Being a CNM is Lovely

Let me start off by saying that I am first and foremost a Midwife and I have learned that life often takes us to places we may never had anticipated. But for me, being a CNM is lovely. heart.birthWhen I first decided to commit to this journey and become a midwife, I was absolutely going to become a CPM. I had zero interest in working in a hospital and never wanted to become a nurse.

Then I started to look for a preceptor and quickly became acquainted with this well known struggle! Eventually, I found an experienced homebirth midwife who would consider taking on an apprentice. However, I quickly realized that we had diametrically opposed philosophies, and that a relationship would not work. While I re-started the search for another apprenticeship opportunity, it also became clear that as a single mother to a young child keeping the schedule of an apprentice midwife would be nearly impossible. These factors caused me too look at other options. I started nursing pre-requisites at a local community college; reasoning that I would learn good information on A&P, microbiology, etc that could be useful as either a CPM or a CNM. I kept up the search for an apprenticeship and become involved in the local childbirth community. I still hoped, prayed and worked toward becoming a CPM. Then seemingly before I knew it, I was done with the pre-reqs and had to choose whether or not to apply to nursing school. I begrudgingly filled out the nursing school application. In my area of the country, in 2002, it was nearly impossible to get into a nursing program and it was common to spend a couple years on a wait list. I assumed that if I even got in, it would be on one of these wait lists.  To my complete shock and awe, I was accepted on the first try! After some serious contemplation, I decided to take this as a sign, made a HUGE leap of faith and went to nursing school.

Fast forward many years, trials, tribulations, a new marriage, joys and sorrows, a new baby, a few more years and I came out re-birthed as a Certified Nurse Midwife. In hindsight, which is of course always 20/20, everything worked out perfectly and as it needed to. I am thankful for everything that being a nurse taught me and I am proud to be able to call myself one. When I started this path, I had starry, rose colored glasses and was high on the idea of birth and babies. I had no idea how much I would also fall in love with full scope women’s health care. I appreciate that, in many years, when the realities of being on call will become difficult I can choose to still serve women, just in a different capacity. Additionally, the security of being able to practice in any state or even internationally is comforting.  The past few weeks, and these cases, have exemplified why I love being a CNM and why I love working in a free standing birth center;

  • A sweet first time pregnant person at term calls to report that she thinks her water broke. A couple hours later I have her come in to the center and confirm that, indeed, the bag of waters has broken. We do an US to confirm that baby is cephalic (yes, I also did Leopolds and knew that babe was head down, but in these cases we also use the US) this way I did not do an internal, cervical exam. Because she is not in labor, we also do a Non-Stress Test or NST and the baby looks gorgeous. After a good discussion on all the risks and benefits and answering all their questions, she and her husband go home with some herbs to try and encourage labor to start. Several hours later, they call in a great labor pattern. When they arrive to the center, it is clear that she is in active labor and is entering transition, I do not do an internal cervical exam. We labor. A little while later, while in the birth pool she begins to spontaneously push and shortly thereafter gives birth to a beautiful baby. She never, during the entire course of her pregnancy, labor or birth had an internal cervical exam and I love that!
  • Recently, one of my midwife sisters had a client in for a Well-Woman exam who wanted a photograph of her cervix. We were excited and made that happen, it didn’t even phase us.
  • I have collected a pap smear while a toddler was latched and nursing and placed an IUD with the entire family present.
  • A few weeks ago, I had a couple come in for a Preconception Counseling visit. The client has a long and difficult history with some past drug use and mental health issues. She has felt judged and mistreated, “labeled”, in traditional medical systems and practices. I was able to sit with her, spend a lot time and make her feel safe and comfortable. It was very likely her first ever positive experience with a health care provider. And she is now on track to plan a healthy and much wanted pregnancy.
  • A little while back, we had a client present for an annual well woman exam. Her physical exam lead us to do some blood tests to assess her thyroid function. These came back abnormal and we referred to a specialist. She was quickly diagnosed with thyroid cancer and had surgery to remove her thyroid, luckily the cancer had been caught early and there was no spreading of it to other organs or systems. She is now home and healthy with her sweet family.
  • There were two families at the center who had given birth and there were two families at the center in labor. The midwife on call received a phone call; a serious family emergency with one of her own children. I immediately sent her out to go to the hospital to be with her family. The other midwives in our group quickly stepped in and provided care to these families. This process was seamless and incredibly quick, the families did not even realize what had happened.
  • I have provided care to a woman who had never been sexually active, then met a wonderful man and counseled her on contraception and safe sex practices. Before their wedding I placed an IUD as they no longer needed to consider “safe sex” but contraception only. Then after they had been married and were ready to start a family, counseled them on preconception planning and removed her IUD. They then came to our center for their pregnancy and birth.
  • For the past year and a half, I have been providing care to a client with a significant history of abuse. She desires children some day. With time, care and the absence of any type of pressure we have worked up from our first meeting which had to take place out of the clinic to her being able to come into an exam room and have a partial physical exam. With the same care and patience, I have faith that we will be able to work up to a full exam.

All of these stories and many more make me grateful that my path took unexpected twists and turns, leading me to my current position. I truly appreciate every stage and aspect of being with woman…in all the ways that women need me. If you are a midwife, what type are you? And why did you choose that type?

Image credit Plus Size Birth

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