Midwives, how much experience is enough experience?

[jljeppson]

Just a question for you midwives out there, how much experience did you have when you started? I know those that started out as birth instructors, etc and were asked to give a friend a hand and went from there but those very same ones are very negative about someone starting out that actually has a good bit more experience, equipment, etc than they did but not a degree or anything along those lines (yet). What's your opinion? When is hands on experience, along with some formal training (neonatal resus, etc) enough to start out?

[jljeppson]

That's not taking into acct different state laws, or anything along those lines. Just what's commonsense to you.

[Charmie981]

Okay, I'll bite

I think if I was going to assign an arbitrary number, 50 would be good. But it also depends on what you see in those 50 births, I guess. 50 butter births wouldn't do a whole lot to prepare a MW for a terrible shoulder dystocia where baby requires resus. But then I don't if ANYTHING will "prepare" a MW for that, KWIM? I also think 50 births in 6 months is really different than 50 births in two years. Time between births can be a good thing, I've found, because it really allows what you learn at each birth to simmer in a way that it can't when you're rushed from a shoulder dystocia to a hemorrhage to a CPD (and yeah, I did stuff like that during my apprenticeship ).

So I guess 50, give or take some time and some births. And I think at least half of those should be primaries, although again, there's really no such thing as a primary until you are *the* midwife there with no safety net.

[jljeppson]

Ok, that makes sense to me. I agree that time between births and the type of births you went to would have a lot to do with when a person felt ready to move on their own. My preceptor generally stuck to a 2doz rule; after that, or before depending on the birth and the apprentice, she began letting apprentices catch. But she retired before I made it to that number with her, darn her! Anyone else? When did you or your preceptor feel you were ready to step out on your own?

[daintyfrump]

I'll probably have seen about a hundred babies born before I'm fully "winged".

[Malga]

This is an interesting topic (especially after the births I attended tonight-- thick mec, big baby, 4th degree repair; labor progressing very slow, finally pushing, shoulder dystocia, 4th degree repair again . Anyway, 50 seems so low to me. I would say my first 100 births were pretty straight forward, nothing too crazy. But, its almost as if the more experience and births I attend, the more I feel like I don't know A LOT OF THINGS! kwim? Sorta like ignorance was bliss?

[Carolinamidwife]

Well, my school only required 40 (20 assists, 20 primary) but for me I think if I had to come up with an arbitrary number I would say closer to 50 maybe. Not a big difference I guess. I don't know...

Just out of curiosity what kind of clinical hours do OBs have to have? Anyone know?

[kltroy]

Originally Posted by Levatrice

Just out of curiosity what kind of clinical hours do OBs have to have? Anyone know?

One of my good friends is finishing her OB residency right now... When they first graduate from medical school (and therefore are technically an MD) they've had about 3-4 months being "on" in the OB unit, where "on" is probably about 60-80 hours per week. But this does not get them licensed as an OB - they have to complete their residency for that. Residency is in both OB and GYN and it lasts 4 years. Every program is a little different but in general that will be 4 years during which they work 80-100 hours per week and have about 3 weeks of vacation per year. My friend's program they do something different every month - L&D days, L&D nights, OB consult (if a pregnant woman shows up in the ER, for example), Gyn, urology/Gyn (dealing with incontenance issues, for example), etc etc. And each year they will have different responsibilities, so her first year in L&D she might be doing some monitoring and baby catching and holding retractors for a c-section. Second year she may get to do some assisted deliveries and some surgeries. Etc. etc. By the time they complete their fourth year they are ready to be in charge and a decision maker.

I don't know whether this helps or not... I have no idea how many actual births they attend but I'm guessing that if they spend about 1/3 of their time actually delivering babies (as opposed to dealing with other gynecological and pregnancy related problems) they probably do about 20/week * ~60 weeks = 1200 babies? (this would include c-sections and maybe other births that they observe but don't technically do the "catching" at).

[JunipersMom]

See I think that most students should start hands on right away. I think the only true way to know there is a problem is to have your hands on a bunch of exactly right times so that the wrong stands out. I cant imagine waiting 100 births before supporting a perineum. Why on earth would that number make a difference? Maybe its just me. If we are talking about working at births alone without any supervision or help, well then that's a bit different and after being in midwifery for 7 years now I'm still not comfortable going to births by myself. I always like having another trained person available to help if needed, or just to hang out with if we're not needed.

[daintyfrump]

Juniper, I expect to catch at least a third of those hundred. My midwives expect that the 20 primaries they sign off for narm be births that I've provided almost all of the prenatal, birth and postaprtum care. I will be "catching" before those final few so that I can be guided, but those 20 primaries are for the senior midwife to observe, not teach skills.

[Reha]

I think it is interesting how so often 'catching' is associated with acting as primary. I've been primary at about 21 births now, and I've only "caught" about 7 babies. The majority of our clients catch their own babies (mom or dad) and our hands never come anywhere near their perineums (well, that's true even when we do catch, too). So, for me, 'catching' isn't synonymous with being the primary.

