Direct entry midwife

  1. I need help in choosing between a direct entry midwife and a CNM. I want to be a CPM and then go to school later and become an RN. The autonomy of the job as a CPM is what I like, but not having a steady paycheck and health insurance scares me. After all, I don't want to live paycheck to paycheck. For all you direct entry midwives, would it be hard to make a living as a CPM? Any advice would be greatly appreciated.
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    About Vicky003

    Joined: Aug '07; Posts: 4


  3. by   Apgar10
    Quote from Vicky003
    I need help in choosing between a direct entry midwife and a CNM. I want to be a CPM and then go to school later and become an RN. The autonomy of the job as a CPM is what I like, but not having a steady paycheck and health insurance scares me. After all, I don't want to live paycheck to paycheck. For all you direct entry midwives, would it be hard to make a living as a CPM? Any advice would be greatly appreciated.
    I'm a CPM of 2.5 years, graduate of a 3-year MEAC school program and licensed to practice. I am currently applying to any nursing school (ADN/BSN) that will take me in hopes I come out on the other side of 5-6 years as a CNM.

    If you're at the beginning of your educational process and will eventually end up a CNM anyway, save yourself the time, money, and energy it would take to do the CPM process and go toward nursing school. The two worlds do not merge when it comes to schooling. The CPM path is happy to have your traditional college education (tried and true) but the CNM path wants nothing to do with the vocational education of a CPM because it isn't standardized. That's a fact, though NARM and MEAC are working hard to do so. At the very minimum while you hash out your decision I would strongly recommend you do all of the prerequisites for nursing school on the community college level (cheaper!), that way you'll have a strong base for CPM education in sciences, speaking, writing, and basic maths and you'll be good to go for nursing school if you change your mind. If you do the basic education the other way around none of it will count on the community/university level. I learned the hard way and had to do it again!

    If job security and a paycheck are important to you, being a nurse-midwife is going to open up more opportunity to you than a CPM. Not least of which is having the educational scope of practice to serve more women in more [clinical] settings.

    If I had it to do all over again knowing I'd be in this spot now, I'd have gone straight through nursing to midwifery. I'd have been a CNM for 2.5 years now instead of trying to get into school as a CPM! I didn't do myself any favors and it was tough on my family.

    I'm happy to answer more questions if you define what advice specifically you're after since I went for what seems obvious to me. Good luck :redpinkhe
  4. by   LynnetteCPM
    I am also a CPM (2 years) and am in nursing school right now for some of the reasons that you state here. When I started my CPM training I thought that would be enough for me and my family. Things changed over time and now I feel the pressure to have a steady income since I am the bread-winner now.

    I love most aspects of being a CPM and am making it work at this time. Unfortunately, my education and training as a CPM do not allow me to move to something else or expand my duties and abilities. I never thought I would become a nurse, but I do love the fact that I have many options with a RN/MSN. I hope to continue to do midwifery and may even still do home birth after achieving CNM.

    Many women do what Apgar10 and I have done. I did take prerequisite classes for the RN during my CPM training, so have not lost much time in that sense. I did not go to a MEAC school and am glad not to have spent that money. I am fairly self motivated and just did self study for the NARM PEP process

    I am glad to have done the CPM first. I think that has solidified my thinking about care during pregnancy and birth. This being confirmed after my recent OB clinical; that was a joke. Becoming a CPM was also a confidence booster for me. You will also want to consider in your decision where you live, your options for CPM training as well as the legal status of DEMs in your area.

    If you have more questions, feel free to ask here or privately.
  5. by   Belinda-wales
    If this world was the place it should be you should be able to qualify and work as a CPM but midwifery in america is hard I would look into Direct entery where you do nursing first and then go straight in to midwifery- but make sure all your ducks are in a row otherwise its like hitting head up against a wall belive me I have marks to show it I am finally having to do midwifery training all over again simply because the USA is so unflexible on midwifery training. Good luck but think hard about which path you are going to take if you can stand nursing you can even do acclerated BSN or ADN which take anything from 11 to 16 months.
  6. by   clhRN2b2010
    If you're thinking that you will be able to work as a licensed RN and continue to practice as a CPM on the may run into some legal difficulty. Can anyone speak to what might be construed as practicing outside of your authority or risking losing your RN license in that situation?

