Your BIRTH Partners

Certified Nurse Midwife Role with Angela

February 03, 2020 Your BIRTH Partners Season 1 Episode 2
Your BIRTH Partners
Certified Nurse Midwife Role with Angela
Chapters
Your BIRTH Partners
Certified Nurse Midwife Role with Angela
Feb 03, 2020 Season 1 Episode 2
Your BIRTH Partners

This week we look into what it means to be a Certified Nurse Midwife in the US. You'll walk away with a greater understanding of their roles and challenges, and misconceptions they face. 
You'll also get to know our own Angela Mike, CNM as she shares her passion and her path as a birth professional.

Support the show (https://www.paypal.me/yourbirthpartners)

Show Notes Transcript

This week we look into what it means to be a Certified Nurse Midwife in the US. You'll walk away with a greater understanding of their roles and challenges, and misconceptions they face. 
You'll also get to know our own Angela Mike, CNM as she shares her passion and her path as a birth professional.

Support the show (https://www.paypal.me/yourbirthpartners)

Maggie, RNC-OB:

Hello, welcome to Your BIRTH Partners. We are here to breakdown barriers and cultivate community as we discuss issues that impact pregnancy, birth and postpartum. We welcome you no matter what your background is and are so excited to learn together. Today we have our own Angela Mike, certified nurse midwife. You will learn more about Angela and her path to pursue midwifery, how she's worked as a birth worker, and how she's practicing today. And you'll also gain a greater understanding about the roles that certified nurse midwives play in care during pregnancy, birth and postpartum. On to the show! So Angela, I'm so glad to be talking to you today. Tell us a little bit about yourself.

Angela, CNM:

Well , um , thank you. Maggie it is good to talk to you too. I am a 37 year old married mother of four. Um, I am originally from Chattanooga, Tennessee. I currently live in Las Vegas . I started my career off as a labor and delivery nurse in the U S Army. I was on active duty for about eight years and left, became a midwife, got my doctorate in nursing. I worked in private practice for about a year and a half before I returned to active duty, which is how I ended up in Vegas. I'm currently in the Air Force and I practice full-scope midwifery . I am also the nurse manager of our clinic. So that's my life in a nutshell.

Maggie, RNC-OB:

You are busy for sure.

Angela, CNM:

Yup.

Maggie, RNC-OB:

Okay. So tell us a little bit more about, you know, what brought you to this field, k inda your whole, your journey.

Angela, CNM:

Believe it or not, it was actually the army , um, that introduced me to women's healthcare . I always thought I wanted to be a trauma nurse; that was my goal. I was at Walter Reed at the height of the war and we saw all of these soldiers coming straight from the battlefield with these wounds. And I thought, I need to do this type of hig speed medicine. But about , uh , three months into my first assignment they needed nurses on L&D. They were short staffed and I was forced into it. I cried like a baby. Um, I thought it was boring. I just didn't get it. And then I don't know, I just fell in love with it. And here I am 14 years later living my best life and taking care of women. So.

Maggie, RNC-OB:

I love it. And so tell us more about like kinda what are you think like if you had like the touchstones that have really like shaped your professional journey?

Angela, CNM:

I think the things that have helped to shape my professional journey , um , has a lot to do with the, the women and the families in general that I've encountered over the years. Some of the other nurse midwives that I've worked with, some of the nurses who trained me, and some of the obstetricians that I trained with as well. It was, has, been very much of a blessing to have lived all over this country. And I worked in all types of um, birth settings and all those things, the good experiences and the negative ones have all helped to mold my personal practice philosophy and how I choose to care for women and what I think is most important when it comes to women's healthcare.

Maggie, RNC-OB:

Absolutely. And then how do you feel like you kind of balance and weigh in kind of like personal experience and intuition with kind of the schooling and what you, you know, you've learned both theoretically and clinically.

