Allison T

Just mentioning that it is absolutely not necessary to be a nurse to become an IBCLC. IBCLCs also come from PT, SLP, OT, MD/DO, social work, and many other backgrounds.

Hi Claralee, I racked my brain and found I knew 3 CNMs who attended Jefferson University. All 3 liked it a lot. They all said it's a program where you know your faculty and that was important to them. I worked with 2 of them clinically and to me 1 seemed exceptionally green as a new midwife. Like, I used to ask myself how she passed certain classes. But that could come from any program, believe me. She was an older student; maybe this played some role.

I could not agree more! The media perpetuate this notion of injecting the vaccine up high, too close to the shoulder. Ouch. Both times I got the COVID vaccine, the person injected it much too high. It felt like it hit bone. I was worried it had not gone into the muscle. I wish I had said something. Neither time did they palpate my arm: they just jabbed. No Z-track, either. Working in a mass vaccination event, you may not have a choice of needle, so "modifying the arm" (bunching or not bunching the tissue, or Z-track -- try it! it's so amazing -- and considering depth of injection) are ways to best administer a vaccine. I keep the injection guidelines in my head about depth to inject. I palpate the area to make sure there's not going to be scar tissue in my way and to locate the muscle. ACIP Vaccine Recommendations

I am giving COVID vaccines, too. I hadn't given deltoid injections in a while: I am usually injecting a larger volume (>1 mL), so I favor the dorsal gluteal or ventral gluteal sites. I was required to take the CDC website training on giving the vaccines: anyone else do this? And I read up about vaccination techniques, which said that the Z-track method is recommended (though ACIP doesn't mention it). I've now given 100 or so deltoid injections using Z-track, and it's been truly life-changing. It's so easy, and most people don't feel it. https://www.CDC.gov/vaccines/covid-19/downloads/COVID-19-Clinical-Training-and-Resources-for-HCPs.pdfhttps://www.immunize.org/askexperts/administering-vaccines.asp

There are actually a number of birth centers that employ lactation consultants (IBCLCs). They tend to be the larger birth centers. For example, Women's Birth and Wellness Center in Chapel Hill, NC, and the Midwife Center for Birth and Women's Health in Pittsburgh, PA.

I'm sorry I didn't see these replies months ago. I love the discussion. I do want to say that however much CNMs with L & D experience who work in busy, medicalized practices may feel that their L & D experience was helpful (and I am one of those who felt it was helpful), the research does not support that it is necessary. The parallel credential to CNMs, i.e., CMs, does not have L & D experience because they do not enter midwifery from nursing. Yet they go through the same midwifery education as CNMs, take the same board exam (AMCB), and belong to the same professional association (ACNM). There is no statistical difference in outcomes between CNMs with L & D experience and CNMs without it. I know people who've worked at and volunteered at Holy Family Birth Center and loved it. https://www.holyfamilybirthcenter.com/ There is an organization for those affiliated with or interested in birth centers (for birth center midwives, birth center owners, doulas, etc.) called AABC (American Association of Birth Centers). www.birthcenters.org.

I didn't go to Jefferson (which used to be called Philadelphia Midwifery Institute) but I have friends who did. I'm a CNM who went to a different school.

Well, hello. I am a certified nurse-midwife who loves talking about midwifery. I'm pretty active in midwifery organizations and will try to direct you to resources and answer questions. I'm sorry the midwife at your local hospital wasn't open to networking (?). Going from RN, ADN to CNM (or getting BSN along the way first, depending on which school you go to) is certainly doable. http://www.midwife.org/ http://www.midwife.org/Education-and-Careers

