midwife2b

Until about 6 months ago I was the only CNM at a large hospital in Charlotte. It is sort of lonely. My patients are happy to have me but the rest of the OB community just doesn't seem to be so receptive. I try to do my job and not get involved in the politics, but it is not so easy. Here's hoping we get some younger, interested physicians who "get it".

LOL I waited 25 years! I thought I was supposed to be a CNS. Then I thought I was supposed to be a WHNP. It was one patient situation that gave me the realization that if I wanted to support women's choices, the only way that would be a credible option was the CNM route. So I've been a CNM for 2 years. I have more clients than I ever imagined. Our service has a waiting list. Midwifery care and the midwifery model of care is desired and requested! Don't wait as long as I did!

Having been in such situations, I agree with Deb 100%. Families need to feel that they've been treated well, their choices respectfully addressed, and their needs have been met. The AMA documentation did not save us from several lawsuits and investigations over the last few years when I worked as a L&D nurse. As our attorney so aptly stated, "Policies are for the institution. Guidelines are for the people, and you cannot dictate behavior in a free country". FWIW my ladies are "forbidden" to have more than one page on their birth plan :) Their plans actually addresses more newborn and postpartum issues than labor ones, because we talk about the unpredictability of the birth process. Less is more, and a lot of times less is better. That's how our midwifery service "meets in the middle".

We let the dads support mom. I put a chair right behind dad so if he gets weak all he has to do is sit down. I've had some dads get faint but not always when they were supporting mom. Sometimes all they had to do was be in the room LOL The nurse is the person responsible for making sure "all is well". When I am there I will support mom if dad cannot.

I've gotten many laughs from these posts! Thanks for brightening my day! I remember calling a resident about a C-Section pt. who was complaining of a rash from her abdomen to her thighs. He came in and looked at it, and wrote some orders, including "Give Dilaudid 2 mg q6 hr around the crotch". What was he thinking? He meant "around the clock". He never lived that one down, we still laugh about it!

I work in a multi-specialty private practice with over 70 physicians. My personal malpractice rate is quite low because of that. (I don't have to pay it out of pocket but I could if need be). Depends on where and with what kind of group you work with.

Speaking as a CNM, I LOVE doulas! There are times when I have 2 or 3 ladies in labor at the same time. If it hadn't been for doula care I would have FAILED miserably in providing emotional and physical care. The more people involved who understand and respect the patients birth choices, the better, IMHO. HOWEVER, I have worked with the occasional doula who has argued with the doc (or me) over management of prolonged or arrested labor. I dont mind argument/disagreement with me, but I do wish the doula hold her opinion until the physician (who I have called, consulted with, and prepared the parents to see) has left the room. It is one thing to suggest an alternative strategy. It is another issue to argue with physicians over medical management. I am still recovering from my last birth... where the doula did not want me to do AROM. The poor woman labored at least 6 hrs. longer than she had to. She was 8 cm. for 6 hrs. When I finally broke her water she had a wonderful birth 20 minutes later.

LOTS of changes from my first job in L&D (age 20) until now (49 and holding...) 1. Sterile delivery room. Just mom, doc and me. Caps, masks and gowns. Trilene inhalers (inhaled sedation) or some nitrous administered by ME (no ologists or CRNA's). 2. Tie arms down. Strap legs in stirrups. NO EXCEPTIONS. 3. I sterilized all our delivery instruments. We used all glass supplies: including syringes. Reused needles. 4. Circs were done immediately after birth, before the baby left the delivery room. NO anesthetic of any kind. (what a mess!) 5. Dads were usually not present at birth. They waited in the "fathers waiting room". 6. Babies were placed in bassinets on their right sides with the head down for 24 hours to help mucus come out. 7. Some peds wanted gastric lavage on every newborn so they wouldn't spit. So we inserted an OG tube and lavaged with saline. IMHO it did help with spitting... 8. Babies were "shown" twice daily in the nursery. All the relatives gathered in front of the nursery to ooh and ahh over their niece, grandchild, etc. The babies were our property! Only MOMS could touch them. Dads had to gown before the baby came into the room. 9. We cared for primarily farmers, the Amish, and Native Americans. Our breast feeding rates were pretty high. Our nursing moms got a bottle of beer (Genesee or Iron City) each night to help their milk come in. 10. Bottle fed moms got a shot of Deladumone OB as the head was crowning. OR, better yet, they got three days worth of Tace or DES (!) 11. Best of all... if a mom was going to feed her baby Pet milk or goats milk at home, WE MADE THEIR FORMULA FOR THEM!!! circa 1978... :) (Those were the days !?@%$) :lol2: 0

I work in the office 3 days a week (or about 24 hrs/week). I make hospital rounds 2 days a week, roughly 2 hrs. each day. Then I share call with 2 other people. Roughly 12 days a month of 24/7 call. Most of our ladies go into labor at night :) Other places probably do things a bit differently.... but I do earn my keep with an average of 6-7 babies born per midwife per month...

I've been educated in both WHNP and CNM roles. I liked working as a WHNP but missed the L&D aspects of care. You need to decide if you like working more with "families" or "babies". From my perspective the NNP role is very technical. Procedures that need to be done. Very early gestations with lots of counseling. And, BTW it is never too late... I was 37 when I got my WHNP and 47 when I got my CNM...

ECU also has an online program. Clinical sites are highly competitive. Often many schools ask for the same clinical site. And it is the clinical sites where you really learn how to help women birth. I can't stress this enough...

I absolutely agree!! I know many midwives who have never given birth...

I WANT to be "nursey"; that is why I didn't go to medical school. My patients are nurtured and supported and their birth plans are respected by me and the nurses I work with (even if the birth plan guarantees a trip down the hall to the OR LOL) That is what makes me different from the docs. That is the attraction women have to midwives if they have not had a good experience with the doctor the first time around. There are still many women who believe that midwifery care does not include pain management. About half my patients receive epidurals or intrathecals at some point. I feel I am providing a great service in our community!

To my knowledge, there are 2 CNM's who have backup to perform homebirths in NC. One is near the Triangle area and one is in the mountains. you can get more info from the nchomebirth.org website.

Online education was NOT EASY for me. I am not sure I could have done it with small children (although a lot of my classmates had small children). I think it depends on if you have to work and your ability to prioritize. I got my BS when my girls were young (8 &6) my MSN when they were 12 and 13 and WHNP when they were teens. The online CNM program was the most challenging of all and they were out of the house by then :) I think it is up to you and how much your children need you. Good luck with whatever you decide