Midwife or Doctor?

[premedwife]

I know this is similar to an ongoing thread, but I didn't want to horn in on that conversation. The conversation also got derailed by a budding debate over the legitimacy of CNMs.
I am a 28-year old postbaccalaureate student. I wanted to be a doctor in high school simply because of a sort of generalized compassion & interest in
the subject. In college I convinced myself I was too stupid to become a doctor and how dare I think I could memorize/understand enough to actually have another person's life in my hands. I was young and still recovering from an abusive childhood. So I majored in my other love, fine art. When I was doing an apprenticeship in bronze sculpting I was a nanny half of the day for the artist's wife to "earn my keep" and spent the other half of the day in the studio. I was present at the birth of her second child and held one of her legs during the birth. I have had a fascination with childbirth since I was3-4 years old. My Mom says the two things she couldn't keep me away from were crayons and "A Child Is Born." She thought I was a strange three year old to be pulling that book off the shelf over & over again. Needless to say I was
thrust back into my fascination with childbirth and decided I wanted to be a nursemidwife. I then moved to El Salvador and volunteered in a remote,1-room clinic for a year. Nurses and doctors I met and worked with from El Salvador and the USA unanimously told me to become a doctor (an OB/GYN so I could back midwives). They knew I loved school and I was young. When I returned to the states I started going to school to complete the prerequisites for medical school. I also worked all year at a perinatal support center for patients on MediCal (Medicaid in California). All the nurses and CNMs I shadowed & worked with there emphatically told me to go to medical school. They had suffered the whims of insurance policies/coverage,etc. and still only got to spend 15 minutes with each patient.All this was going on while my current husband was courting me. I have continued on my medical school plan path and we got married 11 months ago.He is an R2 general surgery resident. The last 11 months have really thrown my world upside down. Do I really want to put my husband through medical school again? Now I'm 28 and when will we have kids? We both really want kids. Who will take care of the kids when he works 60 hours a week? I worry about doing any kind of OB profession CNM or MD, because
kids would have no regular schedule and they REALLY wouldn't see their parents much
(we want to practice rurally and its hard to do part-time OBGYN work rurally, but probably not impossible). So if I am going to be a family medicine doc, isthere really any point in getting an MD these days? Studies (NEJM)seem to point to APRNs giving the same quality primary care as MDs. I just applied to one medical school and one graduate CNM program both in our area. I have a med
school interview 12-17. So, I find myself with the desire to use the resource of my completed prereqs to get a really rigorous and extensive training in med school (partly because in rural and international settings, the more you've been exposed to the better...). Yet I remain confused. In terms of primary care, what are the advantages of having an MD? I haven't been able to get a clear answer on this one. If I already know I don't have time to become highly specialized should I just stick to mid-level practice? I hear so many nurses say, "Oh, I just hate school, or "I was too old to go back to med school, so I got my CNM degree." I love school & have a good chance of getting in at this point. Do I owe it to myself & society to use this love of school to pursue
and MD degree?? I don't mean salary or prestige. Maybe I could be a family med doc, have kids after residency (age 35 deliver at 36 some increased risks), take some time off, work once the kids are in kindergarten, and do an OB fellowship once the kids are in 5th or 6th grade. After training is said & done, would it be just as easy to work 3 days a week as a family med doc as a CNM? I am leaning away from my original dream of OB/GYN because of the extra year before having kids at what seems to be a crucial age. Maybe this is silly. Is it possible to approach family med OB with a midwive's
perspective on promoting the birthing experience blended with MD clinical expertise?
I know this is fairly scattered, but any help or advice would be much appreciated.
Thanks!

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[smq123]

Yet I remain [/COLOR].confused. In terms of primary care, what are the advantages of having an MD? I haven't been able to get a clear answer on this one. If I already know I don't have time to become highly specialized should I just stick to mid-level practice? I hear so many nurses say, "Oh, I just hate school, or "I was too old to go back to med school, so I got my CNM degree." I love school & have a good chance of getting in at this point. Do I owe it to myself & society to use this love of school to pursue
and MD degree?? I don't mean salary or prestige. Maybe I could be a family med doc, have kids after residency (age 35 deliver at 36 some increased risks), take some time off, work once the kids are in kindergarten, and do an OB fellowship once the kids are in 5th or 6th grade. After training is said & done, would it be just as easy to work 3 days a week as a family med doc as a CNM? I am leaning away from my original dream of OB/GYN because of the extra year before having kids at what seems to be a crucial age. Maybe this is silly. Is it possible to approach family med OB with a midwive's
perspective on promoting the birthing experience blended with MD clinical expertise?

