epiphany

http://www.cms.hhs.gov/nationalProvIdentstand/

Yes. And I would chose a male midwife over a female OB any day. I don't endear myself to female OB's after what I have seen.

Zahryia - Pecola is right - you'll be fine. Most of my classmates did not have L&D experience, and are getting jobs they want. I did have a friend who went through a second interview, and then was turned down, she was told "because of her lack of L&D experience." That's a little fishy to me - that information was in her resume before they put her through all the interviews, so I suspect it's an excuse. In any case, that particular place turned out to be a place she wouldn't have wanted to work at anyway - the CNM's had no autonomy and the residents had all the say. In the end, she got a job she loved. Most people hired from the integration. In fact everyone received an offer from the place we were at clinicals, me included. Something to keep in mind when you choose your sites.

Most of the hospitals that I applied to work in shifts, as is the one I'm working at now. There 2 private OB's I applied to that had calls.

There's research to support that less is more. Whenever I can, I only suture minimally, just to create an internal "bandage" to allow the healing to take place naturally. I have seen enough skin tags and puckering to believe the research and not to over do it. So yes, it is possible to oversew, and as one poster said - don't let them tell you it's in your head. Be prepared to get a second opinion if you have to. Do you know what degree laceration it was?

Just right off the bat, I don't think I would like on-calls. I would really have to learn to how relax during the day knowing someone could give birth anytime. Give me 40 solid hours of work, where the rest of my free time belongs to me. Of course if it were my own business and/or partnership, I think I would feel more protective of my clients and be willing to be at the beck and call of their labor.

What's your birth census like?

yes (just found out I need at least 5 words to post or it's "too short")

Any CNM's care to comment? I was hoping to hear from both CNM's and L&D nurses, but maybe it's not realistic in this forum.

The relationship between an L&D nurse and a CNM in the hospital setting is never properly and openly discussed, so what I do? Start a topic on it. :nuke: I invite anyone to start it first.

I should also mention that if you worked for a federally qualified site, you will get loan repayment. As far as I know it's 25K a year. Check the facts for yourselves, I didn't actually apply but my friends did. You should also peruse their site: http://nhscjobs.hrsa.gov/

I think the job market is tougher in general these days. Unfortunately I don't work in that area, so I don't know it specifically. I do know that there are job openings, according to the midwifejobs.com listing and there some new grads were hired in that area recently. You should peruse that site, too. When do you plan to have graduated? Things change with time, what's happening now may not be the case when you are ready for job. I expect that need for increased primary health care if the new healthcare plan gets passed, will open ways for a lot of NP's and midwives.

I've said my views on this many times and ways, but the important argument is, you learn bad habits. A woman has so much more capacity than is allowed or seen in L&D, and it's hard for any human being, even a midwife, to believe in possibilities when it is consistently re-enforced upon them that the opposite is true. And there is really nothing you need to know about L&D nursing that you cannot learn on the job as a midwife, if you end up working in a hospital, which many of us do. Nobody ever suggests that doctors learn to be L&D nurses first, and they have to work just as closely with them, if not even more - ie, PIH pts, c-sections, pitocin management (which midwives may deal with on some levels, but much less). Midwifery isnt a step-up from L&D nursing anymore than an OB is.

If you take the high end of the spectrum of nursing salary (experienced nurses, overtime, high paying institution) and compare it with the low end of the spectrum of CNM's (new grads, lowpaying place, no overtime) yes, it could overlap. It's a like a magic trick - look we can make those two ends meet, can you believe it. People find that sort of thing fascinating. What I am saying is that the site that I gave, is a true representation of what I am seeing. Most CNM's with a couple of years of experience are making close to 90K, and you can't say that about nursing salaries. Everybody makes more money with overtime - many CNM's do per diems. I will say that job satisfaction is no comparison (and we are undervalued and underpaid) but still, if you are just talking money, there is incentive to be a midwife besides loving the job. Yes, it is in my interest to encourage midwifery for anyone with doubts about money, and that's why I posted this, but only because it's the best job in the world, and if you have the heart, we need you. :)

sorry, i wasn't too clear on that. so, to breakdown - for 2 days, I have regular clinic hours, 8 hours a day. Clinic hours are mostly weekdays. You would see pregnant women, as well as GYN care. In the 12 hour shifts are L&D shifts, 7am to 7 pm. You clock in, and are on the floor managing labor, including triaging and postpartum rounds. It would work like a nursing shift. In many places that offer that 40 hour/wk, you never have to do calls. Btw, I don't really like calls because it's like having this 24 hour period waiting for the other shoe to drop. You have to learn how to relax, go about your day or night until you get paged, sleep when you can. Some people can get used it but it would be hard for me.

