beckinben

I have never worked at a hospital or even heard of routinely checking the blood sugar of a non-diabetic mother in labor. Newborns, yes, although routinely checking their blood sugars is not recommended either, but it's still done. The only labs I routinely order in labor are a type and hold (blood type) and a CBC without diff.

Becoming a CNM almost always requires a master's degree. It is usually a 2 year program full time. My suggestion would be to go to the American College of Nurse Midwives website at http://www.acnm.org or http://www.midwife.org and click on the tab that says "Become a Midwife." There is lots of great information there, including links to every school that offers midwifery education. Good luck!

This is the article I refer to when people ask me about delayed cord clamping. I believe in the benefits of it, however, our nursery staff seem unable to evaluate babies anywhere except the warmer, so I have been pressured to cut the cord earlier so that the baby can go to the warmer faster Sometimes, delayed cord clamping is the only way I can keep a mom and baby together in the first few minutes after birth. My understanding is there is even more benefit shown in premature babies. I don't have any articles on that at the moment. http://jama.ama-assn.org/cgi/content/full/297/11/1241

Limiting the practice of CNMs to non-delivering roles might be a way to increase workload for residents - they have requirements on how many deliveries they have to do and the hospital might not have the volume for other providers. It might also be due to malpractice concerns or political issues. I deliver, and I teach residents. It all depends on your setting.

Why do they have to come in to see a labor check? I don't go in to see simple labor checks. I review the strip on my computer at home and dictate a note stating that serial exams by the RN showed no cervical change, the strip was reactive, and that she may be discharged to home. Any issues, sure, I'll go in. But the low risk primip at 38 weeks who's having some contractions? Probably not.

I repair 1st and 2nd degree lacerations. If I have a 3rd, one of my backup docs comes in. I do know CNMs that have privileges to repair 3rd degree lacerations. I haven't seen or had enough 3rd degrees to feel anywhere near comfortable doing them myself. :) The basics of what CNMs are trained to do are in the ACNM Core Competencies, which you can find here - http://www.acnm.org/siteFiles/descriptive/Core_Competencies_6_07_3.pdf This is what is covered in your midwifery training. Repair of lacerations is specifically mentioned in the core competencies. However, skills beyond these can become part of CNM practice, if you have some training and can prove competency. For example, I first assist on c-sections (which could be considered surgery, LOL). My docs trained me to do it, the hospital granted me privileges for it. The ACNM has a specific position statement supporting CNMs who want to first assist. Other CNMs do vacuum assisted deliveries. The biggest limits on what you can do as a CNM are going to be from state law, hospital policies, what your back up docs (if any) are comfortable with you doing, and what you yourself feel comfortable with.

If it was a private patient of the attending, no, he probably won't get paid for the delivery if he wasn't in the room. Don't feel bad. If he was that invested, he could have stayed in the room with his patient. He made the decision not to. I haven't missed a delivery in quite a while (probably because I stay in the room with them :)), but I had one a couple of months ago that I almost missed. I checked a patient with a history of precip deliveries - without her nurse in the room, go ahead and slap my hand - and she was 6. I left the room to ask a nurse to get the delivery cart. I walk back in a minute later and the head was halfway out. It happens to all of us. Don't worry too much about it.

Holistic Midwifery by Anne Frye is probably the most comprehensive text for out of hospital birth. There are two volumes - prenatal care and intrapartum care. Volume 1 is getting older (1998), but I've heard it's good. I have volume 2, it came out in 2004. It is very comprehensive, and I actually refer to it for some things because it is more indepth than Varney's Midwifery, which was the text I used in school. Anne Frye also has a new edition out of her book on diagnostic testing in pregnancy, which is also a good resource. The other text that many CPM-type programs use is Elizabeth Davis's Heart and Hands, which also came out with a new edition in 2004. I have that one, it is not very indepth and I think not sufficient by itself. Henci Goer's Thinking Woman's Guide to a Better Birth is a very good resource for evidence relating to pregnancy and birth. It is written for the pregnant woman, but is very valuable for health professionals as well, because of the emphasis on research and evidence. It's getting fairly old as well (1999), but I know she is in the process of updating, and I would expect the new edition is coming in the next year. Another recent release that talks a lot about evidence in childbirth is Marsden Wagner's Born in the USA. Either of those would be much more up to date than Immaculate Deception. There is a new book that as a hospital CNM I am excited to see - I found it on Amazon. I am hoping it will have some good evidence in it as well. http://www.amazon.com/Homebirth-Hospital-Integrating-Childbirth-Medicine/dp/1591810779/ref=wl_it_dp?ie=UTF8&coliid=I2V3CSZAJ5B0RG&colid=3RXIATWQJWRAE I'm wondering if money is her issue? I know old books are cheap, but if she wants to be serious about midwifery, she is going to have to prepare to shell out some money for books.