There are some things to consider.

* A lot of people think that, since they like delivering babies, they should automatically do OB/gyn after med school. This is unfortunate because OB/gyn is HALF obstetrics, HALF gynecology. If you don't like surgery, and don't like being in an OR, then you will particularly hate residency. I think that that's an important point to consider before you think about doing ob/gyn.

* Sure, you could certainly approach family medicine - OB with a midwife's perspective. I think that that's one of the reasons why people go that route. And that will be useful if you decide to do rural medicine - to have the family med background, with extra training in OB.

But do you mind taking care of old men with terrible diabetes and asthma? That's part of what you'll be doing as a family medicine doctor/resident - I think it will be hard to build your ENTIRE practice on OB.

* Part of the difference between a NP/PA and an MD is the amount of control that you have over your patients. An MD diagnoses, examines, and treats a patient. That sounds great, but it is a lot of responsibility. Some people really need that level of control because, otherwise, they're not convinced that everything was done "correctly."

As far as I can tell, being an NP/PA is sort of like being a resident forever. You're always going to need supervision, and a lot of autonomy is taken out of your hands. Some people are fine with that - they just want to take care of patients, but don't want to be responsible for the whole production.

It really is up to you and what you feel will fit best with your personality.

* Don't focus so much on "I'll be too old to have children, but if I do XYZ then it'll be okay." Life never works out that smoothly. If you're doing what you really enjoy, then the other details (like when to have children, how to juggle family life) will fall into place.

 

[BBCatcherVA]

Your story is very similar to mine, with a few exceptions. I too was always interested in medicine but thought that everyone else was as well. I didn't think I was focused enough to stay on the pre-med track even though I knew I was "smart enough" to be a doctor. I finally decided to give med school a try when I was 29, married, and had two children. Now for the pep talks:

• if you think that you would have to put off having children until after med school and residency, that's not necessarily the case. I'm currently an M4 with kids and I have many classmates who had children during school. It's not necessarily the easiest thing and you may not think it's "ideal" but there is no perfect time to have children and adapting to the new family is always difficult.
• should you put your husband "through med school again" - While it may not be a walk in the park to be the spouse of a med student, I suspect that it will be easier for your husband to be married to a med student than for you to be married to a surgical resident.
• decide whether you want to be a physician or not - leave the specialty choice decision until a later date. While I went to med school with an interest in Ob/Gyn, I can honestly say that I found myself interested in fields that I wouldn't have predicted. You will have clinical experiences throughout med school that may change your mind.
• don't sell yourself short - if you've excelled in a pre-med curriculum, I'm sure that you will be competent in medical school. Age brings the ability to see the bigger picture and I think that has been one of my greatest strengths in med school.
• having said all of this - don't go to med school because "everyone else" told you too. You will resent the hell out of the long work hours and that will put a definite strain on your marriage.

Good luck with whatever you decide! I have a feeling that deep down, you already know the best thing to do in your particular situation. You just need to listen to your gut.

 

[Diane L. Evans]

Not a good idea to put off childbearing for careers. While you may think you are fertile until 40+ this is not true. At age 40 risk of fetal anomaly is close to 25%.

 

[hidradenitis]

My 0.02 as an FP doing some OB at a teaching facility-

1. Don't forget that as an FP, you will be training for a bunch of stuff you may not care about (if OB is primarily your thing); this stuff (like adult dm, ambulatory peds, lumps and bumps, lumbago, etc, etc, etc) will still be your bread and butter. Even if you do an OB fellowship and end up doing a lot more OB than usual, you will still have to recert on 'the other stuff' for boards.

