Question for the midwives....

jkaee · Aug 12, 2005

From all the posts I have read here, there are many facilities that will hire nurses without L&D experience into L&D. We did a couple of years ago. None were new grads, but none that we hired had ever been in L&D before. Bear in mind, however, that it takes at least a year to even begin to feel comfortable with L&D and labor management in general.

I know that they do exist, in fact I was offered a job in L&D once about 2 years ago....but I didn't take it because of a multitude of reasons....very high turnover of staff....high incidence of drug babies/very young moms...12 week orientation (which is no where near enough in such a high risk area such as L&D). Plus personal reasons. But, for future reference, how long of an orientation do you think an experienced nurse who hasnt done maternity should have? I think that's what scares me the most...that I'll be on my own and not know anywhere near enough.

katwoman7755 · Aug 12, 2005

I guess my thought (for the sake of argument) is...what about the direct entry midwives? I mean, they aren't even nurses....and obviously they go to school and precept and learn what they need to know to successfully deliver babies and provide care to women. I mean, I can certainly see where L&D experience would benefit re: actually having helped with a delivery, but outside of that aspect.....

I'm just trying to get as much info as possible.

I do like the suggestion about trying to shadow a midwife and sorta pick her brain before enrolling in such a program.

I also emailed my friend who is currently in her residency as an OB-GYN...and she thought it sounded like a wonderful option. Her opinion was that she felt it really had more to do with each individual than previous experience...how much you wanted it...how invested you were in the care of your patients.

Kathryn

fergus51 · Aug 12, 2005

I guess my thought (for the sake of argument) is...what about the direct entry midwives? I mean, they aren't even nurses....and obviously they go to school and precept and learn what they need to know to successfully deliver babies and provide care to women. I mean, I can certainly see where L&D experience would benefit re: actually having helped with a delivery, but outside of that aspect.....

That's why some people would not use a direct entry midwife and their job options are much more limited.

amber1142 · Aug 12, 2005

Just wondering, did all of you that are midwives have L&D experience before becoming midwives?

I think most schools offering nurse midwife programs require experience in L&D, though I'm not sure that they require it as an R.N. or if experience as a doula might count. A few phone calls to CNM programs would clear up that question.

As an aside, most direct entry midwives do not suddenly one day decide to deliver babies. They apprentice themselves to a master midwife and assist at hundreds of births, gaining their experience that way.

katwoman7755 · Aug 12, 2005

I think most schools offering nurse midwife programs require experience in L&D, though I'm not sure that they require it as an R.N. or if experience as a doula might count. A few phone calls to CNM programs would clear up that question.
As an aside, most direct entry midwives do not suddenly one day decide to deliver babies. They apprentice themselves to a master midwife and assist at hundreds of births, gaining their experience that way.

Yes, I realize they don't "suddenly one day decide to deliver babies." They apprentice much the same way that the CNM's do....I looked up the info on the websites at the "top 10" schools that was provided in one of the links...some of those "best" schools do not require any L&D experience at all.

From the UC San Fran site:

Q: I am in nursing school. Do I need labor and delivery experience before I can apply to midwifery school?

A: Experience as a labor and delivery nurse can be very helpful in developing an appreciation of the process of labor and birth. However a variety of experiences in women's health are valued and this experience is not an absolute requirement.

Requirements according to Yale:

Requirements for admission for registered nurses include a baccalaureate degree from an accredited college or university and graduation from a school of nursing (approved by the licensing board of the state in which it is located). Professional nursing experience is considered desirable but is not required for admission.

Ohio State:

Candidates must meet the following admissions requirements of both Ohio State's Graduate School and the CON:

bachelor's degree in nursing from an accredited program

GPA of at least a 3.0 on a 4.0 scale in undergraduate courses

competitive scores on the Graduate Record Exam (GRE) taken within the last five years

completion of a statistics course and a nursing research or research methods course. A deficiency should be completed during the first quarter of graduate study, if not completed prior to admission.

From ACNM:

Certified Nurse-Midwives:

Careers and Backgrounds Rich in Diversity

A career in nurse-midwifery offers an individual diversity and independence in practice and attracts prospective students from all walks of life. America's certified nurse-midwives (CNMs) are former elementary school teachers, writers, missionaries, general practice nurses, etc. They mirror today's society--rich in diversity. However, they all share a deep commitment to bettering maternal and child health, not only in this country but throughout the world.

Now...I'm not trying to be argumentative....I'm just trying to really gather perspective on this...and the perspective I'm gathering from the CNM info out there is that L&D experience is not "crucial." I'm only pointing this out, as the overall opinion I am hearing on this board is that you really SHOULD have L&D experience. I am just trying to find a realistic means to an end. I can certainly see where that experience would be valuable...and if I had that option readily available, this discussion would not even be occurring.

It's funny how we as nurses feel so strongly about how we think things in nursing SHOULD be (ADN vs BSN, experience or not, etc), yet we often do so little to really try to invoke change in nursing or in the world for that matter. I am just looking for an opportunity to embrace an area I am interested in and that I feel I could really effect some change in the world..even if it's only in my own backyard

Kathryn

futureTMA · Aug 13, 2005

If you wanted an opinion or consensus from nurses about it, I think you got it. You should ask your question in the Midwifery Today forums at http://midwiferytoday.com/forums/ and I'm sure you'll get a different answer. Their forums include DEMs and CMs as well as CNMs and not just RNs such as this.

