CNM or CPM? Opinions/advice?? - page 2

by BrittK 6,754 Views | 22 Comments

Hello everyone, I'm a student, going to school for my ADN but, I can't decide whether I want to become a CNM or CPM..my ultimate goal is to do home birthing..I REALLY do not want to work in a hospital once I become a midwife (I... Read More


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    I feel exactly as you do trauer..I too resonate more with the holistic, low-intervention birthing style. I think I am gonna end up doing the CNM route..I too, am afraid of the nursing school aspect of it all but mostly just don't like the idea of having to be trained in a hospital doing things the "hospital way" I just feel like so much of it is unnecessary intervention (some yes, is necessary..but not all) but I suppose in the end, it can help me not only with stability, but in becoming a better midwife.
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    I live close to Houston, TX and I haven't looked into speaking with any midwives here or even shadowing..do any of you know of any that would be good to speak to? I'm also torn about a nursing/nurse-midwifery program/school to attend once I get my associates degree then bachelors. I was looking at Maternidad La Luz but they are really more for CPM certification (though, I would still love the extra knowledge and training!) There's a part of me that is unsure about my ultimate goal as to whether I want to be on-call 24/7 or work in a birthing center..I DO know that I DO NOT want to work in a hospital though.
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    If you just want extra knowledge and training, maybe do a cheap, non MEAC CPM program. There's one called Via Vita, Via Vita Midwifery Foundation's Course Information, that is super cheap, the midwife I am apprenticing with used them for all her academic training.
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    I completely resonate with midwifetobe85.

    I decided on the CNM track. But I do plan on shadowing or assisting a DEM midwife as well to have that extra OOH birth experience. My ultimate goal is to open a birth center.

    I at first did not see the correlation between a nurse curriculum and a midwife, but as I started reading more, I'm starting to see the connection. I do think the US has a curriculum gap, and quite honestly I think nursing should be broken into several paths to allow more specialized focus for the different care paths, such as geriatric, L&D/OB, surgical, etc.

    There are varying programs out there though. I am lucky that a program local to me offers a choice of practicum at the close of senior year. I hope I can get into L&D for that.

    Also, there are midwife courses that give training in all settings as well. University of PA, for one, states that training will be in hospital, birth centers and home birth settings.

    On another note, the show Call the Midwife, is actually what started opening my mind more to the full scope of the nurse-midwife connection. After the first episode or so I finally had this excitment come over me to BE a nurse. Not just a midwife. Which was pretty mind blowing, because for years I had looked at the nursing portion as a hoop to jump through. Now I'm just as dedicated and excited about all the training.
    Not_A_Hat_Person likes this.
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    Hi Ladies,

    Thanks for all your positive comments to my post!

    Queenanneslace - I completely agree with you. You will NOT be indoctrinated in nursing school if you don't want to be. I went into my ABSN because I wanted to be a midwife. I knew who I was and what I believed in. I had a CNM teach my OB class in nursing school and she was a total medwife. I asked her (already sort of knowing but wanting to confirm), "Full-term is considered 37-42 weeks, correct?" And she replied, "well not really, I would never let a woman go past 40 weeks..." Did I change my stance on postdates? Definitely not. She was wrong in fact, to suggest that those dates are not full-term. The definition of postdates per ACNM and ACOG is past 42 weeks. But I digress. I also did not expect to enjoy anything in nursing school. But I did have quite a few positive experiences. I found my geriatric rotations very fulfilling in particular. It was still quite challenging emotionally - especially the OB rotations. I did my senior practicum on a mother/baby unit and was constantly seeing nurses undermine breastfeeding attempts. But, I just told myself, do what I can today to help, and someday I'll be the midwife.

    EmmKay - thank you for your kind words!! I'm glad I'm able to be helpful. While its definitely true that the medical model is the foundation of an ABSN I think it's quite likely that you may find the same in the first year of a GEPN. The classes in the first year are just general nursing courses and very well may be taught by other kinds of APNs, not necessarily midwives. But, as I said before, you will make it through it, and it won't indoctrinate you if you don't want it to.