2. Delivering babies is honestly the funnest thing I've done in my medical training/career. Having said that, the day will come (long before I retire for good) when I'll decide that taking OB call just ain't worth the hassle. And it's not uncommon for OB/GYNs to cut back on the OB side of business as they mature in their careers for similar reasons. Point being, have something besides just OB and avoid burnout.

 

[hidradenitis]

One other thing - on rereading your post, it seems working in an international setting is important to you. You also ask 'what's the point of getting an MD'?

Having done a number of overseas rotations/medical missions, my take on that is being an MD carries a lot more clout than being a CNM (everybody knows what a doctor is, but it might be hard to explain the CNM as being something any more than a lay midwife).

Good luck!

 

[mdjobexchange]

You may want to check out mommd.com it has quite a bit of good resources for this.

In rural areas CNMs can be independent. Keep in mind that for your husband, being a general surgeon in a rural area is going to be tough. Most pts out there are medicare or medicaid which pays poorly. Look carefully at your debt to see if it will work financially. It is unfortunate that doctors are having to calculate these things out, but it is reality. You going to med school vs midwife school could mean an extra 200k of debt possibly. If you just want to do deliveries, I don't know that the price tag justifies the extra credentials. If you do go to med school, I would go OB rather than FP. It will give yo more options.

 

[premedwife]

Well, I just got done with my medical school interview and have the final CNM interview on Friday. I am overwhelmed by the kindness of all the responses to my post. I am now just waiting to hear back from both schools before really delving into the final decision-making process. Each of you have given me pearls of wisdom.
Thank you for taking the time to do so!

The immersion program here at the University of Washington (RN to CNM 3 years) is actually on par if not more expensive than 4 year of medical school. My husband & I live really, really simply so we won't have to worry about finances. I have the luxury of being able to make the decision based upon what my dreams are...what a privilege. That is one of the reasons I am eager to pursue my greatest loves in learning while giving back to communities.
Thanks again. I will start looking into some of your resources.
All the best!

 

[premedwife]

That was one of my reasons for choosing the MD path (before I married a surgeon). I really already made this decision after talking to CNMs, shadowing them, & working in a perinatal support center for a year...They unanimously counseled me to go to medical school. They said, "You are young, you love school, get your MD and back CNMs." Even the CNM I interviewed with told me she would love to see a person like me go on to get my MD and back CNMs.
I guess just got confused when I married a general surgery resident & felt like I would be doing my family a gross disservice not to be a stay at home Mom. We are stuck in Seattle, so I only applied to UWSOM and the UW MEPN (RN to CNM 3 yrs). I should probably wait to see if I got in to either school before stressing out too much!
Thanks for your thoughts.

 

[BBCatcherVA]

... I hope you end up with what is best for you and your family. You sound like you will be an excellent patient advocate at whatever you choose!

 

[MDLove]

Just to add...
I have met so many female OB/Gyn Residents with children (more than I ever thought existed), and there are some who started having children while they were still in medical school. I think there is this widespread myth out there that once you start to pursue medicine, you have to put all thoughts and plans for a family on hold. I have found this to be far from the truth. Many women have done it, still do it, and are planning to have families while pursuing their medical careers. Two of my past attendings had children while they and their husbands were all in medical school, both planned it that way, and both said they would not have planned it any differently.

I can't comment on how difficult it is to have a family during this time because I don't myself, but it really has surprised me how many women do, and feel comfortable doing it. Most residency programs that I have looked at are pretty family friendly. And ob/gyn programs almost have to be since the majority of the residents are women! Medical school is not easy, but there is a whole lot of flexibility in how you manage your time.

Good luck to you, and it sounds like you will be great at whatever path you choose.

 

[Farmer Jane]

If you're wanting to serve rural populations, go for MD. No question.

I'm an RN who has spent three years in obstetrics: 2 years in a tiny rural BFE hospital (there were no OB/GYNs--only FPs) and 1 year in a large urban center. In a rural setting there are not specialists available to you like in an urban hospital. The CNM role works very well in a large hospital with residents and at least one attending in-house. In a rural hospital, there may not be a physician in-house, of any sort, anywhere. The surgeon is on call and may be up to 20 minutes away. It is a horrible, horrible feeling to desperately need a specialist, to see fetal heart tones plummeting, and know that there is absolutely nothing you can do because the surgeon is still on the road. If you ARE the physician, and when you come across the inevitable complication, you will be able to handle it. You won't have to depend on someone else to use forceps, or perform a c-section, or repair a severe laceration. It's much better for the nurse's nerves, too.

