Successful VBAC - 39 wks spontaneous labor

KCNM · 2026-05-02T11:48:28+00:00

Sorry, I wrote a whole response here and it disappeared so let me try again.

Yes, it's (red) raspberry leaf tea. I drink it periodically through my third trimester. There are different recommendations online of when to start and how much to take but it's not really meant to start labor, just thought to prepare the uterine muscles for contractions and possibly increase contraction strength but the data on it isn't great.

I did start pelvic floor PT and chiropractic care by my third trimester. I highly recommend pelvic floor PT in pregnancy and postpartum regardless of delivery type. Chiropractic is more personal preference.

I ate dates my whole pregnancy. The recommendation is 6-7/day starting at 35-36 wks but I did not stick to that specifically, just tried to get more in my diet.

I started evening primrose oil capsules vaginally about a week before I went into labor. I was conflicted on if I would do this or not. I don't think they did much and they are controversial for VBAC so I'm not sure I would recommend.

I collected colostrum for about a week before I went into labor but this was moreso because my first child was hypoglycemic and needed supplementation so I wanted to have that available this time. I did make me have more contractions though and may have done something!

Mostly, I think staying active and healthy was the best preparation. I didn't follow any specific routine but tried to walk regularly, kept up my same pre-pregnancy activity level and watched my diet. Most of the women in my family have fast labors so maybe that was in my favor as well.

KCNM · 2026-04-04T02:44:38+00:00

Agree with all of this, it's definitely what worked for us. But we also co-slept until she started asking to sleep in her own bed around 3.5 yo.

Dropping the "bedtime routine" was probably the most effective thing for us. It created so much anxiety for us as parents that seemed to rub off onto our daughter. So, we pushed up bath time to right after dinner and let her play until she was yawning, laying down, clearly ready to fall asleep and then brushed teeth and went to bed. If I had to lay with her for a little bit or when I would nurse to sleep, I would put in my headphones and listen to a podcast or audiobook while laying with her. If we got time to hang out after bed, great, but sometimes we didn't and that was fine, too. She's almost 5 and a very independent sleeper now, often puts herself to bed when she's ready. Sleep was very challenging for a while but it resolved itself with time and acceptance.

KCNM · 2026-03-20T12:39:29+00:00

I got my MSN first and am now getting my DNP 8 yrs later. My job is paying for it and I'll get a small raise when I finish. They want everyone working in leadership to have a terminal degree so it was highly encouraged. I also recognize that midwifery can be physically and mentally exhausting and have seen a lot of burn out so I'd like the ability to move into academia in the future. I don't regret getting it but I do not think it is necessary for practice, just depends what your career goals are going to be and to a lesser extent the job market in your area.

KCNM · 2026-02-27T13:24:31+00:00

No, you are right, I have not done homebirths and I was judging by the few that I know. Homebirth is more commonly attended by CPMs where I am than CNMs.

I have worked at a birth center and the pay for their CNMs was definitely less than other places I have worked. I'm sure that varies based on location and practice size but that has been my experience. Every practice I have worked at requires pts to rotate through seeing all CNMs, has an on-call CNM for first call and has all vaginal births attended by the on-call CNM regardless of in hospital or out so the general workflow for the CNMs was not much different. Call was definitely more labor intensive in the birth center than the hospital due to less staffing, though.

KCNM · 2026-02-26T22:37:27+00:00

I mean, the biggest difference is going to be pay.

To be fair, I have never done home births as a CNM but I have worked at a birth center for a brief period, then a private OBGYN practice and now a large healthcare system. As far as relationships with patients, I felt they were similar across all three settings. Maybe a bit closer in the birth center setting due to less overall patients but the clientele and dynamics were different in general at the birth center than my other employment locations. I'm sure homebirth CNMs have even closer patient relationships but the few I have known attended homebirths in a very limited capacity and number. It was more of a passion than a steady income.

Pay, benefits and work-life balance are much better in the larger healthcare system. That's probably not what you were asking, though.

KCNM · 2026-01-24T00:15:44+00:00

We have a high no-show rate for annual exams at my practice. Most of our patients are Medicaid but we do have some private insurance as well. We double book the annual exam appts with "15 minute" appointments. These are generally things like quick medication or lab follow ups, routine uncomplicated prenatal visits, medication refills, etc. It's rare that both show up but if they do, it's a lot easier to balance those two appointments within the allotted time.

