CEG

An old thread reborn.... but to be fair to the birth plan, the soaps used in hospitals are some of the crappiest stuff out there. Johnson's baby soap for instance is full of chemicals considered unhealthy. Johnson & Johnson Baby Shampoo Has Cancer-Causing Chemicals, Group Says I wouldn't want it on my baby either.

The non compete clause says I can't perform my same specialty for any other private employer within a 45 mile radius for a year following termination of my employment there. I think it is fairly common as I signed one at my last job as well. I guess it's to prevent you from stealing your patients away... I will be moving far away from the area where I live now before I change jobs anyway.

I have a written offer letter but no contract at my job. In my case it's because they don't consider NP's to be on par with the physician staff so it doesn't occur to them. I asked for one and was told no. I did have to sign a noncompete clause, though. Apparently I am not good enough for a secure contract but possibly good enough that someone else would want to employ me Given my experience I would be leery of taking another job without a contract, because I think it reflects on their overall attitude towards me (i.e. physician "partners", NP "employee" although in reality we are all employed the same way by the same company). So it may be just fine, but I would say buyer beware! My last job had a very specific contract that spelled out leave days, sick days, work days, etc.

Consider doing a lactation educator or doula (depending on the types of facilities), NRP, childbirth educator or other similar type of course. It will give you a good background of knowledge as well as some practical experience. It will also show the manager that you are committed to OB, you have some clue what you are getting into, and you are teach-able. I went to nursing school to be a CNM so I knew I wanted/needed to work L & D. I got doula certification, took NRP, became a lactation educator, and did my preceptorship in L & D. I did get several offers in L & D for new grad positions. Best of luck.

There's really no way for anyone to do this. How would a patient go about finding out if intermittent monitoring is possible or if iv fluids are required? Especially considering that a patient has the right to refuse anything, even if we coerce them into it. If I call the desk and talk to a nurse I will likely get a different answer depending on who I talk to. Often if a patient asks their provider, the provider will give them an answer they want to hear rather than the truth. Many patients are limited in where they can go due to insurance. ACOG and local OB/GYN groups have made it very hard to have birth centers in most places so it is not an option for many people. It's oversimplifying greatly to say people should just do their research and pick a better place. It's simply not possible for most people.

Some states require collaboration and some don't. It seems safer to require this but it really doesn't accomplish a lot other than restrict practice. My state law requires a physician in the state, so they could be 4-5 hours away and still meet the requirement but are surely no help in an emergency. In a non-emergency situation I am not going to refer my patient to them, I am going to send them to someone local. (For the record, I work in an academic medical center, I'm not a homebirth midwife). Even if I have a local doc, if I have a true emergency I am going to get the closest/fastest option, not wait for my doc to show up. A family practice doc is not required to have a collaborating cardiologist or ENT in order to see patients for BP management or sore throats. The scope of practice in OB is the same as for a CNM or family practice doc. The same principles should apply. Ideally, there is a local hospital with 24 hour in house anesthesia and OB. I wouldn't consider a transfer anywhere else in an emergency. Ideally, transfer wouldn't be hostile and midwives would not have to "dump" their patients for fear of prosecution or harassment. An Emergency room is hardly in a position to be upset about receiving an emergency in any case.

As far as where you serve, you would be assigned to a particular unit at a particular location, so you would have to plan on going back each month to that locations for your drill. With regard to deployment, my understanding (I am previous Army going AF Reserve so not 100%) is that you have a sort of "on call" period, I think they called it a "bucket" where you are subject to deployment. From what I was told, most of the people who have deployed from my gaining unit did it voluntarily, but I am sure not all of them. Of course any time you are in the reserves you are subject to deployment-- obviously that is the purpose of having the reserves! But I think they have worked hard to provide some sort of order/predictability. Sign on bonus depends on the job you take in the reserves. Some positions are harder to fill and therefore pay a better bonus that others. It also seems to be in a constant state of change, so you would best ask a recruiter. If you check out the GI Bill website you will see the rules-- I earned mine on active duty so it was a little different and I am not sure how it relates to reserve service. The Army definitely has programs like STRAP that pay for education while you serve, I am sure the air force has equivalent ones. If you haven't already, I would start talking to a recruiter. The process is very long. Good luck!

Emory is your only regular option. Very pricy but seems to be a great program. Otherwise the distance programs- Frontier, Case Western, maybe some others. I don't know if it is still there, but I used the website allnursingschools.com to look for grad programs. Good luck! Not to be a downer, but Georgia is not a great state for midwifery practice. In my opinion, midwives here tend to be utilized as physician extenders. Mostly they are hired by physician practices to increase patient volumes and do the low risk deliveries. There are very few (but they are out there!) providing midwifery care or midwife only practices. It is mostly ob-model care with a midwife touch-- myself included unfortunately.

There are plenty of reasons not to bathe- temperature regulation (leading to blood sugar problems, etc), bonding, breastfeeding, leaving vernix on the skin, and more. Reason to bathe-- so the staff does not have to glove and gown. Seriously-- I very often touch, hug, etc my patients and I have no way of knowing what they have on their skin and hands. How about mom that just held her unwashed baby. You bathe the baby but mom still has the "contaminants" on her but I have never seen anyone glove up to take mom's pulse or bp. "Just" having baby under the warmer has plenty of negative effects. We need to understand that less is more in OB.

