[EarthboundMare]

I agree with all that Marla has just said. I am in an illegal state, meaning DEM's are completely illegal. That does throw a different slant on things, especially where money is concerned.
When you are working semi-underground, for one, you are way more picky about who you will take on ( less clients, less money), also because I practiced in a poor, rural area, my fees were very low, though competitive with the other midwives in my state..for 2, there are less midwives, at least in my state, so taking call for eachother normally only happened occasionally, for well planned vacations and such.
I certainly didn't mean to sound negative about being a DEM, homebirth is where I am in my element. The idea of nursing school and the medical model is not an easy pill for me to swallow. I finally had to decide that serving mothers in a way that allows more personal benefit for me was the path I needed to follow. I will say if I was in a legal state, where I could get state licensure, work collaborativly with other midwives and docs in an open way, could take medical insurance, etc...there would be no choice to make. I apologize for not being clear about legal issues in my previous post.
My fantasy is to find a super great physician who just loves out of hospital birth (wink) and a few like minded CNM's and open a free standing birth center. Or possibly open a homebirth practice with another CNM and that same birth loving doc.
I will admit I am terrified of the protocols that I will have to adopt, I have made my own choices, based on each individual woman for years now. There's nothing I love more than VBAC's. This is a very diffiult choice for me. My sister midwives and I have battled legality in our state for soo many years...I don't like to feel like I am selling out. But I do have to provide for my family.
WOW that was a mouthful huh? lol... I look forward to the response

[nizhoni]

EarthboundMare,

It sounds like you have really looked at (and lived through!) the options available in your state. If I were in your situation, I absolutely would go for my CNM. I lived for 17 years in Utah. During most of my time there, direct-entry midwifery was not regulated but eventually, true to form, the "powers that be" determined that non-CNM midwifery was in reality the practice of medicine. We began the lengthy legislative process to create a licensure mechanism for midwives, which was successful in 2005. In the midst of that, our family moved to California and I became licensed here.

Life as a licensed midwife is not perfect, but it's significantly easier than when I was living in a state in which midwifery had no real legal standing. I can only imagine what you had to deal with practicing in a state in which it is illegal.

All the best to you! We need more midwives, both CNMs and LMs/CPMs. We need more birth centers. And I know those physiologic birth-loving docs are out there. You just have to coax them out; often they are taking more heat than any of the rest of us. After all, everyone expects the midwives to be "off the hizzle," right?

Marla

[EarthboundMare]

Thank you for the encouragement! I have a lot of mixed feelings as I start out on this new path. I discussed it all with my old midwifery preceptor this week and she also surprised me by being totally supportive.

I know what you mean about those poor docs that dare go outside the realm. Both of my previous back up doctors went through absolute he$$. I couldn't believe the way they were treated by their own peers. One eventually moved out of state and the other, after LOSING HOSPITAL PRIVILEGES (can you believe it?) quit doing OB all together and is just doing GYN now. Unreal.

Thank you again, and I look forward to talking with you more on this! Belinda

[clhRN2b2010]

I just wanted to pipe in that I am also beginning the journey to CNM after planning on DEM for three years and realizing that for all the above reasons and more...it wasn't the best fit. Philosophically, HB and DEM is absolutely where my heart and head are and I am preparing to be challenged in my core. Some of my very hard core friends are treating the decision to go CNM like a betrayal. For me, it has practical reasons: insurance, money, practice partnerships, being where the women are who need you.. and in addition to the reasons listed above, we want to be able to international mission work and in most countries the DEM is not recognized at all. To do such relief work and be eligible for aid and collaborative partnerships, the CNM is the way to go.

So....18 years after graduating college for the first time, I am heading back for NS this Fall to begin this journey.

[okchug]

Thanks to all of you.
This is a very enlightening thread. I have struggled with the same decision for years and felt alone and confused. In my state, there is no regulation on lay midwives. They are perfectly legal and don't have to be licensed or anything. though they are not supported either. We've lost 3 birth centers in the last few years. I had a friend recently start a home-birth and ended up going to the hospital and they wouldn't let the midwife thru the door! so sad..
I have finally decided to go to nursing school, then on to CNM in order to avoid all the obstacles around here. As a doula I have worked with some great CNMs in the hospital even. The moms had "home-away-from-home" experiences. So I know it's possible to work within the system. It's just a matter of finding the right system.

[smallwonders07]

Hello. To those of you who have done both CNM and direct-entry midwifery, how similar is the curriculum? Do both sides emphasize herbs/homeopathy? Thanks.

[nizhoni]

Smallwonders07,

I am an RN who is a California licensed midwife and a direct-entry midwifery educator. I have not done a CNM curriculum but have seen several. I would say there tends to be more variation between the curricula for direct-entry midwifery schools than there is between the various nurse-midwifery programs. And in answer to your specific question, you are unlikely to find much regarding herbs and/or homeopathy in CNM curricula. DEM pharmacology typically includes the study of the usual birth-related allopathic meds (Pitocin, methergine, antibiotics for GBS prophylaxis, cytotec for hemorrhage, etc.) as well as the study of alternative pharmacology, including herbs and homeopathy. However, some of the newer nurse-midwifery texts now make mention of alternative pharmacological methods, and I think that's very useful. Why shouldn't all of us midwives have equivalent knowledge in these and other areas?

Marla

[clhRN2b2010]

As far as I have seen and heard, if as a CNM student I want to expand my knowledge base of alternative, herbal, or homeopathic treatments I will need to do that on my own. Some programs are beginning to make teeny tiny steps in that direction.

It is something that I would do though because I think that the women we serve would be better served if I had that knowledge and experiance to draw from also.

[smallwonders07]

Nizhoni, Thanks for the reply. I didn't know direct entry midwives used things like pitocin and other drugs. I thought they weren't allowed to prescribe drugs?