you in the US. San Francisco is know for its "hippy/ natural/alternative" ways so I have no doubt you'll do well there. Are you sure you don't want to move to the East Coast????
  11. by   Tanvi Tusti
    Quote from rbytsdy
    Did I mention that some midwives are "traveling midwives?" That's how some women get to have their homebirths. San Francisco is know for its "hippy/ natural/alternative" ways so I have no doubt you'll do well there. Are you sure you don't want to move to the East Coast????
    Thr traveling midwife sounds like a great idea, I guess it means that she goes wherever there is demand, is that right? My husband is from Seattle so thats where we will probably end up eventually although who knows lol.
    I'm very much in favour of the non medicalised approach to birthing and like nothing better than delivering a home or water birth. Just love it and to see the joy on the parents faces after a birth that THEY planned is out of this world.
    Thanks for your support. :icon_hug:
  12. by   Kelky
    OK as an English midwife working as an OB RN here's my input. I came from a unit in the UK where we did 'team' midwifery, so I often (not always) met the women before they went into labour. We rotated in and out of the hospital to homes and antenatal clinics as needed as well as staffing the hospital.

    Here the RN's in the hospital have done some sort of post reg certification or training in OB, they are not midwives but do deliver babies in emergency situations. My role is to provide nursing care to the laboring woman and call the doc in as she gets close to delivery, then basically be his handmaiden, and then provide post partum care, do notes etc until the mom is transferred to the PP floor. In the unit I work women have to be continuously monitored, all have IVI's, it is very 'medical' and I do less labor support and more monitor watching and trying to keep up with the endless documentation and charting. Women always deliver in lithotomy and the docs even though they've seen these women throughout their pregnancies are very detached. I have to admit I find it stressful and demoralising and am moving to PP.

    I did have my second baby over here with a group of midwives attached to a large OBGYN practice, and my experience was that they were autonomous and I never saw a Dr in my pregnancy, they only took on low risk women though. I had to have a hospital birth, I was told home birth is illegal in GA and I wasn't bothered enough to look into it. In the hospital I was looked after by OB Rn's and my midwife was hovering around (the docs in my experience don't do that andI don't know if the MW's always do but it was late evening). I was free to move around and monitored intermittently, and did not have to have an IVI. I was allowed to drink fruit juices etc in labor too. I delivered in a standing squat at my midwife's suggestion. I was visited then on M/B by the midwife and discharged by her the next morning, but there is no home visiting like we do, in fact I don't think I saw her again till my 6 wk check.
  13. by   Tanvi Tusti
    Thanks kelky, for you reply, it sure does sound different although having done a bit of reading, I think there are some opportunites to practice midwifery in a less medicalised environment. It's sure given me a lot to think about. :icon_roll
  14. by   rbytsdy
    Quote from Tanvi Tusti
    Thr traveling midwife sounds like a great idea, I guess it means that she goes wherever there is demand, is that right?
    Yep! That's pretty much how it works. Here is a list of midwives that travel (just to give you an idea that we do have such midwives in the US!): http://birthwithlove.com/Search/Midw...ll_Travel.aspx

    I'm not sure what the process for licensing, etc is in Oregon but you could likely have your own midwifery service doing homebirths. In most states, you can get hospital privileges as a CNM (but not a direct entry midwife). Again - I'm still in school so I'm not even that familiar with regular RN licensing but we have many foreign nurses in this country). I know that the home birth CNMs in my state usually limit their travel to 1 hour from the hospital they can deliver at (I'm sure they are well aware of the nearest hospital in case of an emergency though). Direct entry midwives in my state only do homebirths but will accompany women to the hospital (should a transfer be necessary) and function as a doula. Some hospitals are known to be midwife friendly and some won't allow midwives (it really just depends on the hospital).

    Mothering.com has a number of midwives that hang out there (the website seems to be down today but hopefully they will fix it soon). They have boards like this with a midwife forum. I know they have a midwife forum here but I don't know how active it is. Mothering magazine is the crunchy natural family living magazine in the US.

    As I'm sure you've gathered, being an OB RN is very different from being a midwife who wants to support natural, not medical births. There are certainly opportunities for both here; it really just depends on which direction you want to pursue.

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