Hope this helps.

katwoman7755 · Aug 13, 2005

If you wanted an opinion or consensus from nurses about it, I think you got it. You should ask your question in the Midwifery Today forums at http://midwiferytoday.com/forums/ and I'm sure you'll get a different answer. Their forums include DEMs and CMs as well as CNMs and not just RNs such as this.
Hope this helps.

Point taken.....

That is why I posted here and not somewhere else...I'm not really interested in what DEM'S and CM'S think(not that it isn't important )...but I am sure their opinion is much different. Wasn't really trying to debate or argue....guess I just wanted a little support...like maybe this was an attainable dream without the previous experience.

Thanks anyway,

Kathryn

SmilingBluEyes · Aug 13, 2005

I think you did get some support......please re-read the thread. And if you disagree w/others, that is ok. Don't need to feel unsupported. Some of us DID encourage you anyhow.

katwoman7755 · Aug 13, 2005

I think you did get some support......please re-read the thread. And if you disagree w/others, that is ok. Don't need to feel unsupported. Some of us DID encourage you anyhow.

Did not mean to sound unappreciative....I do know that you all were being supportive. I guess I am just frustrated, b/c obviously I can see where L&D experience would be beneficial...and if I alone could make that happen then I would. I want to be able to achieve my goals, but I also want to do what's best for the patient's. I do not want to do something that I wouldn't be able to provide great care. I wish I could find the info statistically about CNM's who weren't L&D nurses, but who became really good CNM's...I guess I'm just concerned if there is such a thing. Trust me...I see all of your points entirely...as that has always been my opinion also, until I started reading the websites, which said you didn't have to be an L&D nurse. I don't know....just obsessing right now I guess.....It's hard being stuck in your thoughts this much :rolleyes:

THanks

Kathryn

SmilingBluEyes · Aug 13, 2005

Well whatever you do decide, I wish you nothing but the best on your path to midwifery. I wish more midwives were here to respond to you.

epiphany · Aug 13, 2005

We have similar goals, and I've had to make that same decision, and I am a few steps ahead of you. I can share with you what I did, and why, and you can take it for what it is and help you make your decision.

The most important question for me was my end goal. CNM's (at least in NY) do different things - and some end up just doing delivery, and some just Woman' Health. A CNM is just as much a Woman's Health Practitioner as she is a midwife. To me, delivering would be a part of my practice. I just graduated BSN and am entering a CNM program in September. For the first year, I will be working and taking about 2 courses a semester. In the beginning of next year, I will quit my job and go fulltime into the clinical CNM setting.

But I chose not to be in L&D for this one year experience, for these reasons:

1. Patient (general health) assessment is so challenging, and I badly need that experience, even more than delivery experience. Inversely, if I had delivery experience, and no health assessment, I would be worst of at the end of year, and don't know how I would catch up. L&D's assessments are narrowed down to women who are in labor, not the entire spectrum of pregnancy.

2. The hospitals in my area - they are literally swimming in pitocin. That's exactly what I don't want to learn. I am not an extreme, non-intervention type of person, but I think pitocin should be used only when a woman can no longer do without it. In addition, at the drop of a hat, a woman is wheeled into surgery, or vacummed. So I ask myself, after one year of witnessing this, now how am I going to build confidence in the woman's own power? With that, I decided it would actually be detrimental for me to do L&D as my initial work experience.

I don't really know what I'd be doing. I have an ICU offer, but I don't know if I'd stay there too long - I feel like a low level ER would be the best place to hone my assessment skills. But what I do would be very goal orientated to be in a good place when I finally get my CNM.

So, if I had one advice, it would be for you to ask yourself where you want to be. If you want to be delivering a hospital for the rest of your life, and you'd be happy as clam doing that, I say L&D is where you should be. But I'm headed off a different direction. I want to work in primary health care as well, and the delivery I would be doing would be healthy births. So here I am for better or worse. I wouldn't be suprised if there are flaws in my plan, but I have faith it'll work out in the end. Even if I was compelled to do L&D in order to get into CNM schools, it's not the end of world. There's always something to learn.

Good luck.

BETSRN · Aug 13, 2005

Did not mean to sound unappreciative....I do know that you all were being supportive. I guess I am just frustrated, b/c obviously I can see where L&D experience would be beneficial...and if I alone could make that happen then I would. I want to be able to achieve my goals, but I also want to do what's best for the patient's. I do not want to do something that I wouldn't be able to provide great care. I wish I could find the info statistically about CNM's who weren't L&D nurses, but who became really good CNM's...I guess I'm just concerned if there is such a thing. Trust me...I see all of your points entirely...as that has always been my opinion also, until I started reading the websites, which said you didn't have to be an L&D nurse. I don't know....just obsessing right now I guess.....It's hard being stuck in your thoughts this much
THanks
Kathryn

One of our 5 CNM's was NOT a nurse before becoming a midwife. She is exceptional. However, I think she is the exception. I still feel that those with previous nursing experience as well as some L&D background do far better (in a far shorter period of time) in midwifery. Just their assessment skills alone are far superior to thjose who ahve ot had a nursing background.

The last student midwife we had recently didn't make it: mostly because her assessment skills were so weak. She was one of those go through and become a nurse in a year masters candidates and her lack of background was so obvious. I'm sorry but I think that those "fast track" programs (and I am talking about programs like Yale) do their students a terrific disservice in this arena.