I will be done with my apprenticeship this coming summer, and by that time, I will have attended just under 60 births, 35 or so of which will have been primaries.

[jljeppson]

I meant to come back and mention that the catches with my midwife after the 2doz would be with her there supervising. I'm sure she would say around 50 as well before supporting a student going on their own as primary. I've attended around a doz, done a hundred (more?) prenatals (sometimes with midwife, sometimes not). Good number of postpartums, all w/out midwife. Ending up being asked to act as primary earlier this yr, even though I sent the family the info for the midwife that bought my preceptors practice, and decided to assist at that birth. Didn't catch, dad did, but did all care during and after labor. I'm not interested in opening a practice, have kids to raise and training to do first, but can see myself being asked to assist at other births here and there. I always pass families on to the other midwives I know, but have a hard time telling a family no which is how I ended up at this one. I keep my training current, neonatal etc, and may start doing prenatals soon to help out a midwife in the area so will be up with that as well. I guess the reason I put this question out there is because I took a lot of flak from our HB community for helping this family. I think most of it was territorial, but some may have been true concern and that is the part I worry about.

[jljeppson]

I meant to come back and mention that the catches with my midwife after the 2doz would be with her there supervising. I'm sure she would say around 50 as well before supporting a student going on their own as primary. I've attended around a doz, done a hundred (more?) prenatals (sometimes with midwife, sometimes not). Good number of postpartums, all w/out midwife. Ending up being asked to act as primary earlier this yr, even though I sent the family the info for the midwife that bought my preceptors practice, and decided to assist at that birth. Didn't catch, dad did, but did all care during and after labor. I'm not interested in opening a practice, have kids to raise and training to do first, but can see myself being asked to assist at other births here and there. I always pass families on to the other midwives I know, but have a hard time telling a family no which is how I ended up at this one. I keep my training current, neonatal etc, and may start doing prenatals soon to help out a midwife in the area so will be up with that as well. I guess the reason I put this question out there is because I took a lot of flak from our HB community for helping this family. I think most of it was territorial, but some may have been true concern and that is the part I worry about.

[jljeppson]

Sorry about the double post. Server was giving me problems.

[Charmie981]

I would be very concerned about a student with a dozen or so births acting as primary with no supervision. I guess it never dawned on me that it's an option because in my state and neighboring states there are regulations about what students can and can't do. Anytime anyone is approached, they are required to send the person to a licensed MW and clarify that they are only a student.

I don't want to sound harsh, but I definitely think that your MW community is not *just* being territorial. I think they probably feel that you don't have enough experience to be on your own and that their concerns are something you should heed.

[MidwifeErika]

Here in WI I can't do anything without supervision until I have a license, which takes a CPM to get, so 40 would be the absolute minimum I would do before being on my own. I figure I will have a whole lot more than that in though before I actually begin to attend births as a primary without supervision.... and even then I will be bringing someone with me to assist.

To be honest, I can't imagine acting as a primary without any supervision after a dozen births. I have been asked and I passed on the info of other midwives and let them know which ones I am apprenticing with, so I would still be at their birth if they wanted but there would be someone much more skilled than me in the role of the midwife.

[jljeppson]

Here licensure is voluntary, so pretty much anyone can practice with almost any amount of training as long as families will hire them. Actually, what everyone has said has been what I've always agreed with. With that one family it came down to I felt it was a lesser of two evils to have someone there with equipment and some training than no one at all. Of course I didn't request payment (am actually out a good bit for gas, and some equipment I refused to do without). As for the backlash, if it was from the midwives I would have no problem with their disapproval. They have a lot of experience behind them and know what they are talking about. The people I was having problems with were a few clients of theirs who began to spread rumors that I was planning on practicing/taking the new midwives clients away. Absolutely absurd, I don't even know WHAT they were thinking or where they got their info about the ONE birth that won't be happening again anytime soon or why they ran from there, but you never know. When it's a small community where everyone knows everyone or someone else that knows that someone, I guess word somehow gets around. Though obviously not always correctly. Anyway, thanks for everyones input. Pretty much confirms what I've been feeling that no matter how much someone asks the next time the answer really has to be no. I'm just not ready to move on my own and am not willing to take another family on until I feel that I am.

[Carolinamidwife]

I would be very concerned about a student with a dozen or so births acting as primary with no supervision.

I'm not comfortable with a student doing anything without supervision. I trained and went to school in Texas where it was strictly prohibited for a student to even conduct a prenatal without supervision. Here in NC CPM documentation is not recognized and I definitely notice a difference between how much students do on their own vs. how much I personally feel comfortable with. I was just never in a hurry to be on my own, I'm still not.

I do agree that there is no reason to wait to get your hands in there under supervision of course, do a few births standing in the back charting or gooping up the doppler and then get in there. It will never get easier to start so you might as well go.

[daintyfrump]

Different perspectives, who'd a thunk!

How many prenatals did you observe/conduct during your school?

[Carolinamidwife]

Originally Posted by daintyfrump

Different perspectives, who'd a thunk!

How many prenatals did you observe/conduct during your school?

Are you asking me?

75, if so