Angela, CNM:

Okay . I think the biggest balance or the biggest thing that I had to remember to sort of balance all this stuff is that I can only do one thing at a time. And so it can be really overwhelming. And I, it has been a very learned and practice behavior. There are certainly times where I had complete total meltdowns thinking that I can't, I can't do all the things that I want to do. I can't cause I want them to happen now and I want to be able to put all of me into it. But I also want it to be that for myself cause I need time for myself and my children and my husband. And it's just a matter of making lists and I prioritize things like which things will I tackle today and which of these things take priority so that even if I don't get through my list, this one or two things, these things have to be done today. So, and just taking the time to breathe and learning to say no.

Maggie, RNC-OB:

Yeah, I think learning to say no is a lesson. We're all probably continually learning for the rest of our lives. And then in your, you know, when you're acting as a midwife, how do you feel like intuition plays into it?

Angela, CNM:

Oh wow. It's so funny that you asked that because I'm , I'm always reflecting on that. Um, as a clinician you learn medicine. You learn what you're supposed to do, what you're not supposed to do. And that's great. That's the black and white portion of it. But in the middle of that, black and white of that science, is an art. And that is where the gray area is. The art of midwifery, the art of birth, the art of medicine, is so gray and it truly is, anyone can do this, anyone can do this. Um, if you go to school and learn it. Yeah . Intuition is something that you develop over time. And it is something that I truly feel that my higher power has gifted all of us with and learn. It's a listen to that gut instinct and intuition. Um , it's probably one of the most important aspects of my practice. I know all the signs. I know when things aren't quite going a certain way, but I will tell you and every instance where I've had a really beautiful outcome or I've had , um, outcomes that were not optimal, I always knew it in my gut, and I listened to my gut; to call in the people I needed or to calm down people when there was no need to be concerned. It has worked out every single time.

Maggie, RNC-OB:

That's wonderful. And then, so, you know, future dreaming here, where do you see yourself in 10 years?

Angela, CNM:

Oh wow. You know, I've always thought that once I finished , um, doing birth in a hospital setting that I would always kind of resort back to , um , this ideal of a women's health care , um, in birth outside of the hospital setting. But I think as I grow older in years, wiser in years and in my practice, my philosophy just continues to evolve. I think that I need to stay in the hospital birth setting. Um, and I need to teach, I need to teach other midwives to trust birth and I need to teach other midwives that birth can be done differently, and still safely , and teaching them to, to watch birth because that, it doesn't happen often. We don't watch it; we seem to be very action oriented. So yeah, in 10 years I see myself being a birth educator in a school setting, in the university setting and, hopefully as a preceptor to midwives because currently I don't do that. I precept family medicine residents and first year OB residents.

Maggie, RNC-OB:

Oh, I just, I love hearing you talk about that. Like, gives me chills. I can totally see you being just an outstanding professor and a mentor to other, you know, midwives who are coming up and who, who want to see us, you know, make hospital birth, everything that it can be in kind of the best of both worlds. So . Yay . And so we're going to just switch gears a little bit just to tell us about more about kind of midwifery and what it means to be like a certified nurse midwife kind of generally. So if you could just talk a little bit more about like the schooling training that goes into becoming a CNM.

Angela, CNM:

Oh yeah, definitely. Um, so I do want to just add that there are also certified midwives. These are board certified midwives who are not nurses. We have the same exact , um, schooling and we take the same boards. So I just want to put that out there. But , to become a certified nurse midwife , you have to be a nurse first . There are many routes. I'm just going to explain my route. I got my bachelor's of science in nursing first, from the University of Tennessee to be exact. And then , um, once I decided to go to midwifery school, I found a university that did not require me to take a GRE, just a certain grade point average , with my bachelor's and I basically applied to the program. I spent three years exactly working on my master's degree. Once I finished the didactic portion of my master's, we started the the clinical portion, which was, almost 700 hours, 40 births that I had to attend a nd a t on of outpatient visits with different expectations. And then my preceptor had to sign off on my declaration of safety, and they have to sign off on that before I c an even take the, u m, the final exam for midwifery school. So it is everything that you've learned in the last three years. A nd so I took that and passed it. Once you pass that, the school releases, your name saying that you can s it for boards. Boards was a six hour test as well. You find out if you pass right away and once you become board certified, you can practice medicine in your state. And then with my d octorate, i t was a 15 month program full time. I did my DNP project on substance use d isorder, specifically in pregnancy and specifically opioid abuse. And I created a program, that was evidenced based to support women, pregnant women who are addicted to opioids. And I developed a provider toolkit so that those counselors who w ork with substance use disorder can now care for pregnant women appropriately. So that's it.