I too was the pioneering CNM at a hospital. I was on call virtually 24/7. My plan was to gradually persuade management to hire another CNM. I did ultimately succeed with that. However, our service got shut down by the CEO a short time after we hired the 2nd CNM. I am an experienced midwife (and state affiliate leader) who has heard many, many sad and abusive stories from midwives who started midwifery services at hospitals. One thing to do is really thoroughly research the hospital, the CEO, and the OBs. For example, I have seen hospitals hire a CNM to start a service, then fire the CNM when the local OBs get threatened. Then a few years later, with the OBs complaining about the workload, the same hospital again hires a CNM (who is unaware of the history). You may learn some helpful things from the state ACNM affiliate members and/or other APRNs such as NPs. If I had done my research, and seen how the hospital treated NPs (like they were disposable), I wouldn't have gone there. It is essential that the office staff understands you and midwifery. If the person answering the phone says "Do you want to see the doctor or just a midwife?" it is not good. Another tricky thing is that you are not really a midwifery service if you aren't 24/7. How will your patients feel if they come to a midwife for prenatal care and get a non-midwife at their birth? When you are the sole midwife at a hospital, it is inevitable that this will happen. Many, many hospital administrations do not understand that midwives labor sit. I would get phone calls asking, "Can't the nurse or the monitor watch the patient?" In fact, I was trying to get to the place that the nurses would be at the bedside (or birth ball side, LOL) with the patients so that I could stay in office a bit longer, but I lacked the support of administration with this. There was no nurse training unless I provided it, uncompensated, and with no one stepping in to help with my other other duties. And this in a state that provided nurse training in Lamaze childbirth techniques, lactation, and other relevant topics at a huge discount for nurses. So make sure that admin understands this about you (if indeed you do plan to practice "real midwifery" and be with your patients in labor). You have to be willing to either reschedule people's prenatal or GYN visits, or have your office colleague (MD/DO or whoever else you are working with) see the pts if you are at a labor/birth. I do recommend monthly team meetings (CNMs/CMs, head L & D nurses, OBs, CEO or maternity service leader) to ensure everyone is on the same page. We had these, but because the CEO was essentially off his rocker, they didn't work well. However, in general they seem a helpful concept. Good luck, and I hope you do your research.

Oh, I just answered this in the Georgetown thread...

Re Georgetown and dual specialty, I would highly recommend not doing CNM with WHNP. The WHNP doesn't increase your scope of practice. Do an FNP. Even if you think you only want to see women now as a future CNM, I can guarantee there will come a time when you want to care for a man or for a baby past one month. I believe there are just 3 states in the country where having WHNP with CNM makes sense due to state regulations.

In most states, it would not be worth your while to be both a CNM and a WHNP. Everything that a WHNP does is within a CNM's scope of practice. The reverse is not true. If you want to be an NP in addition to being a CNM, consider being an FNP, etc., or something that would expand your scope of practice beyond what a CNM does. I highly recommend touching base with the ACNM affiliate (i.e., state chapter of American College of Nurse-Midwives) for your state if you are considering the CNM-WHNP combined option. Do not rely on what a graduate school tells you. Even if they are a wonderful program, they cannot possibly know all the political ramifications.

Hello. Your plans and questions sound good. Note that since you are already a nurse, you would become a CNM, not a CM. The certified midwife (CM) path requires a bachelor's degree in a non-nursing field, and then a program for a master's degree. Only 2 schools offer CM: SUNY Downstate and the Midwifery Institute at Philadelphia University. Here's the link from the ACNM's website which explains the pathways. The vast majority of midwives in the ACNM are CNMs, not CMs. Pathway Results As for the HRSA, I found the process and language complicated. Also there are several options within HRSA. Legislation is being debated that would expand the options. Stay tuned. You could possibly contact your legislators' offices, too, for info. I took a job where another CNM and I were told, "No one's ever been turned down for the loan [NHSC]." It turned out that the HPSA score (Health Professional Shortage Area) disqualified us. HPSA Find I definitely recommend signing up for alerts through HRSA and being on their webinars and conference calls. Also some states have their own loan repayment options, and some employers offer loan repayment. And yes, I got into one of the schools you mentioned, with a somewhat similar background (I am also a certified childbirth educator, an IBCLC, and I have my RNC but it's not RNC-OB) and had 2 years as an L & D nurse. Keep on reading and posting.

I agree about e-mail! I get a fair amount of people wanting to e-mail me to ask about being a CNM. I'm definitely willing to meet people face to face if they are serious about it after several rounds of e-mails. I did have one recently who ended up working alongside me for a while, and I was surprised that she had not really read (or understood?) my e-mails. She kept asking me about being a "nursing midwife." And yes, I have had this conversation with a number of patients, and lunch/coffee with them too. Not an issue for many of us.

Sadly, on social media, I sometimes see practitioners who are advanced practice nurses (such as nurse practitioners) being called "doctor," and not correcting the person who posted it. Like "You are the best doctor." There's also an issue with some dialects of American English where people say, "I do my doctoring with Ms. Smith the nurse practitioner." That one surprised me . . .