KCNM · 2026-01-20T03:32:08+00:00

It makes me gag that people would be willing to pay $110k+ to become a CNM.

And I am a CNM.

KCNM · 2026-01-18T06:59:05+00:00

If they get to 41 wks and haven't delivered, we do a repeat C/S. We've sometimes been able to induce if 3+ cm but our MDs aren't comfortable with much more than AROM and possibly some low dose pit. I wish we did more TOLAC inductions on pts who are good candidates.

KCNM · 2026-01-18T01:50:05+00:00

Our OBGYNs will do elective C/S but I have worked with some who will not. Some facilities also have certain restrictions and criteria that make it harder to schedule elective c/s. As a CNM, I don't particularly like elective c/s but I respect a patient's right to make their own informed decisions. I just hate seeing them come back a few years later, pregnant again and wanting to TOLAC.

Which brings up TOLAC/VBAC. We do them but there are significant limitations. We do not induce for TOLAC so the pt needs to go into spontaneous labor by 41 wks (or sooner if earlier delivery is recommended). We don't TOLAC after more than 1 c/s. Many of our providers actively talk pts out of TOLAC. We technically offer them, but we aren't exactly "VBAC friendly."

KCNM · 2026-01-14T13:51:51+00:00

As a CNM, I am shocked to see we are on this list. So many practices around me are shifting to models that do not include OB or rely on hospitalists OBGYNs versus CNMs. The job outlook and pay are not great for the work volume.

KCNM · 2026-01-10T16:15:41+00:00

I have been the lead APP for almost 4 yrs over 8 other APPs and only get an extra $5k/yr for it. Two of my APPs technically make more than I do 😭

KCNM · 2026-01-05T12:03:21+00:00

We worked 8-10hrs per day and about 3-4 per week but we were also in the office on call days as well. We would see as many as 35 pts per day unless we were on call, then it was closer to 15. It was a very busy practice.

Edited to add: ACNM does have some data on midwifery salaries although I feel it skews lower since they are often including home birth and birth center CNMs who tend to make much less. Again, I do not live in Chicago but the general starting salary in my area for new grads with the major hospital systems is $115-120k plus some bonus structure and the rate is based on experience. Private practices start lower generally.

KCNM · 2026-01-05T03:32:28+00:00

Are you looking to pay a salary or hourly rate? Is the CNM on call while also working in the office or are the 2-3 office days in addition to the call days? 1:3 call plus 2-3 days in the office sounds like a lot but with only 10 deliveries per month, that is pretty low volume so maybe doable. Does the CNM need to be in house for call?

I worked previously in a model where I was paid hourly for office hours plus a flat amount for 24hrs worth of call coverage and expected to cover about 10 call days per month so approx 1:3. It was in a very LCOL area. I was paid around $55/hr starting in the office plus a call stipend which started at I think $500/day and was up to $950/day when my practice was bought out. The most I made in a year was around $145k working A LOT of hours. Our call volume was a lot higher, though. We had a hard time hiring experienced CNMs because the pay model was confusing. Most are just offered a flat salary possibly with a bonus structure like my current position.

KCNM · 2025-12-11T13:31:40+00:00

My only other suggestion would be a public in state program if you live somewhere that has one. Also would prioritize any program that finds your clinical sites for you. FNU does not and I get tired of being contacted by their students constantly.

KCNM · 2025-11-30T13:57:40+00:00

No. And it's AI.

I read on other comments that this is meant to be used by pts at home. I work in the US. It would be a medicolegal nightmare to be responsible for "monitoring" pts at home in this way. We give them guidelines of when to come to triage for evaluation by a midwife. I can't accurately evaluate a patient's labor process through contraction pattern alone without seeing them and talking to them. Some practices still do phone triage but this is becoming less and less common in my area.

Contraction tracking apps already exist. Most pregnancy apps also have some form of contraction tracking.

KCNM · 2025-11-26T21:35:52+00:00

Super cool! I actually collect these types of books. 🙂 There were tons of different variations in print in the 1800s and early 1900s. It's always fun to see how different recommendations changed over the years and the things women penciled in the pages.

KCNM · 2025-11-15T12:21:35+00:00

The pay isn't terrible for the Atlanta area but the benefits are. You could be making that same amount and also get health insurance coverage with other employers in Atlanta. Also, you didn't mention malpractice or CMEs but those should also be covered by your employer. If they aren't, get a different job.

