CPM to CNM

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Greetings,

I am looking for experiences from CPMs who went back to school to become CNMs. I am currently in my 2nd year of CPM school at a MEAC accredited program, but for many reasons I have decided that the CNM route may work better for me. I didn't want to "quit" CPM school this close to the finish line so my plan is to finish CPM school and then start with Nursing.

Please tell me it is all worth it :-)

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Specializes in Reproductive & Public Health.

Oh boy. I've been there! I went straight to CPM school after high school. Had both my kids in school, so it took me 5 years to complete. Graduated and received a Florida LM license in 2006. Went back to nursing school in 2009. Got my ASN in 2011, my BSN 2012, MSN in 2013, and will get my nurse-midwifery certification in May. Whew!

None of my CPM credits transferred over to my CNM program, and I am fairly certain this is an almost universal situation (i think credits from Bastyr might be transferable though). And I will say it has been a little shocking and humbling to find out how much I didn't know. The major reasons I went back were:

A) I found my CPM education grossly insufficient for providing safe, entry level care,

B) I wanted a larger scope of practice that included GYN care, prescriptive authority, and hospital privileges,

C) I wanted a credential that was more universally respected and acknowledged by other health care professionals, AND

D) I wanted MORE MONEY. I got paid crap as a CPM. Shameful.

I do not regret my CPM experience. It has given me a solid grounding in natural birth that is pretty much impossible to get in CNM school. However, my CPM education was also steeped in woo- lots of "alternative" medicine that was completely not based in reality. I also felt that a lot of what I learned was natural birth propaganda- it took me a while to lose my mistrust of allopathic medicine and learn how to be an educated consumer of research. Example- I was trained that vaccines are dangerous, there was no reason to give vitamin K universally, GDM testing was unnecessary in asymptomatic women, women with multiples, breeches, etc are appropriate homebirth candidates, etc etc. I really resent this.

I am a huge supporter of healthy living, my mom owns a health food store, and I use herbs on a fairly regular basis, but not to the exclusion of actual, evidence-based medicine.

If I could go back with the knowledge I have now, I would have gone straight for my CNM. But I think you are smart to just finish up the program (assuming you have ~ 1 year left and won't accrue too much more debt). I am involved with the US MERA project (google it!!!), and I am a huge supporter of stronger standards for all entry-level midwives, as well as better collaboration between all types of midwives. I plan on keeping my CPM certification active, even though I don't know if I will ever use it again.

Hope that helps a little! Which school are you in right now?

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Specializes in Nurse Leader specializing in Labor & Delivery.
Oh boy. I've been there! I went straight to CPM school after high school. Had both my kids in school, so it took me 5 years to complete. Graduated and received a Florida LM license in 2006. Went back to nursing school in 2009. Got my ASN in 2011, my BSN 2012, MSN in 2013, and will get my nurse-midwifery certification in May. Whew!

None of my CPM credits transferred over to my CNM program, and I am fairly certain this is an almost universal situation (i think credits from Bastyr might be transferable though). And I will say it has been a little shocking and humbling to find out how much I didn't know. The major reasons I went back were:

A) I found my CPM education grossly insufficient for providing safe, entry level care,

B) I wanted a larger scope of practice that included GYN care, prescriptive authority, and hospital privileges,

C) I wanted a credential that was more universally respected and acknowledged by other health care professionals, AND

D) I wanted MORE MONEY. I got paid crap as a CPM. Shameful.

I do not regret my CPM experience. It has given me a solid grounding in natural birth that is pretty much impossible to get in CNM school. However, my CPM education was also steeped in woo- lots of "alternative" medicine that was completely not based in reality. I also felt that a lot of what I learned was natural birth propaganda- it took me a while to lose my mistrust of allopathic medicine and learn how to be an educated consumer of research. Example- I was trained that vaccines are dangerous, there was no reason to give vitamin K universally, GDM testing was unnecessary in asymptomatic women, women with multiples, breeches, etc are appropriate homebirth candidates, etc etc. I really resent this.

I am a huge supporter of healthy living, my mom owns a health food store, and I use herbs on a fairly regular basis, but not to the exclusion of actual, evidence-based medicine.

