Rural nurse midwife: pros and cons

monkeybug · Aug 27, 2012

I work at a hospital that serves 5 to 6 counties because several of the smaller hospitals in outlying counties have closed their L&D units. We have clients driving as much as 2 hours one way to get to the hospital. If these clients had access to midwifery, life would be much easier for them. Our state is very restrictive on the practice of midwifery. Home births are illegal, there are no birth centers, and midwives can only practice with close supervision of a physician. The pros? Choice for the low-risk client. Why should someone set themselves up for continuous monitoring, inductions, and interventions that are often directed by the lifestyle choices of the OB (tee time, long call hours, money) when they could have a low intervention home birth, if that is their choice. Home birth and midwifery care for low-risk patients is the standard in many European countries. You only see an OB if their is a problem with your pregnancy. Had I had access to midwifery, I probably could have avoided my cesarean and the problems that arose from it (postpartum depression, serious breastfeeding issues, and the pervasive feeling of failure, not to mention PAIN). Read Spiritual Midwifery by Ina May Gaskin, it will open your eyes to worlds of possiblities. I had worked in L&D for 12 years when I read it, and it amazed me.

Cons? Legal liability, and long hours. We do live in a sue-happy society, and people are more likely to sue over birth gone wrong than anything else.

I know that my life path will probaby never allow me to become a midwife, but I still dream about it.

RNperdiem, RN · Aug 28, 2012

Demographically, who seeks out a midwife for their care? It seems that all the articles I read describe thetypical mom who uses a midwife as urban and upscale. Is that a bias by the authors, or is this something you will have to take into account before getting into rural midwifery? Will there be enough work in a rural area to sustain a living?

meanmaryjean, DNP, RN · Aug 28, 2012

First - home birth is NOT illegal anywhere. What IS illegal is a nurse-midwife attending and being paid for a home birth in some states. It is disingenuous to say 'home birth is illegal'.

PS I am NOT anti-home birth, I have friends who have had multiple home births and I think it's a great thing for many women. I just think that your statement was - intentionally or not - misleading.

slfranco · Aug 29, 2012

Thank you for sharing your experince and wisdom. I look forward to reading Spiritual Midwifery. I will be sure to carefully consider the legal issues and concerns of general midwifery as well those that are state-specific.

simmaplease · Sep 2, 2012

I am considering studying midwifery for my masters degree too and I know the kind of reaction most people have to midwives. If it is something you are interested in and believe it is your way of helping people, then go for it 100% and advocate for alternative birthing options. Many people react negatively to midwives because they just don't know enough about them to trust them. But I hear midwives are making a comeback so as long as all of us (potential midwives) work hard, maybe people will ease up their opinions and trust midwives someday. I want one for when I have a baby, and if I think it's good enough for me, then it's worth defending and promoting!! Lots of luck to you :)

slfranco · Sep 10, 2012

Thank you for your encouragement. I agree wholeheartedly. I think that understanding abolishes fear in most cases. I believe it will work for the reputation of midwives. Thank you, and good luck to you too!