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CPM VS. BSN

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So I was all set to start my LPN program next month and low and behold I ran into a site that opened up the door to midwifery. My ultimate goal was to get a BSN and hopefully land a job in L&D because that's where my heart lies. I really have no interest in any other specialties in nursing. Due to sum scheduling and childcare circumstances I would have to take the ladder approach, which is why I was starting with the LPN first. By total accident I exposed myself to the world of Doulas and midwifery. I knew that both existed, but I never researched either of them, until now. I was completely unaware that a CPM certification existed and now that I do know it's made me question the path I'm currently taking. I would like some advice from people who have been thru this phase, what was the deciding factor for you? Do you regret your CPM training? Can you make a suitable living? All of these things cross my mind daily, but I'm just not sure which way to turn. If working with pregnant women and babies is really my passion does it make sense to obtain a nursing degree? Any advice would be helpful at this point, since I don't have much time to decide a path.

I think the safer, more respected route would be to continue on your path to become an RN and then get a master's to become a certified nurse midwife. CPM's scope of practice is much more limited and they aren't allowed to deliver in hospitals in most areas across the country. If you love OB, continue with your RN studies, possibly work as an OB tech or doula, and then go from there. It may take more time and be a little more difficult bur it's probably a safer choice in the long term.

Sammis1CNP2b

Has 3 years experience.

From my knowledge of also recently discovering the Midwifery life, CPM is only recognized in some states so be sure to check the guidelines for your state. I hope it all works out for you!

Thank you very much. I appreciate your advice. Looks like I still have some soul searching to do.

queenanneslace, ADN, MSN, APRN, CNM

Specializes in Nurse-Midwife.

I would like some advice from people who have been thru this phase, what was the deciding factor for you? Do you regret your CPM training? Can you make a suitable living? If working with pregnant women and babies is really my passion does it make sense to obtain a nursing degree?

What was the deciding factor?

That is such a long answer - and a question that has been answered by myself and others on these discussion forums. Do a search for CPM vc CNM here and see what you find. For many of us on the CPM to CNM path, it was a long, slow unraveling.

Do you regret your CPM training?

Yes and No. There were some good things about it, and I learned some valuable things. Probably the most valuable thing I learned during my CPM training is it is not a credential I want to pursue any longer, and I have no regrets about pursuing my CNM.

Can you make a suitable living?

Not really. Not financially. Or socially. Or sanely.

If working with pregnant women and babies is really my passion does it make sense to obtain a nursing degree?

ABSOLUTELY! Yes. Unequivocally. Yes. You will be better trained and you will be able to help many more women and babies.

cayenne06, MSN, CNM

Specializes in Reproductive & Public Health. Has 10 years experience.

I became a CPM in 2006 and a CNM just a couple months ago. Search my posts, I've said a lot on this topic!

Cayenne06 Do you regret doing CPM first? Do you still have contact with people who have preferred to stay within the CPM route? I do know that taking the route to CNM is probably the most secure because you can work in any of the 50 states without red tape. I'm planning on moving back to California anyway though, where CPM and CM status is honored and you can practice in a wide scope of places. There are just so many obstacles with nursing school and it's not very flexible here. All of the programs I've researched have been full-time daytime and I currently work full-time. I'm trying to shy away from LPN, which I have been accepted to. Mainly because I'm creating another step for myself to go thru before intimately becoming an RN and being able to practice labor and delivery. At this point things are very confusing 😔

LibraSunCNM, MSN

Specializes in OB. Has 10 years experience.

queenanneslace and cayenne---curious about the pay for a CPM. You've mentioned that it's not really a good living. How much did you generally find CPMs charged each patient per birth? Was it less because insurances wouldn't usually cover birth with a CPM? The homebirth CNMs I know all make bank.

queenanneslace, ADN, MSN, APRN, CNM

Specializes in Nurse-Midwife.

queenanneslace and cayenne---curious about the pay for a CPM. You've mentioned that it's not really a good living. How much did you generally find CPMs charged each patient per birth? Was it less because insurances wouldn't usually cover birth with a CPM? The homebirth CNMs I know all make bank.

