Baby Steps to a goal of becoming a Nurse Midwife?

Selke · Dec 22, 2006

My generic advice is ...

are you planning on working in an OB or mother-baby related area as a CNA? Few L&D units use CNAs, but some M/B units do. On M/B, you can start learning about things like, how women transition into motherhood, about infant care, start learning about assisting with breast and bottle feeding, &c. Some L&D units will train CNAs to become scrub techs.

Do you have children? Have you breastfed? You could become a volunteer for the local La Leche League. You can build up hours with them that count towards IBLCL (?) certification, which would be a fantastic certification to have on your application for CNM school -- and you don't have to be a nurse to be a lactation consultant. I think there's a less intensive certification available -- LC? I think -- that you could get. In the real world, midwives are lactation consultants for their clients.

Find a place to get training as a doula and learn labor support. Become a doula, even as a volunteer, at the local OB hospital. If they don't have a doula support program, start one -- demonstrate your leadership skills and committment to helping women. Maybe help establish a doula program for teen moms, vulnerable populations, like the Chicago Childbirth Connection did when they started their teen mom/mentorship/doula program in Chicago, which has been a huge success. Anything you do with vulnerable and underserved populations will shine on your nursing and CNM school application.

Are there HIV/AIDs clinics in your area? Clinics dedicated to the homeless? What kind of public health clinics are in your area? Are there many Spanish speakers in your area? Clinics dedicated to their maternity care? Begin volunteering at these -- learn Spanish if you don't know it. Several years ago I spoke with Holly Kennedy on the phone about UCSF admissions, and she told me if I knew Spanish they'd put my application on the top of the list.

Are there any birth centers in your area? Any midwife practices? Find out. Contact them and offer your services as a volunteer -- offer to do scut work, office work, answer phones, anything at all that will help them. Many birth centers are on tight budgets, due to skyrocketing malpractice premiums and other compensation problems. Midwife practices likewise may welcome an enthusiastic volunteer. You can learn much about the health care business from the ground up by learning how a midwife's or birth center's office runs -- invaluable education you will need but not all schools teach. And, you may find mentors and reference letter writers. You could provide labor support and informally learn from the midwives as well once you become a doula. Eventually you could start teaching childbirth education classes.

Do you already have a bachelors' degree? If not you may need to do the ADN or BSN route. If you have a BA degree you can apply to a direct entry MSN program, and I say this because these programs don't have the long waiting lists the ADN/BSN programs do. If you get an ADN, more and more MSN programs offer ADN to MSN tracks. You could find a CNM program that offers that and not spend the extra time getting a BSN, which you won't need in any case. (Frontier School of Midwifery just started an ADN to MSN track which is an extra 9 months; other schools have these as well.)

Good luck to you! You are on a good path; it will have many twists and turns, each should be an invaluable learning opportunity for you that will help you achieve your goal.

DesertRain · Dec 22, 2006

This was incredible advice! Thank you so much. A few of the things you had said were things that I had journeyed my thoughts into but some of the other stuff was brand new to me and not only gave me some insight but made me want to do it more than ever.

I have 2 children and due to their separate and quite individual birth experiences I had always had such an interest in childbirth. My first child was born via "emergency" c-section by an OBGYN and the second was a natural vbac childbirth with a midwife and a doula (to a 10lb baby just to add my bragging rights lol)

I have explored the ways to become doula certified in my area and was thinking about doing that while I finish my ADN. I wanted to work for a little bit in the field after that and make sure it was something I really do want to do after being exposed to it and it's funny you mentioned UCSF because I was thinking about getting my BSN and would love to apply there--completely as if you read my mind???? The things you mentioned about HIV/AIDS clinics really stuck out to me and I honestly think I will be looking into volunteering somewhere like that.

Thanks for opening up so many more roads for me to explore!

Selke · Dec 22, 2006

Forgot to mention another bit in my patented advice for future midwives ... if there is a Planned Parenthood in your area, talk to them about becoming a patient care advocate (whatever the exact title is). PP doesn't hire RNs to do intake, counseling, contraceptive counseling, &c -- too expensive for them, so they hire non-licensed people at a lower pay scale to do the actual intake interviews, counseling, contraception counseling, &c. They actually train you in family planning methods and counseling clients -- invaluable experience you won't get anywhere else. This will make your application shine.

The bottom line is, diversify your experiences and potential reference letter writers -- don't depend entirely on nursing school for these things. In fact, just have one reference from nursing school for the academic reference. You want nursing school to appear to be more of a prerequisite you're doing to become a midwife; these other activities I suggest will teach you as much about midwifery as nursing school and diversify your real life experience and should help shape your ideas about future practice. The doula training is very important, IMHO, because you won't get that in nursing school, and it (should be) is at the heart of L&D nursing and midwifery -- labor support skills, which is a skill you can acquire NOW. In your training you'll read Penny Simkins and Polly Perez on labor support and fetal positioning.