 

[hilseb]

What a great thread!

I studied as a midwife for two years, and now I am a first year medical student. I want to practice the midwifery model of care as an OB, but I am nervous about the amount of surgery and intervention based medicine I will have to perform in order to finish my residency.

However, I do want to be that person who can use the forceps or scalpel if necessary - as a last resort, I hope. I am still torn between an FP residency with an OB fellowship and an Ob/Gyn residency. This thread has given me a lot to consider!

 

[kimiij]

What a great thread!

I studied as a midwife for two years, and now I am a first year medical student. I want to practice the midwifery model of care as an OB, but I am nervous about the amount of surgery and intervention based medicine I will have to perform in order to finish my residency.

However, I do want to be that person who can use the forceps or scalpel if necessary - as a last resort, I hope. I am still torn between an FP residency with an OB fellowship and an Ob/Gyn residency. This thread has given me a lot to consider!

I am going through the same predicament in terms of making a decision. I'm also a postbac student and part of me feels like it would be such a waste of money for me to change my mind AGAIN and study midwifery but I feel like my philosophy of birth is more in line with the midwifery model of care. And frankly, why go to school for 8 years, when I can do what I really want to do- catch babies.

However, I also feel like I could do good work as a FP (with ob fellowship) or OB/GYN and perhaps change some of the climate surrounding modern obstetric care (does anyone else think the 31% c-section rate is ridiculous? why is it that american women can't birth vaginally but the rest of the world can? anyway..i digress). So, I'm still thinking it out, kinda scared to tell me family i may switch to midwifery, but i'm also in the midst of orgo II and that has all of my attention right now.

Anyone else's thoughts would be much appreciated...

 

[smq123]

I am going through the same predicament in terms of making a decision. I'm also a postbac student and part of me feels like it would be such a waste of money for me to change my mind AGAIN and study midwifery but I feel like my philosophy of birth is more in line with the midwifery model of care. And frankly, why go to school for 8 years, when I can do what I really want to do- catch babies.

However, I also feel like I could do good work as a FP (with ob fellowship) or OB/GYN and perhaps change some of the climate surrounding modern obstetric care (does anyone else think the 31% c-section rate is ridiculous? why is it that american women can't birth vaginally but the rest of the world can? anyway..i digress). So, I'm still thinking it out, kinda scared to tell me family i may switch to midwifery, but i'm also in the midst of orgo II and that has all of my attention right now.

The difficulty of studying midwifery, it seems to me, is the lack of good, stable, accredited schools in the US. One of my friends studied it for a while out in the west, and the school (I think) briefly shut down, and was just about to open back up when she was accepted into med school. They just seem to have a somewhat tenuous existence, which is definitely not the case for med schools.

But my question to you is - why do you want to be a physician? Is it just to deliver babies? I think that the trouble with going into medical school because you "want to deliver babies" is that you often don't know what the everyday practice is.

Yes, ob/gyns deliver babies - but often in a way that midwives and doulas disagree with. And you will spend half your training doing things that are totally unrelated to obstetrics (i.e. gyn surgery, gyn-onc, urogyn, REI, etc.) This is what drives a lot of people away from ob/gyn - they can't stand gyn, which is what makes up at least 50% of your training.

Sure, family med doctors deliver babies - but you have to learn how to capably manage very elderly men with uncontrolled diabetes, CHF, COPD, cellulitis, etc. If your main interest in going to med school is delivering babies, are you willing to spend large portions of time taking care of elderly men?

And you can advocate for changes to modern obstetric care without being a physician as well.

 

[kimiij]

But my question to you is - why do you want to be a physician? Is it just to deliver babies? I think that the trouble with going into medical school because you "want to deliver babies" is that you often don't know what the everyday practice is.

