Time We Discuss: What It's Really Like to Be a Midwife (Amanda Snyder)

Transcription

(Music)

Amanda Snyder: There's a lot. So communication for sure, if communication is not your jam, that is, this is not your thing. Also, there's a lot of blood. There's so much

Dan: Today on "Time We Discuss," I wanna welcome Amanda Snyder, and it's time we discuss what it's like being a midwife. Amanda, thank you for joining me today.

Amanda Snyder: Thanks, Dan, for having me. I'm excited.

Dan: Me too. I know pretty much nothing about midwives. The extent of my knowledge is this. My wife watches the show, I think it's called "Call the Midwives." I think it's what it's called. And the only experience I have is if I'm walking through the living room and it's on. (Amanda Laughing) That is it. So tell me.

Amanda Snyder: It's a very accurate show. So if you've seen little snippets, they do a really good job.

Dan: That is good to know. Okay, so because I have not, what is a typical day like for you as a midwife?

Amanda Snyder: Oh man, it's so different every day, which is one of the reasons I love it. Midwives broadly can practice in lots of different settings. I practice in the clinic, which is prenatal care most of the time, sometimes some postpartum visits. I also practice in the hospital on the postpartum unit. I'll visit families who've had babies in the last 24 to 48 hours and just see like check in on them, help with breastfeeding, make sure medically they're safe and okay to go home. And then most of my time, which is the fun part is then on labor and delivery, which is just the best. Every day is so different. When I get there, I work day shifts and night shifts, so it kind of depends, the flow is a little different depending. It's a pretty busy hospital. So from anywhere from four to eight, women are laboring at a time. When I arrive, I find, I like kind of touch base with the midwife who's there previously, and we go through each of the patients and she gives me a little rundown on what's going on and what their needs are. And then I round and I meet them all. And everyone's typically at a different point and needs different things, but essentially I just labor with them throughout the day or the night. If they're an induction, I help manage their labor. So if they need medications to encourage their labor to continue, all while very closely watching the fetal heart rate tracing. So like watching baby's heart rate, making sure baby is safe and happy. And then just providing tons of emotional support for mom and dad, because it's really hard and really scary having a baby. And then ultimately catching their baby in the end, which is like the coolest part ever. And then postpartum, helping them recover, making sure they're not bleeding. And like I said, just kind of hand holding and walking people through labor and birth and that transition into parenthood, whether it's their first time or second time or third time, it's big and it matters. And it's scary for a lot of people. So I try to just like meet people where they're at. And so every shift is very different. Sometimes there's a lot of people who just walk in, ready to have a baby in the lobby and that we do that. Sometimes people walk in at one centimeter and there's a journey they have to go through still. And there's a lot of education and a lot of hard moments and a lot of days of laboring. And I will be there with them in that. It's just different. Every day is different. Every day is so different. And ultimately the biggest summary, I guess, would be just being with families during this time and making sure moms and babies stay healthy.

Dan: That is awesome. So originally, this shows how little I know, I assumed this is more of like a, I hate to phrase it this way, but more of like a new age-y kind of thing where it's like you were in people's homes for like a home birth or something like that. But no, this is in a clinic or in a hospital or something like that.

Amanda Snyder: I work in a hospital. Some people you can, there's lots of different types of midwives. Some work at home, some work at birth centers, some work. There's a lot of different settings. We're independent practitioners. So we don't need like a physician supervision. So you can independently practice really wherever. I like the hospital setting personally, mainly for the work-life balance. When I'm on, I'm on, when I'm off, I'm off, and that feels nice to me. Midwives who work in the home birth world, you're really on call pretty much 24 seven. You're just waiting for a phone call from that person saying I'm in labor and then you have to go. And just where I am in my life right now, that doesn't work for me. But yeah, you can work in any setting really. There's a lot of different ways to do it.

Dan: Okay, and it sounds like your relationship with the mom, it's very short-lived. It's not like you meet them once ahead of time or something like that. It sounds like you pretty much meet them, you know, in the moment or maybe a couple hours ahead of time, maybe a day, depending how long labor takes, but it's a very short relationship it sounds like.

Amanda Snyder: Sometimes, I do prenatal care. So it's not like one, like I see a bunch of patients in prenatal care and the hope is always that you see somebody when you walk in and that you recognize. That's always a lovely moment. But it is set up in a way where you're not on call. So I don't go in for specific patients. I don't go in for patients that I've seen previously. There's always like the patient that you're hoping is there when you come in because it's just so lovely. But they've learned over time that that actually improves outcomes because I don't have any skin in the game. I don't need like someone to have a baby so I can go home to my kid's birthday party. So it seems a little bit more impersonal, but it actually improves outcomes all around. So we go with it.

