autonomy as a CNM

[kenya1982]

Hi everyone! This is my first post on All Nurses. I am sitting at the first step of my midwifery career and I am trying to figure out what to do.

My end goal is to be a midwife. I've known this for years, but I am just now in a position to really begin pursuing this dream. I am torn between going to a MEAC school and becoming a CPM or going the nursing route towards a CNM. My dream is to work in a birth center and I know this is an option in my state regardless of which route I take. However, the legal field is always changing and I really don't want the constant headache of the legal battles, fighting with insurance, etc. I feel that being a nurse and working as a CNM would be a more safe route. I personally know of CPMs who have shut down their practice because the cost of trying to keep up with state standards was just too much.

My question is, do you find that your hands are always tied as a CNM? Do most hospitals have strict policies on Pitocin, when to move to a cesarean section, etc? I fear that as a CNM, I will start to become "medicalized" and lose my values and personal beliefs about the birth process. Don't get me wrong, I know that hospital births have their place! I am just wondering how many CNMs truly get to practice physiological birth the majority of the time.

Also, has anyone worked as a doula while in nursing school? I realize that taking on clients would be pretty impossible, but I'm hoping if I get my doula certification that I can maybe shadow some midwives. If I do go the CNM route, my ultimate goal would be to get into Frontier. Since we have to find our own preceptors, I think having doula experience would help me start to establish some references/contacts. I'm sure it would make my application look a little better as well.

I know I am looking WAY down the road, but nursing is such a huge investment of time and money. I want to make sure I am doing the right thing. Thank you so much for reading this (if you have!) and appreciate any feedback! Feel free to be brutally honest. I can take it!

[LibraSunCNM, BSN, MSN, CNM]

My question is, do you find that your hands are always tied as a CNM? Do most hospitals have strict policies on Pitocin, when to move to a cesarean section, etc? I fear that as a CNM, I will start to become "medicalized" and lose my values and personal beliefs about the birth process. Don't get me wrong, I know that hospital births have their place! I am just wondering how many CNMs truly get to practice physiological birth the majority of the time.

Also, has anyone worked as a doula while in nursing school? I realize that taking on clients would be pretty impossible, but I'm hoping if I get my doula certification that I can maybe shadow some midwives. If I do go the CNM route, my ultimate goal would be to get into Frontier. Since we have to find our own preceptors, I think having doula experience would help me start to establish some references/contacts. I'm sure it would make my application look a little better as well.

I know I am looking WAY down the road, but nursing is such a huge investment of time and money. I want to make sure I am doing the righThose are difficult questions to answer because I don't know the work environments of all CNMs everywhere (as I'm sure you understand!

t thing. Thank you so much for reading this (if you have!) and appreciate any feedback! Feel free to be brutally honest. I can take it!

Those are difficult questions to answer as I'm not familiar with the working environments of all CNMs everywhere (as I'm sure you understand :)), but I can do my best. At my previous (and so far only) job, yes, I felt my hands were tied a lot and I couldn't always practice the way I wanted. That was a fairly high-risk population and when we did get low risk patients I think it was hard for a lot of my colleagues to be able to relax a little and allow a more evidence-based approach. So intermittent monitoring, more upright positioning and ambulation, were a harder sell to some nurses and doctors. The protocols for newborn care were also completely arcane until we became Baby Friendly last year, so that helped a lot of my earlier frustrations with routine separation of the newborn from mom.

That being said, I had the opportunity to attend plenty of beautiful, somewhat intervention-free births with amazing nurses and doctors. It just varies so much depending on where you work. Some environments are very medicalized and midwives are basically OBs "lite." I'm about to start work in a freestanding birth center and I'm sure the amount of autonomy I'll have is going to be almost overwhelming. The key is to be flexible about your clinical experiences during school, learn as much as you can no matter the setting, and then when you graduate, be open to moving to a new part of the country for the right job (or be willing to accept that your hands may be tied in certain ways at certain first jobs, but you can still learn from them and move on to something better when you get experience). There are plenty of jobs all around the U.S. in incredibly diverse settings, if you are passionate about the profession you will succeed.

In terms of doula certification I think it's always a good thing. If you have summer or winter breaks from school you could always take clients due during those periods to at least get a little experience. Frontier is an awesome program (sometimes I wish I'd gone there!) and I have heard they like doula experience.

Finally, I would encourage anyone interested in midwifery to go the CNM route rather than the CPM route for a multitude of reasons. It sounds like that's how you're leaning anyway! Good luck!

[crossingfingers10]

I can't yet speak to my practice as a CNM because I'm still a student. However, I CAN tell you that I know many CPMs who, like you said, have had to close their practice, or are even pursuing becoming a CNM instead. I have absolutely nothing against the CPM credential and know some amazing ones; this info is just what I've heard in my community. My understanding is that their hands can be very tied in some situations depending on the state rules. I am sure there are other factors that go into it that I may not be aware of. You can certainly work in a birth center or home birth practice as a CNM if you choose, though :)