Yes- I really just want to deliver babies. I do want to work with new moms too (breastfeeding, infant care, attachment parenting, etc.) I do know that most OB/GYNs have to do gyn as well, BUT there are OBs that only do obstetrical work. Also, what they might do is have NP doing the pap smears and such while they handle the deliveries. So, there are several options for how someone would want to organize their practice.

Yes, ob/gyns deliver babies - but often in a way that midwives and doulas disagree with. And you will spend half your training doing things that are totally unrelated to obstetrics (i.e. gyn surgery, gyn-onc, urogyn, REI, etc.) This is what drives a lot of people away from ob/gyn - they can't stand gyn, which is what makes up at least 50% of your training.

Midwives and doulas are committed to evidence-based obstetrics and there are doctors who are committed to evidence-based obstetrics as well (have you heard of Michel Odent?). So, I think that I could be set apart from most ob/gyns. I spend a lot of time on boards for women/mothers and there are countless threads looking for ob/gyns who allow intermittent monitoring, allow eating/dreaking, don't do routine episiotomies, etc. There is definitley a market for a different kind of obstetric care.

BUT surgery is exactly what I'm dreading (and why I'm considering FP)..hours upon hours of surgery just does not interest me. At. All.

Sure, family med doctors deliver babies - but you have to learn how to capably manage very elderly men with uncontrolled diabetes, CHF, COPD, cellulitis, etc. If your main interest in going to med school is delivering babies, are you willing to spend large portions of time taking care of elderly men?

Well, I've read up on FP who also do obstetrics and what I've found is that because of the obstetrics, their practice is kept young. You work with women as their primary care providers, when they're pregnant they stay with you for obstetric care, when the baby comes they stay with you for pediatric care as well, and they drag their husbands along for good measure . So, I am less worried about working with very old men with diabetes, etc. I probably will have to but I would want to shape my practice towards being "young" as I explained above.

And you can advocate for changes to modern obstetric care without being a physician as well.

I agree.

Basically, I agree with a lot of your points even though its not as black and white as you've made it seem. But, they're valid points nonetheless and something for me to think about.

 

[Comfortdoc]

You're forgetting about medical school and residency. That's 7-8 years of having to work with older patients, children, and different disease states that have nothing to do with pregnant women. That's a long time to be miserable or bored just to delivery babies when there's another option.

 

[smq123]

Yes- I really just want to deliver babies. I do want to work with new moms too (breastfeeding, infant care, attachment parenting, etc.) I do know that most OB/GYNs have to do gyn as well, BUT there are OBs that only do obstetrical work. Also, what they might do is have NP doing the pap smears and such while they handle the deliveries. So, there are several options for how someone would want to organize their practice.

So, I am less worried about working with very old men with diabetes, etc. I probably will have to but I would want to shape my practice towards being "young" as I explained above.

I think everyone goes into medical school convinced that they can tailor their practice to exactly what they want. (This is particularly true of people who want to do international, pro bono medical work.) Things don't necessarily work out that neatly. Sometimes they do, but they often require that the stars align correctly, and a lot of ingenuity, (and usually a private inheritance) in order for that to happen. The pre-meds like to cite certain cases of a doctor who had a tailor-made practice, but they never realize that these are the exceptions, and not the rule.

The kind of FP practice that you have described is possible in some parts of the country - but if you wander over to the family med forums, they make it pretty clear that these are the exceptions, not the rule.

Midwives and doulas are committed to evidence-based obstetrics and there are doctors who are committed to evidence-based obstetrics as well (have you heard of Michel Odent?). So, I think that I could be set apart from most ob/gyns. I spend a lot of time on boards for women/mothers and there are countless threads looking for ob/gyns who allow intermittent monitoring, allow eating/dreaking, don't do routine episiotomies, etc. There is definitley a market for a different kind of obstetric care.

Yes, there is a market for that kind of care.

But, as a resident, you often don't have the final say in what kind of care your patients get. If your attending decides to override you and gives a woman an episiotomy, what are you going to do? Worse, as a med student, if your attending instructs you to do an episiotomy, are you necessarily going to contradict him right there in the patient's room?

