Question about some things a midwife can and cannot do?

klone, MSN, RN · Mar 8, 2015

1) no

2) she can co-manage a low-risk pregnancy with MD. She can also manage low-risk labor. Most places will do second stage in the OR for twins. The CNM is usually there along with the OB, as well as other staff present in case of a need for c/s.

**LibraSunCNM, BSN, MSN, CNM** · Mar 9, 2015

Midwives actually can do vacuum-assisted delivery (ACNM has an educational handbook about it), but I haven't ever met a midwife who does, I think it would be in a rare, extremely autonomous practice. Multiples would have to be co-managed with an MD. In my practice most of the experienced midwives have delivered twins, with the OB in the room for assistance as needed.

klone, MSN, RN · Mar 9, 2015

Midwives actually can do vacuum-assisted delivery

Really! I had no idea! Forceps are no?

**LibraSunCNM, BSN, MSN, CNM** · Mar 10, 2015

In terms of vacuums, I think it's more just what you can convince your individual hospital to credential you for, kind of like circumcision or first assist in the OR. There's no actual law or strict guidelines for it, you just get experience doing it and then get credentialed by your institution to do it. ACNM seems to have no comment regarding midwives and forceps deliveries, so I'm assuming they don't support the practice. And as I said, I've never met a midwife who actually does vacuum assists, although I think it would be a cool skill to learn.

CNMidwife2Be · Mar 10, 2015

I second LibraSun's comments. Also, it really depends on the state. I know of home birth CNMs who attend twins and breech. Of course, this is controversial but I know these midwives feel they're fulfilling a significant need (often lady partsl twins/breech are not an option in hospital) and maintaining a woman's right to choose her place of birth.

CNMidwife2Be · Mar 10, 2015

As far as the MSN vs DNP - not anytime soon. ACNM is against the change since they state more midwives are needed and that yet higher educational requirements create an unnecessary barrier to practice. Especially since the safety of MSN prepared (and indeed BSN/cert) midwives has already been demonstrated.

Simplyroses · Mar 10, 2015

Yes, midwives can take on Vacuum assist as an advanced role. I've seen this more commonly in rural areas.

Twins are special. DiDi twins who are both vertex might be allowed by your hospital or collaborating physician. It is very much a state-by-state and hospital-by-hospital decision.

Red Kryptonite · Mar 10, 2015

Why would a midwife want to get into all the machines that go ping? Isn't the point of being a midwife to NOT be an OB?

Simplyroses · Mar 10, 2015

Why would a midwife want to get into all the machines that go ping? Isn't the point of being a midwife to NOT be an OB?

Lol. A midwife doesn't WANT to play with the machines that go ping. A vacuum is just one tool in her toolkit to assist a baby into the world when/if it becomes necessary. Midwives value and believe in birth as physiologically normal. However, there are times when extra assistance is required.

**LibraSunCNM, BSN, MSN, CNM** · Mar 10, 2015

Lol. A midwife doesn't WANT to play with the machines that go ping. A vacuum is just one tool in her toolkit to assist a baby into the world when/if it becomes necessary. Midwives value and believe in birth as physiologically normal. However, there are times when extra assistance is required.

Agreed. It isn't remotely as simple as "midwives use no technology, OBs use all of it." We are trained to view pregnancy and birth as physiologically normal, AND trained in how to manage complications (to a certain level).

If I'm with a patient who, for whatever reason, is having a difficult second stage or baby is descending but in distress, it would be nice to be able to do a vacuum myself, instead of calling the OB in, and standing to the side while they do the exact same thing I would have done, if I were trained. An operative lady partsl delivery (most of the time) is preferable to a C/S, no?

cayenne06, MSN, CNM · Mar 10, 2015

There's really no clear "line" as far as what is too complicated for CNMs to manage. It all depends on your training, your facility, your practice, and your back up. At the practice I work at as a student CNM, midwives manage all the OB patients, regardless of complexity, with physician collaboration and back up as needed. We don't do vacuums, but that is because they are so rarely needed that the midwives feel it would be difficult for them to maintain competency. We comanage multiples and breeches, care for pre-e patients on mag, preterm labors, vbacs, diabetics, planned sections, etc etc. The only time they "risk out" of midwifery management (with consultation/comanagement as needed) is if they are too high risk to deliver at our facility (a relatively small-ish community hospital).

In contrast, the midwives I worked with last semester risked out a lot of women- GDMs who were not diet controlled, any HTN patients, etc, because there were no obstetricians in the practice to provide collaborative management (the house staff provided back up).