Can CNMs in Utah attend homebirths?

SiennaGreen · May 2, 2009

First, I would suggest going to the ACNM (American College of Nurse Midwives) web site. They have links that will take you to the information you seek re: CNM legalities in each state. You may want to also check over the Utah State Board of Nursing. They will have more detail re: what you are allowed to do and under what guidelines.

I would guess that you cannot be licensed as a CNM and practice as a CPM. You woud likely have to relinquish the CNM. Maybe someone else will have better specifics but those would be good places to begin.

Best wishes!

AOX4RN, MSN, RN, NP · May 3, 2009

You can be a CNM who is a CPM but the CNM trumps the scope of a licensed DEM.

Amberholmestm · May 4, 2009

Thank you, Sienna - the state fact sheet for UT at ACNM didn't list homebirth in CNM practice areas - not that that necessarily excludes it, but it's not too encouraging. I couldn't get to the state by state laws and regulations page because I'm not a paying member. The state board of licensing was far less detailed in describing CNM scope than LM and didn't mention homebirth. I'm thinking maybe the problem is that CNMs just can't find backing physicians in UT for homebirths? Still, though, don't LMs have to have a backup physician as well? I can't figure it out.

Apgar, you are saying that a CNM should be able to do anything an LDEM can?

AOX4RN, MSN, RN, NP · May 4, 2009

Apgar, you are saying that a CNM should be able to do anything an LDEM can?

Well, yes because a CNM has a broader scope of practice so in theory s/he should be able to do anything a LDEM with a smaller scope can do, but you wondered....

...can they obtain CPM certification and UT licensing and practice homebirths as a CPM still, or does being a CNM completely bar them from homebirth practice?

A CNM can be a CPM because the CPM is a credential, not a license for practice. If a CNM (which is also a credential but states license the APNs as such) is prohibited from attending home births in Utah it doesn't matter if she has a CPM credential because her license to practice restricts her from home birth. You can't go get licensed as a CNM and then tell the state you're just going to do the things a LDEM would do and to only hold you accountable to that level of care and license. I hope I am making more sense this time around :)

I wasn't able to find anything here to say a CNM can't attend a home birth (http://dopl.utah.gov/licensing/certified_nurse_midwife.html).

I am also curious about CNMs and non-nurse midwives in Colorado. Someone said that nurses can't be LMs there? That doesn't make sense...

That is true. My original license to practice midwifery was as a Registered Midwife in Colorado. The law expressly prohibits doctors and nurses from also being Registered Midwives.

Amberholmestm · May 4, 2009

Thanks, Apgar. I see what you're saying about licensing.

You're right - there's certainly nothing in the state licensing law limiting the practice setting of a CNM, and the "consulting physician" doesn't need to be present or even supervisory. I'm wondering about the provision of "manage the intrapartum period according to accepted standards of nurse midwifery practice and a written practice and referral plan". It's defined as "a written plan entered into with a consulting physician and detailing guidelines by which a certified nurse midwife consults, collaborates, and refers patients." It sounds more like the CNM is sort of a distant partner to the doc, rather than someone he dictates to and takes responsibility for. So, it doesn't...sound... like a collaborating physician should be hard to find.... Of course, real life may be different.

So, yay! It sounds like CNMs are wide open for homebirths here in UT, but I don't understand why none can be found who attend them. It just seems suspicious. I guess my next step should be checking on the Utah Medical Association. I could imagine them having a standard against supporting homebirth CNMs. (I just read a paper about how concerned ACOG is with the recent legislations in many states supporting DEMs and homebirth. One of their big tiffs was that CNMs had proved fickle allies in the fight against legislation allowing DEM licensing. :) I was amused.) Anyway, so far things sound good, but the last thing I want would be to go all the way through nursing and grad school and find out that I can't practice where I want to.

My research will continue! I've been thinking about it, though, and I think that doing FNP and LM would be a pretty good way to go, too, even if NM doesn't work out for my particular goals. (Unless I move next door to CO, that is. It's too bad, it's a nice state. I just don't get it - it makes no sense. Who would have even thought up the idea that nurses and midwives were just not compatible w/o a graduate degree involved? A struggling CNM program, maybe?)

