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Nursing School Worries

I’ve had several women come to me lately telling me they are entering nursing school, but are worried about losing their natural/home birthing mindsets. While I haven’t gone to nursing school myself, I have talked many women through and wanted to share some of my thoughts about how to keep centered even while moving into the medicalized world of nursing and hospital care.

The biggest concern seems to be having to do extraneous things that have nothing to do with midwifery… orthopedics, cardiology, geriatrics, psychiatry… all seemingly so far from birth work, but in reality, have everything to do with birth –if you just look with a soft-focus lens.

Everything you do in nursing school (and nursing in general) has something to do with midwifery, even if they seem so far away.

Why would you need cardiology in birth work? Part of the job of a midwife is to determine if mom has a heart murmur or not. Heart murmurs can be indicative of underlying cardiac conditions that need to be addressed by specialists. Also, listening to newborn hearts is a crucial part of immediate postpartum care. If you’ve listened to a thousand hearts, most of which are normal, you are able to quickly determine if there is an abnormality in the heart you are listening to. As an apprentice midwife (out of hospital apprentice), you don’t get the chance to listen to the wide variety of hearts that you do in nursing school. It’s a distinct advantage to be able to hear so many hearts.

What would geriatrics have to do with midwifery? Besides listening to the heart advantages, there is also the ability to work with folks with depression, orthopedic issues (more on that in a moment), chronic pain and family dynamics… all aspects that have to do with the care of women in the childbearing year and beyond.

Orthopedics? What in the world does that have to do with birth? One of the first things a midwife does with a new baby is check his or her clavicles to see if they are broken. Knowing what a break feels like as well as how to refer out if necessary or even how to fix it can be crucial for a midwife. Plus there are other physical conditions a newborn can have that a midwife needs to be aware of: hip dysplasia, club foot or femur fractures can all be a part of what might happen in birth.

Time in psychiatry is infinitely helpful because midwifery is all about the psychology of things. Getting to know a family, deciphering whether there is abuse in the family or not, understanding eating disorders and more are all covered in the psych portion of nursing school, something that isn’t typically covered in non-nurse midwifery education. It’s something we pick up along the way. I learned a lot from my own years in therapy.

So, putting the positive spin on nursing school can help keep your eye on the prize of the nursing degree.

What of possibly losing the idealism of out-of-hospital or natural birth? Won’t nursing school ruin the belief that birth is normal?

I always find that question so interesting. If you have the belief and there is nothing to counter it, you’ll stick with the belief. If, however, you have information that shows otherwise and you change your viewpoint, then that is the perception you’re supposed to have. If there is nothing to change your point of view, then you will stick with it. But, nursing school does change perceptions because there is new information, why wouldn’t it? Does it make you not believe in natural birth anymore? Not in my experience. It widens your attitude towards birth, eventually bringing the two (or more) positions into alignment. Is there a way to be a nurse and still believe in home birth? Absolutely! There are plenty of nurses who have their babies at home. They are probably more discerning about whom they choose to oversee their births, but they do believe in their abilities to be safe while birthing at home.

You know you’re going to learn new information. Why wouldn’t you want it to blend with your already strong knowledge of birth? Do you really feel you will be brainwashed? Or might your beliefs be questioned. Now, that isn’t such a bad thing. We should be able to stand strong in our beliefs even as someone stands in front of us showing us counter-proof. If we shift, we are brilliant humans, using all the information at hand and developing a new mindset. There is nothing wrong with that.

Will you see things that make you crazy? Absolutely. Will you want to reach out and stop people from doing things that you know to be dangerous or bad? You bet. Will you do it? Or will you stand there and learn. You will learn. Even when someone does something that you think to be dangerous, you must sit still and learn because there really might be another way to do what you’re watching. And even if you say to yourself, “I will NEVER do that to a woman,” put the skill in the file drawer because you never know when you might need to do just the thing you’re finding abhorrent. I remember learning how to do controlled cord traction. My mind screamed at me to stop; it was a horrible thing to do with a placenta. But, I sucked it up and learned. Was I ever glad when I had to get a placenta out from a hemorrhaging mom. I never thought I’d use the skill, but thankfully, I paid attention and learned anyway. I’ve learned there can be a reason to use any skill you acquire along the way, no matter how awful it seems at the time.

