The elephant in the room - relationships between CNM and L&D nurses

melkwhyte · Jul 28, 2009

Okay, I will bite...being a newbie...I am starting school this fall, looking forward to working in L & D, eventually earning a CNM/WHNP

Is there a problem between L&D, I should know about.

Leave it to the innocence of children to get the ball rolling.

By the way..I am 47 years old and waited a long time to got to school.

Someone please enlighten me.

Barkow · Jul 28, 2009

No CNM/RN issues at the hospital I just came from - CNMs delivered about 50% of the patients, and we are a pretty low intervention unit to start with. Low epidural rate, intermittent monitoring, tubs, etc. I guess if you're at a hospital where you're been trained with the medical model of birth, or the unit's policies fall more toward the side of the medical, then it can be harder for an RN to deal with a different way of doing things.

Epiphany - What have you experienced? I guess I'm not quite sure what you're getting at here because I haven't experienced any problems.

RNLaborNurse4U · Jul 29, 2009

I have to say, I work with some terrific midwives. I don't feel like there is "an elephant in the room" when working with the CNMs on L&D. Power struggles? Nope. We all seem to be on the same wavelength. I do think though that my relationship with the midwives on L&D has improved since I started the Bridge program at Frontier in my journey to become a midwife.

However, we are all nurses at the core --- why should we have conflict when we are working on the same team? :nurse:

misstreviRN · Jul 29, 2009

I work at a hospital with midwives and we dont conflict at all. Actually I am closer to the midwives than to the OBs, because as nurses we have more in common and more stories to share. I enjoy deliveries with them.

epiphany · Jul 29, 2009

Any CNM's care to comment? I was hoping to hear from both CNM's and L&D nurses, but maybe it's not realistic in this forum.

kalley · Jul 30, 2009

I work as a scrub tech at a large inner city teaching hospital. I often feel that there is a separation between the midwives and nurses. Not that the nurses are mean or anything, but you often see that they don't agree with the midwife's way of doing things. I have took the side of the midwives on more than one occasion regarding eating during labor, birth plans, or monitoring. I have had a couple of nurses get a little touchy when you suggest that the midwife model is better. I tend to keep it to myself that midwifery is the path that I intend to pursue after I get my RN. Mostly I just tell them that I plan to pursue labor and delivery nursing exclusively after I graduate. It is sometimes uncomfortable for me, but it keeps the conflict at a minimum.

lovingpecola · Aug 1, 2009

Hm. I been at a hospital where nurses and midwives clash a little bit. A few nurses have said things like "I don't *do* back rubs" or "I'm not going to stand here all day" or "she's going to have to lay still, the monitor keeps coming off" etc. and there have definitely been some issues surrounding that. I would say it was 50/50 as far as those who are supportive of the midwifery model and those who weren't. We had a hard time getting the nurses to come over to the "birth center" part of the hospital where we did water births- even if it wasn't going to be a water birth.... even though they were sure to get 1:1 with the patient... they didn't like the paper charting required in the birthing center, and I also think it was hard to know"what to do" since so much of what nurses do now involves monitors/machines/data entry/meds etc. This caused tension because in order for a woman to birth in the center, we had to have a nurse. Some nurses tended to want epidural + AROM + IUPC + FSE as a given... and I can't really blame them because honestly that's kind of how it happened with most of docs on the floor and so you get used to it.... and if you've never seen normal, uninterupted labor (besides when folks come in pushing :up: ) you really have no idea what else it could be.

So, yeah, we had a few issues, but there were enough nurses there that appreciated the midwifery model that it didn't seem so bad. And basically with that many nurses and that many patients (high volume hospital) managers usually just assigned patients in a way that made most folks happy most of the time. (RNs who were also CNM students or RNs who loved the midwifery model got the "I have a birth plan, no meds please, natural labor mamas, and the "I don't do back rubs" folks got the rest, and everyone took turns for the stuff no one wanted, like triage)

And really there weren't many women who knew what they wanted and why and arrived early enough to need much... those mamas usually came in at about transition or later simply because they know better.

But thank god for good nursing managers.

mommy2boysaz · Aug 5, 2009

Oh, where do I begin?!

I have been an OB nurse for 12 years. The first half of that time midwives were unheard of. The second half, our former OB manager became a CNM, jumped MANY hurdles to be able to practice there, and got so busy she brought in a second CNM and now they really need a third (which I hope to become after I graduate in 2 years with my CNM!) They are in practice with the hospital's only 2 OB/GYNs and get along well with eachother. (Small, community hospital.)

Now for the conflicts. Many of the staff nurses are very adversarial, even disrespectful of the midwives. They question their orders, ignore orders they don't like, and generally "roll their eyes" a lot. These midwives are not difficult to work with but for the most part, the nurses only want to do the bare minimum, which does not include intermittent FHM instead of just using the monitor, or actually coaching a woman through labor instead of just offering her drugs.

Another HUGE problem has been a new OB nurse manager who for some reason has chosen to draw battle lines between herself (and the department) and all the providers from that group! (Who deliver probably 90% of all the babies in the hospital!) She fights them at every turn. She's told the staff nurses that if they see "anything" that they question in a delivery, they MUST tell her or risk being written up. She hates that the babies can stay with mom, with cord not cut until pulsing ceases. She thinks every baby should be resuscitated. Granted, she did come from a larger hospital where things were done differently but we have very good outcomes so her concerns are unfounded.

This has gone on for a couple of years now and has destroyed morale in the unit as well as completely unneccessarily stressed relations between the OB group and the OB dept. I left because the stress level was just too much. I liken it to the feelings that kids go through when their parents are on the verge of divorce and fighting constantly. It's a feeling of constantly walking on egg shells when one of the OB group and the nurse mgr are both there at the same time. Ridiculous!!

As I said, I hope to become a CNM and I would like to work there, but I sure hope some things change before I get to that point!

lovingpecola · Aug 10, 2009

mommy2boysaz,

I agree with what you're saying because I really do think the nursing manager can make all the difference between peace and, well, not-so-peaceful! (not that all the responsibility falls to the manager, but I surely appreciate a good one when I meet them! )

summersunset · Sep 29, 2009

I work with a group of 3 very popular CNMs run a birthing center and have hospital privs. They are no longer taking hospital birth clients and only using the hospital for transfers because the staff treats them like cr#p. (The aforementioned eye rolling, ignoring orders, etc.) The lead CNM for this practice says she worked in other states and was treated very respectfully. It depends on your state. Here CNMs aren't in the doctor club. I can't believe that the nurses would side with the docs and that there is no sisterhood in nursing. Makes me sick. I definitely will choose carefully where I go to work.