Are these things a CNM would do?

Here.I.Stand, BSN, RN · Nov 6, 2014

Well woman care, yes

Part-time hours, maybe, it depends...and workday nannies don't raise children any more than public school teachers do

Abortions, only if you work for a clinic that does them

Artificial family planning, yes. As CNMs do well-woman care as well as the pregnancy stuff, you would be talking to clients about their preferred method, and would then prescribe it if she says "I'm planning on going on the pill after my post-partum check," or whatever.

Not a CNM, but a client of them :)

queenanneslace, ADN, MSN, APRN, CNM · Nov 6, 2014

The best way to allow yourself to work as a CNM part-time would be to avoid exorbitant student debt. This might mean taking the slow-road to becoming a nurse-midwife, but will allow you the financial freedom to not have to work full time with lots of call shifts.

In addition to pregnancy and birth care, CNMs provide well-woman care, and many are skilled lactation counselors.

It is within the CNM scope of practice to provide a wide range contraceptive options. This will be something you will be required to learn, though no one can make you prescribe medications. Patients might seek care elsewhere, if you are unwilling to provide the services that they are seeking. It also might be a problem if you are planning to be employed by a group practice where contraception is a service offered by the group. I work with a CNM group, and there are nurse-midwives who do not insert IUDs, but all nurse-midwives prescribe hormonal birth control. It could pose some obstacles in your employment, just something to consider.

cayenne06, MSN, CNM · Nov 6, 2014

I would discourage you from becoming a women's health provider in ANY capacity if you are not willing to counsel on and provide "artificial family planning." I am sure there are plenty of women who would want to see a CNM who is anti-birth control and anti-abortion, but when women come to an OBGYN provider, they deserve to have access to the full spectrum of reproductive health services, including referrals for abortion and prescriptions for contraception.

Family planning and abortion access are directly responsible for lowering infant and maternal m&m. I understand that some have religious objections to these practices, but your religious beliefs should not prevent your patients from having full access to reproductive health care.

I don't mean to be rude or accusatory. As a CPM, and LDRP RN, and a student CNM, this is very important to me. I went into midwifery because I love catching babies, but the public health impact of midwifery has become my passion, and birth control, breastfeeding, abortion, nutrition counseling, social services- these are the areas where midwives can really make a difference.

JJ1994 · Nov 7, 2014

I realize I made a mistake in my original post. "Artificial family planning" was not the right term to use. I meant artificial conception like IVF. I'm very supportve of birth control, including the IUD and would have absolutely no objection to providing it.

Cayenne06, thank you for your input but I don't believe that providing or supporting abortions would make me a better women's health care provider. I can not claim to be an advocate for health and family while participating in something that ends a life.

cayenne06, MSN, CNM · Nov 7, 2014

Well there are many successful CNMs and OBs who are anti-legal abortion, so that alone shouldn't preclude you from working as a CNM. As long as you are willing to counsel women non-judgmentally and refer them for abortions as needed.

And artifical conception-many midwives perform inseminations and IUI, but that is a specialty skill and certainly not required. But... will you care for women who conceive by IVF? What about through sperm donation? What about surrogates? Women's health is fraught with ethically challenging situations. You have to be able to put aside your own beliefs and provide care that is in the best interest of the patient, as well as care that is aligned with your patient's wishes. it really doesn't matter if you think abortion is murder. It is legal, and as a women's health care provider, you would have the moral and ethical duty to provide a legitimate referral for an abortion if your patient desires one.

I can not claim to be an advocate for health and family while participating in something that ends a life.

This statement? Is problematic. Your moral views on abortion does not magically make abortion go away. When women do not have access to safe abortion services, they turn to self abortions and "back alley" procedures. This greatly increases maternal m&m.

I understand the viewpoint of those who believe abortion is immoral. I really do. But if you believe abortion is wrong and should be avoided, then you need to think about what you can do, personally, to decrease abortion rates. Increasing barriers between women and abortion services DOES NOT further your goal of reducing the abortion rate. Free and easy access to contraception (ESPECIALLY long acting reversibles like IUDs), comprehensive sex education, increased access to health care in general, and better social support programs from families- these are the interventions that actually work.

queenanneslace, ADN, MSN, APRN, CNM · Nov 7, 2014

JJ1994

There are some midwives who believe that hormonal birth control is 'artificial birth control' and have very strong beliefs about not using it or prescribing it. Thank you for clarifying.

It's very difficult in health care to find yourself always aligning with your personal sense of "right" and "wrong." And this goes beyond the discussion of choice to all areas of health care.

