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what do we think of CNMs?

Discussion in 'Topics in Healthcare' started by brightness, Apr 10, 2007.

  1. brightness

    7+ Year Member

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    I do not want to go to medical school, necessarily, but I would. However, I am very interested in holistic childbirth and with women's health. I've thought about doing a certified nurse midwife program. I want to know that these professionals are able to handle their jobs effectively, but I've never heard anything to the contrary. Do you have opinions?
     
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  3. vegetables

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    First I would say only go to med school if it's a passion, not just because, because you will hate it otherwise (and your OB residency, too!). I was looking at some of your other posts, and I think it's especially relavent given your situation.

    On the topic of midwives, I think as with docs, nurses, etc there's the good, the bad, the ugly. On my residency interviews I found some programs that utilized the CNMs in mentoring residents and teaching quite a bit, and the ones I met were impressive and probably do great jobs. Those hospitals seemed to have a great CNM-doctor relationships. But I think that may not be the case everywhere...

    There are lots of ways to get involved in women's health that don't involve an MD, and a CNM may be just one option...
     
  4. tiredmom

    tiredmom Senior Member
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    As usual, vegetable has great words of wisdom. I've worked with some amazing CNMs, and some that scared the bejesus out of me. The professionalism starts within you. Most are great, some have chips on their shoulders and take it out on everyone they can... like in MANY fields. If you are really into holistic care and obstetrics, it's a great field.
    Good luck. :luck:
     
  5. vegetables

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    ....please call my mom and tell her that... ;)
     
  6. brightness

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    What other sort of opportunities are there? Obviously, I could go for Ob-gyn PA, I suppose. I've thought about it extensively, as many people seem to think that the PA education is far superior to that of an NP. Still, I think that for women's health, nursing is a great field to be in.
     
  7. emedpa

    emedpa GlobalDoc
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    have you looked into doula training? they are fairly holistic in their approach.
    we had one in addition to the regular staff at the hospital birthing center and it was definitely worth the extra money.
    doulas are essentially birthing assistants or coaches. they are there to help the parents with the birthing process through breathing exercises, recommended positions during labor, etc
     
  8. vegetables

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    You could also get an MPH and focus on Maternal and Children's Health. Look at this decription. Then you could apply it ina bunch of different ways, both clinical and non-clinical.
     
  9. tiredmom

    tiredmom Senior Member
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    Do PA's and NP's deliver babies? I've never worked with an ob/gyn PA and the NP's I've worked with only did office visits, not L&D... that might have been their choice though, I'm not sure. Anybody know?
     
  10. Bernalillo

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    I believe that being an NP preculdes you from doing deliveries. A CNM is more of an advanced nursing degree, though, as well. Maybe you could combine them though?
    Check out this site: http://www.allnursingschools.com/faqs/cnm.php
    I think being a midwife could be awesome and I've seen some great partnerships between OBs and CNMs (of course there are some ugly ones too). But if you really like surgery obviously an MD would be the way to go. Being a midlevel provider also means that you really have to know what your limitations are and when to call the MD. I'm not trying to sound like a snob, because obviously the MDs don't always know what they're doing, but you get my point.
    I wish I would have considered PA, NP, and CNM tracks before medical school. But oh well, here I am on the eve of Ob-Gyn residency!
     
  11. brightness

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    I am still debating. I really want to have a good knowledge base and scope of practice, but I also want to do holistic care. Today I saw a D.O. for an annual and I felt like she was really a model of the physician/provider I would like to be. I am not hell bent on surgery, but honestly I'd like to be able to make the majority of the 'calls' in any case I handle. I can't completely figure out how to blend an interest in complementary medicine, medicine, and women's health, but I know those are the areas I really want to work in. My math skills are HORRIBLE, but I've never really focused on trying to improve them. I am good at biology and good with people...currently finishing a psychology major as a junior. Although I would be a year behind, I could still take the classes to apply to med school.
    My major question is- do you regret medical school and becoming an OBGYN?
     
  12. vegetables

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    My goal is to be able to blend all those things together when I am practicing. I want to be the MD that is at least familiar with the complimentary medicine techniques that my patients are using (mainly to be aware of safety issues but also incorporating the ones that do work) and have good relationships with comp med providers. But I am also highly interested in the surgical/management of complicated medical patient aspect of OB/GYN, and so OB/GYN was ideal. I think you have to really be sure that the long hours of OR, rounding, etc will be able to fulfill you when you can't be doing holistic stuff...or at least make you not hate life.