And that’s the way it is with nursing school. Even with all the things you think you’ll never need to practice home birth midwifery, you are wrong; you will utilize every extra skill and piece of education that comes out of nursing school. Midwifery school, even more so. But that’s a different post.

I hope this helps those wondering about nursing school and having concerns or second thoughts. I hope you’ve found some peace about the possibilities that await you in a place completely foreign from anything you’ve ever known. What an adventure! I only wish I had gone that route when I was your age. But now I get to share my old lady wisdom with you all who might go on to be awesome nurses and possibly certified nurse midwives. I am all the way behind you. Go for it!

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Reader Comments (8)

I remember having these fears. I remember being frustrated at the thought of spending useful time in the aspects of nursing I believed had little to do with what I would need as a nurse midwife. It's amazing how education changes you. Learning to assess all kinds of people gives you a well rounded education. I have listed to hundreds of normal hearts and lungs at this point in nursing school, and several dozens of abnormal hearts and lungs. I now have the sound of these organs and can pick out when something is amiss. This skill, I am only beginning to polish, will be invaluable to me as a nurse midwife, as will my ability to assess every human system. I have seen non-reactive eyes, heard absent bowel sounds, seen changes in level of consciousness, the affects of low blood pressure, low oxygen saturation, seen the effects of diuretics, blood pressure medications, I have seen peripheral edema in a wide range of ages and health statuses, it all helps me in the long run. Knowing how to spot changes in mentation is valuable no matter what kind of patient I learned how to spot it in. I first assessed hypovolemia in a middle aged women with a GI bleed; nursing school taught me what to do when it happens, then gave me the opportunities to perfect the skills I would need to handle it. It doesn't matter that I didn't learn it on a postpartum mother.

Another very important aspect of nursing that is relevant for nurse midwives is the introduction to medication administration. There is no telling what kinds of meds the women in my care will be on, or need to be on. I give so many medications right now, and spend so much time in the study of medications, I am beginning to understand them as well. No matter who it is that I give medications to now, old, young, or pregnant, the more practice administering, and the more exposure to medications I have, the better off I will be when it comes time for me to prescribe medications safely.

Nursing school cured me of my worry that the majority of it would not be useful to me as a midwife, when I realized everything is relevant.

As for my ideals. I am one who has had a change of heart. I am not certain I have completely abandoned my feelings about home birth, but I have seen enough in nursing school to have my doubts about its safety; I have seen enough now to wonder if I would have another home birth myself, and that changes how I feel about attending women in a home birth setting. I mourn a little that I have changed. I wonder if I failed myself somehow, or allowed myself to be polluted by a medical mindset. When I feel that way, I remember to remind myself of what I have learned in my experience with birth in and outside the hospital. My conclusion is this. It is not the where, it is the who. A birth experience can be made or broken by who is attending you. A home birth can be made incredibly sour and unsafe by a poorly educated, laissez-faire midwife. Likewise what might have been a wonderful hospital birth can be made terrifying, and emergent by doctors and nurses who treat it like an illness. On the other hand, I have seen incredible care by attentive nurse midwives who barely leave their patient's side, and let birth unfold as it will, while still having access to the most cutting edge in lifesaving medical care. I have seen, with my own eyes, the need for that lifesaving care arise in moments. I have seen birth when every second counts, babies who need to be transported immediately to a NICU, and because of that I have lost my certainty of home birth. Even though that has happened to me, I am not worried. I know who I am. I know what birth can be when given its chance to happen unaltered. I know I can provide outstanding care to families in a hospital setting, and that is what is most important.

I do not, nor will I ever, regret my decision to become a nurse. I know I am a better person for it. I now understand that becoming a nurse is integral to becoming the kind of midwife I want to be.