Our hospital tends to run in whatever is left in the ubiquitous labor augmentation bag and one more bag. I am a CNM and most of my patients decline routine pitocin :) I recommend it in the case of risk factors, but since most of my patients avoid other interventions as well, their risk for hemorrhage is lower.

The parents!

Nurse midwives are a type of midwife, there are several other flavors as well. Probably less likely to perform abortions or work in abortion services than nurse midwives are as the other types of midwives will typically practice in out of hospital/independent settings.

It does depend on the state- some states including the one where I practice, prohibit anyone but physicians from providing abortion services. Other states, like where I was previously, allow midwives to perform certain types of abortions. To clarify the above post, Nurse Midwives ARE advanced practice nurses and are licensed independent providers. Some states require formal collaboration with a physician, others do not. Midwives provide women's health and primary care across the lifespan. This includes prenatal, well woman, gyne, lady partsl deliveries, and often first assisting in c-sections and other surgeries. My facility does not provide abortion services but I often counsel my patients on termination as an option in my current position as I might see a gyne patient who is unexpectedly pregnant or a new ob who is unsure if she wants to continue her pregnancy.

I like the FNP/CNM model (which was not offered at my school, I am CNM only). I'm not sure about the usefulness of the CNM/PNP model though. I am sure there are some places it would work well or the program wouldn't exist! It is within the scope of practice of a CNM to provide well newborn care. But routine pediatric care would be difficult, office not set up for it, stocking childhood vaccines, ped size equipment, different scale, etc. Not to say it wouldn't be done anywhere. It would be nice for job opportunities to have both options though. Has anyone worked in a combined CNM/PNP role?

Go to the website and read the info, it will answer all of your questions, it is very informative and easy to navigate. Your site must be located within a HPSA (health professional shortage area). Based on the location it is assigned a score. The higher the score, the more loan repayment you get. You must be located in a HPSA to be approved but just being in a HPSA does not get approval, you must also meet the requirements that are outlined on the website (sliding scale, services offered, etc). You can't apply for loan repayment until you have a job at an approved site.

I am working to try to get the loan repayment now. First I have to get my site approved, but the actual loan repayment application looks pretty straightforward. I have had some friends use the program and seems to be a great deal. Let me know if you have specific questions and I can pass them on.

You could, in theory, work there, but I doubt many people go to midwifery school with that aim. Most midwives want to deliver babies or at least work in the OB field. It is within the scope of practice to provide women's health and primary care. There are some programs which offer a dual CNM/FNP program. Honestly if you want to work in a clinic setting doing primary care FNP would probably be a better choice since CNM largely focuses on OB.

As far as baby not going to the nursery- that is consistent with evidence and is best practice. Going to a nursery is not good for anyone- detrimental to breastfeeding, bonding, increases infection risk and security risk, etc. It is recommended however that a second nurse is available at delivery to be responsible for neonatal resuscitation. So if you mean truly alone, that is a concern.

But why would it matter if the birth log were used in court? It contains statistical information that is already in the record. A journal where you describe the delivery with or without the minutae (stats, etc) would be far more troublesome if it described malpractice or deviation from protocol..

I am a CNM and I keep a birth log. Pretty much Same info as you listed. It's important for a provider to know/track their stats. It isn't a HIPAA violation, you aren't divulging the information to anyone else, it is information you have as part of doing your job, and you are not giving it to anyone else. You could even ask the patients' permission to put them in your log if you are really concerned about it. ACNM sells a birth log in the format you described. You just have to protect the info from falling into the wrong hands, mine is either in my office or in my home office.

Look a little closer... for that organization to certify a doula it is the hours of instruction, attendance at childbirth classes, completion of a reading list, attendance at births with evaluations filled out by the provider, and a test. The healthcare provider should be the one explaining the r/b/a to a patient, not the doula. The doula may help the patient decide based on the healthcare provider's information. A doula is generally more qualified than the average person to make those decisions, why wouldn't that be helpful?

I love them but as a nurse midwife they generally make my life easier so why wouldn't I :) At my facility they are few and far between but I encourage my patients who desire a natural delivery to have one. I think it is a control issue for most.

Not to split hairs, but the introduction of fetal monitors was not evidence-based. There was no evidence in support of their use, they were simply marketed and sold. They were originally intended for high risk women and somehow evolved to near universal use. Now the evidence has shown that they actually worsen outcomes, but we are stuck with them. They aren't even FDA approved having been grandfathered in. This is the case for many ob practices including routine episiotomy, prophylactic forceps, c/s for breech, etc. Only when we stop starting things that aren't evidence based will be break this cycle.

I was thinking the same thing about retained products and milk supply. The only other thing I would add would be a manual exploration of the uterus might be necessary if you were remote from being able to do a D & C. If nothing else you could explore the uterus and perform bimanual compression. Obviously this would be very painful for the patient.

It is not evidence-based to have patient NPO. Both ACOG and the Anesthesiology professional organization have policy statements supporting clear liquid intake in labor. D5 is also not evidence based- tends to result in hypoglycemic babies. I have done this research but don't have time now to look for the files. In any case as someone else posted the majority of cases performed under GA are emergencies where people have not been NPO. The risk of aspiration is really very low. I chose to eat and drink as desired during my own four deliveries. Also, it's not a matter of comfort. Going 12, 24 or more hours without food is torturous for a pregnant women and results in problems. When a pregnant woman comes into triage with ketones we scold her for her dietary habits then restrict her intake in labor.