Like me, you have/had kids, so you can't sign up for Peace Corps, and overseas experience will be difficult with small children. Overseas experience seems to be the other necessary life experience to get into a CNM program. However, if that's not an option, do these other things. International experience is the chi-chi in thing to have at the moment for going into maternal-child health -- if you can afford it.

Wow, a 10lb VBAC? You go, girl! You were LUCKY to find a provider who would do a VBAC. Maybe the midwife who caught your baby could be a resource for you. Recently I've read articles on the aftereffects of rising C/Section rates:

http://www.nytimes.com/2006/12/20/business/20leonhardt_sidebar.html?_r=1&oref=slogin

Boston Magazine: Restaurants, Shopping, Events, Best of Boston

We've talked at school about the implications of the rising c-s rate discussed in the Boston Post article, about a potential backlash among mothers who will stay home to deliver so they can't be forced into a repeat c-s.

Good luck to you.

luv4nursing · Dec 22, 2006

I just wanted to say thank you for posting this great information. I am interested in pursuing this path as well. Im an LPN completing my RN and would like to be an OB nurse and most likely become a midwife at some point. Would becoming doula certified help me obtain a job as a RN in L&D or mother/baby straight out of school? This is the first time I have heard of this DOULA thing, (btw how do u pronounce it? is it pronounced dooluh?). I found some workshops coming up in my area and Im very interested in this. thanks again for the info.

DesertRain · Dec 22, 2006

Unfortunately I can't go overseas you're right about that but that does sound like something anyone else without kids should think about as it would definately be some experience! I am definately trying to do the Doula training by next year. I loved my doula, she was fantastic and the teamwork between her and my midwife was phenominal. The doctors told me I would not be able to have a lady partsl birth and how much of a risk it was to me. Well, I am 5,2" and small framed and my first c-section baby was 7 lbs 3 oz and my second vbac was 10 lbs. It was not much of a risk at all with the proper care and with women who really were educated in providing that type of birth experience. Although when my labor was progressing and I had been denied any pain medication because it was going along so quickly, I do remember begging for a c-section at one point! LOL.

DesertRain · Dec 22, 2006

I just wanted to say thank you for posting this great information. I am interested in pursuing this path as well. Im an LPN completing my RN and would like to be an OB nurse and most likely become a midwife at some point. Would becoming doula certified help me obtain a job as a RN in L&D or mother/baby straight out of school? This is the first time I have heard of this DOULA thing, (btw how do u pronounce it? is it pronounced dooluh?). I found some workshops coming up in my area and Im very interested in this. thanks again for the info.

Yeah you have the pronunciation right! I was looking at attending those workshops too. Which organization is the one you were looking at?

Selke · Dec 22, 2006

My thought is that becoming a midwife first, then volunteering those skills in a third world country might be easier to do. That is my plan, as I've never been overseas. However, there are places in central and south America, and Mexico, where you can volunteer and bring your family too, I think. I'm planning a Spanish language intensive for this spring in central America, which sort of counts, as it combines health care work.

As far as being a doula helping get an L&D job, I'd think it would and should help ... the problem is, as many L&D RNs on this board can tell you, is not every L&D unit practices labor support and the RNs may not know what it is so they need education. These places tend to be not very friendly to midwife or patient centered birth -- they are very medically oriented. If you find a hospital that has doulas, and/or midwives, and they practice labor support, you will have an advantage when you interview. Check with the doulas you know about the local facilities and their philosophy of care. If doulas aren't well thought of or used much in your hospital where you will eventually work, you can become a change agent and change that :) get practice being a change agent and introduce labor support as routine standard of care (this will sell you to the admissions committe, believe me! you will prove to the faculty you can walk into hostile territory to midwives and make friends and change hearts). Once you're in CNM school -- if you're in a good one that has a lot of nurses in the program -- the faculty will tell you to start advocating for family centered and low intervention birth NOW as an RN. Use the doulas you know as resources as they know your area and the philosophies of care.

Check out Rush University Medical Center in Chicago -- their OB nurses, several years ago, systematically adopted labor support as routine nursing care and implemented a program whereby they convinced the medical staff of its value. You can find their website and contact somebody in the OB nursing department; I think they gladly provide consults and "how to" establish this philosophy of care in your OB unit.

Good luck to all of you. I think advocating for women, to educate them in their reproductive choices, and how to have control over their bodies and pregnancy and birthing experiences, is like missionary work.

TTFN and happy holidays!