I agree with the above comment, but in many areas, there simply are not any or many full-scope CNM positions. So in that case, if you are faced with a choice between a job that doesn't use your CNM skills at all, or one that uses part of your CNM skills, it could be a wise decision to take what you can get. The "problem" I personally have had in CNM jobs is that I am strongly committed to evidence-based practice. I took a job in an OB-CNM practice and in my interviews talked about how important EBP was to me. They all said, yes yes, that's what we do. And I came to find out very quickly that they (ANY of them) wouldn't have known the evidence if it hit them in the face. The CNM did what their "ancient wisdom" told them and the MDs did what the drug reps told them. I have since interviewed for other CNM jobs, and found similar lack of dedication to EBP. At one job, it was all about "stripping" membranes starting at 39 weeks, and AROM in labor. I hope to start my own practice within a few years. Meanwhile, I am working clinic, and taking call for another midwife at times, and teaching. The argument many CNMs make for taking a triage-only job is that "the doctors will get to know you, and begin to accept CNM practice." Perhaps this works for some. In my area, there are numerous hospitals that have used CNMs for triage only for years, and they still don't have full-scope CNMs.

I did check with the agency, thanks! And thanks to JenLPN as well. The Maryland Board of Nurses has been extremely UNhelpful, to the point of not answering phone messages or e-mails. They provide (on their website www.mbon.org) a long list of people who have had allegedly had the training to train CMTs. However, after contacting numerous people from this list, I haven't found any to teach our counselors. As far as becoming a CMT trainer myself, a representative at the MBON told me to contact community colleges, which she said are authorized to provide the training. So far no luck with those either. So frustrating because I want to provide safe, legal medication administation!

Certified Medication Technician: Maryland?? I am looking for information on how an RN can get trained to teach people to become CMTs in Maryland, and information on CMT trainers who can teach CMTs to work in the residential summer camp setting in Maryland. Our camp has overnight trips which take place in the absence of a RN. The senior counseling staff administer the medications on these trips. To comply with Maryland regulations, medication needs to be administered by physicians, nurses, or CMTs (or certified medication aides, which is a training available to nurse aides). The nurse packages and labels the medications: each individual dose for each individual camper. I am finding a shortage of CMT trainers, so I've decided to become one myself. I welcome any resources you might have . . .

I recommend joining the Association of Camp Nurses (ACN) (www.acn.org) which is a very cost-effective way to learn a great deal about camp nursing. See if the camp will pay for the membership! It benefits them to have you practicing as well as you possibly can. ACN has a quarterly journal that, among other things, includes camp-related continuing education for nurses. Regulation of camps varies state by state, so there is no "blanket answer" to many camp nursing questions. However, it's also important to know if your camp is American Camp Association (ACA) accredited, because then in the absence of state regulations, you are held to ACA standards. www.acacamps.org is the website. ACA has fantastic resources, as well. IMHO far too many camps just kind of "wing it" with nursing care, and this is terribly wrong. Unlike hospitals, which are run by healthcare people, camps are generally not run by healthcare people, and the directors often literally don't know an RN from an LPN from an EMT.

That sounds like a really tough position to be in, and it sounds like you made the right decision for your family. To me, the idea that each woman "has to" get her own midwife for labor is fostering the concept of "cult of personality." By acting as though each client must have that one midwife only, we act as though the woman should be depending on the midwife for labor. This is not healthy. Look at the toll this took on you. The midwife should be the "guardian of normal labor and birth," not the force propping a woman up in labor. A quote attributed to Lao Tzu [sixth century, common era] "Imagine that you are a midwife: you are assisting at someone else's birth. Do good without show or fuss. Facilitate what is happening rather that what you think ought to be happening. When the baby is born, the mother will rightly say: 'We did it ourselves.'" I am a midwife, and when people tell me I was "amazing," I think I have a problem. I want the woman to know that she was amazing. I was just there quietly in the corner or down the hall, being the guardian of normal birth.

I want to say that for anyone involved in camp nursing, a very worthwhile investment is a membership in the Association of Camp Nurses. This gives you a super-helpful quarterly bulletin (newsletter), and access to a members-only forum filled with dedicated and skilled camp nurses. Check out Association of Camp Nurses - ACN. I recently returned from my first ACN Symposium and it was fabulous to network with other camp nurses. Membership is $50/year or $90/2 years.