CPM pay? I'll put it this way - for being a solo business owner in a profession that has phenomenal responsibility and liability, a 24/7/365 on call schedule and a credential that is not recognized academically by any other profession, the pay is not enough.

Sometimes CPMs were reimbursed quite handsomely for some births by some insurers. Other times the pay was a barter agreement with the client that included a back massage and a loaf of banana bread. And you have to remember, that even if the midwife is taking in $3000k per birth (which is a modest income) - that is the business income, not her salary, or her employees salaries (hardy har har har har!!!). It doesn't take into account the overhead of running the business.

Most CPMs I knew were lacking in business skills - (business training is not part of the educational curriculum) so they don't even really understand it themselves - and struggle to make a living. Dollars in do not equal salary, benefits, time off, retirement..... for the most part it's a solo business. With no potential for career development. The CPM is a terminal credential. That's it.

LibraSunCNM, MSN

Specializes in OB. Has 10 years experience.

Thanks for your insight, that's really good to know.

cayenne06, MSN, CNM

Specializes in Reproductive & Public Health. Has 10 years experience.

. Other times the pay was a barter agreement with the client that included a back massage and a loaf of banana bread.

And there is this idea that midwifery is a calling, and we should be lucky to get any payment for our work because isn't that warm fuzzy feeling enough compensation?!

This was actually a big reason I went back for my CNM. In Florida, we were lucky enough to be able to accept medicaid and private insurance for home and birth center births, but in most states CPMs are not licensed and therefore can't easily get insurance reimbursement. So either I would work for practically free in order to serve lower income women, or only be able to take care of the rich ladies who could afford to pay privately. I'm sorry, but while I have the utmost respect for every woman and her childbearing experience, I didn't go into midwifery to help affluent women have beautiful home births. I went into midwifery to serve ALL women, in all areas of reproductive health, regardless of their socioeconomic status.

With no potential for career development. The CPM is a terminal credential. That's it.

And that right there is the cold harsh truth. After my daughter was diagnosed with ataxia telangiectasia and I decided to leave my birth center/home birth practice, I worked as a medical assistant for 10 dollars an hour. Because my CPM credential means nothing if you aren't actually working as a CPM. And not a single credit from my direct-entry midwifery school transferred to my RN or CNM schools. Not a one. (And for good reason, too, IMO)

I don't regret my CPM education, especially because my parents paid for it (haha). I feel it gave me valuable experience and helped me buld a foundation that respects a woman's right to autonomy. But if I am being objective, my decision to pursue CPM school right out of high school (instead of nursing school like my parents thought I should!) cost me a ton of money over the long term (both because my parents weren't about to pay when I decided I really DID want to go back to nursing/CNM school!) and because of the many many years of delay before I was able to start making a CNM salary.

I also came out of CPM school with a lot of woo, misinformation, and a wary attitude toward "mainstream" medicine. Took me a while to detox, and now I bristle at the idea that holistic midwifery (or nursing) mean eschewing pharmaceuticals for homeopathy and chiropractic care. ARGH! That's not what holistic means!

Clearly I still have some baggage lol

queenanneslace, ADN, MSN, APRN, CNM

Specializes in Nurse-Midwife.

I didn't go into midwifery to help affluent women have beautiful home births. I went into midwifery to serve ALL women, in all areas of reproductive health, regardless of their socioeconomic status.

This. Right on. Amen, sister.

cayenne06, MSN, CNM

Specializes in Reproductive & Public Health. Has 10 years experience.

I didn't go into midwifery to help affluent women have beautiful home births. I went into midwifery to serve ALL women, in all areas of reproductive health, regardless of their socioeconomic status.

This. Right on. Amen, sister.

I work at Planned Parenthood and don't even catch babies anymore. And I've never felt more fulfilled in my work. Being a midwife is so much more than catching cute slippery newborns (although that's an awesome perk!).

Dollars in do not equal salary, benefits, time off, retirement..... for the most part it's a solo business. With no potential for career development. The CPM is a terminal credential. That's it.

