BAtoCNM

Apropos of drug companies, check this out: http://www.nytimes.com/2007/05/10/health/10psyche.html?pagewanted=1

AK, You might want to read Born in the USA by Marsden Wagner. He offers a lot of evidence for why birth with a MW (even home birth) is often safer than the highly medicalized alternative for mom and baby.

You might want to check out this website: http://nofreelunch.org/faqs.htm A resident told me about it and I've learned a lot.

The midwives I've spoken to in Boston work a total of 35 hours a week "officially." They are on call 1-2 times per week, which is roughly a 12 hour shift, and spend the rest of their time in the office. 80 hrs/wk doesn't make sense to me-who could be effective with that kind of schedule? Are you sure that these midwives are actually working all those hours?

Likewise, I"m happy to help.

Yes, I've heard this from several woman that, when they choose the CNM route or a low-tech birth in general, people accuse them of everything from being a naive hippy to being a child abuser. Some women who want to give birth at home or with no epidural pain relief are chided for being silly or denied choice once they're in labor and can't really argue.

epi- i'm starting at penn this summer and in the dual concentration as well. i tried to private message you but your box is full. feel free to private message me!

Deann, you might want to take a look at this book: Born in the USA: How a Broken Maternity System Must Be Fixed to Put Women and Children First by Marsden Wagner The information provided is current and backed up by research, plus it's written in a very conversational style.

I'm so sorry you've dealt with judgmental jerks Deanna! I guess those come in every profession. I am a soon-to-be midwifery student, but one reason I chose that route rather than OB was the emphasis in midwifery education on patient advocacy, and giving the patient all the information she needs to make the best choice for her. For some women (I'm sure for me!) that will include an epidural. For others, it may not. The history of OB in this country, which many awesome OBs have been working hard to change, has been to perform interventions for the convenience of the practitioner and/or the hospital rather than for the benefit of the mom/baby. For example, episiotomies were standard operating procedure for decades, and now research shows that they are associated with a slew of negative outcomes for mom and do not improve outcomes for baby unless s/he is truly in distress during delivery. Also, there is peer-reviewed data that one intervention often leads to a cascade of others. I've read that an epidural often predicts a C-section, even when controlling for other factors that could require one. Likewise, constant electronic fetal monitoring is associated with epidurals and C Sections. And C sections do carry the risk of death, disability, infection, and complications in your next pregnancy. It really sucks that one helpful intervention can trigger a whole slew of others, and that's why CNMs are trained to be conservative on that count, at least according to the midwives I interviewed. I've met a few people who think CNMs will only perform "natural" births, or that working with one means you can't get a C Section if you need one. However, most of the time, CNMs are medical professionals working within a hospital system that allows them access to all kinds of pain relief, including epidurals, and the surgical skills of OBs should a section be neccessary. Several midwives I've interviewed in the area (all CNMs - perhaps CPMs are different) said that although they did not have epidurals during their own labors, nearly all of their patients choose to have one. Like any practitioner, a midwife should not judge the choices you make for your own health! I have had this experience with MDs in the past and the result has been I never return to their practice. I guess when you know a lot about health you can get to thinking you know better than the person whose body you're treating, and yours is a cautionary tale for clinicians and other health professionals (ie breast-feeding folks) to remember their place as advocate for, not overlord of, a patient.

Yay Massachusetts! I think in general things are pretty good here, though they may be better in states with less of an MD presence. Sort of related, I was looking for an NP for my mom outside Chicago and found essentially none. So, my questions to piggy-back on Diahni: a) what is the best site for finding an NP, if you are a patient? b) does the number of NPs practicing in a particular area serve as a good marker of how NPs are treated there? I found loads on NPs in the Boston area, but just a handful in Chicagoland. Thoughts?

I can't speak for the field, as I'm not in it yet, but the CNM that I shadowed at an urban safety-net hospital was a midwife, not an L and D nurse. There were 2 L and D RNs assigned to her cases, and the 3 of them worked together, but the CNM was the primary practitioner responsible for her laboring patients. This same set-up applied to the OBs as well, who were assigned 2 L and D RNs but were the primary practitioners responsible for their patients. At least here, it doesn't make sense to hire a CNM with a Master's and pay her upwards of $80K if she's going to do the same job as an RN.

I got a preliminary one in the mail several weeks ago. You might want to check with Financial Aid to see what they hold up is-I've always found them to be quite helpful.

I'm not the first person to ask this but only one person seems to be offering more detail about why Illinois is such a terrbiel place to be an NP. Several people have mentioned it's among the worst, but only one person has offered her 2 cents (thanks, mamanaynay!). Any body else want to comment? IL is also not ranked well on one of the websites that offers a measure of job conditions for NPs.

Right on, Asherah! Iriska, every time I get the "but why don't you just go to med school" speech, I take it as an excellent opportunity to be an advocate for my chosen field. That way, I educate the many people utterly ignorant of what NPs do and the focus of their training-more public health, more preventive med, etc, etc. Also, the training philosophy is different, and I for one DO NOT want to suffer as a lowly med student and then a lowly resident working 60 hours a week for pennies just to "prove" I have what it takes to put MD after my name. Some people are willing to do that, but I'm not, and that's one big reason I chose to go the NP rather than MD route, and I often explain this as well.

I'm going too, CNM route! I've been calling around to landlords in the area (I'll be moving from Boston) and they seem to think apartments open up two months or so in advance.