Thank you so much, Apgar. You are a wonderful resource. Will you tell me more about yourself? You live in CA, right? Where? Tell me the story about your call to midwifery. You too, Senna. What is your background?

AOX4RN, MSN, RN, NP · May 4, 2009

It sounds like CNMs are wide open for homebirths here in UT, but I don't understand why none can be found who attend them. It just seems suspicious. I guess my next step should be checking on the Utah Medical Association.

You will be better off contacting the Utah chapter of ACNM to get the answers quickly about whether or not CNMs attend home birth, what the reality of collaboration with a physician means. Call any CNM in the phone book and ask how to contact the chapter secretary or president and go from there.

(Unless I move next door to CO, that is. It's too bad, it's a nice state. I just don't get it - it makes no sense. Who would have even thought up the idea that nurses and midwives were just not compatible w/o a graduate degree involved? A struggling CNM program, maybe?)

It goes back to when the negotiations for a direct-entry law were being made. The board of nursing would support the bill only if the law excluded nurses from also being DEMs, unless they were CNMs and then under their board. Many nurses dropped their licenses in favor of being a registered midwife and many midwives gave up the idea to be a DEM and either stuck with nursing or went on to become CNMs. I don't believe the U of CO's nurse-midwifery program figured into it but the old 'uneducated direct-entry midwives bury dead babies in the backyard' card was played many times in the legislature.

Thank you so much, Apgar. You are a wonderful resource. Will you tell me more about yourself? You live in CA, right? Where? Tell me the story about your call to midwifery. You too, Senna. What is your background?

I gotta run now... I'll try and remember to do this later :)

Amberholmestm · May 7, 2009

Hooray! I've found a CNM in Utah who attends homebirths. It's amazing how hard I had to look to find her, though. I'll be getting in touch with her. Thanks!

squat · Dec 20, 2009

Hooray! I've found a CNM in Utah who attends homebirths. It's amazing how hard I had to look to find her, though. I'll be getting in touch with her. Thanks!

As a Utahn, I'd advise you to look at the law and not just at what that CNM is doing. You need to have a physician trained in OB sign off your intrapartum protocols (meaning if the doc says you can do homebirths than you're ok, but you need that magic paper). I'm not saying that she doesn't have her protocols signed, but I am saying that it is EXTREMELY hard to do as any physician working for IHC or the U is risking losing his/her job if he/she signs. You might be able to be dual licensed as a CNM and an LDEM, but you have to be clearly not violating any regulation of that particular license. No one has done dual licensure yet, and so it is uncertain how a problem might play out. Also, your earlier post talked about being a CNM so that you could have hospital privileges in case you transport. That's not going to happen in any hospital on the Wasatch Front. Too political. There were some CNMs that delivered at hospitals or birth centers about 7 years ago, but the hospitals managed to write their protocols in such a way to stop that from happening.

CNMDude · Feb 11, 2010

I am a CNM in Utah and although I don't know of any CNMs that do home births, I have never seen anything that would prohibit CNMs from doing home deliveries. I do know an OB that provides backup to a DEM. I believe the real issue for most CNMs is malpractice insurance. To practice in the hospital, you must have malpractice insurance and most will not insure CNMs doing home births. In my practice, I find that my patients want the security of the hospital but the attention of a midwife. I am busy enough that attending home births would be difficult. As far as being dual licensed, I understand that you would be held to the higher license standard (CNM) regardless.

JTNNP · Apr 25, 2010

I am surprised that nobody has chimed in on the biggest reason CNMs don't attend many home births, anywhere. It's malpractice insurance! As your scope increases, so does your liability. Unfortunately this is what limits your plans the most. A little bit of research into the cost of CNM Liability Insurance and what your rate of reimbursement would be for a midwife attending home births may reveal that a home birthing practice as a CNM would be cost prohibitive.

photobooklady · Apr 28, 2010

Amber, I'm also in UTah looking at becoming either a nurse, a cnmw or a midwife...you said in your first post that your education is being paid for by the government? Can you tell me more? (Is there someway to post to just you? I saw that we live in similar areas of utah.)