April 28, 2013 | Unregistered CommenterAubrey Hatch

Being in nursing school, on my way to a CNM, I would add that it teaches you equanimity, broadens your perspective, and gives you a great deal of insight into and compassion for the human condition in all its messy, painful glory. I had NO idea how many barriers to leading a sane, productive, healthful life many people face. Nursing shcool helps you see that most people do the best they can with the resources at their disposal, and most of us have a strong survival instinct, even if it looks crazy sometimes. I would also add that my psych/mental health nursing rotation was extremely valuable in helping me deepen my understanding of various mental health conditions that people have to contend with as part of their lived existence. That is, for sure, a major part of whole woman, midwifery model care, and something to which many care providers give inadequate attention. Additionally, even if you intend to practice in an out of hospital setting, you would do well to understand how that system works, how to navigate it, who to make alliances with, and how to make referrals if the women and babies in your care need to access allopathic physicians, PT, or other services. I agree with you, Barb, more knowledge is always, always better than less. And if it is in your toolkit, you can use it or not, but at least you have the option.

April 28, 2013 | Unregistered CommenterKatherine

While I am a nurse and do advocate for the nursing route for midwifery, lets not get too rosy here. As a graduate nurse you most likely have not heard an abnormal heart rhythm. And you might have heard dozens if hearts but not thousands or even hundreds by any stretch (though you probably listened to your cats and kids hundreds of times). I know I definitely didn't feel any broken bones. Really, you've probably only started an IV or two on an actual patient. The value in nursing school does not come from actual hands on skills, you learn those mostly as a nurse on the job. The value in nursing school comes from the extensive knowledge of physiology and pathophysiology, the ability to think critically and look at the whole patient (and family), adequate charting, and a systematic and structured approach to learning that minimizes gaps in education.

April 28, 2013 | Unregistered CommenterOosphere@gmail.com

Whenever someone thinks that additional education or knowledge will make them change their beliefs I have to wonder whether the doubts that their currently held beliefs are already present but not acknowledged. And not just about midwifery. I've known people who don't want to learn about another religion simply because they fear they will lose faith in their own.

There is no such thing as "useless knowledge". As you point out, while midwifery is generally associated with the care of healthy women, women can be healthy now but not have been so in the past, or can become unhealthy at some time in their pregnancy and a midwife MUST know what to do and to be aware of untoward things happening. YOu cannot divorce a uterus from the body in which it resides.

Midwifery in the US will NEVER be a respected and true profession until all midwives are nurse-midwives.

April 28, 2013 | Unregistered CommenterAntigonos CNM

Thank you for this. I am preparing to go to nursing school next fall, solely because in my state, they only recognize nurse midwives. In the back of my mind, I've been worrying that I will lose focus of why I am doing all this work. Worried that I will become one of those, pushing intervention, because that is what I've learned. This article has made me realize that I will be at an advantage to my future patients. Thank you again, for putting things into perspective!

June 24, 2013 | Unregistered CommenterAngela

It's late for me, I really should be in bed but am reconnecting with all the blogs I could remember that were on my old Google Reader. If I make no sense, this is why.

I have not read any of the birth related blogs in years, as I think I may be suffering from PTSD. Both because of my career and my own birth experience. Also, I am no longer in midwifery.

But this post grabbed me. And I have to say this: yes- nursing school will teach the medicalized approach to birth. Students might get lucky with an instructor who supports a "natural" or "normal" approach, but most of them have worked in traditional medical birth settings. It's just their paradigm.

But I can say as both a former nursing student, former registered nurse, and now former nurse midwife, I did learn a lot in that environment. I learned what I would NOT do, and what I would do. If these students don't allow themselves to get sucked in, and keep their eyes open, they will do well.

Thank you so much for this post! I am a midwifery-minded nursing student in the third of five semesters. I'm taking OB right now, as a matter of fact. You crystallized concerns I didn't even realize I had! Now what about addressing my concern that EVERYONE is going to realize what a brilliant idea it is to become a midwife and take all the jobs? ;)

September 19, 2014 | Unregistered CommenterNonna

Helping and taking care of people is so natural for woman, while studying medical students have remember not only about their essays, bit also about inner state.

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