labor nurse has been reborn and shares her experiences as a new nurse-midwife, woman, and blogger

Saturday, December 13, 2008

Thoughts on Why I Can't Get a Job

Several posts back I wrote about a doctor asked me for my assessment on whether a woman was fully dilated or had an anterior lip. I found it ironic that I was trusted enough as a CNM who happens to still work as an RN by the doctors that I work with yet none want to actually work with a CNM, let alone hire one.

This post got the following comment that I have been thinking about since:

Sounds like where I live. There used to be six or eight midwifes at the local hospitals; now we are down to two. I'd like to someday become a CNM but would anyone hire me? I'm in an isolated area and because of my husband's career can't move.And they say there is a midwife shortage? Sure...but will they let the midwives in? So much hostility - on both sides - that I think might be playing into the problem. And there really shouldn't be. We all want the same things at the heart of it, I really do believe.Would love to hear more about your thoughts on all of this.

I've heard about the midwife shortage, as well. But it's hard to believe there is one when there are midwives in many areas who can't find jobs. When I was still in school, and had to travel for my clinical sites, I met several nurses who were CNMs. Why did they still work as RNs? Same reason as me- can't find a job, can't relocate at that time.

When I was in school, most of my preceptors seemed surprised that I would not be relocating for a job. I really hate getting into all the reasons why with all these people. And I won't get into them here. And besides the several things that tie me to where I am right now, why should I leave the area and women I want to serve? I happen to really like the area I live; I actually like the hospital I work for and wish I could just stay and change my roles. It's been very cool to care for women and their families and have them come up to me in Target or the grocery store showing off their now grown baby, saying they remembered such and such thing I said or did. I even had one woman say I needed to tell her where I ended up practicing as a CNM because she was going to switch her care over to me. Why would I want to leave this?

I also happen to believe that nurse midwives are desperately needed in my area. We had a large exodus of them several years back, and not by their own doing. The hospital dumped them. Those who were pushed out our door were snatched up by a hospital about 30 miles away and they have increased birth rates at that hospital by 60%. This hospital was already the leader in birth in its region, it just didn't have any midwives until they went over. And clearly that area needed them- women wanted them.

Not surprisingly, the birth numbers at my hospital has been steadily decreasing each year.

One of the things I noticed in my both my years as an obstetrics nurse and a student midwife who did my clinical training in large city hospitals is that the large city hospital obstetrics practices had large flourishing midwifery practices. This allowed the doctors to attend to the high risk population and gynecology while the midwives did the majority of normal births. This worked well for all involved. The low risk women got superior midwifery care and those who needed more intensive obstetrical care were attended by highly skilled physicians.

In a smaller city or a community hospital, the dynamics are different. First, just the sheer numbers of women seeking regular ob/gyn care are smaller. As is the high risk population. In these areas most women go to physicians who kind of do it all. Therefore, the competition is greater because there may be a good number of providers for a smaller number of women. At least, this is how it is in my area.

Then add midwife hostility to that, and therefore difficulty finding a place to practice.

I am very close to start researching how to start my own practice. It is very overwhelming, however, to even think about. Part of my problem is being afraid of some of the powerful opposition I may be up against. But I know there is a need where I live. Women need midwives, and they have to travel to find one right now.

So those are my thoughts. For now.


Ethel said...

Have you contacted the Navelgazing Midwife about how she put together her own practice (just google her blog under that name, she's Barb, she's a lay midwife but successful)? If you have that many gals who respect you and desire you for care-giving, then you already have a large client base you just need to provide to them. I know there are places in the country where midwives are setting up birthing centers adjacent to hospitals, it's not a hospital of course but it's in close proximity if there is need.

Ugh. Regardless, keeping up your bravery and resolution, it's to the benefit of all us women when one of us steps up like you do.

Renee said...

Perhaps the rejection is a sign to you to start your own practice? You certainly seem to have the drive and desire to do it. Good luck to you!

TJWriter said...

I wish we had CNM's around here as it would have been the choice for both of my births. However, I did have a much better doctor the second time around and a beautiful newborn to prove it.

Everything in my area is very medical oriented and I would love to see more natural methods favored.

MrsSpock said...

I used to see a fantastic midwife group practicing locally, and they were forced out by the local hospital- they weren't bringing in enough money to offset the malpractice insurance that was equal to the physicans' cost. Such a shame!