Day in the life of
Nurse Midwife – Rosemarie Bello Hornak CNM MSN
I have been a Certified Nurse Midwife for 27 years working in an inner city hospital caring for women throughout the life span. Our program began running a Teen Midwifery Program and has now expanded to women and girls with Gynecological issues and Obstetrics at any age.
My Typical Day
There are 3 different scenarios: first a day in clinic, second a day on the Labor and Delivery floor, and third a Teen Gyn clinic day.
Clinic day, you typically review the patient list we are scheduled to see prior to that day i.e What number baby this is for the patient and what gestational age she is at, so that the visit will run smoothly and you can concentrate on any questions they may have and target the teaching you would like to cover. You review their vital signs and look for any warning signs of complications without patients even realizing New patients are a bit longer, but it is nice to engage in conversations with the parents making them excited about this upcoming birth. Of late it is fun to make Gender reveal letters if they are being surprised. Typically we see approximately 14-18 patients each in a day. You never know what may come up NO day is the same and we are fortunate to have physicians who co-manage any higher risk patients with us.
Labor and Delivery
Labor and Delivery is my favorite shift. You may leisurely walk into L&D to look at the labor board or there are those days someone notices you swiping into the unit and is yelling to “Hurry quick” and you cannot get dressed fast enough. We have our own patient load, but in our hospital, we care for every first pregnancy to help encourage a vaginal delivery and decrease our C/secton rate.
For me OB has been rejuvenated with so many different positions for the Mom to be in that have been used for years in other countries we are now realizing will target and help the baby to descend. Midwives pride ourselves with having the tools to guide either the pt, nurse, or doula onto a successful labor for every patient. Just because you have a Midwife attending your birth does not mean you cannot have an epidural, rather it is encouraged at the proper time or if not wanted …we are there for them. Helping a Mom give birth and guiding a baby out is so rewarding, I still get excited and choked up. Everyday you are invited into the most special times in these couples lives.
That is the beauty but there are also those days you have many pt’s on the board and are prioritizing and caring for in many rooms. It is a difficult day but in the end can be so rewarding when you have realized what you achieved. We can rest on our 24-hour shift but are always a phone call away.
Teen Gyn Day
Teen Gyn days are much like a regular clinic day above but with teenagers, you are helping them learn their new bodies and understand she now has hormones that are influencing many aspects of her life. My biggest issue is for girls to understand that lifestyle, diet, and exercise is important not to look good but to feel good and stay on a healthy track. We work closely with our social workers and nutritionists. Again NO day is ever the same and in-between we check our labs/call patients and prescribe if they need any medications.
Let me start with the cons which thankfully are few. It is sometimes frustrating that the load is so hard, where I work, we all work together so that if you need help it is there, but in a private practice setting it is only you. The phone calls at night can be frustrating you need to be able to sleep easily. It can happen that you are up all night and have office hours in the morning. In a group/hospital practice the day can still continue and you do not get much of a break at all. I have eaten in the cafeteria maybe 20 times in 27 years. Yes often you want to be with your co-workers and we all cannot be there together but is more common to have someone grab you something because you cannot leave.
The Pros, I think all of this is fun./exciting and a constant challenge. I never stop learning. No day is the same, It keeps you on your toes and at times makes you realize just what is important in life. As a young girl, this is a profession that you can mold to your needs i.e., reduce to part-time when your children are small and possibly increase again when you feel you can. That is something no one thinks about when they are young.
As I mentioned OB now has such exciting new techniques that are becoming mainstream as far as positioning it is exciting to watch these positions actually work. Lastly, the look on a Mom’s face after you have helped them deliver a baby is like no other. As I had said your love for your profession will never get old, and how many careers can say that!
Advice for aspiring Midwives
If your readers would like to become midwives I always suggest considering becoming a nurse and then working on labor and delivery for at least 2 years. This is what I did and Columbia at that time required 3 years before applying. I worked where there were no residents to examine pts it was the nurse so we were in essence little midwives.
In nursing school the last year junior year summer you can apply for a nurse externship to work along side a L&D nurse and this too exposes you to the unit.
Pre-COVID college or high school students would follow me always to see what the job entailed. Now that is unfortunately not allowed, but one can hope this will again be an option. Apprenticeship is in my book always a great insight into any field.
diagnose and coordinate all aspects of the birthing process, either independently or as part of a healthcare team. May provide well-woman gynecological care. Must have specialized, graduate nursing education.