cnm vs. cpm

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    I recently graduated with my BSN. I started nursing school wanting to become a Certified Nurse Midwife. However, I live in Southwest Missouri where midwives do not have hospital privileges and OB/GYN's are not incredibly friendly towards midwives. From what I understand, a CPM can practice independently (doesn't need a Dr. on call) which is starting to sound more and more appealing.

    My dream is to have a birthing center, hopefully with several other midwives, and I always just thought it would be easier as a CNM. Many CPM's this area travel LONG distances and I don't want to do that, especially when I have young children. I thought having a "home like" birthing center close to my home would be a good compromise.

    I am considering going back to school in the next few years, and just wonder if anyone has any advice? Are there any real benefits to becoming a CNM? Especially in an area that is still learning to accept midwifery & home birth as legitimate and safe?

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  2. 0
    So what happens with a CPM when something goes wrong during a delivery and a Dr needs to get involved?
  3. 1
    to OP...Midwifery Today has an excellent resource on CPM v CNM. Basically, it does come down to what types of births you want to facilitate, in what setting, and what your state laws dictate. Look at the MANA and ACNM websites, too, while understanding that there isn't a place in the nation that has "arrived" as far as MD/Midwife relations goes. Hope those ideas help.

    To reply poster: If the CPM has a referral relationship or collaborative practice agreement with a MD, she would transfer to that MD and transport to the facility where the MD has privileges. If not, she would transport to the local hospital with OB service, and the patient would be a "drop in" or unattached pt.
    LoveANurse09 likes this.
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    I'm still undecided about this too, but I think I'm leaning toward CPM. I became a nurse with the sole intention of becoming a CNM. I had both of my babies in a free-standing birth center with CNM's and had a wonderful experience, and I always "knew" that is what I wanted to do.

    But in recent years I've really had second thoughts. Maybe this is reflected by the fact that I am still an LPN working in a completely unrelated specialty - after some poor experiences in nursing school I haven't regained my motivation to go back for my RN with the prospect of working in L&D.

    In my area, CNM's are becoming increasingly limited, even the birth center transfers more patients to the hospital than they used to. There is only one hospital left in an area that covers half the state that still allows CNM's to practice there. Others have pushed CNM's out and now you see them only working in gynecologists offices doing routine well-woman care.

    The real market for birth seems to be for CPM's. Even though their scope of practice seems more limited, they actually have more freedom in home births. Unlike CNM's, they don't need physician back-up for everything, and they are not required to carry the expensive insurance that has pushed some CNM's out of business. CPM's are legal and there are state standards regulating their training, license requirements, and practice. Basically, CPMs are the professionals that manage "normal" out-of-hospital births in my state. In a hospital, only OB's practice. So those are basically the choices.
  5. 1
    check out mana.org for some state-by-state info to help understand that laws for CPMs vary HUGELY by state. MANA is the midwives alliance of north america -- the group doesn't focus on breaking up midwives into all of their respective certs (CNM, CPM, CM, DEM, LM, lay midwife, etc.), but instead trys to encourage good standards of practice across the realm of midwifery (to wildly reduce their entire mission statement... sorry MANA).

    here's the state by state breakdown of laws for direct-entry midwives/CPMs/LMs (so many terms that effectively point to the same person -- a non-CNM midwife):
    Direct-Entry Midwifery State-by-State Legal Status

    in most localities, i don't think it's as easy as 'not needing backup' as you mentioned, whether legally or culturally in your area. there's usually more to it than that. for instance, some states require licensing and in order to get your license you need to have backup -- it doesn't have anything to do with the hospitals in your area, but the licensing board of the state.

    i applaud whichever route you take -- i started training as a CPM but am now waiting to hear back from CNM programs... we need more midwives regardless of what letters are on your license, i say! on either side of the coin (CPM vs CNM) there are midwives i would want at my baby's birth, and there are midwives i wouldn't even let in the building... they're just letters, in the end. go the route that makes the most sense for YOU and be the best midwife you can be.

    this is a topic i feel strongly about and love to discuss so let me know if you have any more questions.
    WantToBeMidwife likes this.
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    also, i think a lot of states where CPMs are legal don't allow CPMs to operate birthing centers -- they can only do homebirths.
  7. 0
    Quote from 88nurse2010
    I recently graduated with my BSN. I started nursing school wanting to become a Certified Nurse Midwife. However, I live in Southwest Missouri where midwives do not have hospital privileges and OB/GYN's are not incredibly friendly towards midwives. From what I understand, a CPM can practice independently (doesn't need a Dr. on call) which is starting to sound more and more appealing.

