Why is there a nurse when you have a midwife with hospital birth?

fromtheseaRN, BSN, RN · Oct 13, 2010

i'm guessing it was that hospital's policy? was she a midwife, but not a certified nurse midwife? here you can be a midwife, or a RN-midwife, so if she wasn't a RN midwife perhaps the hospital requires a RN to be there as well.

if you'd like to limit the number of health care providers at your own birth, there are several options including a birthing center with a midwife, or a home birth with a midwife.

heron, ASN, RN · Oct 13, 2010

2 vastly different roles. The midwife is there to manage the birth in the event that it's uncomplicated. The RN is there ... from my non-L&D perspective ... to monitor the laboring woman's condition along with the midwife, deal with meds and begin intervention if the birth becomes complicated.

cayenne06, MSN, CNM · Oct 13, 2010

A midwife alone cannot provide all the care a women needs during labor- it is pretty much universal that a midwife has an assistant- either an RN in the hospital or a birth assistant (or RN) in a home or birth center setting. It is truly not safe to deliver a baby without two professionals present. As far as labor support, it is perfectly acceptable to ask for privacy, or for one or both professionals to leave you alone except when they need to check on you.

Think about how long a woman can be in labor for- it is unrealistic to expect a MW to be fully present and provide all the care for such an extended period of time. Plus, it is not uncommon for a MW to have more than one patient laboring at the same time- she needs to provide care to all her patients! To me, the benefit of a midwife is a more natural-minded approach and more personalized care, not necessarily 1:1 care all the time.

Fromthesea- there is no hospital that I know of that allows non-nurse midwives to have hospital privileges- I am a direct entry midwife (not practicing) and I have never been allowed to deliver when my patients have to transfer, and that is true across the country.

This is why I am back in school for my CNM license!

Trauma Columnist · Oct 13, 2010

Is the CNM role different in Canada? That's what it sounds like to me.

fromtheseaRN, BSN, RN · Oct 13, 2010

A midwife alone cannot provide all the care a women needs during labor- it is pretty much universal that a midwife has an assistant- either an RN in the hospital or a birth assistant (or RN) in a home or birth center setting. It is truly not safe to deliver a baby without two professionals present. As far as labor support, it is perfectly acceptable to ask for privacy, or for one or both professionals to leave you alone except when they need to check on you.
Think about how long a woman can be in labor for- it is unrealistic to expect a MW to be fully present and provide all the care for such an extended period of time. Plus, it is not uncommon for a MW to have more than one patient laboring at the same time- she needs to provide care to all her patients! To me, the benefit of a midwife is a more natural-minded approach and more personalized care, not necessarily 1:1 care all the time.
Fromthesea- there is no hospital that I know of that allows non-nurse midwives to have hospital privileges- I am a direct entry midwife (not practicing) and I have never been allowed to deliver when my patients have to transfer, and that is true across the country.
This is why I am back in school for my CNM license!

thank you cayenne06 for the clarification- i have only had experience with midwives at several of my friend's homebirths, and was unaware of whether they had hospital privileges or not.

klone, MSN, RN · Oct 13, 2010

Many times, a midwife may have 2 or 3 different women in labor at the same time. Our midwives are fabulous, generally speaking. A few act more like doctors (check in once in a while, and then appear for the delivery), but most of them spend a lot of time in the room with the patient. But they don't do things like IV starts, vitals, etc. and they don't do the regular charting on the patient that is required (beyond their assessment notes and delivery records).

AOX4RN, MSN, RN, NP · Oct 13, 2010

A couple of days ago I visited my friend who was in labour at a hospital. She had a midwife but I noticed that she also had an assigned nurse. The nurse did what any labour/delivery nurse does - meds, assessments, etc. etc. But I thought what was the point of the midwife except to catch the baby? The nurse was also doing almost all the pt teaching. Is there a policy that you must have a nurse assigned to you?

The midwife still needs an assistant during the labor, birth, and postpartum process. She doesn't manage and perform all of the duties at birth. That isn't safe. The RN does what an RN does, the midwife does what the midwife does.

HealthShepherd · Oct 13, 2010

At my hospital (in Toronto), the nurses and doctors have nothing to do with the midwives' patients unless the birth starts looking high-risk and care is transferred to the OB team. The midwives may be assisted by doulas or midwifery students, but it's the norm here for the midwife to be the only professional attending. But of course, help is just a code pink button away.

klone, MSN, RN · Oct 13, 2010

But of course, help is just a code pink button away.

What does "code pink" mean for your facility? Ours means "child/infant abduction". Interesting how different facilities have different designations.

HealthShepherd · Oct 13, 2010

Code pink for us is like a code blue (I think that one's universal, isn't it?) but for an infant, so a different team comes running. We also have a code 77 for a pregnant woman in crisis - both the code blue and code pink teams go. And we have code pink and code blue buttons on the wall in every delivery room, to make it faster to call for help.

Oh, and we call a missing child a code amber. Not that I've ever heard this one called.

klone, MSN, RN · Oct 13, 2010

Ah! Our code teams aren't trained in NRP. So if there's a newborn that needs resuscitation, it's up to the peds/NICU team.