    I may be crazy but I've loved medical school....to me it was easier than college b/c finally I could breathe a sigh of relief and say "ah I made it." But I truly loved 2nd year and didn't mind all the path, and loved the majority of my clerkships, so I think I may be different from many med students who sometimes seem a bit bitter!! I really think it's a huge decision though and probably the reason I didn't mind med school was b/c I REALLY made sure it was what I wanted to do before going for it. So think it through long and hard and if you decide it's for you, best of luck! But don't feel you can't do women's health care w/o an MD....there's lots of options if you decide that too.
     
  13. brightness

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    Thanks for the reply. I sort of do feel that once I got into med school I would feel better, but I have a good deal of anxiety about getting there. I've thought a great deal about going into psychiatry and IM as well, and lately I have been thinking a great deal about going the med school route.
     
  14. emedpa

    emedpa GlobalDoc
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    yup- pa's can do deliveries. I did several as a student.
    there are pa's who work only in L+d as well as obgyn pa's who work in the o.r. and in clinic. there is even a pa residency in obgyn(see http://www.appap.org/ca.html#one )one of my former students attended the residency and did > 100 solo deliveries during his residency in addition to 1st assisting lots of sections, learning colposcopy, endometrial biopsies, care of high risk ob pts, etc
     
  15. tiredmom

    tiredmom Senior Member
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    Cool - thanks for the info!
     
  16. OB/GYN RNtoMD

    OB/GYN RNtoMD ASA Member
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    Well, I was a L & D nurse for several years before entering medical school. Now I will be an intern in Ob this June. Now, what made me go into medicine? Well, I knew floor nursing wasn't working for me. I just have an assertive disposition and I always wanted to know everything in depth regarding my patients. I felt that with that knowledge it would enable me to make treatment decisions all of which were beyond the scope of my role as a nurse. So, I thought about becoming a midwife and I decided against that. Reasons: your role in delivery is somewhat limited. They do "normal" vaginals and to my understand were to call the Ob for operative deliveries. Also, they can't do c-sections and I just felt all of these reasons still would leave me wanting I guess you could say "to do more". But the midwives I worked with were definitely the "hands on individuals". They would spend a very great majority with their patients and yes some MDs are "touchy feely" but the lifestyle of an Ob definitely precludes them from having that time and personal relationship that a midwife can acheive although they would like it. So, I went to med school. I enjoyed medical school a lot except 3rd year. The personal reason I didn't like it is because you are soooo low on the totem pole and when you've had a career before and kids like I do, it tough. It's demanding of your times and people can just be rough. But overall I learned so much I get migraines and I really did have a good time. Now talk to me this time next year after intern year and we'll see. Sorry bout the extended response but hope it helps. :)
     
  17. Noyac

    Noyac ASA Member
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    I come from a different perspective but it really gets to me when people want to take the short cut to get somewhere. A cnm is someone with limited knowledge who does a defined task (deliver babies). I personally want to have as much knowledge as possible. Therefore, I went to Med Sch. If you go to med sch and do a Obgyn residency, you can still offer a holistic ob experience to your pts but with some knowledge to back it up. Trust me, the difference is huge.
     
  18. brightness

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    You know, I'm beginning to see that...and the midlevel role doesn't seem like it will satisfy me. So, I am back to the med school thing- and thinking about doing clinical psychology still as well.
    UGH. I gotta make a decision.
     
  19. WhoisJohnGalt

    WhoisJohnGalt NYC Psychiatrist
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    I've been watching your struggle on various threads, and I have to finally throw my two cents in... I really think that the best way for you to make this choice is to spend as much time as you can spare shadowing each of the fields you're considering. Then try to imagine as best as you can which one would make you happier. Don't worry about the training it takes to get there... no matter what path you choose, if you really want it, you'll get through the training. Just focus on which CAREER will make you happier. And that's really hard to decide without seeing the day-to-day lives of people on those paths with your own two eyes. Best of luck! :luck:
     
  20. Diane L. Evans

    Diane L. Evans SDN Moderator
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  21. zenman

    zenman Senior Member
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    I've been thinking about the term "career counseling...." Maybe a few therapy sessions...hypnotherapy, lol!
     