Dan: Okay, that's pretty cool. Okay, so what is your schedule typically like? I realize it might vary depending on hospital or scenario, but do you typically do, are 12 hour shifts common? Is it more like eight? What's kind of typical, I guess?

Amanda Snyder: Typically 12 hour shifts. Every once in a while, if I'm feeling crazy, I'll do a 24 hour. In clinic, it's more normal days. So clinic resembles a more normal work time. So like nine to five-ish. And then nights and days. I work at a place where we flip-flop. Some places will just be straight nights or straight days. I kind of like the variety. So the flip-flop works for me, but 12 hour shifts is pretty typical in hospital settings all around, I think.

Dan: Okay, and how common are midwives? Are they available at most hospitals? Does a mom, do they need to request a midwife? How does that work?

Amanda Snyder: It's so different depending on where you live. They practice a lot. So in California, where I am right now, they're very common. It's just the thing. Like if you get pregnant and you're normal and healthy and you are low risk, you kind of automatically see a midwife. If you're more high risk, a lot of people will do dual care and bounce back and forth between a midwife or a physician. That is the norm here. Back on the East Coast where I was born and raised, it's not as common, but it's becoming more common. I think when my mom was pregnant with me, midwives were like not a thing at all, but my friends who are having babies now, I do see that popping up more and more. They're not being used to the fullest extent of their scope. It's more, I think on the East Coast, it's been more of, they're like helping doctors is kind of more the vibe. We're moving towards more of that independence still. We're working there, but they are popping up more and more. Especially in the middle of the country, sometimes that's all there is, is a midwife and there's no other option, especially the ones that come to your house. So it really depends on where you live. Big cities, big hospitals, almost all of those facilities do have a large amount of midwives at this point, which is cool.

Dan: okay. Now, we have to take the good with the bad.

Amanda Snyder: Totally.

Dan: So what happens when things take a turn and things aren't looking good for the baby or the mom? Is the midwife still involved at that point? Is it like, no, we need to get another specialist in here? What typically happens at that point? I hate to say it, but you have to deal with that?

Amanda Snyder: Yeah, oh, for sure. That's part of the job. And it's handled differently wherever you are. Where I work, it's handled beautifully, in my opinion. I work very closely with our OBs and our doctors who are on. And if I'm worried about something, I will go to them and be like, "Hey, this is what I'm seeing? I don't love X, Y, or Z thing. I'm gonna touch base with you in 30 minutes. And can you just kind of stay around?" Ultimately, midwives are trained in all of the emergencies that happen in obstetrics. So all of the big things I know how to handle. I love the fact that I have OBs right behind me because it's just, we work better together. So typically, if something, if we're worried about baby and we need, let's say, an emergency C-section, I then step into more of a supportive role. The OB will step more into the primary role and take control of the OR. I first assist in the OR, so I help, I'm like the surgeon's assistant. And then ultimately, I'm their person still. So I will go with them postpartum. We will talk through the C-section. Sometimes that's really hard for people to just wrap their mind around, that's what happened. I try to stay very involved in their life and their care while they're in the hospital still. Even though the medical care then becomes more of the OB's responsibility.

Dan: So let's stick on C-section for a second. So my wife had a C-section and I was there for that. And it was an experience for me. It was an experience for her, it was an experience for me. So, and that leads me to this next question. I like to ask people that I'm talking to, think about an aspect of the job where it's like, if you don't like blank, this job is not for you. So can you think of something where, something that you have to, it's something that's core to your job, that if someone is like, this is a game changer, I don't like this, they should not do it.

Amanda Snyder: People. I mean, honestly, so much of my job is just connecting with people and really like understanding where they're coming from and not pushing my own agenda on them. It's a lot, like it's way more communication than I think I ever imagined. I think I thought when I first went into this, it would be more like medical and doing more things with my hands and catching babies, which is obviously a part of it, but it's so, there's so much communication. There's so, I mean, people are so vulnerable in that phase. There's a lot. So communication for sure, if communication is not your jam, that is, this is not your thing. Also, there's a lot of blood. There's so much blood, like all over the, all the time. And normally it's a normal amount of blood and that's always like very surprising to people. I think the amount of blood that comes out with a vaginal birth or a C-section that is considered normal is considered a large amount for most people. And it's, if that is not something that you can watch or be around in a regular way, then it's not your thing.

