Finally! I'm starting to see several patients for several of their prenatal visits -- and even seeing them at both their birth and their postpartum check up too! This -- the continuity of care -- is what I have been looking forward to as a midwife.
You see, as the labor and delivery nurse, I do get to care for some women repeatedly during their pregnancy, but it's usually because they are either hospitalized with complications, or are in and out for multiple outpatient visits. Although I do love that part of my job as a nurse, it is definitely not the same as seeing women over the course of their pregnancy, birth and postpartum period as the midwife. Plus, as the midwife, I take a more important role, because I am actually doing education and teaching, as well as offering treatment options to women and their families.
It's just ...... different. But a good different! I like it!
The other thing that's different as the midwife is that I am the one making management decisions/offering options (if there are multiple options). Instead of just gathering assessment (subjective and objective data - what I do as a nurse), I am gathering the data, formulating the diagnosis, making management decisions and providing comprehensive education.
I freaking LOVE IT!
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I still have moments where, when I am working on L&D as the nurse, I start wanting to make the decisions on the plan of care. I have to be careful not to overstep my boundaries, especially when it comes to the minutiae of explaining options and risks vs benefits. For example, even though I want to tell a woman that it is her right to decide if she would like to VBAC or have an elective repeated c-section, my mouth is often taped shut because the MD doesn't bother to offer it (VBAC) as an option. This all truly depends on which MD is on call that day, and what type of mood they're in. This is what happens when one works as a nurse in a very VBAC-unfriendly hospital environment. (Which is so different where I am doing my midwifery clinicals!)
Other things as a nurse: I technically cannot tell an outpatient client that she has a urinary tract infection, based upon the urinalysis results. As the RN, that's out of my scope to make a medical diagnosis and tell the patient. I can skirt around it though, by telling her that it looks like she *might* have a bladder infection, but I'm going to run your results by your doctor/midwife, and he/she will be in to talk to you. Sounds crazy, right? But it's a matter of sticking to my scope as the RN. It's frustrating.
However, there are providers (mainly, the midwives, but also some of the docs) that I work with that totally trust me on my ability to make a medical diagnosis. They trust my assessment of the patient, my thoughts on the possible treatment options, and take that into consideration in their management. I really respect that they trust me like that. Then again, I'm about 90% of the way towards becoming their peer as a very-near-in-the-future CNM.
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I love it when a laboring woman arrives back on L&D after I have seen her as an outpatient evaluation several hours before, and I have that gut feeling when they left earlier that they will be back in active labor ----- and they come back in active labor! I call it my "Spidey Sense". Sometimes, I seem to have this knack for being able to just observe someone and know what's going on with them. Kind of like when I can see a pregnant woman and know that she has preeclampsia: she just has this "look" about her. Hard to explain! Maybe it's the generalized facial edema, or the under eye circles, or just that they look "sick". I know that other nurses have this ability to just "see" when someone is sick. Please tell me I'm not alone!
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Anyway, hoping for some more births this weekend. I am ready to add some more to my birth log!
5 comments:
Yes, I too found the ongoing care, from antenatal through postpartum, to be the most satisfying part of midwifery. I think it is for the patient, too -- to know she has an address for all her concerns throughout her pregnancy. In the UK, where I trained, the midwife's legal responsibility extends from the time she is notified by the GP that a woman is pregnant until 10 days postpartum. Many district midwives also could put women in touch with one another when one had baby stuff to sell or give away and someone else was looking for it.
The "sense" you mention is very real, and I have it too. In my last job, in a Women's Health Center, I used to amaze my non-midwife colleagues with my "instant" [and usually correct] diagnoses as patients arrived, often for other reasons altogether.
Glad to see you're finally doing the "real" midwife stuff; so much of the early courses you took was "padding". Real midwifery, like nursing, is very different from the public perception of "baby catching".
I so love reading this...
It is nice to see how a nurse soon to be midwife views the clients who come in. I like that there is that thought out there for a woman's best care. It's very comforting. I also love the continuity of care with midwives...in that they do one thing my OB's and family docs have never done in birth. They are there IN THE ROOM and they CAN read me. It's odd to have someone just know things by observation, but midwives (and some really good nurses I've had) just know. But also, my midwives have responded well to my emotions as well. I love that they "get" that I don't want to be bossed, I AM the momma after all. They understand that I felt abused once in labor and don't want too many VE's. I don't want to regret my choices in labor, so they make double sure before they do anything. I'm not just a part of the job to them, I'm a woman and they actually have THANKED ME for the honor of being there for my baby's birth. Isn't that the coolest?
Blessings!
Dawn
I'm a NICU nurse, and I can often tell when a baby is getting sick--often long before lab results or radiology tests confirm it. We have a lot of residents in our NICU, and I tell them that if a nurse tells them "I don't have a good feeling about this"--TRUST them! Nurses have a certain intuition that doctors should respect!
PS I'm in my MSN program for FNP, and I feel your pain about feeling limited in my RN role! Although, I still have 2.5 years until I'm done with my program!
I absolutely love the continuity of care as well :-). Welcome to midwifery!
I don't think ob/gyns can really appreciate the knowledge to be gained by observing women throughout labor rather than just at a couple points. I'm a doula, and I sit with women laboring at home and help them determine when to go to the hospital. I can almost always tell where they are in the labor process. I recently had a client who arrived at the hospital 6cm. The doctor asked when labor started and why she waited so long to come in. She told him she wanted to wait until active labor. And she told him that I suggested they go in at such and such point. He said well what was she when you checked her at home. I told him I don't do that. He asked how I knew how far along she was then, and I told him I've seen a lot of women in labor and had several kids myself. There's a lot to be said for observation and intuition.
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