Experience to Enter CNM Program

Specialties CNM

Published

Hello!

I'm a senior nursing student in a BSN program and graduating :mortarboard: this coming May (Woo HOO!). I am planning on entering the CNM program at The Ohio State University in the coming year after my graduation from the BSN program. I feel that my lifestyle and personal goals might stand in the way of me going back to school if I don't do it right away.

The OSU program does not have a qualification for years of experience but I was wondering if anyone had any input on the importance of experience before entering a program. I am quite nervous that my peers will have so much more experience than me that I will find it hard to keep up or compete with them. Other people tell me it can be just the opposite where I have the advantage due to the freshness of my schooling. Any input would be well appreciated! Thanks so much!!

Specializes in Nephrology, Cardiology, ER, ICU.

Hi midwifeinthemaking....how do you know that you want to be a midwife if you have no experience? Working in the hospital (where at least some of your clinical time will be conducted) will allow you to be more comfortable with the "medical" aspect of the care. Not all deliveries go as planned.

I'm pretty sure from having my kids at home with a midwife that it is what I want to doand also being part of deliveries with midwifes...but you can never be completely sure of anything until you do it. But I certainly don't think working in L&D will answer that question for me...since most of the way things are handled go against what I believe. Yes I did do my clinicals and a practicum in L&D...I liked med surg better just because I did not disagree with as much........I'm not here to say whats right and wrong...people have choices

sorry I spelled midwives wrong :)

Trauma, I don't know if your question was to any one particular person at first, but as a direct entry advanced practice student, I'll answer for myself:

How did I know I wanted to be a midwife?

There are a million reasons, here are a few:

I have three generations of midwives before me, I know what midwives do and I have deep respect for it and a passion to follow and add to the profession.

I've worked in the doula capacity, without certification, so I know the basics of how to support a woman in labor.

I shadowed bedside RNs for a semester before making the decision in undergrad to go this route.

I shadowed wonderful CNMs for months before entering the program.

I was the director of a women's resource center and so I know about sexual and reproductive issues faced by women, social and political issues faced by women, and have the relative communication experience with women.

I've volunteered at a community health clinic ran by RNs (in manager capacity), CNMs and OBs, which is a good way to make a comparison between the roles of each.

And, although YOU may not value these "ways of knowing," they are valued by others, including those who are in the profession:

I have known since I was a very little girl that this is what I was going to do, although I wasn't sure if it was going to be through the RN entry route.

I eat, sleep, and breath midwifery and women's issues including their interaction with other people.

I am intrigued by the political issues surrounding midwifery and women's rights in this country and globally and make the committment to be involved

I read tirelessly about all of the issues that come my way about the profession and I think critically about policy, autonomy, the physical work itself.

I have always, simply, known.

--------

I understand the basic logic behind people's "how can you be an *ADVANCED-PRACTICE* nurse with out any practice to begin with" comments. But I have to say that Midwifery is a little different in that there are multiple routes of entry, RN entry is just one of them.

WHAT ABOUT ALL THE MIDWIVES WHO ARE NOT RNs? THEY DON'T HAVE, NOR WILL THEY EVER GET RN EXPERIENCE, ARE THEY NOT GOOD MIDWIVES?

And by your logic ("how do you know without experience") one wouldn't know if they wanted to be a midwife until they actually caught a baby. Surgeons wouldn't know they wanted to be surgeons until they cut somebody open, etc. But do we allow them to do any of this until they make the decision and get the education and training? NO. In my opinion, APRNs are doing the same thing: They made the decision, and they're getting the education and the training. They'll get better over time, just as in any other profession.

There many different ways to do a given thing, any thing. But it requires open-mindedness to accept this.

My advice to future practitioners on this board is to ask advice (as you are doing), sit down and *really* think about what YOU want, then make the decision and be proud of it. Once you make the decision, don't let anyone make you feel inferior, or otherwise incapable based on the path that you choose. Seek out experiences that will strengthen your weak areas and reach out and help someone in those areas that you feel confident. I've worked with some wonderful nurses so far. They have a lot to teach, but I have also taught them a thing or two. It's a reciprocal relationship, but it only works well when people are open to it.

Good Luck with making your decisions!