We've had three sets of twins in my practice this year, and all were induced 36-37 weeks due to PIH issues. In general, though, we don't induce prior to 39 weeks. My physicians will do lady partsl deliveries as long as baby A is vertex. One does lady partsl breech deliveries of baby B, the other will do a version on baby B after baby A is born. But we try very hard to lady partslly deliver as many of our twins as possible.

And if I'm really thinking someone might deliver on the toilet, or she's worried about the baby falling in, I'll put a hat in there, just to help with that fear. Hats are good for placentas, too. Sometimes just sitting on the toilet gets that placenta right out, and the hat makes it much easier to retrieve.

Of the women I know, the most any one has had is 9 (yes, nine) c-sections. Her last was a planned section at 36 weeks due to the increased risk of uterine rupture. The baby did have some problems related to preterm birth. In the last month, I've first assisted on the c-sections of two women having repeat sections. One was the woman's fifth c-section, the other was the woman's sixth c-section. Both had placenta accreta. In case you don't know, this is where the placenta starts to grow into the uterus, which can make it very difficult to remove. This is a known complication in women having repeat c-sections because the placenta has an easier time growing into a scarred uterus. In the one case, we were able to remove it after some time. In the second, we ended up doing a total hysterectomy. One of the OBs I work with strongly prefers women not have more than 3 c-sections. I think what I take from this is that I really do my very best to avoid performing that first c-section. When I talk to women about c-sections (especially people who express the desire to have one rather than a lady partsl birth), one thing I like to say is that the first one is relatively easy and safe, but they also have to think down the road, and will they be OK with limiting the size of their family due to the risks of the third or the fourth or the fifth c-section, when the risks are much greater? JMHO.

I rarely, rarely get the stirrups out. I probably have a 50% epidural rate (for a variety of reasons), and I still try to get the ones with an epidural into a side lying position for delivery. It's better for preventing or decreasing tears, and reduces your chances of a shoulder dystocia, but it's hard to do if the bed is broken down. I remember the days of feeling like I might drop the baby. You will get to the point where you don't worry about it quite so much. It takes practice. Yes, and the nurse and patient both laughed their you-know-whats off.:chuckle

If you go the more traditional route to CNM, where you attend nursing school, receive an RN license, and then continue on to a graduate program in midwifery, most people do choose to work as a RN between the RN program and the CNM program. After you graduate from a RN program (whatever type you may do), you can choose to work only in labor and delivery or a women's services unit and only care for those types of patients. However, you are, during nursing school (ASN or BSN), going to be caring for all types of patients. Most nursing students spend only one or maybe two clinical experiences in OB, and the rest in other areas of nursing. But let me tell you that the experiences you get in nursing school will absolutely help you when to get into CNM practice. As a CNM, you will still see women who have a variety of medical problems and it helps to have some familiarity with them. For example, I see many women with thyroid issues. I have women with blood clotting disorders in my practice. I see women with migraines, which calls for some experience with neurology. I even diagnosed one of my patients with a seizure disorder after she started having absence seizures during pregnancy. I order and interpret lots of different labwork and imaging/radiology tests. I get all sorts of dermatology questions ("What is this rash?") All these require me to know something about lots of different areas of medicine, not just OB/GYN. As a CNM, you will be trained to provide primary care for women. Obviously, some practices are more broad in the types of patients you will be required to see than others, but it is to your advantage to not look at caring for patients other than pregnant women (or women in general) as something that you want to avoid. Look at it as a way of gaining experience that may come in handy in the future. And with regards to the direct entry programs, even in those programs, you will still have the same basic nursing experiences as a student whose goal is a RN license. You will still do med-surg, psych, and other non-OB clinical rotations. That is because, even in a direct entry to CNM program, you will still need to take and pass the NCLEX, and the NCLEX does assume you have some training in all areas of nursing.

Interesting that the nurses have that preference. At my hospital, I (virtually) never break the bed. I've really had to get the nurses used to it. I think it's easier to keep the bed clean if you break it down, but the advantages of not breaking the bed are worth it to me. If you do break the bed down, the only realistic position that moms can do are being on their backs. If you don't break the bed down, it is much, much easier to get moms on their sides, or up on hands and knees, or up squatting. I will break the bed down, though, to do most repairs. It's much easier to really get a good look at what's going on with a laceration with the bed broken down. I guess I've never thought of it as helping to not drop the baby. For me, babies almost always go straight to the mom, so I have an extra pair of hands to help hold onto them. :chuckle I hear you , though, about the end of the bed. I broke one once. :imbar I still feel pretty strongly about doing what I can to keep birth as normal as possible. And breaking the bed just feels so medical to me.

I was first assisting one of my docs on a c-section yesterday, and the patient asked us in the middle if we were almost done yet. We told her no, and she actually said "but it doesn't take this long on A Baby Story." :smackingf