schedule/work hours for a CNM? - Mothering Forums

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#1 of 11 Old 02-01-2010, 10:12 AM - Thread Starter
 
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I am considering becoming a CNM and am curious about the schedule/work hours that might entail for being a CNM in a hospital setting.

Can you work part time? This is important because DH and I plan on having me homeschool our children...

Is it "shift" work, or do you work like 9 - 5, Monday through Friday, and are on call the rest of the time for the entire week?

If a client comes in at midnight and is 3 cm., do you also go in with her at this time?

Please don't think ill of me for asking such detailed schedule questions, and perhaps seeming like I don't want to be there! I am torn, because I love birth and working with new and becoming mamas, but I am such a planner and scheduler! Even the two weeks on call, 24/7, a a doula, before a birth, is really tough for me to deal with.

Just trying to decide what I want to be when I grown up. I have a BS in Forestry, but DH's military career makes that difficult to pursue, and I have found another passion in birth, and I love it, and am trying to determine how far I want to "get into it."

Thanks!

Emily--Married to the love of my life 2008--Joyful mommy to Rachel Elizabeth 12/10
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#2 of 11 Old 02-01-2010, 11:25 AM
 
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Speaking up as an L and D nurse, so I'm not 100% sure but this is what our midwives do. There are 9 of them and they have clinic hours 4-5 days a week, and then work one 24 hour shift (some split them up into two 12 hour shifts) about every other week or so. They don't have clinic hours the day after their on-call shift. Oh, and they are in house typically unless it is extremely slow.

However, I know that it really depends on the group that you're working with---it would obviously be more on call time with fewer midwives or if you go in and support specific women.

In general, I would think it would be very hard to home school and be a CNM and actually attend births---it seems that most part time jobs I've seen listed are for clinic hours only.

Mama to P. born at home 10/09, and W. born in the hospital 2/13

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#3 of 11 Old 02-01-2010, 12:55 PM
 
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I used to be a CNM, but it was too much with little babies, so now I'm at home full time.

I've worked two different jobs as a CNM.

#1 job was private practice. Me and 2 doctors. We shared call with another group of 1 doc/1 CNM. My practice was on call 2 weekends, then the other practice one weekend. Me? I was in the office 4 days a week (off every Monday, and we got off at 2pm on Fridays). I was on call every Tuesday and Thursday and 2 out of 3 weekends (Fri noon-Mon AM). Also, because I was the only midwife, if I had a patient that really, really wanted a midwife, I'd come in special for them on my off weekends or my off days during the week. I made rounds 4 days a week (Tues-Friday) on all the OB patients in the office, and on my weekends on call, I made rounds as well.

It was a LOT of call. We had privileges at 3 hospitals, and we frequently had patients in each one. We delivered about 20 babies a month. And, if they came on Tuesday, Thursday, or on 2 out of 3 weekends, I delivered them, unless they requested a doctor (rare). Every day, I'd leave my house around 6:30 to round at all 3 hospitals, then come to the office, work 8-4:30, then on Tuesdays and Thursdays, usually head back to the hospital to see about whoever was there, blah, blah, blah. I probably averaged 1-2 nights sleeping at the hospital every week.

Not every private practice job is like this. I was young, naive, and I got taken advantage of because I didn't know any better. But, I'm not the only one, either.

#2 was a clinic setting. We didn't make as much money as private practice, but we only worked 40 hours a week usually. There were 8.5 midwives in that practice, along with 4 (?) doctors. There was one part time position. We averaged 2 days of clinic, plus one 24 hour call in a week. Some weeks were 5 days of clinic. Some weeks 2 days of call. We averaged 40 hours when looking at a month at a time. We had the post-call day off, but we really, really needed that day off. It was not unusual to get less than 30 minutes of sleep in a 24 hour call. That practice was BUSY. We delivered about 120 babies a month (just the CNMs). We saw all the walk ins to the hospital. We first assisted on every c-section. The on-call midwife made rounds on weekends. During the week, a different midwife made rounds (and we were so busy that rounds alone might take 2.5-3 hours).

This was med-wifey-ness more than mid-wife. But, on the other hand, we gave really good care to patients that probably otherwise would have gone without PNC because of money issues. So, it was a balance there. We did not have hours to sit at the bedside, nor 45 minutes to spend at a prenatal visit. However, all 9 of us did the best we could, and we all really cared about our patients. We had a low c-section rate, were VBAC friendly, nad about half of our patients went without epidurals. So, there were goods and bads. It was very rewarding know that we were making a difference. And very frustrating knowing that we weren't being good crunchy granola midwives. Trade-offs.

I hope this helps!! There are so many variations on how practices are set up. I think you have to ask a LOT of questions to find the practice that is right for you.
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#4 of 11 Old 02-01-2010, 01:10 PM
 
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Quote:
Just trying to decide what I want to be when I grown up. I have a BS in Forestry, but DH's military career makes that difficult to pursue, and I have found another passion in birth, and I love it, and am trying to determine how far I want to "get into it."
Have you thought about doing CBE? That is what I am working towards right now. With 5 children in the house, and probably more in the future, that we are homeschooling, being on call or away several hours a week would not work for me. Doing CBE I think will allow me to set my own hours and still get to work with pregnant momma's. Once my children are older then I may work toward the doula goal.