A couple of issues here. Health teaching should be evidence based. What we "think" or "believe" does not need to enter into it; there is plenty of research to back us up. No nurse who works dialysis needs to give her opinion of appropriate fluid intake or renal diets. We perinatal nurses do not need to give our opinion either. Mothers who say they want to "do both" are probably speaking to wanting someone else to help them with infant care responsibilities. These moms can gently be told, "OK, and the best time to start the bottles is at 4 weeks. Moms who start bottles before 4 weeks usually don't make enough milk. They end up quitting breastfeeding, and then you're not doing both, you're just bottlefeeding. I'm here to help you do what you want, and I hear you saying you want to do both." The research behind this statement is very clear. I'm including two references below, but there are many many others. Dunn, S., Davies, B., McCleary, L., Edwards, N., & Gaboury, I. (2006). The relationship between vulnerability factors and breastfeeding outcome. Journal of Obstetric, Gynecologic and Neonatal Nursing, 38(1), 88-97. Schwartz, K., D'Arcy, H., Gillespie, B., Bobo, J., Longeway, M., & Foxman, B. (2002). Factors associated with weaning in the first 3 months postpartum. Journal of Family Practice, 51, 439-444. It's too great a burden for all of breastfeeding education to be dumped onto inpatient nurses and lactation consultants. (By the way, not all with "IBCLC" are nurses, so they should be called lactation consultants, not lactation nurses.) I'm sorry the lactation consultants have set up a warfare state with the nurses; this benefits no one. Maybe you could ask them to model a conversation with you? Have them come in for a night shift and do an inservice? Or just observe on nights and see what you're up against. Prenatal care providers (physicians and midwives) need to be talking about breastfeeding and giving patients appropriate educational materials. Many indigent families participate with WIC, and WIC has been steadily improving at breastfeeding education. Some counties in some states have free breastfeeding peer counselors who meet with WIC-eligible moms prenatally and postpartum. In my area, several hospitals breastfeeding committees' have collaborated with the prenatal care providers to ensure a consistent message to mothers. This is a lot of work, but so worth it. Every successfully breastfeeding mother and every breastfed baby has a chance at optimal health (and this saves our country $). When I worked nights on mother/baby, and had 4 couplets, and all the moms sent the babies to the nursery but wanted them back for breastfeeding, I wore a pedometer. I logged over 5 miles one night. I feel your pain! Good luck; please post more and let us know how it's going.

I am a former NICU RN/current lactation consultant who covers NICU. Many RNs at the hospital where I work use infant formula even in breastfed babies. For example, they squirt infant formula onto the mother's nipple to "entice" the baby to latch on. Recently, our amazing pro-breastfeeding neonatologist told our breastfeeding committee that she is piloting a new "minimal enteral feeds" option for preemies, in which babies whose mothers are pumping and/or intend to breastfeed will not have enteral feeds introduced until there is sufficient available mother's milk. I was thrilled and told her so. Then I asked what about the "rinsing with formula" practice. Many NICU RNs at this hospital add some formula to "help the breast milk get out of the bottle," like if the pumped milk is low volume and not very liquid (as is the case with much colostrum). Obviously this exposes the babies to infant formula. The neonatologist did not know about this "rinsing with formula" RN practice; I guess she has not observed it. My questions for you current NICU RNs are: (1) Do you do this rinsing with formula? (2) Do your coworkers do this? (3) Has your hospital educated RNs about avoiding formula exposure in breastfed infants? (4) Do many NICU moms ask about avoiding formula so they can exclusively breastfeed? (5) Is anyone using donor breast milk (from a certified human milk bank) in NICU? Thanks!

I'm answering this from the standpoint of someone whose only OR experience has been circulating as an L & D nurse for cesarean births and a few other surgeries. But I want to address the "lose my skills" question. We nurses seem to use that phrase fairly often to refer to things like trach care, IV starts, wound care, etc. If we are in a position where we don't do certain procedures, we are afraid we will lose them. As a nurse who has worked in several areas of nursing, I have stopped being afraid of "losing my skills." It is the critical thinking that is the most important in nursing. I would be afraid to take a nursing job where I did not have to think critically. In reality, I think the "skills" part will come back if you return to a job where you do those procedures. The important thing is being able to look up how to do them, having a resource person to show you the procedures again, etc. Your critical thinking skills can direct you in how to efficiently look things up and will help you understand the basis for the procedures. Procedures change over time, anyhow.

That is a beautiful description. All of us nurses have so much potential to give, and to receive, from our patients and our coworkers.