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Backgrounds
of CNMs Rich in Diversity
A career in nurse-midwifery offers an individual diversity and independence
in practice and attracts prospective students from all walks of
life. America's
certified nurse-midwives (CNMs) are former elementary school teachers, writers,
missionaries, general practice nurses, etc. They mirror today's society--rich
in diversity. However, they all share a deep commitment to bettering maternal
and child
health, not only in this country but throughout the world. Today's CNMs
provide personal, family-centered, understanding care in many different
practice settings. CNMs are highly skilled health professionals
who are able to draw on the vast resources of modern science to give
women the best care possible no matter where the practice setting.
HOSPITALS
According
to a 1990 survey by the American College of Nurse-Midwives (ACNM),
23.2% of CNMs are employed by hospitals: either public, private,
university or military. In addition, almost 95% of births attended
by CNMs were
in hospitals. The roles they play in such a setting vary greatly--from
intrapartum care only to prenatal care to well-woman care to
full scope care. The most recent innovation in hospital obstetrics is
the creation
of labor and delivery rooms that provide a more comfortable atmosphere
for deliveries. Added features include showers or jacuzzis to
ease
labor and more privacy to begin breastfeeding.
- Working
in a hospital is a wonderful set up for CNMs who like practicing
with physicians always around. If we ever need doctors, they're
only a page away. My particular hospital is a teaching hospital,
which gives me the best of both worlds. In addition to seeing my
own patients, I also have the opportunity to teach medical students.
Because every medical student here learns how to do a pelvic exam
from a certified nurse-midwife instructor, we take great delight
in knowing that we're making a difference in how the future medical
community will view and treat the importance of nurse-midwifery
as well as individual CNMs. I see the growing acceptance of nurse-midwifery
by students and residents.
Barbara Orza,
CNM, University of Oklahoma School of Medicine Health Sciences Ctr.,
Oklahoma City, OK
HEALTH
MAINTENANCE ORGANIZATIONS AND MANAGED CARE
With the
advent of Health Maintenance Organizations (HMOs) 20 years ago, the
managed health care system was initiated. Today, Preferred Provider
Organizations (PPOs) and Independent Practice Associations (IPAs)
have been added to the health plans that offer a variety of capitated
payment
systems through provider networks set up by insurance companies and
employers to control soaring healthcare costs. CNMs are being employed
by these managed care medical facilities, primarily in HMOs. CNMs
have proven themselves as cost-effective, quality healthcare providers
for
OB/GYN care and family planning. In 1992, Kaiser Permanente, a California
HMO, reported CNMs managed 70% of the low-risk patients and had lowered
the C-section rate to 12%, compared to the national average of 23.5%.
- I really
didn't know much about nurse-midwifery until after I had my own
children. I was working as a nurse in many different areas...Then,
I had children. My birth experiences were absolutely wonderful
and, consequently, changed my career outlook...So I decided midwifery
was the answer for me. As a CNM, I have considerably more opportunity
to effect change...An HMO is like a whole health care community
or family. Patients can come to our facility for any problem under
the sun and we'll have the specialists and means to treat them...I
never have a problem finding someone to discuss various aspects
of a case or finding someone I trust to refer my patients to, either
for high-risk obstetrics or a completely unrelated problem. Furthermore,
HMOs allow me the opportunity to build long-term relationships
with clients.
Lisa Wachholz
is a staff CNM at Physicians Plus, an HMO in Madison, WI.
PRIVATE
PRACTICES
A large number
of CNMs work in private practices. These practices include: private
OB/GYN practices with physicians, private all-CNM practices, freestanding
birth centers and home birth practices. CNMs seek to work in private
practice for more independence, less bureaucracy and institutional
rules, allowing them to empower their patients in making healthcare
decisions.
- I feel
working in a private practice with a physician creates a perfectly
balanced setting...I am able to be my own boss and practice in
the way I want. Because I don't feel providing health care and
birthing babies is a "business," I don't run my practice as one.
Too many health care "businesses" forget their objective: caring
for people...Working with a physician is not only rewarding and
convenient for me, but also my patients. I have developed a strong
relationship with my partner physician...He knows what kind of
care I've been giving to those patients I refer him, and I know
what kind of treatment they're going to receive from him--the best.
