Anyone start as as a lay midwife or CPM and then become CNM?

[Hecate]

I was hoping for some insight on this issue because right now its at the center of my life. It would be so helpful to have the advice of those of you who have been there, especially to know the reasons for your decision.

My dilemma is that I am currently a student in a direct entry (CPM) midwifery program. It is amazing and I have learned a great deal from the program, but the problem is being an LM or CPM can be so limiting. In my state, FL, one must purchase malpractice insurance which can cost up to $8k per year, while OB-gyns in our state are not required to carry it themselves.

I also plan on moving out of the country and am worried about credentialing as a CPM overseas, in the Caribbean to be exact.

Unfortunately I feel that the way hospitals treat pregnancy and birth is appalling on so many levels, especially all of the unnecessary (and problem causing) interventions passed off as routine care. I really believe in the midwifery model of care and am quite non-interventionist/holistic in approach.

But, it seems, the trade off may be legality, and financial stability.

I know that I am rattling on but if anyone could share some personal insight I would be so grateful!

[AOX4RN, MSN, RN, NP]

I'm starting nursing school in January as a LM, CPM for all the reasons you mentioned, with the exception of wanting to practice outside the US.

btw, for all the hard work in your direct-entry program you are doing (and I have already done) we deserve better than to be referred to as lay midwives!

[LynnetteCPM]

I am a CPM, RM and will be finishing the BSN program December of 2009. My plan is to enter a CNM program as soon as possible. I think you can make a living being a CPM and do good work- it makes a great second income for a family. But, it is more limiting than having a CNM/RN as far as job prospects. I am going further because I have to make the first income for my family.

Too many women (CPMs and CNMs) worry about the malpractice insurance costs and who is going to pay for it. If you are self employed, you just pay it. If you are not paying it and your employer does, then you are still paying it indirectly. It is just the cost of doing business like paying rent and buying supplies.

It is good to look at long term goals and futher education. Some women love being a CPM midwife, others need more or life changes during or after that process. I think that having experience as a CPM will help me keep it real wherever I practice as a CNM. Investigate what will be needed overseas- who knows what you may or may not be able to do with a CPM. There are CPMs in other countries that have birth centers.

Yes, please don't call CPM/licensed midwives "lay"; it is a word that implies no training or education and I have plenty of that, thanks. I always try to educate hospital staff about what I do and let them know I am a "registered midwife" and have a license from the state.

[Hecate]

Its good to know that there are others in the same boat- at least almost. Thanks for your thoughtful replies. Every little bit of insight I get from either side helps.

As far as the term lay midwife, I meant no disrespect. When I said "...lay midwife OR CPM" I was referring to two distinct paths. But while we're on the issue, I don't consider "lay midwife" a derogatory term and I don't necessarily think that it connotates a lack of experience, education or backwardness; rather self education or apprenticeship, by either choice or circumstance. Remember, CPM credentialing isn't recognized in all states and I'm sure there are many others who have simply chosen not to become certified.

In fact, the (now) CPM who runs the school which I am currently attending started out that way- as did many of the other "mothers" of the modern midwifery movement. I have the utmost respect and awe for her, and a good deal of her knowledge base comes from her humble beginnings as a lay midwife.

I do understand that there is a lot of confusion over the semantics and I'm not trying to add to that. Im sure there are lay midwives out there who have decided to become CNMs at some point in their lives, too. Let's not fall prey to the same kind of ignorance or snobbery that we, too, are victims of.

[LynnetteCPM]

Good point. What I don't like about the term (and I did catch that you said lay or CPM) lay is that in the past it was assumed that non-nurse midwives were completely untrained. Sometime we get a bit touchy.