What are care restrictions like for CNMs?

[minkajane]

I'm studying for my Bachelor's right now, after which I'm hoping to attend OSU's grad-entry MSN nurse-midwifery program. I had been hoping to be a CPM, but that didn't work out. Now I'm wondering about the kinds of restrictions I'll be facing as a CNM. I'm hoping to practice in OH, KY, and/or WV. I'll likely work in a hospital for at least a few years, and I'm eventually hoping to open my own birth center and natural family living shop. If there are any CNMs out there, if you could answer the following questions as to what your practice is like, it would really help me out. Thanks!

1. What kind of birth environment do you practice in the most? (birth center, hospital, home)

2. What kind of "higher-risk" clients are you allowed to take? (breech, VBAC, twins, etc) Do you have to get an OB's approval before taking them?

3. If you disagreed with one of your hospital's policies (like a VBAC ban or handing out formula samples to BFing moms), how would you go about trying to get that changed?

4. Do CNMs in your practice ever do circs? Have you ever felt pressured to assist with or become qualified to perform circs?

[trb310]

I am CNM. I deliver in hospitals. I will co-manage my high risk patients (ie GD, IDDM, PIH) but I do not nor am i comfortable with planned breech, vbac deliveries. After being a l&d nurse for 10 years I have seen the complications that can arrise from these situations and do not wish to be apart of them. CNM's do do circs in this area. I do not feel pressured to assist or to learn them. I want to. I try to meet the needs of my patients and if they desire a circ then it would be my pleasure to preform it for them.