*Bethany* · Jan 1, 2007

Desert Rain, thank you SO much for posting this question. I too, am working toward the end goal of being a CNM. I haven't even started yet (I'm making an appt. to speak with a counsler at my local community college tomorrow) to see how I should begin.

I myself have had 3 kids (the first one being a natural hospital birth and my last 2 were homebirths). My last one was 9lbs 14oz and I'm 5'1" so, I love the looks I get when I tell people what her weight was. My homebirths were physician attended Welcome to Homefirst.

After my first homebirth was when I knew I wanted to have a career as a CNM. My first plan was to become a doula. I even took a workshop in Chicago, read all of the books, observed a Bradley childbirth class..but in the end, I just cannot do the doula thing right now because of my kids. A doula needs to be on call and I just don't have child-care at the drop of a hat.

I got very discouraged and it was just recently that I decided to go ahead and start taking classes towards my end goal. I am SO excited to finally be taking the first steps towards my dream.

The advice in this thread has been incredible!!!!! What really hit home was doing all the work outside of "just" nursing school, such as being a doula, a lactation consultant, teaching childbirth. ed. classes (another thing I looked into), etc.... I would have never thought of how important these things will look on an application letter. Oh, and the learning Spanish too. My area is popluated heavily with Spanish speakers, yet I would not have thought to take Spanish classes.

Thanks for the thread and thanks for the advice!!

ChristineN, BSN, RN · Jan 1, 2007

Hi, as another on the future CNM path, I wanted to contribute my :twocents:

I spent a year at community college working on gen ed classes, intending on staying and getting my ADN. However, when I found out I could get into a private diploma (RN) school out of state sooner and not have to pay a dime in tuition, I went for it. I'm getting ready to start my 2nd semester in the diploma program (tomorrow!). After moving out of state in order to attend the diploma program, I started looking for a job at a hospital or nursing home where I could get on the job nurse's aide training. I ended up at a teaching hospital on a cardiology/general medicine floor. I'm learning nurse's aide skills, and can in a year, if I desire, transfer to the women's hospital if I want (haven't decided if I will or not, since it'll be only 6 months or so before graduation with RN). Don't rule out aide work outside of women's health, because, it is enjoyable, and you're still learning the skills you'll need for the future. After getting my RN, I plan on going to one of the local universities and enrolling in an RN-BSN program. Finally, I'll get my MSN in nurse-midwifery, perhaps from Fronteir.

My city is fortunate to have a free standing birth center. I went there once as a patient and quickly fell in love with the place! I have considered volunteering there (they are always looking for volunteers). Also, they are always hiring RN's. I could definitely see myself enjoying that sort of RN work more than a hospital OB/GYN nurse, but I have a 2 year work agreement with a hospital chain in town (it's how I'm getting my education for free), so unless I could volunteer, somehow pay off the hospital chain, or work part-time, I don't know how that would work. When my 2 years are up, I would definitely consider switching to work for them!

Selke · Jan 1, 2007

Bethany - I'm in the Chicago area right now for awhile.

You can be a doula and say you'll work certain shifts, or only be on call certain times when you have childcare. I think even just having the workshops, even if you can't "do it" and be on call for awhile, is most helpful, and helps you feel like you have some control over making progress towards your goal. You might also make friends of others who are on your same path. Look up the reference I gave, Chicago Childbirth Connection. You might be able to start volunteering with a group like this, teaching classes, &c. I think they do outreach to local schools and might need volunteers.

Another thing I didn't mention was taking massage therapy classes, even an intro or basic class. You can take massage classes oriented towards pregnant women, labor, and for infants. This is a skill you won't get in school unless one of your preceptors happen to know techniques and will teach you. You can practice on your family to keep your skills up -- they'll love that!

DesertRain · Jan 1, 2007

Bethany - I'm in the Chicago area right now for awhile.
You can be a doula and say you'll work certain shifts, or only be on call certain times when you have childcare. I think even just having the workshops, even if you can't "do it" and be on call for awhile, is most helpful, and helps you feel like you have some control over making progress towards your goal. You might also make friends of others who are on your same path. Look up the reference I gave, Chicago Childbirth Connection. You might be able to start volunteering with a group like this, teaching classes, &c. I think they do outreach to local schools and might need volunteers.
Another thing I didn't mention was taking massage therapy classes, even an intro or basic class. You can take massage classes oriented towards pregnant women, labor, and for infants. This is a skill you won't get in school unless one of your preceptors happen to know techniques and will teach you. You can practice on your family to keep your skills up -- they'll love that!

Selke your advice is a blessing. I have this post in my favorites for future references. That massage therapy class seems like a fascinating venture that I might do this summer. Thanks for all your insight!