Maggie, RNC-OB:

That's amazing. So , it definitely is, I mean a huge journey and tons of time invested into that, both, you know , theory and clinical. And so, you know, as you kind of grow into your midwifery practice, do you find, like, what are the professional organizations that kind of back up certified midwives and how do they kind of work? Do they, how do they guide your practice or do they have certain kind of conferences you're doing or, you know, mission statements that they're on? How does that influence kind of as an organization?

Angela, CNM:

Okay , wow. So there are so many organizations that influence , um , my practice because you think midwifery is not just birth, it is primary care. It is adolescent care. My youngest patients are sometimes 11 and 12 years old cause they start getting their periods. It is geriatric care because I'm caring for women through the lifespan all the way through menopause. So when it comes to organizations that kind of support or back our practice, obviously, the American College of Nurse Midwives, help to set a standard of care and clearly defines what our scope of practice is. For just baseline midwifery practice, ACOG, which is kind of like the "OB Bible" is what we generally call it, the American Congress of Obstetrics and Gynecology. They put out practice b ulletins on a regular basis. They help to g uide our practice in medicine, the CDC, the American Academy of Pediatrics, even, I mean there are so, so, so many organizations I could list just, I mean continuous....family medicine, these are the vast majority of organizations that I lean on for how to practice and care for my patients.

Maggie, RNC-OB:

Yeah, that's great. I mean, cause you need it, obviously we need to have so many different resources that back up for each individual patient is going to be different and you know, you need a different, a different lens to look at it sometimes. That's great. And then if you could just kind of talk through a little bit more about like what the role is , you know, for a midwife in, you know, pregnancy, birth and postpartum, that whole continuum.

Angela, CNM:

Oh yeah, absolutely. So , um, depending on the state you're in, it's going to determine your scope of practice. Of course, dependent on your knowledge base, will either expand or minimize your scope of practice. But in general , I care for mostly low risk women during the antepartum, intrapartum, and postpartum period. Though I do care for moderate risk patients, sometimes independently, sometimes with co-management and I care for high risk patients as well. This includes preconception counseling all the way to infertility treatment and intervention. We care for them; we usually do anywhere between 10 and 12 visits during the pregnancy screening and changing or modifying their plan of care depending on, you know, what's going on in their pregnancy. For intrapartum periods, we induce labor or we just care for our patients who are spontaneously laboring. We also assist with C-sections whether that's primary, repeats, or crash C-section; so I first assist in those procedures o r cases. And as far as the delivery goes, I am completely responsible for the management a nd safety of mom and baby during the birth and being able to control any potential complications that may arise, d uring that intrapartum and c lose postpartum period. I generally will call in my OB backup, if I'm concerned about potential for adverse outcomes or if there's like a very severe laceration that I can't repair or don't feel comfortable repairing.

Maggie, RNC-OB:

Awesome. And then if you could just, I often hear confusion with this amongst consumers, and even amongst other birth workers, about the distinction between midwife and doula. If you could just highlight how that, how that role is different.

Angela, CNM:

Okay. So , as far as doulas go, and I actually consider myself a doula as well, because of the work that I do and the time I spend with patients. But doulas are not licensed professionals. They don't have to have any formal certification to be considered or t o call themselves a doula legally. But there are certified doula p rograms that you can go through and basically they are non healthcare professionals whose sole purpose is to support them, the woman and her family during her pregnancy, during her labor and during the postpartum period. They offer emotional and physical support to the entire family. They offer, they assist with breastfeeding in the postpartum period as well. And they help the families kind of adjust and transition to that postpartum period. They may be able to assist with advocating for personal wants, goals, needs; they help with planning for the birth and delivery aspect as well. But by no means do they offer, or should they offer, medical advice about management or appointments, et cetera. They are truly there just to support the woman or her family during the process.

