Home-Birth/ Doula Friendly CNM Program

**LibraSunCNM, BSN, MSN, CNM** · Sep 10, 2014

What geographical area are you in? Are you willing to travel somewhere else to find a program that suits your needs or are you committed to your area?

mstacer · Sep 10, 2014

I currently live in Austin, Texas. I'd be willing to move, but of course I'd rather not.

queenanneslace, ADN, MSN, APRN, CNM · Sep 10, 2014

I understand what you are saying, because what you're looking for is just about exactly what I was looking for when I was first exploring midwifery nurse-midwifery programs 10 years ago. I ended up very frustrated in my first direct-entry MSN program - and left.

Then started nursing school. Then quit.

Then apprenticed with CPMs

Then became a nurse.

Now I'm a student nurse-midwife.

My perspective has changed a lot. I think the best place to find natural birth experiences is in birth centers or OOH practices. It is very difficult to get those experiences in CNM programs. I know a few (very few) SNMs who did some of their training in freestanding birth centers. They had to go out of their way to get those experiences. And truthfully, it is very hard to complete the clinical requirement of a CNM program without a higher volume hospital-based practice.

Working with CPMs allowed me to learn natural birth, woman-centered birth, and OOH birth. This was wonderful - and I don't think there was any way to get that experience through a CNM program. It really derailed my progress to becoming a CNM, but I don't think I could have sat through lectures on dialysis and chest tubes if I didn't have that experience.

Frontier Nursing University is pretty open toward OOH clinical sites - though they do have restrictions. Also, I don't know that it's possible for any SNM to get their full clinical experience in an out-of-hospital setting.

Other CNM programs will say they have OOH clinical sites. But translated that means: "We had one student once, who did one semester of clinical at one CNM-run birth center."

**LibraSunCNM, BSN, MSN, CNM** · Sep 10, 2014

I went to NYU, and I did integration with a homebirth midwife. I actually had as many births as I had the previous semester for IP in a hospital. I was lucky to have a program director who is a former homebirth midwife. I agree with the above poster that it is hard (and I would say not advisable) to do ALL of your clinicals in OOH settings. It IS also possible to learn from midwives with different philosophies from you, or to suffer through a semester at a site that you have issues with, and still come out richer for the experience. But I completely understand your concerns, and I felt the same way.

I would contact the closest program directors by email (I guess that would be Baylor and Texas Tech) and ask directly about your concerns. You could also contact the Austin Area Birth Center and ask if they ever take students, and if so, from where. And to echo the above poster, Frontier is an excellent option as well.

Simplyroses · Sep 11, 2014

Oregon Health and Science University!!!! All the way, baby!

Portland is a Mecca for homebirths and doula's. The CNM faculty practice at OHSU delivers at the hospital but they routinely get home birth transfers and they have a great relationship with the local homebirth midwives. They also do (and teach) waterbirths in the hospital.

AspiringNurseMW · Sep 12, 2014

My plan is to go to Frontier because I think it would give me more options in what kind of clinical site to choose. When I worked at a birthing center in NYC we had a SNM from Frontier, but she had completed other aspects of her clinicals elsewhere.

CNMidwife2Be · Sep 13, 2014

I'm a student midwife at Frontier and they are highly supportive of physiological birth. I would say most content reflects what I learned through my own self-study as a doula and is philosophically in line with my beliefs. It's very evidence based and thankfully the evidence is beginning to really support physiological birth (rejection of Friedman curve and acceptance of longer first stage, spontaneous rather than valsalva pushing, delayed cord clamping, no routine bulb suctioning, skin to skin, early breastfeeding etc,). I've been really happy with it. I also have a background as a doula and CBE. I never worked as an RN and they accepted me based on that experience which certainly says they acknowledge the value in that work.

They also require all students to attend AABCs How to a Start a Birth Center workshop, which I think also reflects their support for OOH birth.

With regard to clinicals it totally depends on what's available to you. There are a number of restrictions based on malpractice insurance that can make it challenging. For home birth or birth center practice midwives they cannot attend VBACs, breech or multiples. Many home birth midwives attend VBACs. Also birth centers must be CABC accredited.