LP

Wow - I've been needing to read this for awhile! (of course, nursing school itself has been keeping me pretty busy!:)

I am also a student in a direct-entry master's program - I will finish my RN in May and begin my midwifery classes in June. I have continually been going back and forth as to whether or not I should take a year off in-between and get some nursing experience before starting my master's- and I still haven't made a final decision. I can definitely see the value of working as an RN and really honing those skills that we are just getting a taste for in school; but, for mostly personal and financial reasons, I feel very pushed to just go straight through my program and become a CNM. An idea though that I have been playing with, and that I would love to get some feedback on, is this - what about finishing up all of the schooling (BSN and MSN) and then working as an RN for awhile before taking (or getting!) my first midwife job. I live in NYC and have heard that midwifery jobs are pretty hard to find here, so I have been thinking I will probably have some downtime anyways between graduation and finding work - but of course, there is also the concern that I will forget everything I have learned and trained for in midwifery school if I don't work as a midwife right away.

Any thoughts?

"lovingpecola" thanks for your imput, your lucky some of us have to go on a little less but I am hoping I love it as an occupation as much as I love being in the room when those babies are born. As for midwifery I would be an advocate whether I wanted to be one or not and I wasn't lucky enough to be raised in an atmosphere that nurtured it. Most everyone I knew thought I was crazy for having my kids at home and yet it was one of the most wonderful experiences of my life. I feel like I have been going against the grain of society to get here...just for once it would be nice to be in an environment that truly supported it.

Specializes in Nephrology, Cardiology, ER, ICU.

lovingpecola - I do sincerely respect your opinion (I've read some of your other posts too). I do agree with you on many aspects though my experience with midwives was related to my own experiences as a young expectant mother. My question is: if clinicals are not done at the hospital and you have no experience with complications, how do you deal with them in the throes of a crisis? My other concern is the liability? What kind of must a home-birth midwife have??

I am in no way denigrating what midwives do. It is not my cup of tea but then that is the neat thing about nursing, ER nursing isn't for everyone either - lol.

Thanks very much for your intriguing post.

Thanks for being open-minded Trauma!

As for the complications question: you do learn about complications (what they look like, what to do, why, etc.) in classes and through reading, but, in general, there are far fewer complications in homebirth than in the hospital. A lot of complications in the hospital are "hospital induced," meaning they are complications of interventions, if that makes sense. That being said, there are (of course) sometimes complications in home birthing, and that's when women would be transferred to the hospital to be collaboratively (hopefully) treated by their midwife and OB, with OBs having a lot of experience in the "complications" arena. Part of midwifery education (as far as I can tell right now - in my first semester, and talking with senior students) is knowing when to transfer. I HOPE SOMEONE ELSE ANSWERS THIS QUESTION, TOO!?? because I am in a CNM program, which means I *DO* have clinicals in the hospital, and will probably mostly be working in hospitals, so this is less of an issue for me personally.

As for insurance: That's sticky! Different states have different requirements for . Some states have requirements, but no insurers offering the coverage. Sometimes the coverage is unaffordable (which is also becoming a huge issue for OBs, too, btw). So, even if recommended or required, some homebirth midwives don't have any. But also, traditionally, homebirth midwives haven't needed any either - because of the kind of relationship they have with their clients. And it is NOT required everywhere. Again, I hope someone else weighs in from the homebirth midwife point of view.

As for CNM insurance, the ACNM offers malpractice insurance, but for CNMs, too, it has been tough. It is sometimes not as big of an issue because CNMs often fall under the hospital's insurance plan (or it's part of their benefits package) from my understanding. But for those who must pay, the cost is rising very fast (as with OBs) and there are *VERY FEW* companies offering coverage.

ibambamama: I have heard that it's a hard to find midwife jobs in NYC because of oversaturation, also. The students who have graduated from my program say that the people who find jobs the fastest are those with the fewest restrictions on where they want to live! Experience as an RN can be good if that's what you want to do. You can also try to get experience in other ways, like doing an internship or externship at a birthing center or something while waiting/looking for a job...Nursing school is really hard (to me) and I can't imagine i would come back after taking a break, it just takes too long to get into the groove of it!

midwifeinthemaking: I do just want to let you know that the ivy CNM programs that I am familiar with (just two of them) don't really give homebirth training experience...just in case you thought you'd get a lot of it in nursing school...apprenticeship programs do, though! My point in saying that is you'd be suprised just how many differences of opinion there are in a group of 14 midwifery students! I think it's great, but it suprised me!