    I have to third that suggestion of going RN to CNM. I was a few months away from selling it all to do a licensed CPM program and changed my mind do to the reasons that you discussed and more.
  7. by   Apgar10
    You'd have to research the state to know the absolute answer to the question, but it is possible to be an RN-CPM in some states, Colorado for example prohibits nurses from being midwives unless they are Certified Nurse-Midwives. The nurse who is a midwife will have to understand her scopes of practices under each license without question otherwise mixing the scopes could find her practicing nurse-midwifery without a license.
  8. by   NewGrad79
    Hi, APGAR10...

    If you don't mind could you please post a link to Colorado's policy prohibiting RNs from practicing as CPMs?

  9. by   NewGrad79
    Never mind... I found it.

  10. by   seattlemama
    Apgar & Lynnette,

    I'm wondering what it's like (or what you think it's going to be like) to go from attending OOH births to primarily attending in hospital births? Do you have any thoughts on running into practices that don't jive with you personally or professionally? It's something I wonder as I approach the CNM route. I am a birth doula, homebirth midwife assistant and had both of my kids at home, but I don't want to limit myself with the CPM license like you've mentioned here. I also want to be of service to underserved/rural populations and feel the nursing route better suits that vision. Anyway, I'd love to hear more of your thoughts.
  11. by   queenanneslace
    Hi seattlemama - I'm not either of the people you're directing your question to - but can answer your question.
    I apprenticed with a CPM, assisted other CPMs, had home births myself, worked as a doula - and after having kids (repeat reasons - job options, flexibility, pay, etc etc etc) decided that finishing my CPM was not the option for me and that I would be going into nursing. I'm one semester from completing my RN program and plan to apply to CNM programs in the future (how soon is another question).

    I was just having this discussion with my husband about where I would work once I finished my RN - and strangely enough I'm considering applying to probably the most interventive high-risk patient maternity unit in the area. (Someone check my brain!)

    But the reason is although I've seen lots of low-risk, low-intervention OOH births, I have witnessed (gratefully!) very few high-risk patients and scenarios. If I want to be a nurse - I want to be a good one - I want to be skilled and adept at assessing my patients. I am extremely grateful for my experience attending births with midwives - because I think it gives me the ability to be 'with women' and employ the really wonderful aspects of the midwifery model in nursing. But what is missing from my experience is experience in the more critical situations.

    That said - I had a very hard time with the factory-line style OB unit when I did my OB nursing clinical. When you know it can be better - and you've been exposed to the personal care that one gets in the midwifery model - it's a little frustrating to be on the OB unit. For sure. Slowly what I started to see amid the frenetic atmosphere was that the patients of the CNMs were more relaxed, had fewer problems nursing their babies, were connecting and snuggling their babies, were more educated about their options in giving birth - they just seemed better adjusted - and I'm glad I could slow down and see that. I think CNMs do great things - MOST women give birth in the hospital, because that is where they want to give birth. I know there are challenges for nurse-midwives, and I know many have opinions about how they would like maternity care in the US to change to better support the midwifery model.

    The RN is giving me more options than the CPM ever would - and that is very appealing. I still love midwifery and labor and birth - I really don't know if I will be OK in a situation where the model of care (hospital obstetrics) is not one that I think is necessary for most birthing women... I'll probably have my moments of crisis.
  12. by   seattlemama
    Thanks queenanneslace! I truly appreciate your response! I am pursuing nursing for the same reasons as you. I figure it's all a learning process and can only make me a stronger practitioner. I think you are right -- having the experience with high-risk situations can really teach you how to spot them and give you confidence to manage them with more grace and skill. Having sais that, I'm sure there will be trying moments too! Good luck to you and congrats on being almost done with your RN portion! That's exciting! I'm only just beginning my prerequisites!