    My dream is to have a birthing center, hopefully with several other midwives, and I always just thought it would be easier as a CNM. Many CPM's this area travel LONG distances and I don't want to do that, especially when I have young children. I thought having a "home like" birthing center close to my home would be a good compromise.

    I am considering going back to school in the next few years, and just wonder if anyone has any advice? Are there any real benefits to becoming a CNM? Especially in an area that is still learning to accept midwifery & home birth as legitimate and safe?
    Hi! Im in SE KS and Im facing the same thing here. I want to be a CNM but am finding that there are no midwifes around..just a few in the larger city..and the enrollment rate for the program has dropped so much that its accepting every 2yrs instead of every year.

    There are a handful of midwives that are doing home births but I dont think they are getting a lot of "business"

    so Im at a loss of what to do...I've thought about going for Women's Health Nurse Practitioner as a compromise when I get my RN....as this area seems to favor NP's a lot!!

    I wish people and medical professionals in my area would see the value of a midwife.
  8. 0
    I'm currently an LPN with the ultimate goal of becoming a CNM. Which route would be wiser: LPN to BSN to MSN... OR LPN to RN to MSN?? Which route would be faster and more cost effective? Which route would have more CNM schools open/available to me.. as a RN or BSN? Ready to take the next step further to becoming a CNM, just not sure which route to take to get there?! How many years until I reach my ultimate goal of becoming a CNM? Thank you for any information or insight you might have!
    On another note I'm also considering becoming a CPM. The care setting of a CPM is more what I'm looking for compared to the hospital doctor supervised CNM. However, when considering job security and all the different state regulations CNM sounds the more solid route to take to becoming a midwife. My husband in in the Navy and has greatly affected my career and schooling. Not knowing where we will be from year to year makes schooling extremely difficult. Online schooling is gonna have to be the way to go for me. We own a home in Jacksonville, FL near Gainesville, FL where they have a MEAC accreditied CPM program, which would be most ideal for me at this time. However, we will be in Virginia until atleast June 2012 and after that noone knows. Waiting another year and a half hoping we move back to Jacksonville, FL isn't ideal when I could spend the next year and a half advancing to becoming a CNM.

    So much to consider! I appreciate any helpful advice!!
  9. 1
    Quote from arabianeyez83
    So what happens with a CPM when something goes wrong during a delivery and a Dr needs to get involved?
    I imagine they would transfer to a hospital, just like if it happened with a CNM.
    WantToBeMidwife likes this.
  10. 0
    I just started another thread about a similar topic.

    I am a midwife with an inactive CPM license. I graduated from a MEAC accredited school, and at least half of the women I graduated with went on shortly thereafter to get their CNM. I am struggling with what to do with my license right now. I love home birth and birth center birth, but the on call hours can be very difficult if you work by yourself or with only one other partner. At a birth center/homebirth you need to be present the entire time your client is in labor- you don't have the same support system that you do with a hospital birth (ie nurses to assess and admit your pt, monitor them PP etc). If you have a busy practice it can be very grueling, especially if you have young children.

    In Florida (where I originally got my license and practiced), LMs were eligible to receive medicaid reimbursemt and were able to practice independently in a home birth settings. Birth center midwives needed a physician to sign their protocols. My practice did BC and HB, so we had a formalized relationship with an OB- which was generally a great thing.

    The other thing to remember is that a CPM is virtually USELESS for anything outside OOH midwifery. When I went back to nursing school, virtually none of my credits transferred despite the fact that I went to a MEAC accredited school and have attended hundreds of births in all sorts of settings. You are also generally not allowed to do 'well woman" care under your own license.


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