Also preceptors must have a masters degree, have worked at least a year as a CNM and carry malpractice insurance. Depending on the number of midwives or birth centers in your area the impact this has can vary. I found a home birth midwife who has agreed to work with me who meets the criteria. We're in the middle of the credentialing process so it's not a guarantee yet but I'm hopeful. There is a CABC birth center near me but they have an exclusivity contracts w another midwifery program. So competition can be an issue. I'll also have another clinical site or two for hospital experience and more gyn. You are technically supposed to get some hospital experience but it's not really defined how much. I know of one student who got her hospital hours because the midwives from the birth center stayed with their patients for transfers. But for the most part people who do OOH placements also do hospital. Also consider that not all hospital practices are created equal - some will be much more hands off/expectant management than others. Look at hospital stats and community reviews.

I think I've heard Austin has quite a few options. And I know a couple Frontier grads who are practicing home birth midwives in that area. I'd say start researching now and see what you find.

A nice thing to consider if you're able is traveling/temporarily relocating. You can reach put to midwives and birth centers anywhere. I have a friend who went out of state for an amazing birth center placement. If you're in an area with a lot of options (research home birth CNMs and CABC accredited birth centers) then I'd get in touch w all of them early and see if they take students. Or consider others places you be willing to temporarily relocate to if possible.

In short, the clinical element is challenging across the board. I've heard about students not getting placements on time in programs that are supposed to find ones for them (and then not being allowed to look themselves) so I'm actually grateful to have control over who I contact. And many programs do not have OOH clinical options at all.

I believe Phila U and Georgetown may be similar to Frontier but don't have the OOH VBAC restriction. But Phila is a lot more expensive and Georgetown tuition is insane. I can't really speak to their quality though. Know that Phila U awards a Masters in midwifery (not nursing or nurse-midwifery, which would *I believe* prevent you from practicing in Oregon.)

Overall, I've been quite happy at Frontier. Feel free to PM me w any questions too!

(Also FYI, I have actually heard first hand info that OHSU is highly, highly medicalized. This really surprised me since they're supposedly ranked so highly, but I think it goes to show that the rankings report is not necessarily accurate.)

iloveSF · Sep 23, 2014

hi, i am currently an LPN student, used to work as a doula and had a home birth. i also would like to become a CNM and would love some info if you find something. i'll be sure to follow this thread. thank you.

Simplyroses · Sep 23, 2014

(Also FYI, I have actually heard first hand info that OHSU is highly, highly medicalized. This really surprised me since they're supposedly ranked so highly, but I think it goes to show that the rankings report is not necessarily accurate.)

CNMidwife2Be, that hasn't been my experience at all. Some of the faculty at OHSU also have home birth practices and it is possible to participate in home births. OHSU as a HOSPITAL is highly medicalized and the program teaches ALL aspects of midwifery care, so you do learn how to manage pitocin, epidurals, and internal monitors. However, normal physiological birth is emphasized and interventions are only done when medically necessary.

cayenne06, MSN, CNM · Oct 1, 2014

Working with CPMs allowed me to learn natural birth, woman-centered birth, and OOH birth. This was wonderful - and I don't think there was any way to get that experience through a CNM program. It really derailed my progress to becoming a CNM, but I don't think I could have sat through lectures on dialysis and chest tubes if I didn't have that experience.

I agree 300%. Part of me wishes I had gone to nursing school right out of high school instead of pursuing my CPM and now finally my CNM, but the experience I got both in CPM school and as a practicing home birth CPM was invaluable in maintaining my perspective in the much more medicalized environment of hospital birth.

Would you consider CPM training before entering CNM school? it's hard to justify the expense and committment if you don't plan on practicing as a CPM, but the other posters are right- that kind of experience is almost impossible to get in CNM school.

This place is like 8 hours from you- Midwifery School - Maternidad La Luz - MEAC Certified Practicing Midwifery School and Birthing Clinic in El Paso, TX

klone, MSN, RN · Oct 1, 2014

I remember when I was at Frontier, and Kitty Ernst spoke to our class (80!) about the importance of bringing midwifery back into the home.