We see ectopic pregnancies at least once a month, and the treatment for an ectopic pregnancy is termination of pregnancy. This is challenging for women who experience ectopic pregnancy on multiple levels - how would you counsel a woman in this situation? What if this woman is pro-life?

Outside of pro-life and pro-choice discussions regarding pregnancy terminations, there are many decisions that patients make that I would not make for myself, nor would I recommend based on my own personal beliefs. But they are the best decisions for the patients based on their own self-assessments and needs. It is very hard to be non-judgmental in some of these situations. Working as a health care provider will challenge your beliefs and your opinion about absolute right and wrong - probably on a daily basis.

I'm not saying that you should not have your personal beliefs or convictions, either. But want to let you know that as you progress through your career, your beliefs may have to shift to accommodate new circumstances that you had not considered before.

I think it is a good thing to have our beliefs challenged, because it makes us more compassionate care providers. But it is a struggle. I am always surprised when I find myself recommending something that I never thought would. Or how I struggle to provide compassionate care when I disagree with the choices that the patient has made for herself.

cayenne06, MSN, CNM · Nov 7, 2014

And to address your comment again:

"The most striking finding is that the increase in legal abortion rate is the single most important factor in reductions in both white and nonwhite neonatal mortality rates." JSTOR: An Error Occurred Setting Your User Cookie

"The legalization of abortions in 1973 resulted in a marked increase in legal abortions and marked reductions in maternal and infant mortality over the course of the 1970s. " http://www.ncbi.nlm.nih.gov/pubmed/8339110

"Unsafe abortion procedures, untrained abortion providers, restrictive abortion laws and high mortality and mobidity from abortion tend to occur together."http://www.who.int/bulletin/archives/78(5)580.pdf

I, personally, could not claim to be an advocate for health and family if I did not actively promote women's access to safe abortion on demand.

Simplyroses · Nov 8, 2014

JJ1994:

I have full understanding of your beliefs to not interrupt a pregnancy. Since my beliefs hold that life begins at conception, I am morally obligated to not intentionally interrupt a pregnancy - and I answer to God for this, not any colleague, patient, or legislative body.

In the almost 2 decades that I have been practicing as a nurse, my beliefs have never been compromised. My employers know my religious beliefs and do not assign me patients that choose termination.

Now moving into an advanced practice role, I find that there are many voices who condemn my religious beliefs and claim that I am morally obligated to offer women options that are against my beliefs. I will stand firm, because again, I answer to God for my actions.

That being said (before I get blasted by the colleagues who are very vocal about their pro-choice stance for women) I do very much believe that if I cannot offer the service the woman is requesting, I will be non-judgmental in explaining that "While I cannot offer you this service, I can refer you to those who can help you."

I do not explain my religious beliefs to my patients. I do not evangelize. I do not expect them to believe what I believe. However, I would appreciate it if my colleagues would respect MY religious beliefs and objections to providing services that are against my beliefs without judging that I am not compassionate towards women.

It is fully possible to become a CNM and never provide for abortions or work in fertility clinics that offer IVF. We can give the women compassionate, evidence based care and promote healthy pregnancies, healthy women, and healthy families. In many states, CNM's do not have the prescriptive privileges for abortifactants so it is taken off the table. It requires additional training outside of the MSN program to become an abortion provider, so it is a role you would choose if you wish to provide that service for women.

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JJ1994 · Nov 9, 2014

Thank you everyone for responding. Most of your answers were very helpful. Cayenne06, I can't agree with you but thanks for taking the time to respond.

ButterflyRN90, ASN, RN · Nov 9, 2014

Thank you everyone for responding. Most of your answers were very helpful. Cayenne06, I can't agree with you but thanks for taking the time to respond.

So if I couldn't get pregnant with my husband naturally and wanted a child and chose IVF, you'd refuse caring/educating/helping me?

I'm not understanding here. I'm Christian, but the patient has a right to the choices he or she makes. What is wrong with IVF? Or surrogacy?

JJ1994 · Nov 10, 2014

MariposaLPN, I believe a patient does have the right to make their own choices if no one else will be harmed. However, there are certain things that I won't participate in, abortion and artificial conception being two of those things. I'm not a Christian so I don't know what the christian teachings are regarding ivf and surrogacy but I don't believe we need to use science to create more lives when we already have more than enough people to create children naturally and more than enough children to adopt. I understand everyone is not going to agree with that and I would have to explain to patients seeking those servies that they would have to look elsewhere,