  22. brightness

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    Yeah, I'm a crazy. Thats part of what makes this decision kind of difficult. I was diagnosed with bipolar disorder about 6 months ago, and although I am really interested in medicine, I'm not sure about high stress careers. So, I've really been thinking my options through. :) I feel passionate about medicine, but I don't want to be so stressed and overwhelmed that I have episodes.
     
  23. Josh L.Ac.

    Josh L.Ac. MSA/LAc & BSN/RN --> AA-S
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    My wife and I [well, mostly her] exclusively used a FNP / CNM for our son's birth. She did all the antepartum care, delivered the baby, then did followup for a few weeks.

    There was an obstetrician on the floor, but we never saw him/her.
     
  24. zenman

    zenman Senior Member
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    Ah, the shaman nails it again, lol! I would think most healthcare careers where you actually take care of patients are stressful. Have you thought about something a little different say, medical anthropology?

    My ex was a faculty CNM for 20 + years at a Louisiana university teaching hospital but was pushed out when an ex Army guy came in who didn't like med-levels.
     
  25. brightness

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    *grum* Its just a hard decision. I don't know what to do. I am very interested in going into psychiatry- I have a huge, insatiable interest in brain function and behavior. I'm a psychology major and I've thought considerably about going into clinical psychology. I know this is different from the topic of this thread, and yes, I'm very interested in women's health as well. However, I don't think I would want to be an ob-gyn, even though I was interested in a midlevel career in women's health. Annyyyywayy, :) I felt like opportunities in clinical psych to get involved with 'brain stuff' were scarce, and you can't write perscriptions. That leads me to the idea of med school.
    And thats my story.
     
  26. hilseb

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    Sorry, I haven't read all the replies, so this may have been answered.

    When I trained as a midwife, (didn't finish, going to med school...) I worked under a CNM, ARNP, a nurse practitioner midwife. She did well woman gynecology and could deliver babies in a hospital, birth center or at a home birth.

    Keep us up to date. I was in a similar situation to you, passion wise, but my passion to be a doctor came first, and then my passion for birth and holistic women's health. I think med school is the best path for me, but the world needs women like us in all disciplines. Good luck!
     
  27. hilseb

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    I have a friend who has a Masters in Feminist counseling, and is a counselor at a women's clinic. She loves it, and makes very little money. I also have another friend who is bipolar and is a pediatrician. She does have episodes, she is stressed out, and may tell you she regrets it one day, and loves it the next. That was not a bipolar joke (really), I think that is true of a lot of us. She thinks life and her mental health will be in a lot better shape when she is in private practice, not in her residency. I have another friend, also bipolar, who just graduated as a surgical nurse at the top of her class. (I wish I knew the program). And, all of these people are mothers.

    With luck, passion, and persistence, you can accomplish any of these paths. But, choosing the right one can make a big difference in your quality of life, depending on what your priorities are. I feel your pain, really I do, and I think I picked the right path (after wandering a bit). Keep us up to date.
     
  28. km446

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    Can you please clarify what you mean by "the difference is huge?"

    I've seen a lot of posts that suggest that midlevels, such as CNMs, are inherently inferior. In fact, the role of the midwife is to be the guardian of normal birth (i.e. vaginal). Normal birth is not a medical problem, per se, but rather a normal life process. It shouldn't, therefore, necessitate the care of a surgeon - the ob/gyn. Ob/gns are trained for high risk births that may need intervention due to possible complications, that is why they have more training than midwives. We need midwives to help fill the huge shortage of OBs in the country, and I hope that physicians will recognize this need and support the growth of the midwifery profession.
     
  29. km446

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    Zenman,
    I am currently considering a career as a CNM, but I want to know what their lifestyle is like first. I live rurally where the midwives do only home births and the volume isn't that high. How many hours/week did she work? Was it a good career fit to have a family and be able to spend a lot of time with them?

    Thanks!
     
  30. zenman

    zenman Senior Member
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    She and another CNM worked fulltime in a medical school for the ON-GYN chief. She's my ex but I don't remember her complaining. She's also an FNP now.
     
  31. hurdlepup

    hurdlepup Surviving Intern Year
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    1st - Normal birth can be a definite medical problem. The evolutionary bipedal trend has rendered several difficulties with the process, not to mention certain bugs you don't want mom to share with her new biped.

    2nd - It doesn't sound like you are CONSIDERING midwifery, it sounds like you are a proponent for the career.

    But hey, just saying...
     

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