    As far as Frontier goes, you do not need to have any labor and delivery experience to apply. In fact, I was told the majority of their accepted students have no L&D experience. (It's very hard to get into these days.) They require that you have one year of nursing experience OR other significant birth-related experience such as being a doula, childbirth educator, or breastfeeding educator/lactation consultant, etc. I applied with 5 years of doula/CBE experience as well as some breastfeeding assistance. I'm still waiting to hear, so I'll let you know how it goes. But the director was very encouraging and I've heard of other students with similar backgrounds being accepted. As far as preceptors are concerned, I was told by their regional coordinator that I shouldn't have a problem in the Boston area. I think the students who have difficulty finding a preceptor are in rural areas where there are not a lot of CNMs and students in areas where there is another local midwifery program to compete with. This is an issue in western MA for Frontier students because many of the midwives in the Springfield area are already precepting Baystate students. Boston has no midwifery programs and there are many midwifery groups. Once accepted, Frontier provides you with a list of previous preceptors in your area. Its not a guarantee that they will work with a student again, but it's a starting place. I think my approach would be to research midwifery group reputations (I've heard better things about the Cambridge birth center than the Beverly birth center, for example) and to call them one by one, meet and hopefully make a connection. Frontier preceptors are also given a stipend as an incentive (paid for by the school), which I've heard is not true of all programs.

    Lastly, I loved what you said about all practices offering home, birth center and hospital care. I completely agree that this is the ideal - it's common in England. My dream is to start another Boston area birth center and grow the practice to also offer home and hospital births as an option. This may be WAY too ambitious. But I get the feeling that midwifery is rapidly expanding now - especially awareness and interest in birth centers. (Has everyone seen the new AABC birth center study? Midwives Say Birthing Centers Could Cut C-Section Rates and Save Billions | TIME.com)

    Trauerweidchen - I agree Midwifery Today's Paths to Becoming a Midwife is a great resource for the undecided aspiring. You're also right about potential logistical complications for a CNM doing OOH work. In MA for example, there used to be a written collaboration agreement requirement for midwives. This was basically a permission slip from an MD saying they would back you up in practice as needed. This was not an issue for CNMs working in practice with those physicians, but it was basically impossible to get an OB to sign on as backup for a home birth practice, not only because many are out right opposed to home birth, but also because their insurance companies wouldn't allow it. Last February a law was signed that changed it to a verbal agreement (the same as NY), which basically removed that complication. There aren't any home birth CNMs in MA yet, but I believe we will start to see them shortly. If you are still trying to decide on a route to midwifery, it would be important to research both if CPMs are legal/supported in your state and if there are current home birth CNMs.

    BrittK - You're so welcome! Its wonderful to meet other woman who feel as 'called' to this profession as I do! There are definitely home birth CNMs and CPMs in Texas, heres a practice that has both kinds of midwives working together! Take a look: Welcome - Official Website Heart of Texas Midwives - Offering natural choices for home birth, water birth in Central Texas You may also have the option of working in a birth center as a CPM, here's one: EdenWay Birth - Charlotte Russell, CPM I definitely think your best bet would be to interview several of both types of midwives and shadow them. This is what I did in the beginning and I research laws in the states I thought I might end up in. This helped me feel certain about the CNM path. Here's a Houston-based, CPM-run brith center: West Houston Birth Center | Compassionate Care for Women and here is a Houston-based home birth CNM - About Pat Jones, Certified-Nurse Midwife Just call and tell them you're an aspiring midwife and that you're looking for some guidance.

    Cjyff - I don't really agree that finding a cheap non-MEAC program is the way to go. I'm not saying that theyre not qualified or skilled, but it's tough enough carving our a legitimate niche for yourself as a CPM (its illegal in half our states). Parents want to be reassured that you're qualified/well-trained and so youre really creating an uphill battle for yourself to not even have the CPM cert.

    Phoenixnim - that is definitely true. Many midwifery programs offer a variety of OOH clinical opportunities. SUNY Downstate allows you to set up your final practicum in ANY setting, in just about any state, and even abroad! Frontier requires some hospital experience but you can also have a home birth preceptor. Also, I LOVE Call the Midwife. And yes, its a very nice notion - caring for the whole family unit, incorporating nursing skills as well. This is why I am glad to have done nursing school. It wasn't my first choice, but I'm glad to have done it.