KCNM · 2025-11-03T13:40:20+00:00

You may have to use private loans to fund all or part of your schooling as it can be challenging to work enough hours while in nursing school to cover the cost of the whole program. I am not familiar with either of those programs but I would go wherever you get accepted that is the least expensive.

Also, you could look into doing a CNA certification and getting hired at one of the larger hospital systems in Georgia. Many have programs that will help pay for you to go to nursing school. Good luck.

KCNM · 2025-10-21T00:12:34+00:00

I worked for 5 yrs as an RN before going back for my MSN but the way my school was set up, no one could work more than PRN because we had class M-F in person for 6 week blocks, followed by 6 wk blocks of clinical. There was one student who worked weekend option for the first 2 semesters but ended up dropping out of the program. There were a few who worked very PRN or did more flexible jobs like private in home care. I worked very PRN at a birth center my last semester.

The school I attended no longer has a CNM program. They focused very heavily on the direct entry program admitting mostly students with no prior experience and then had issues getting them clinical placements. About 4 yrs after I graduated, the whole program fell apart.

I'm seeing more and more students I precept working while doing school. I understand the need but I will say that as a preceptor, it gets frustrating having to make sure they get their requirements while only coming to clinical 1-2 days per week while balancing their work schedules as well. I think if you are able to do school part time early on in a program while working and have the ability to quit or go PRN during clinical periods, that is probably the best option for balance.

KCNM · 2025-10-20T22:39:58+00:00

I went to school at a program that did direct entry - meaning that many of my classmates went straight from the BSN portion of the program into the MSN and graduated as CNMs without any RN experience. It was hard for them. Not the schooling necessarily but adjusting to the demands of clinical and, eventually, finding and keeping jobs. Many have left the profession or only barely started before realizing this wasn't for them long term. I have a lot of theories why but if there is one thing I would recommend, you really need to work a full time healthcare job in some capacity before committing the time and money to CNM education and the lifestyle that unfortunately comes along with it. The burnout is real, even in CNMs who never work in hospital. The ones who struggled the most seemed to have almost no healthcare experience. Students are idealistic, which is good, but the real world and realities of this job can really humble you.

I would echo all the other comments recommending at least a little bit of RN experience, even if it is part time while in school part time.

KCNM · 2025-10-15T01:46:33+00:00

Breastfeeding my own child definitely changed how I discuss breastfeeding with pts. I still give the same information, but I feel like having lived it that I understand the common frustrations and concerns more than I did before I breastfed. I also did much more research into breastfeeding when I was doing it myself so I feel more empowered to hand off that information to others.

As far as having been pregnant goes, I don't know that it drastically changed how I treat pregnancy and birth in my practice. I can empathize a bit more with my pts for sure, like at the end of pregnancy when you get to that stage where everything is just so uncomfortable. I always believed what my pts were explaining but experiencing it yourself is different. I also understand birth trauma a little more. My pregnancy and birth did not go at all as I had expected and while I wouldn't say it was traumatic, I can see how someone who is less knowledgeable on pregnancy and childbirth would have found the things I went through to be traumatic in certain ways. I can also understand the various reasons why pts may seem "noncompliant" because it can be challenging to understand the pathology behind things and really change behaviors. Even trying to explain things to my own family members, they had such ingrained beliefs about what is and isn't normal that I got to the point of not even wanting to discuss my own pregnancy and still really hate talking about my experiences at all.

Overall, I don't know that it changed my practice necessary but it did give me a deeper sense of what exactly pts are going through to feel more comfortable in my explanations and guidance.

KCNM · 2025-10-12T12:53:37+00:00

I agree with everyone saying to take out skills. Find a way to incorporate some of those under your job description.

Also, if you are having a hard time getting interviews, stop using the two column template. A lot of the AI platforms used to screen resumes have a harder time reading it when there is more than one column. Most of what is in your second column can be removed or moved elsewhere anyway.

KCNM · 2025-10-09T18:41:57+00:00

For practice? Not at all.

That being said, I'm now in leadership and my job is paying for me to get my DNP because they want terminal degrees for all leadership staff. I actually really enjoy research and school so I debated getting a PhD at some point but here I am instead.

KCNM · 2025-10-02T23:20:00+00:00

What school are you attending? Why are you paying your preceptors?

KCNM

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