Dan: So that's where my mind immediately went to, was that if you don't like blood and gore, you know, maybe not.

Amanda Snyder: Yeah, no, yeah, for sure.

Dan: So many people have said communication is so important to the various jobs that they do. And it's definitely a trend. I would say, I think probably four out of five people I've spoken to over the past year and a half, communication has been so, so key. And it's, I think it's a blessing and a curse, because if you're not a good communicator, you could have a hard road ahead of you. But if you are a very good communicator, it seems like you have a lot of possibilities that are open to you.

Amanda Snyder: Yeah, yeah, for sure.

Dan: So sticking with possibilities, what kinds of other opportunities are there for midwives? Can you do anything to advance yourself? Or is it like, you're kind of at a terminal stop right now, like midwife, that's your thing?

Amanda Snyder: I wanted more education, I could go on to get my DNP in midwifery. So I would be a doctorate of midwifery, which I'd be like a doctor midwife, which is like always just a funny thing for me to think about.

Dan: Let me stop you right there. So what would be the primary differences between that and what you do now?

Amanda Snyder: From a scope perspective, not much. Not much at all. It's more just like, typically there's some facilities that want that level of education in order to be chief or to manage people. And so it's more in that area you advance. The cool thing about midwifery is you can choose a very specific thing to specialize in, and then get trained in it and then do it if I wanted to do, let me think, like preconception care, for example, if people were trying to get pregnant and I wanted that to be my thing, I could get a certification in preconception care and then really just make that more of my specialty. So there's a lot of things you can branch off into. A lot of midwives or a lot of certified nurse midwives, which is the type of midwives that I am, are also nurse practitioners. And so there's a lot you can do through that area too.

Dan: Okay, so you're also a nurse practitioner then?

Amanda Snyder: Yeah, I'm a women's health nurse practitioner, yeah.

Dan: Okay, interesting. Is it possible for someone to be a midwife and not be a nurse practitioner or it is?

Amanda Snyder: It is. So the midwife's scope is so broad that it covers the nurse practitioner scope. So a lot of schools will be like, well, you're already a midwife and you're already doing all of this. So we might as well just like give you the extra class and like have you be a nurse practitioner. Nurse practitioners don't catch babies, but they do all of the other things. They can be trained to catch babies, but the general baseline education doesn't include birth. So as a midwife, I have a more broad scope. And so it covers the nurse practitioner scope.

Dan: So fascinating, I love this. Okay, so let's hang on this, let's hang on education. So you obviously need to, you gotta go to college. There's no way around that. I'm assuming a bachelor in like pre-med, bio, something like that. And then what do you do after that?

Amanda Snyder: So some midwives, you don't need college. The midwife that I am, you do. I know, you can really do it a lot of different ways. Some midwives, as you just get a certificate, it's a lot of training. And those midwives in most locations are not able to work in hospitals. They are home birth midwives. They are trained exclusively in home birth, and they are really good at home birth. Like I was planning a home birth with my first daughter and I was seeking out that type of midwife, mainly because of how well trained they are in home birth. I am a certified nurse midwife. So I had a four year nursing degree. I practiced as a labor and delivery nurse for five years. And then I got my masters in midwifery and women's health. And so it's a four year nursing degree. And then followed by the master's is about two years.

Dan: Okay. And then does that include any kind of like, I forgot what the doctors have, like the internship or anything like that, where it's like years of then like actual training that you have to do as well. How does that work?

Amanda Snyder: That's in the two years. So it's a pretty short thing. It's a very intense two years. I did mine in like about two and a half. Most people can get it done in two. I moved and got married and it was, I had to take a break, but it was, you can do it pretty quick. If it's an all in situation, but the education and the internship is like all in one chunk.

Dan: Okay. Now if someone is looking to change careers, and I think I know the answer to this, but I'm gonna ask it anyway. They are doing something completely unrelated. And they want to do what you're doing. Is there any way around, so if I have a bachelor's in art, I'm a photographer, okay. Can I go and get a master's and become a midwife just by getting the master's or no, I also need to, talk to me about that.

Amanda Snyder: You need a nursing degree. For the type of midwife that I am, you need a nursing degree. And you need a BSN, so a bachelor's of science and nursing. So it's almost always a four year degree. There's a lot of schools now that are making like the whole, you can get the whole thing in five years. So there's a, especially out here, there's a ton of schools where you just go in for undergrad and you finish and you're a full midwife. And they crunch it into the five years, but you do do an nursing degree.