If I could go back with the knowledge I have now, I would have gone straight for my CNM. But I think you are smart to just finish up the program (assuming you have ~ 1 year left and won't accrue too much more debt). I am involved with the US MERA project (google it!!!), and I am a huge supporter of stronger standards for all entry-level midwives, as well as better collaboration between all types of midwives. I plan on keeping my CPM certification active, even though I don't know if I will ever use it again.

Hope that helps a little! Which school are you in right now?

Wow, reading that was eerie. I feel like you're my doppelganger! :)

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Specializes in Reproductive & Public Health.
Wow, reading that was eerie. I feel like you're my doppelganger! :)

It's a long and winding road, huh? lol! The majority of my CPM class went back to school to become CNMs. That really says something, IMO.

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Cayenne thanks so much for chiming in! I am currently enrolled at MCU, but I live in WA state. Living here and talking to a lot of other midwives I have realized how "spoiled" I am when it comes to being able to make a living wage, and WA being a midwife friendly state. Unfortunately I don't feel 100% secure in my CPM career currently. I am a bit of a wanderer so having credential that varies from state to state scares me.

I have also been lucky to work with NDs and a lot of other folks who mix allopathic care in with their midwifery care and less of the "woo", butI have a specific community that I am wanting to reach and I need an expanded scope of practice that I just can't get from the CPM currently.

From what I can tell none of my BSM credits will transfer to ANY school which is what got me questioning some things. You are correct about Bastyr but I think it is absurd to spend $90,000+ for a degree where credits may transfer but at the end of the day folks "against" CPMs lump us all together anyway. For that amount of money I could complete my CPM and a large portion of my RN & BSN!

I have 4 semesters left and I have gone back and forth about the actual benefits of finishing my program, but my last semesters include pharmacology, microbiology, and some chemistry classes that are required for WA licensure anyway. Plus once I am licensed I can hopefully work as a CPM as I am going through nursing school. I love everything about home birth/birth center midwifery especially in WA state, I just need a sustainable avenue for myself and my family.

Any tips, tricks, or advice about this journey through nursing?

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Specializes in Reproductive & Public Health.

OMG, nursing school. My only advice is grit your teeth and try to appreciate the many important nursing skills you will learn along the way. I am not a nurse. I'm just not. I'm a midwife. Nursing school was not enjoyable for me. It was a hoop I had to jump through. i did not even attend my pinning ceremony. I do not particularly enjoy working as an RN either, even though I have a pretty damn cushy job in LDRP at a small community hospital (don't get me wrong- love my job; I'm just not cut out for bedside nursing).

So keep your eyes on the prize, and pay attention to fluid balance and electrolytes! Very important in any area of healthcare!

And watch out for the woo- it is pervasive. I am not a fan of NDs, at all. I am sure some are some very competent, but the profession is based on pseudoscience.

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Specializes in hospice.

As a person who has had home births and has considered CPM, but may pursue CNM in the future, I have a question: how do you get through being a practicing nurse in hospital L&D without losing your mind, or your heart? The whole idea holds me back from even thinking about it very much.

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Specializes in Nurse-Midwife.
I am not a nurse. I'm just not. I'm a midwife.

This is sooooo refreshing to hear from another nurse. I keep saying "I do not have the heart of an OB nurse, I have the heart of a midwife." Nursing is NOT my passion ... it is a means to an end. And it IS a valuable experience. It is. I just can't imagine being a nurse for the rest of my life.

I started my CPM, I didn't finish - I was close - but I started to realize that I would be putting forth a lot of effort for little return. I just plowed ahead with nursing school. And not a single credit of anything from my MEAC program transferred to anywhere.

Grit your teeth through nursing school.... I second that! Just get through it. And someone asked how you don't lose your heart and soul - well, sometimes I do.... sometimes I have to lock my heart up in a box and just do the OB nurse thing.... which is often in line with what the obstetrician wants - and is not very midwife-y.

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Specializes in OB.
As a person who has had home births and has considered CPM, but may pursue CNM in the future, I have a question: how do you get through being a practicing nurse in hospital L&D without losing your mind, or your heart? The whole idea holds me back from even thinking about it very much.