    Can I just say, I LOVE this thread. It's really exciting to see so many like-minded aspiring midwives.
    phoenixnim likes this.
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    Ack!!! There's too much good in this thread to respond to, but I love reading the thoughts of so many like-minded people!! I am currently applying to ABSN programs, with the intention to go for a family nurse-midwife program (or the CNM plus post-master's FNP).
    cjyff likes this.
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    I'm saying if you want addition knowledge, why pay the big bucks. I really don't see why an expensive MEAC backed program would be of use to someone who just wants more information. Especially when becoming a CNM is not cheap. No parent is going to know what MEAC is anyway, there are so many acronyms associated with midwifery.
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    Quote from cjyff
    I'm saying if you want addition knowledge, why pay the big bucks. I really don't see why an expensive MEAC backed program would be of use to someone who just wants more information. Especially when becoming a CNM is not cheap. No parent is going to know what MEAC is anyway, there are so many acronyms associated with midwifery.
    Oh I see what you mean, cjyff. You're suggesting a different pathway to the CPM, not skipping it altogether. Most parents will know CPM vs DEM but you're right they probably don't prefer one who did an MEAC program. I saw your post in the other thread. Did you decide to apprentice with the CPM?
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    I think cjyff was suggesting that if one wishes to have input from both CPM and CNM educational pathways, it might make more sense to participate in a cheaper, non-MEAC accredited program for some of the CPM knowledge, but not certify, and then go on to get the CNM credential. I'm seriously considering doing this; going the apprenticeship route initially and following NARM's PEP guidelines for self-study, with or without the additional help of a non-accredited program, while I finish prerequisites and apply to nursing school (about a year out because I need A&P 1 & 2). The added bonus is that I'd get the experience I need to apply to Frontier without working as a nurse (particularly L&D) for a year post-graduation, though I may choose to do that anyway for experience.

    I've researched the legal implications of CPM vs. CNM for the state I'm currently in, Minnesota (quite favorable for either path, in my opinion), but also am trying to keep in mind the situation in MA, since I have some hope we may move back to the Boston area, and I am aware of the complications there. I've been following the legislative changes with interest; I'm hopeful that the CPM licensure bill will also pass in time, but also that there will soon be out-of-hospital CNM practices there. That might be the nail in the coffin for me, especially if we do end up moving back.
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    Quote from trauerweidchen
    I think cjyff was suggesting that if one wishes to have input from both CPM and CNM educational pathways, it might make more sense to participate in a cheaper, non-MEAC accredited program for some of the CPM knowledge, but not certify, and then go on to get the CNM credential. I'm seriously considering doing this; going the apprenticeship route initially and following NARM's PEP guidelines for self-study, with or without the additional help of a non-accredited program, while I finish prerequisites and apply to nursing school (about a year out because I need A&P 1 & 2). The added bonus is that I'd get the experience I need to apply to Frontier without working as a nurse (particularly L&D) for a year post-graduation, though I may choose to do that anyway for experience.

    I've researched the legal implications of CPM vs. CNM for the state I'm currently in, Minnesota (quite favorable for either path, in my opinion), but also am trying to keep in mind the situation in MA, since I have some hope we may move back to the Boston area, and I am aware of the complications there. I've been following the legislative changes with interest; I'm hopeful that the CPM licensure bill will also pass in time, but also that there will soon be out-of-hospital CNM practices there. That might be the nail in the coffin for me, especially if we do end up moving back.
    Ah, yes I think you're right. I misunderstood. That's a really good idea. It definitely doesn't make sense to invest in an expensive MEAC program when your just doing it for your own study.

    Personally I would also prefer an apprenticeship to a year in L&D. It sounds like wonderful experience. I applied to Frontier w 5 years of doula/CBE experience plus I did my senior nursing practicum on an LDRP floor. But Ive never actually worked as a nurse. I could not find any OB jobs in the Boston area that would accept a new grad and there is no way ill be doing any med-surg. The Frontier admissions counselors REALLY emphasize having SOME nursing experience as preferable. They say, 'if you could get 8 months or even just 6 months that would be good...' like they're bargaining with you..lol But I emailed the director and a couple other faculty midwives (the ones actually making admissions decisions) and outlined my background and they were all highly enthusiastic about me applying now, saying, "we want to make midwives!" I was told the other birth experience isn't scored as high as nursing experience but that every element in your app counts, especially the essays and recommendations. I guess when I learn my admission status Ill know which advice was more accurate!

    I also hope the CPM bill will pass here. Right now I don't think the CPM situation is too bad compared to some states. At least here it's allegal instead of illegal. I think it would be better though for that cert to have some recognition. I'm still also in search of a CNM who would be interested in home birth around here so I can clarify if there are any other road blocks to starting a home birth practice.


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