Maggie, RNC-OB:

Thank you very much. And then, you know, what do you find as a midwife? What's the most challenging piece of that role?

Angela, CNM:

Um, ironically enough, the most challenging piece of my role, one of the most challenging pieces of my role as a midwife is with my staff nurses. Um, I always thought that it would be a battle actually with other physicians. But no, I have found that since becoming a midwife, they, my physician colleagues, truly do value and respect what I do and they respect my practice and they trust me and they treat me like an equal. But it is actually my nurses that I struggle with and I can relate to that because I've been a staff nurse, I was for 10 years. And the battle of not trusting the provider because you don't know them or maybe their practice style is different or even the personal bias, "you know what, they are fresh out of residency, they are fresh out of midwifery school, they've only been doing this for three years. I've been a nurse 14 years, 20 years, 30 years. I've probably delivered more babies than them." And, you know, undermining you in front of the patient or other staff and y ou t ry to be extremely professional and just prove through actions that you are more than capable, and you have the training and the education and knowledge to take care and manage for these family members.

Maggie, RNC-OB:

Yeah, I mean it's obviously there's so many, you know , we navigate all these different relationships during, you know, care. There's so many different people who come into play. And like you said, obviously as a, you know, as a nurse, I totally get that because I've certainly, I've been on the other side of it where you're looking at someone and you're like, "Ah, I know this is, technically this is your job, but I'm not feeling a hundred percent." And I think obviously being able to develop, you know , relationships and openness and that, you know, in a professional way, being able to have conversations and say " Eh, I'm not comfortable with that. Can you explain a little bit more about that?" And kind of trying to get into it. It's really easy I think in, you know, labor delivery can feel very fast paced and everything needs to happen right now. And so s ometimes I think people have a hard time, like, pausing and stepping back and having rational conversations instead of kind of like snap j udgments, which is unfortunate, and obviously something we keep working to improve and to change. And so if there was one thing that you could tell, you know, the birth worker community about your role, what would it be? Like, if you wish everyone knew inside, y ou k now, the m idwife's h ead?

Angela, CNM:

Mmm . I think for me the one thing that I would probably want people to know is that I am more than just a baby catcher, I am highly educated, highly trained , and extremely competent in my ability to care for women in low risk and high risk settings.

Maggie, RNC-OB:

That's great. Absolutely true. I love it. And so, kind of close this out, what is the future of this role? Like why would someone want to become a nurse midwife?

Angela, CNM:

I think that, certainly think midwifery is growing. It's rapidly growing. It is, it is kind of the, it's the foundation of birth work, you know , not just in this country, but in the entire world. Midwives are not new; we've always been with women. We have always practiced medicine, whether, you know, formally recognized it as that or not. But I think that midwifery will always be here. And I think that is the most important part is to not be discouraged. And if you are passionate about women, passionate about women's healthcare , you are passionate about , um, the population of this world, our country, then you have to recognize and you have to accept that the fate of our population lies in the ability to keep our moms and our children healthy because without women and children the future of our world is non-existent. And so that's what I believe wholeheartedly.

Maggie, RNC-OB:

But anyway , you're completely right, obviously midwives have been around for forever, for millennia and I think ideally in our country you're going to just see a resurgence of, you know, them and the valuable role that they play as you know , as equal members of the healthcare team. And helping to kind of grow that model that we see midwives do so well to improve the way that we deliver care to all patients. You know, even those who aren't seeking out particularly, you know, midwife care during birth. Well, thank you so much for sharing about yourself and telling us a little bit about what it means to be a CNM. I love your passion for f rom birth, so thank you. We'll talk soon.

Angela, CNM:

Right. Thank you.

Maggie, RNC-OB:

Thanks for tuning in to Your BIRTH Partners. We love to talk birth, and would love to talk about it with you. Please join the conversation by finding us on Facebook, Instagram, or Twitter; we're Your BIRTH Partners on all platforms, or comment on our show notes blog at yourbirthpartners.org. We would love to hear any questions you have about certified nurse midwives, the roles they play during birth, and we'd also love to hear from our certified nurse midwife friends, you know, what are the challenges that are facing you? How are you living out this role? Till next time.