Pady Dusing,
CNM, practices with Dr. Birky, Kalispell, MT
BIRTH
CENTERS
CNM care
in birth centers to date indicates that birth centers result in financial
savings, are well-liked by women and families, who generally return
for care in subsequent pregnancies, and, with application of recommended
criteria and standards for operation, are as safe for normal childbirth
as short-stay and conventional hospital care. When CNMs are asked, "Why
a birth center?" the general response is, "So that I can provide the
kind of care that healthy women and childbearing families need and
want."
- Before
I became a certified nurse-midwife, I worked as an OB/GYN nurse-practitioner.
As a nurse-practitioner I had a great deal of independence, but
I was unable to provide continuity of care...I wanted to deliver
my patients who I had given prenatal care to and developed a relationship
with. So, I enrolled in the University of Pennsylvania's nurse-midwifery
program and here I am now--delivering babies...The biggest advantage
of working in a birth center is that I don't have to adhere to
any institutional guidelines other than those designed to insure
my patients' safety...In our birth center, women have control over
their environment at a time when they have no control over their
body.
Amy Levi,
CNM, The Birth Center, a freestanding birth center in Bryn Mawr, PA.
CLINICS
Public
health clinics--both independent clinics and those associated with
a hospital--have
long served as facilities that specifically cater to the needs of
indigent and underserved populations. Since the beginning of nurse-midwifery
in the U.S., CNMs have been dedicated to providing care to less fortunate
women. Today CNMs in all types of practices are providing care to
women
from populations that are vulnerable to poorer than average outcomes
of childbirth because of age, socioeconomic status, refugee status,
and ethnicity. A study on vulnerable populations published in the
Journal of Nurse-Midwifery concluded that CNMs, as a group, make
a major contribution
to the care of vulnerable populations.
- Part
of my practice is devoted to Lincoln Hospital's satellite clinics.
In both the hospital and the clinics, I care for a great number
of adolescents. Because of their youth, they require very personalized,
education-oriented care--the kind of care I am able to give them
in our clinics. I have always enjoyed the health promotion aspect
of my profession, and in my situation, I am able to see results
and make a difference. I find pregnant women to be very receptive
to education. We try to get their families and boyfriends involved
in the educational process, too. The combination of the educational
philosophy and family involvement really works to make the woman's
childbirth experience comfortable and, more importantly, successful.
Mary Widhalm,
CNM, Lincoln Hospital Midwifery Practice, New York City
HOME
BIRTH
CNM assisted
home birth assures that women will have access to needed technology
if required. Home births attended by CNMs meet the needs of many
childbearing families for more personalized care in which the
woman retains control
while the CNM insures the patient's safety and provides emotional
support during birth.
- I became
interested in midwifery through gathering information on birth
options. I soon found my niche in home births. Being self-employed
has always been a dream of mine. When I became a nurse-midwife,
my dream became a reality. It's wonderful being a home birth midwife!
One has to have excellent skills and lots of self-confidence in
order to function in the home setting. The relationship with my
consulting physicians is truly collegial, with mutual respect.
Home birth clients are generally very motivated and well informed
people. The most wonderful aspect of home birth is helping clients
give birth on their own "turf"! The client and midwife have a shared
responsibility for the birth. Therefore, the client and her family
have more control and are secure in knowing that their birth attendant
is a highly skilled and sensitive person who will take an active
role in helping them accomplish their birth plans.
Marsha Jackson,
CNM, Co-Director of BirthCare & Women's Health, Alexandria, VA
INTERNATIONAL
HEALTH
Before nurse-midwifery
was widely recognized and accepted in the U.S., a great number of
nurse-midwives focused their energies on the betterment of maternal-child
health worldwide.
ACNM established its Special Projects Section to accommodate the
demand for CNMs to be involved in international projects, as
more and more
international health organizations are funding projects for nurse-midwives.
- Before
I became a certified nurse-midwife, I worked in many different
fields and obtained many different educational degrees...I always
had an interest in health, especially public and international
health, but during my time in the Peace Corps I developed a deep
interest in maternal and child health...Thus, when I returned to
the United States, I looked into nurse-midwifery, for it would
allow me the more freedom in doing the kind of work with women
and children that I wanted to do...In international health, much
of the work benefits underprivileged women. I get so much satisfaction
out of getting health care services out to women who can't afford
it or who are geographically disadvantaged. I also find it particularly
exciting to work with the local people and learn their culture.
Gail Allison,
CNM, Oakland, CA, recently returned from Nigeria, where she worked
for the Special Projects Section of the American College of Nurse-Midwives.
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