Dan: That's really cool. Okay, okay. So there are lots of different paths someone could take. If they really want to pursue this career, there are lots of different ways they can either do, the four, they could do the traditional university route and they get master's and all that good stuff. If they want to just work through people's homes, it's possible to just get a certificate and continue to work that way as well. And then you could also continue on, get a doctorate and elevate yourself up to like a, kind of like a C level almost sounds like. So lots of really, really great opportunities.

Amanda Snyder: It can be what you want it to be. You can work like fully full time. You can do a couple shifts a month. I know people who, and even in the home birth world, will take like one client a month and then you just kind of do one birth a month basically. Or yeah, it can be as busy or as not busy as you want it to be.

Dan: And you talked about your shift, you tend to flip flop between nights and days. I don't know if you would know the answer to this, but how common is that at other institutions? Is it based on seniority? The people who've been there the longest get the worst shifts or something like that. From your experience, what is that like?

Amanda Snyder: I think when you go into midwifery, you know that you're going, there's certain parts that go along with it, like working night shifts, working holidays, working weekends. Like that's kind of the case no matter where you are. I think there's certain places where, it's rare, but there are certain midwives who will like just work day shifts. But those tend to be the hospitals where there isn't full 24 hour midwifery care. Like a lot of hospitals that are still starting out with their midwifery program don't have midwives at night yet. And so it's just like just kind of starting out. It does exist. I would say if you're going to go into midwifery, kind of expect the nights, the weekends, the holidays, that's just kind of part of it.

Dan: Amanda, this is all really, really good information for anyone that's aspiring to be a midwife. Just really, really great. Like I said before, so many paths, someone could take it if they're just starting their career, if they're looking to transition. And even it sounds like if someone is looking to transition later in life, it sounds like it's still possible. If you have your BSN, it's definitely possible. And if you are looking to change careers, it's still relatively easy, for lack of better words.

Amanda Snyder: It is. A lot of the midwives I work with actually became midwives after doing something else first.

Dan: how about continuing education? I'm assuming that during the course of the year, every two years, maybe you might have to do some kind of continuing ed. What's that like?

Amanda Snyder: Yeah, I mean, there's the licenses you have to keep up. And typically one of the requirements for the licenses is some number of continuing ed things, credits. So the easy way to knock them out is a conference. So that tends to be what I try to do at a conference. You can get a lot of them done. You have to renew your licenses every two years. It's different, I have state licenses and national licenses. And the state ones get renewed every two years. The national ones are every five years. And those are bigger and have weight, there's a test and a lot more continuing ed involved in that.

Dan: Okay, so following up on that, I was speaking with Dr. Emma, her episode went live, oh geez, probably the spring of 25, I think. Several months ago, by the time your episode goes live, it's, you know, just a mirror in the rear view. What are some hidden costs associated with your occupation? So for, Dr. Emma was saying, you know, renewing your license is a very big expense. It sounds like if you're going to conferences, you know, you might have to pay out of pocket for that. Are there any other things where it's like, when people necessarily think about being a midwife, they don't think about these other hidden expenses that might go with that?

Amanda Snyder: If you practice in a home, you have to pay for your own malpractice insurance. I'm lucky because I practice in a big facility, so they reimburse my license costs. They reimburse any conferences I want to go to. They reimburse really anything that I need to keep my job, they will pay for it. So any required thing that I need to, like all my, I'm CPR certified, I'm ACLS certified, like all these different CPR things, they will reimburse for all of that if it's required for my job. So, which is a lot of things, so it's nice.

Dan: Do you have any idea how common that is if you're working at a larger institution?

Amanda Snyder: Pretty common.

Dan: Yeah, okay, cool. Pretty common. All right, awesome. Amanda, this is the part of the show where I'd like to invite my guests to talk about a project they're working on, a cause they believe in, about their business, the company they work for. So if there's something specific you'd like to discuss, the floor is yours.

Amanda Snyder: Nothing specific, just like I really would love people to advocate for themselves for how they want to have a baby. Birth matters, it's so important. The way people, the way babies and humans come into the world matters. And I feel like there's so many stories I hear where people are just not, they don't feel heard, they don't feel supported in their prenatal care or at the hospital or at their home, wherever they're giving birth. And there's another way to do it. Just find a different person, you should be heard, you should be listened to. Those things are important. And I would just really advocate for people to look in other places for their person who will make them feel comfortable and seen while they're pregnant.

Dan: Amanda, that is awesome. I hope all the listeners take that to heart. It is such a great, great thing to hear you say. Amanda, thanks again for being on Time We Discuss and learned what it's like to be a midwife.

Amanda Snyder: Thanks for having me, Dan.