This! This right here is why I am choosing CNM over CPM. I have a family with 2 young daughters and need to consider our future. What if something happens that leaves me physically unable to attend births, having a background in nursing means that I can still take my knowledge and schooling to a different type of job, administrative, teaching, etc. I can pursue other post masters or a doctorate. I can work as a nurse if I need to. Even as a midwife, I won't be limited to home or birth centers. I could get a job potentially only doing gyn care.

At first I looked into CNM because my state does not license CPMs, but the more I learn about nursing in general, the better I feel about this choice.

Follow your heart. I am an LPN and started my journey to become a CPM. I toyed with the idea of CNM but my heart lies in home birth and evidenced based births so hospital was out for me. Licensing for CPM varies from state to state but MD just became a licensed state recently and PA is working on it. If you want to work in a hospital environment I guess CNM is best route. Why not take a class at The Farm and see what you think after that. Definitely pick up some books from Ina May and read what she has learned being a CPM. I know some in my unlicensed state in PA that make much more yearly than a CNM

klone, MSN, RN

Specializes in Women's Health/OB Leadership. Has 15 years experience.

Follow your heart. I am an LPN and started my journey to become a CPM. I toyed with the idea of CNM but my heart lies in home birth and evidenced based births so hospital was out for me.

Okay, I have to say I bristled at this. I know the hospital birth system is far from perfect, and in many places, it's downright dysfunctionally broken. But in many places it works WELL, there are robust midwifery practices, and residents/attendings who have working collaborative relationships with them, and practice evidence-based medicine. There are also many wonderful FSBCs, and more are being created every year, all over the country. Please don't paint all "not at home" births with the same broad brush.

I can tell you some horror stories about non-CNM midwives in practice here in Denver, and how very NON evidence-based their practice is.

There are also many CNMs who do homebirths.

@minerwife927 Thats all I've been hearing is how CNM is the best route to take. But then I've read so much information on how CPM's have been so fulfilled and happy on the decision they made to get that credential. I've researched several successful birthing centers that now have staffed midwifery students and no one seems to be regretful about becoming a CPM vs a CNM. I got into the idea of nursing initially because it was thet only way I could fulfill my passion on being involved in the labor and delivery process. There is no other specialty I'm even remotely interested in at all. Dealing with women's health, labor, delivery, postpartum all of these things are what I'm interested in. Which is why the CPM credential was far more appealing to me. I also don't want to make the wrong choice either, which has me on the fence. Especially with everyone saying that I'll be on call 24/7 and I won't ever make any money. I do work full-time and I have 3 children to support, so financials are important as well. I also don't want to have to quit my job to attend school either, I enjoy my household being a two income household. I just hope I'm able to follow the right path and make a sound decision.

LibraSunCNM, MSN

Specializes in OB. Has 10 years experience.

Follow your heart. I am an LPN and started my journey to become a CPM. I toyed with the idea of CNM but my heart lies in home birth and evidenced based births so hospital was out for me. Licensing for CPM varies from state to state but MD just became a licensed state recently and PA is working on it. If you want to work in a hospital environment I guess CNM is best route. Why not take a class at The Farm and see what you think after that. Definitely pick up some books from Ina May and read what she has learned being a CPM. I know some in my unlicensed state in PA that make much more yearly than a CNM

Yes, this is pretty unfair. Hospital birth does not equal a lack of evidence-based practice. Many times it does, but there are great institutions out there keeping birth safe for women who need or choose a hospital birth. And as we've heard from prior posters who actually were CPMs, there can be a huge dearth of evidence-based practice amongst CPMs. I think part of this probably stems from the very broad educational requirements for CPMs (until recently I don't think you even needed to have a high school diploma to be a CPM).

"Taking a class at the Farm" will not open my eyes to anything I don't already know. I have read all of Ina May's books and have the utmost respect for her, but that doesn't mean that CPMs are inherently safer than CNMs because they only do homebirths, or that CNMs only work in hospitals...I could go on.

That's great that you know CPMs who make more than CNMs, but I think that's probably extremely rare (again, going on the excellent insights that cayenne and queenanneslace have given us).

Edited by LibraSunCNM
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