LP

This is such an interesting topic, and a timely one too which I'll explain in a minute. I am currently in a CNM program after recently graduating form my BSN. This is a midlife career change for me, and one I feel is what I am truly meant to do. I think the point that needs to be made is that whether someone is truly ready for a career in midwifery has more to do with what experiences surrounding birth they have had. This doesn't necessarily have to be in the RN role.

I also knew going into my BSN that it was a path to midwifery after having both my children with midwives, one in a hospital, one at home, both in NYC loving pecola! From thoses experiences I decided to dip my toes in the water exploring other means of being around birth before making the committment. With 10 years experience as a doula, childbirth educator and a midwifery assitant for some home birth midwives, I knew I was ready.

It's pretty individual and experience can, but doesn't always need to include nursing to be valuable.

I had a very intersting conversation with one of my instructors the other day regarding this very issue. We have a little micorcosom of people in my program. Some BSN with no nursing, or other experience, some with BSN doula experience, some witih BSN and L and D experience, some with BSN and other nursing experience. In terms of how people are performing academically it doesn't seem to make a difference. Clinically may be a different story, I'm not privvy to those evaluations. Many of the L and D, (and non L and D, as well) nurses say they are having a hard time with the fact that they were once experts on their floors and it's difficult to make the transition back tothat place of not knowing exactly what you are doing. It's an adjustment. That's all.

We have courses dedicated specifically to complications in pregnancy and birth and are obligated to know how to treat those issues in order to pass.

Additionally we have a semester where we basically go to work with a single preceptor in her/his setting practice under their supervision for clients who are willing to have us there. I have seen complications in every setting, and midwives always amaze me at how calm they remain while effectively going about managing the complication. Grace under pressure.

In terms of insurance, each state is so different in terms of their requirements for homebirth midwives. The laws about homebirth itself really varies form state to state. It would be hard to make a sweeping generalization on that one. While I hope to work in a hospital setting, preferrably one with a birth center, if I were to have a homebirth practice, I would certainly want to have a poilcy. Statistics do show, however that nurse midwives are the least liekly to be sued by a pt. Again, I think it has to do with the relationship that gets formed during mom's care. Well, that and there isn't often anything to be sued over.

Whew, nice to be up for some air from studying ladies. Thanks!

I just realized that in my last post I said something about "the students in my program" right after I said something about New York...I don't go to Columbia! Just wanted to clarify, in case people wanted to ask about the program! (But I do know two people there, if you need it LOL)

(I caught this after I pm'd you birthmamaew!)

Specializes in Midwifery, Case Management, Addictions.

I've been a homebirth midwife for 30+ years and have also worked in L&D, PP, nursery and ambulatory settings. I love doing homebirths. The model is very safe provided the midwife accepts as candidates low-risk women with good OB and medical histories and, of course, a healthy pregnancy course. As far as transfers to the hospital go, I have a long-standing reputation for not bringing in disasters. We want mama and baby to still be in good condition when we arrive at the hospital. I tell my students that they may not know why a complication is occurring, but they do need to be able to recognize that things have deviated from the norm. The three little words: "transport when necessary" are very important to the midwife!

As for , I haven't had any for many years. I wish I could have access to it, but it is not available to homebirth midwives (either licensed midwives or CNMs). I do feel that homebirthers tend to "get it" about taking responsibility for their own births in a way that most folks don't, and the relationship between midwife and client is very important in supporting that.

Homebirth is legal in every state. Laws governing the practice of direct-entry midwifery vary, although more and more states are moving toward licensure and professionalization of direct-entry midwives. CNM practice is legal in every state but the laws governing CNM practice in some states make doing homebirths easier (or harder!) there than others.

Nizhoni, I didn't know homebirth was "legal" in every state...I thought there were some states that had a "neither legal nor illegal" status? In Nebraska, tspecifically Omaha, the homebirth midwives are underground, and i assumed this was because we didn't have a clear law...do you know anything else about this? It's very interesting to me!

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