Dear Franny,
Hello! I am an American ex-pat UK RM, but I originally training in a direct-entry programme in the US, with both CPMs and CNMs as mentors, in freestanding birth centres connecting with back-up OBs, so I have some cultural familiarity with your context. I am still not 100% sure what you are asking, but I have interpreted it as: “Can research on MLUs from countries which do not have obstetric nurses be applied to one which does?”
My suggestion, especially given your concerns re: retention, would be look at some of Denis Walsh’s work around the culture of midwifery-led units, and how small-is-beautiful flexibility creates satisfaction for those working there.
The phrase ‘American model of maternity care’ sends shudders down the spines of many UK-based midwives at the moment given our current political situation (a government which is systematically pulling the NHS to its knees and promoting privatisation), but I think there is a lot we can learn from some aspects of the American model, too. Clearly, you manage to maintain your integrity despite having to navigate a whole different level of financial incentives and pressures.
In the UK, we do not have obstetric nurses, but we have midwifery support workers. Their remit is different, much less than a nurse, mostly practical, but they work alongside us on the wards. Another hot potato, but personally I can see how expanding this role into one that is similar to an American obstetric nurse could have some benefits even for UK midwives. Again, I think it comes down to culture, which is why your vision of team-working is important. In large wards built on shift systems, obstetric nurses have the potential to dilute the continuity the laborist model depends on. But in the context of small teams working in a family medicine practice in a district hospital, obstetric nurses and midwives working closely together potentially increases continuity. It enables the midwife to care for more women, developing her expertise and expanding midwifery practice — which again, could potentially enable more continuity for women receiving care under this system.
You may wish to become involved with the Midwifery Unit Network: http://www.midwiferyunitnetwork.com
Good luck & best wishes,
Shawn
Shawn Walker
Midwife and Researcher, City University London
e-mail: [log in to unmask]
blog: http://breechbirth.org.uk
Twitter: @SisterShawnRM
New research: Standards for maternity care professionals attending planned upright breech births: a Delphi study — http://authors.elsevier.com/a/1SXPTydlTotx-
FREE PDF download until 2 April 2016
> On 28 Feb 2016, at 00:28, Franny Meritt <[log in to unmask]> wrote:
>
> My apologies if this is a poor way-inappropriate place to make this query & my thanks in advance for helping put me in touch with the right resource...
>
> I am a solo CNM in a family medicine practice providing clinic & hospital based care in a small town/rural setting in Kentucky. There is also a 3-OBGYN practice that attends women at our hospital & functions as our back up for compilations/cesareans. Last year we had 411 births at our facility-I personally cared for & attended nearly a quarter of those. Many women with private insurance choose to travel an hour or more one-way for care at the larger, big city hospitals so we likely lose 100+/- births every year to women traveling away for care.
>
> The ob group propositioned me about joining them a few months ago...hoping a midwife would improve their marketability. I was nervous about their rules (not necessarily evidence based) come down from the larger city/Mfm practice they are under & they have strict duty hours-nice but doesn't promise midwifery management. Not having a midwifery example within their system- they pay by productivity that is not conducive to midwifery model....I opted to stay put & they have tabled their quest for a midwife.
>
> We have recently had a major change in ob unit management & while nursing is doing some interim scheduling & supervision filling in...the hospital is evaluating how to improve our nursing retention, training & morale while improving our care & marketability. I am interested in how midwifery led units could translate into United States health care with a team model for nursing & midwifery staff, with midwives providing outpatient care, laborist coverage & unit management but not completely displacing nursing duties in L&D.
> I have several articles from Amy Romero, a cochrane review & the NICE guideline on staffing that I am reviewing this weekend- meeting with the nursing ceo Wednesday. Does anyone have any ideas, guidance, suggestions, resources or advice?
>
> Blessings,
> Franny
>
> Sent from my iPhone
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