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#5 of 11 Old 02-03-2010, 02:06 PM
 
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I've worked in different situations. One was a group practice where we each took call for 24 hour clocks at a time. Anyone who came in for triage or labor we went in and stayed with. We got paid the same whether we were there 24 hours or 0 hours. You also take all the phone calls during that time. Then, when you are in clinic, it is from 8-5 (ha-ha more like 6-8pm at night doing charting and lab follow up)

Another was a private practice. Clinic 8-4 (and then lab follow up until 11pm sometimes-not kidding) plus you everyone was on call for their own patients 24/7 so deliveries all night and then clinic the next day or rescheduling patients for births etc...HECTIC.

The most family friendly arrangement I have had as a CNM is the job I have now. We do 12 hour shifts on L+D and triage and deliver everyone who comes in the door (even the very high risk ones-we just touch base with the attending and if we feel we need them they come in), first assist for c/sections and other gyn surgeries etc...hectic but when the shift is over, you go home (well, ok, yesterday I stayed to be at the birth of someone I had been with in labor all day but that was my choice). Then clinic 8 hour days.


When I was a direct entry midwife, just 4 clients a month totaled a very full load of work and running around.

The money is a different story. Obviously it varies based on where you work. I can;t stress enough that it is NOT a good career for someone who does not absolutely live, breath, and love this type of work regardless of getting paid or sleeping. Homeschooling and being a CNM would really be quite a challenge unless you could find a part-time situation, which I think would be VERY VERY hard as a new grad in terms of the profession.
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#6 of 11 Old 02-04-2010, 01:19 AM
 
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oops, double post!

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#7 of 11 Old 02-04-2010, 02:08 AM
 
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My position is FT = 44 hours per week, however it seems like I end up working WAY more than this. Call varies between 12 and 24 hour shifts, and like a pp said we are BUSY and it's not unusual to have very little to no rest on a 24. The CNMs care for 75% of the pts in our hospital, do all pp rounds on vag births, 1st assist at sections and carry the pager for triaging 4 offices worth of pts. I'm in clinic 1-4 days per week depending on what call I have that week - pt's scheduled 8-5, hours realistically 8-7 and working through lunch. It's NUTS some weeks and I'm certainly not going to get rich, but the work can be pretty amazing as well. We are not as crunchy as I'd like sometimes but we are able to bring midwifery care to many women in a great NCB-friendly hospital.

My husband is home with our little guy right now and neither of us can conceptualize how else to juggle my crazy, irregular schedule. I actually think that homeschooling would be a great fit b/c of the flexibility it would afford.

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#8 of 11 Old 02-11-2010, 12:29 PM
 
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I just talked to one of the midwives in our local practice about this. When I first started my journey, the plan was for me to join this group. However, I decided I didn't want to work a zillion hours each week, not really be there for the labors (the midwives are in and out, they don't sit with the women like at home births), not be able to attend a birth that I wanted, etc.

I am now working as a homebirth midwife and in grad school, the plan is now to become a family nurse practitioner, I need more regular hours!

Here is their schedule:
There are currently 3 midwives, they would ideally have 4, but because of the long hours and politics, keep losing midwives!

Office: Each midwife works either 2 or 3 days in the office depending on whether they worked the weekend, the hours are about 8 to 5.
Week hospital call: Each midwife works 1-2 days at the hospital, staying in-house to manage what is going on with the floor. Hours are about the same, 8 to 5.

Evening call: There is a midwife on call in the evenings, but the doctors are the ones who take primary call (the reasoning is that the doctors might have to be there anyway if something happens). Because there is a population of Muslims in the area, the midwives will come in if this population or others only want females and there is a male on call. The midwives tell me that if they are on call during the week evenings, they usually are called in. The hours are 5pm to 8am.

Weekend call: They rotate through the weekends, on call from 5pm friday to 8am sunday. They tell me that they will usually spent most, if not all the weekend at the hospital.

They get 1 or 2 days off during the week, depending on the schedule, but if they have worked all night, they need to sleep and then sometimes are on call at 5pm, so really only have limited time off.

Overall, they work about 50 or 60 hours per week! And really don't make much more than the nurses on the floor (if you count in the overtime hours they would be getting). Not a great deal!
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#9 of 11 Old 03-07-2010, 01:25 PM
 
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Have you thought about just doing nursing? My dh is military and I can get a part-time job in a week after we pcs. I've never worked more than 24 hours a week, there are some months where I only worked 8 hours a week depending on our situation.
I always think about moving into something else, but I love the flexibility so much, and I also want to homeschool, so I don't think I will.
Right now DH is deployed and I'm working 10pm-6am 3 times a week; it's nice because I'm making a lot of money, I can tuck my son in at night and be there when he goes to sleep, and my aunt stays here while he sleeps and the next day until 2pm so I can get sleep. But he knows I'm still there in the house which is nice.
I've done NICU, postpartum, and right now I'm doing pediatric home-health. I would do L&D but I like my lower stress job better for now.

Also a perk- I think the CNM's that have a lot of experience in L&D have an easier time with the transition.
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#10 of 11 Old 03-09-2010, 12:06 PM
 
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Varies so much depending on location, practice type and size of practice.

mama to Max (2/02) and Sophie (10/06); wife to my fabulous girl
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#11 of 11 Old 03-11-2010, 03:37 PM
 
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I did want to add that at least here in Hawaii, most CNMS make less money than RNs. I know that is true of many places on the mainland too. It has to do with the fact that RNs are unionized (and where I work so are the nurse practitioners) but CNMs are not-we are considered the same as physicians in terms of our responsibilities...just not in pay! However, I wouldn't trade it for the world. I think I would be terrible as a nurse-probably get fired on day 1 !!!!
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