What school did not prepare me for was how much salary I should expect to get, and how to negotiate it, so I'm here to share my experience with you because salary seems to be a bit of a elusive topic. Nobody wants to talk about how much they make, so it's hard to pin it down. I have had people offering me and my classmates a range of salaries from over 75K to over 100,000K (over many areas and states). One outlier, a private OB hiring a CNM for the first time, offered me 65K. He had googled it and was sincerely surprised that when I told him it was far too low. After doing some googling myself, I realized that there sites out there that really underrates our pays. Google "salary cnm" and you are usually led to payscale.com, which uses a special scientific method (sarcasm intended) to rate it unrealistically low. Go to midwifejobs.com, the official ACNM site, and it's on the FAQ, but they won't commit to giving a range ("widely varies"). So far, I found this site to be most realistic representation of what I am personally seeing. http://swz.salary.com/salarywizard/layouthtmls/swzl_compresult_national_HC07000229.html. As far as benefits and hours go, private companies seem to be able to give less, but make you work more. In one private practice, I was to work 5 days a week 8 hours a day, but on 2 of those days, I am also on call 24 hours. In addition, I had to be on call every third weekend. I was quite shocked at how they expect me to physically function that way - that is, if you are up 24 hours, how do go in for another 8 hours of seeing patients? Then I realized that mostly, the providers sleep in the call rooms until it's time to catch a baby. In some big hospitals and birth centers, the standard that I have seen are 40 hours - 2x8hours clinics, and 2x12hours. I like that because besides working under more humane conditions, I am able to provide labor support and spend more time with my laboring women when I'm on. Many hospital do have calls. Bigger places come with bigger benefits, usually, not not necessarily - average 4 wks vacation, 1 wk paid CME, personal days, better healthcare, and liability insurance. I know nothing about women who start their own practices, but that's probably a whole different experience. So.... I hope that gives some of you a better idea. If anybody can share their experiences, I would love to hear.

Many more people passed at 75 than fail, if that's any consolation. I can't tell you not to feel so much anguish but, but maybe distract yourself for the next few days?

Becareful not to let your caring be a codependency. You're not going to happy if you don't recognize it and deal with it, especially in a profession of caring. Here's a link to signs for codependency. It happens to a lot of people obviously, or the term wouldn't be coined, so you're not the only one. http://www.codependents.org/tools4recovery/patterns.php

It is violation of your rights when you are alive. Does a dead person have the rights of Hipaa? How can a dead person sue for his rights to privacy? Who is going to be the plaintiff in the suit? Again, I repeat I don't approve of her going public with this - it's disrespectful, but legality is a separate matter.

I do think it's immoral and disrespectful to talk about a person who is dead, especially for the purpose of being on TV - I won't be surprised if she was paid. Having said that, that's not what Hipaa law is intended to protect. We need to be more educated on the intention of the Hipaa law, as well as it the ramifications of breaking it. Besides which, it is protection against a civil crime, ie, the person who has been hurt would be the person to sue you. That would preclude a dead person. Not singling you out, as I would agree that it's really unprofessional and gives us such bad name for her to be mouthing off. Just saying we have to know what we are talking about or we'll loose our authority.

as far as I know thats not in the works right now.

And yes, that's the scope of practice of CNM's.

have you looked at Plannedparenthood? CNM's do abortions there.

Well said. Plus, research also says that use of bulb syringes do not change outcome.

I agree. That was one of the frustration of taking exams in nursing school - as one of my faculty said, it takes 2 years or more for the textbook to catch up with the real worlk. I would ask the faculty what the expected answer would be, and know for yourself what latest guidelines are.