Tell me what you like and dislike about nurse midwives

SmilingBluEyes · Jun 22, 2005

I have not worked with what you can call "bad" CNM's at all. The majority of CNMs I worked with are like you---people with years of L/D nursing experience and are amazing!!!

There is only ONE thing I would ask you do(or caution you against)----try not to become "medicalized". By that, I mean, try to avoid making your practices just like those of MD's----- routine inductions, AROMs, etc. A lot of CNMs associated/affiliated with medical practices seem to absorb their attitudes/habits after a while. I have seen some you would not be able to tell the difference---doing routine inductions and getting annoyed when the patient did not deliver before a given time. They are RARE, thankfully!!!!

Hey, I say go for it. I can't say I dislike working with CNMs at all-----I love it. I have learned a lot from these wonderful professionals. Good luck to you.

BabyRN2Be · Jun 22, 2005

85% epidural rate?? Wow, that's so low! I haven't seen a hospital with that low of an epidural rate in a long, long time. When I first starting working in L&D in 1990, the hospital had a 60% epidural rate. Now this same hospital has a rate of 97%.

What kind of setup are you working in? Are you in California by chance?

As a doula I've never worked with any "bad" midwives in the hospital setting. They've all been really great. Really low intervention rates, great bedside manner. I love our midwives!

RNnL&D · Jun 22, 2005

85% epidural rate?? Wow, that's so low!

:chuckle That's funny. I read that, and thought, WOW, that's really high. I believe our epidural rate is about 65%. I was actually kind of surprised to discover that, because, for being a low intervention unit, we still do quite a few epidurals. We have 3 CNM's who practice with a low intervention MD group. They do their share of inductions and CS, but I love working with this group, because even the docs are pretty low key.

I second what SBE said. I hate to see medwives at work. They aren't any different than some OB's. I enjoy working with our midwives though. They are very supportive of low intervention birth (water birth too). And they work great with the nurses. I think a large part of it has to do with them respecting us and trusting our assessments/labor support. Many times, they will say, do what you want, I trust you. :)

madwife2002, BSN, RN · Jun 22, 2005

OMG cannot believe you have epidural rates of over 90%, have never heard of such a thing here in UK. I bet our epidural rate is 37% if it is that high!!!

I must do some investigation but our C/S rate is under 30%. In my hospital the abnormal birth rate is around 22% and home birth is around 3%. I worked in an area where home birth rate was around 25%.

Fiona59 · Jun 22, 2005

It does seem a high rate for epidurals. But you've got to remember that these are American rates. I've heard a lot of c-sections are done down there to avoid law suits.

Even by Canadian standards those are big numbers. I remember when one health authority came out and said too many sections were being done on a Friday for the Dr.'s convenience...:chuckle

RNnL&D · Jun 22, 2005

I worked in an area where home birth rate was around 25%.

That would be so cool. Unfortunately, in the US, homebirth only accounts for 1% of births. My youngest was born at home, unassisted actually. He wanted to come a little too fast. :chuckle

Dayray, RN · Jun 23, 2005

I'll second what smileing said and add some thoughts of my own. Try not to become to medicalized. As I said in a previous post I work with allot of great midwives. They have good skills and make smart decisions. The only thing I could wish for with them is that they more closely followed the midwife model of care.

We have a group of hospital based midwives and their practice is aimed toward low income/underserved population. Their practice is structured in a way that gives these women excellent care but doesn't allow for consistency of care or a strong supportive relationship and that is kind of sad. However most of the patients they care for don't have the expectation of a midwife that some private patients do.

We have 2 CNM's that are in practice with a group of OB's. Often I find myself feeling bad for their patients. These are patients that choose a midwife over an OB because they wanted the midwife model of care. In my opinion they don't use the midwife model of care. They practice allot like our OB's do. We just call them for delivery. They don't give their patients enough education. I don't know how many times I've explained things to their patients that I would have expected them to learn from the midwife. Often their patients ask "is my midwife going to come and labor with me?" Now when an OB patient asks me this I think it's silly but a midwife should be there at least part of the time because that is the model of care.

One of the private midwives really surprised me the otherday. I was taking care of her patient who was unmedicated and GBS positive, it was 3 AM and the midwife came in. The patient had been in the hospital from 12:00 I had given her amp for GBS at 12:30. She was now 6 cm and doing very well with breathing and positioning. The midwife was upset "I thought she would have been complete by now or I wouldn't have come in, I should go break her bag". It was a little surprising to hear her say that because the patient wasn't the interventional type. I reminded her that recommendations are for 2 doses of amp/pcn and at least 4 hours. She really wanted to get the patient delivered and go home so she went in and told the patient that she wanted to break her bag and get things moving. I told the patient about the recommendation and was really surprised that the CNM seemed perturbed by this. I wasn't that upset that the CNM suggested AROM (because the risk isn't all that great) I was however bothered that she didn't give this patient informed consent. I'm used to having to police OB's and make sure they don't walk over patients but I am troubled by a CNM who needs to be watched.

This is the point that bothers me, that patient had chosen a CNM because she wanted a low intervention birth. Now I'm not anti intervention, I participate in them everyday but on patients that choose that type of care. To me it is one thing to break a bag or start pit on a patient that desires medical care and isn't concerned about natural labor or birth experience but wholly another thing to do it for a patient that desires natural/ low interventional birth.

As for a midwife giving an herbal treatment and refusing to tell the nurse what was in it, this wouldn't fly with me for a minute. I would have had a private talk with that midwife and let her know that it was unacceptable. After all it's my patient too.

Remember why patients choose midwives over OB's and try to honor that for them. After all, if you act like an OB they might as well have gone to an OB.

amber1142 · Jun 23, 2005

It does seem a high rate for epidurals. But you've got to remember that these are American rates. I've heard a lot of c-sections are done down there to avoid law suits.
Even by Canadian standards those are big numbers. I remember when one health authority came out and said too many sections were being done on a Friday for the Dr.'s convenience...:chuckle

I know this isn't a cesarean section thread, but what disturbs me is the number of women who actually choose/prefer to have a cesarean section for convenience or simply because they're scared. I wonder if we stopped referring to it with the cutely benign term "C section" and started calling it "surgical birth" whether that would change the thinking about it.

madwife2002, BSN, RN · Jun 23, 2005

I know this isn't a cesarean section thread, but what disturbs me is the number of women who actually choose/prefer to have a cesarean section for convenience or simply because they're scared. I wonder if we stopped referring to it with the cutely benign term "C section" and started calling it "surgical birth" whether that would change the thinking about it.

Interesting thought :coollook:

live4today, RN · Jun 23, 2005

I've only watched one delivery assisted by a midwife and that was when one of my neices delivered one of her children. It was an awesome experience, and the midwife was great! :) The baby wasn't rushed from her mother's arms to be cleaned up and weighed for quite sometime. There was plenty of time for the parents to bond with their new baby daughter. The atmosphere was serene. My neice had a very relaxing CD playing throughout the entire experience. For the first time, I was able to see the value in having a midwife vs. a medical doctor. It was absolutely wonderful! :)

Littlewonder · Jul 12, 2005

Wow, in our small LDRP, we have maybe a 5-10% epidural rate!!! Because the docs have to do them!!! ...so we do a lot of comfort interventions! Our moms generally do great without, but I admit I kind of miss them from working a unit with a higher rate 70% maybe... it was wonderful to have a patient sleep through part of labor and wake up refreshed and ready to push. Here we often push with exhausted moms .