Deciding Between Becoming a Labor and Delivery Nurse or Midwife

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Many jobs in medicine require taking care of people who have illnesses and injuries. The field of obstetrics is different. Pregnancy is not a disease, and caring for pregnant women can be a great fit for some people interested in working in the medical field. But how to you decide between becoming a labor and delivery nurse or a midwife? The first step is learning what each one does, educational requirements and the differences between the two professions.

What does a labor and delivery nurse do?

Labor and delivery nurses care for women when they are in labor and giving birth. Nurses may perform exams to see how a woman is progressing during labor. They may also monitor vital signs for both mom and baby, administer medication and respond to emergencies as needed.

During the actual birth, nurses will coach the woman through contractions, assist the doctor and care for the newborn immediately after birth. In some facilities, L&D nurses also care for both the woman and baby until they are discharged.  

What does a midwife do?

Midwives provide care for women throughout the course of their pregnancy and provide assistance during labor and delivery. They may counsel women on healthy habits during the prenatal phase, perform exams and educate women on pain management options during labor. In addition, midwives provide support and assistance as needed during delivery.  In most cases, midwifes also care for women during the post-partum time providing support and education as needed. 

Similarities and Differences

Both midwives, and labor and delivery nurses care for women who are pregnant. They also both attend deliveries and provide support. Both professions have the opportunity to provide education on newborn care.

But in addition to the similarities, there are many differences in the two professions. Although midwives care for women during their labor, they also care for women throughout their pregnancy, not just when they are giving birth. Labor and delivery nurses do not take care of women throughout their pregnancy.

Labor and delivery nurses do not provide care to women who are not pregnant. Midwives may provide care for women during all stages of their life, not just pregnancy. For example, some midwives provide preconception counseling and information, treat menopausal issues and provide routine gynecological care.

Which is right for you?

Before deciding whether you should become a midwife or labor and delivery nurse, it is helpful to understand factors, such as differences in education requirements, salary opportunities and working conditions.  

Education involved: In order to become a labor and delivery nurse, you must graduate from an accredited registered nursing program, which may be two or four years long. Passing a state exam is the next part of the process to become licensed as a nurse. After becoming licensed, nurses may apply for work in the labor and delivery department. Some hospitals may require nurses have a few years of general nursing experience before working in L&D. But other facilities will train new grads.

It takes longer to become a midwife. Midwives also have to become registered nurses. They can also choose a two or four-year program and must become licensed. But after becoming licensed, there is additional training. Midwifery programs have different admission requirements. For example, some require nurses have a BSN degree while others may not. In general, midwifery programs take about two additional years to complete.

Level of responsibility: The level of responsibility for L&D nurses and midwives are different. Nurses in labor and delivery work under the direction of a doctor. They have an important role, but they are not alone. For example, an L&D nurse is not the person who makes the decision to use forceps or perform a C-section.

Midwives are usually used in place of a doctor during labor, which means they have the same responsibility as an obstetrician. Similar to a doctor, a midwife is the person who is responsible for making critical decisions, such as if emergency interventions are needed during delivery.

Working Conditions: Labor and delivery nurses most often work in a hospital. Some may also work in birthing centers. They typically work eight or 12-hour shifts. L&D nurses may care for several women during the course of their shift.

Midwives typically work for birthing centers or are self-employed.  Some may also work for hospitals, but that is less common. In many instances, midwives may deliver a baby in the woman’s home. Midwives may work unpredictable hours. If a patient goes into labor, the midwife stays until delivery and does not go off duty.

L&D nurses work with all types of patients from those wanting as natural a birth as possible to those who wish to have pain medication, epidurals and deliver via C-section. Most women who choose a midwife, prefer a natural delivery and use alternative techniques to manage pain.  

Midwives usually do not care for with women who are at a high risk for pregnancy complications. Labor and delivery nurses may care for women with all types of complications related to pregnancy and labor and delivery. 

Opportunities: Labor and delivery nurses mostly work for hospitals. Midwives mostly work for birthing centers or are self-employed. Opportunities for advancement are also different. L&D nurses may advance to administrative positions or charge nurse. Since many midwives are self-employed, they do not receive promotions from the hospital.

Salary: A lot of different factors go into salary for both labor and delivery nurses and midwives. The years of experience a person has, their credentials and where in the country they live all play a role in earnings. In addition, midwives in private practice can set their own rates, which may vary.  But on average midwifes tend to earn more than labor and delivery nurses.

According to the United States Bureau of Labor Statistics, the average salary for registered nurses including labor and delivery nurses in 2012 was about $66,000 a year. The average yearly salary for midwives in 2012 was just over $92,000 according to the U.S. Bureau of Labor Statistics.

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