You actually don't have to be an L&D nurse to be a CNM. I struggled with the idea, and then decided against it. The hospital where I wanted to work, because it would help me pay for my master's degree, has an extremely medicalized OB department, with no midwives. I could have worked there and experience there would have helped me as a new grad midwife, but ultimately I think it was the right choice for me to avoid it altogether. I worked in med/surg and Mother/Baby. If you do decide to work L&D, I agree with queenanneslace that you probably just have to compartmentalize certain things and try not to let them get to you. Or you could get lucky and work on an L&D unit that doesn't require that and will enrich your experience.

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Specializes in Reproductive & Public Health.
As a person who has had home births and has considered CPM, but may pursue CNM in the future, I have a question: how do you get through being a practicing nurse in hospital L&D without losing your mind, or your heart? The whole idea holds me back from even thinking about it very much.

I agree with queenanneslace and LibraSun. It can be very difficult to be an RN in labor and delivery. I see some sad, cringeworthy and/or downright unacceptable things at my job. I do my best to provide compassionate, safe care regardless of what else may be going on. And I savor the moments of joy that make the job worth it- a grandfather crying tears of joy, a laboring woman surrounded by loving friends/family, a quiet hour spent snuggling a noob while mom takes a nap. It's NEVER all bad on labor and delivery.

That being said- there are some AMAZING hospital L&D units. I am doing my integration with a midwifery group that is the only provider at the local community hospital. They do about 700 births a year. They have 4 OBGYNs who do office GYN stuff, but they don't take on any OB patients of their own, they just back us as needed. Their unit is a mix of "birth center" type rooms, and more standard hospital rooms that have been re-organized so that it is clear that the woman need not be in bed. The nursing staff is incredible, and all the nursing policies follow the midwifery model of care. Delayed cord clamping, uninterrupted skin to skin, allowing infants to self-latch, etc etc. Intermittent auscultation is standard for women without risk factors, they have a 50% epidural rate (compared to 90+ in many/most units) and an 11% cesarean rate, which includes the patients whose labors end up being managed by obstetricians- but keep in mind they are a relatively low risk practice.

However. It is absolutely not true that being an L&D RN will make you a better midwife, or even really give you much of an advantage in midwifery school. And you can pick up some bad habits and misinformation that may be hard to shake off.

I don't think I am cut out for any other specialty though. Every once in a while I get floated out of L&D, and I think I would truly rather go back to working at my mom's health food store than work the bedside in most other nursing specialties. (and I am sure some would feel the same about working in L&D lol)

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I'm loving this post. I was considering CPM and even got a full scholarship for a program but due to the age of my children and finances CPM schooling just wasn't a fit. Plus the scope and wider base of knowledge and variety/growth available to me as a CNM has me starting my prerequisites to hopefully start the nursing program next fall. I have no interest really in any other field of nursing other than L&D while I do the RN TO BSN bridge & CNM program. But I am afraid of losing my heart, because I highly doubt the hospitals in my area are evidence based, shoot there is only 1 CNM in my town. . We shall see I guess, I'll have to reminisce in my doula training and my HBAC experiences when times get tough. Maybe find some CPM s to shadow during the summer time

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I didn't go through CPM training but came very close. My heart is in physiological home birth and the CPM pathway really resonated for me. But, for all the reasons the other ladies mentioned above I eventually decided on the CNM route. I did a one year accelerated BSN and it was pretty awful for me. I am also a midwife at heart, not a nurse. Nursing is really quite a different profession and firmly routed in the medical model. So on top of a crazy schedule, emotionally it was quite a challenging for me. But ultimately, it went by very fast. I immediately applied and was accepted to Frontier based on several years of doula and CBE experience. (They accept other birth related experience in lieu of nursing experience, which I'm pretty sure includes CPM training/experience.) It's also an incredibly fast program but it's very evidence based and the focus is really on physiological birth. I do feel like I'm getting a very good education as a midwife.

My advice to get through nursing school is to keep reminding yourself why you're there - it's a means to end - it is a final and necessary step before midwifery school. It was so worth it for me. I am really happy in my program and excited that I will have so much flexibility in my profession. I will be able to work in any setting - home, hospital or birth center, or focus on gyn and work in a women's health clinic. There's also teaching - I love the idea of inspiring a younger generation of midwives one day.

I feel certain that I've chosen the right pathway. I hope this helps!

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