The point is, you'll have to endure years of training in which you do not have any real say in how your patients are treated. You don't just start third year of med school with the ability and freedom to practice how you like. If you don't agree with what your attending does to his/her patients in front of your eyes - tough cookies.

 

[BBCatcherVA]

I agree with the many perspectives presented that Ob/Gyn is half obstetrics and half gyn, but it is usually 75% taking care of women of child-bearing age. So I would say that while the med school and ob/gyn residency curriculum covers topics broader than what you may currently imagine yourself interested in, it is possible to view it as a means to an end: to be able to provide comprehensive healthcare to women of child-bearing age.
Just for some background, I toyed with going to medical school since high-school but hit some educational bumps along the way. I became fascinated with pregnancy and childbirth with the birth of my two children. I investigated several alternative career paths while finishing my undergraduate degree. I thought about becoming a certified childbirth educator, a doula, a CNM... anything to work with pregnancy and childbirth. I realized though that I would not be comfortable with the limited scope of those fields. I know that psychological support of pregnant/laboring women is very important, but not to the exclusion of physiology. Educating women about the birth process would be fulfilling but I can't imagine my involvement ending there. And I couldn't rationalize seeking a nursing degree (at this point, I already had an undergraduate degree) just to pursue being a CNM and the difficulties of working as a mid-level provider.
I am currently an M4 student pursuing an ob/gyn residency. I suppose my point is that you certainly have to do more than be a baby-catcher to get through med school and ob/gyn residency, but you can make an informed decision to pursue this path even with a "midwife model of care" philosophy. I agree that a 40% c-section rate is absurd, that episiotomy is unnecessary (to that end I have not seen any performed during my medical school rotations but I was the recipient of two as recent as 8 yrs ago), that we generally do a miserable job of supporting women in labor, that continuous monitoring is an unproven intervention, and so on and so forth. My plan is to work on these "problems" from the inside. I don't think that there is a singular "right" decision. Good luck to everyone no matter which path you choose!

 

[kimiij]

I agree with the many perspectives presented that Ob/Gyn is half obstetrics and half gyn, but it is usually 75% taking care of women of child-bearing age. So I would say that while the med school and ob/gyn residency curriculum covers topics broader than what you may currently imagine yourself interested in, it is possible to view it as a means to an end: to be able to provide comprehensive healthcare to women of child-bearing age.
Just for some background, I toyed with going to medical school since high-school but hit some educational bumps along the way. I became fascinated with pregnancy and childbirth with the birth of my two children. I investigated several alternative career paths while finishing my undergraduate degree. I thought about becoming a certified childbirth educator, a doula, a CNM... anything to work with pregnancy and childbirth. I realized though that I would not be comfortable with the limited scope of those fields. I know that psychological support of pregnant/laboring women is very important, but not to the exclusion of physiology. Educating women about the birth process would be fulfilling but I can't imagine my involvement ending there. And I couldn't rationalize seeking a nursing degree (at this point, I already had an undergraduate degree) just to pursue being a CNM and the difficulties of working as a mid-level provider.
I am currently an M4 student pursuing an ob/gyn residency. I suppose my point is that you certainly have to do more than be a baby-catcher to get through med school and ob/gyn residency, but you can make an informed decision to pursue this path even with a "midwife model of care" philosophy. I agree that a 40% c-section rate is absurd, that episiotomy is unnecessary (to that end I have not seen any performed during my medical school rotations but I was the recipient of two as recent as 8 yrs ago), that we generally do a miserable job of supporting women in labor, that continuous monitoring is an unproven intervention, and so on and so forth. My plan is to work on these "problems" from the inside. I don't think that there is a singular "right" decision. Good luck to everyone no matter which path you choose!

Thank you SO MUCH for your perspective- it is very helpful. I am actually a childbirth educator and doula right now (I need the extra money while I finish up my postbac program) and you are right that they are limited and mainly just stop-gap measures in my eventual goal of catching babies.

 

[Leukocyte]

Why is everyone picturing old men with DM when mentioning FM?

What happened to the kids, teens, and middle aged people?

I am a FM resident. My FM residency has an "OB Track" were we spend more time in L&D doing C-sections, vaccums and forceps. However, those of us who choose not to do the "OB Track" still get more than their fair share of deliveries (including c-sections) throughout the 3 year residency.

Just my .2 cents.

 

[kristina85]

OH MY GOD. this entire post is EXACTLY what i needed to read.

I am a nurse, just graduated in December, got into nursing to pursue a degree as a midwife. I'm 23, getting married this summer to a Teach for America teacher (he's going to law school after his 2nd year of teaching ends next year), and am completely devoted to the midwifery model of care. I never even considered becoming an OB/Gyn when I was in school because I love midwifery, I love birth centers, home birth, I took doula courses but never finished because I saw that a GOOD L&D nurse IS a doula. I now work at a high-risk hospital in Maternity Float in NYC. And I am just not satisfied with the level of autonomy I have as an RN. I want to be the provider. Which is why I wanted to go pursue my CNM. Except I feel it will really still bother me to not have full autonomy in my practice.

Also plaguing me is that I REALLY want kids. I know I'm young, I know, I know, but I've ALWAYS wanted to have my kids young & I just feel like med school will totally detract from my ability to enjoy life and have a family before I'm in my 30's, which is not what I want at all.

I am very domestic in terms of my loves--I love to cook, I love to nurture, I always wanted to be a stay-at-home mom. I also have lots of undergrad student debt (around 70k) and really dread the idea of accumulating MORE of that debt.

I, too, only want to catch babies & do childbearing/women's health care. I hate the idea of doing surgery just because I think the OR is boring as hell & generally I don't believe in the ludicrously high C-section rate. I would never EVER 'schedule' a C-section 'just because'. NEVER. But I'm beginning to think that if I want to be able to have a fulfilling career with the level of independence and autonomy, maybe I need to go to med school. PLUS then I can back midwives! I am really passionate about workng with underserved women especially urban Latina populations and feel it would make a big difference to have a quality OB physician who is woman-centered and not machine-centered.

So the general consensus is that I would be able to have a baby, maybe? At some point in the next five years? If i begin a Postbac program in September? (I went to BC Nursing & did not need to do Orgo, so I'm really doing it all again...Maybe my Calc will count though I doubt it..)

The other thing is so much of my planned identity and how I see myself is as a Midwife. It's been that way for years. I am in the process of waiting to hear on admissions to midwifery programs. And I know that I'm a strong nursing candidate, but I feel that sciences are my weaker aspects & so it's hard because I could go to a TOP midwifery program at an awesome college & have it take 2 years and only probably $30,000 in more loans. But med school is MUCH harder and more competitive to get into, so I feel like I'd have to compromise and go to a lesser-school. I know that sounds shallow but hey. Not to mention I'll have SO much debt at that point (by the end of med school...plus my husband's debt from law school....)

But I feel like I should leave finances out of the equation and just focus on what I love: delivering babies and working with women. Continuity of care! Autonomy! And I mean, midwives take call shifts too, another crappy aspect of OB, so I have already tried to adjust myself to that idea.

I didn't do pre-med in college because I said "I don't want to hold off on living my life until I'm 30". You guys don't think that's true? You think I can still have (somewhat) of a life??

The other thing--OB's can't do homebirths, anywhere in the US, can they? that is something i would really like to do eventually in my practice, and CNMs in SOME states around me can do that, but i don't think OBs can anywhere due to insurance.

Sorry this is so ridiculously long...

 

[DrJillDiana]

I'm like the previous post- want to be an OB and practice like a midwife- to some extent. ... I'm in public health and perinatal psychology now. . . . .

 

[OBGirlie]

Not a good idea to put off childbearing for careers. While you may think you are fertile until 40+ this is not true. At age 40 risk of fetal anomaly is close to 25%.

And more importantly than the anomaly risk, you have to find a way to live life WITH medicine, not let medicine live your life for you. That will only lead to job dissatisfaction, family conflict making you less able to give your patients your best.

 

[mdocfuture]

Any more feedback on this? This is what I want to do to. Have the autonomy of a physician and be a physician, but practice like a midwife. As a OB/GYN you would be able to handle the high risk pregnancies, c-sections in addition to the low, risk and healthy pregnancies. Any more thoughts?