Need Advice - CNM/CPM

[cjyff]

For the past few months I have been extensively looking in to becoming a CNM by doing an accelerated BSN/MSN (I have my BS in Bio. My husband is military and we will be moving soon, who knows where yet, which is why I can't say if I will be doing the BSN or MSN) and then becoming a CNM. My problem is, I was recently offered an apprenticeship under a CPM. So I would do a correspondence program and get clinical and birth experience with her and become a CPM in around a year or two. I feel like CPMs are, unfortunately, not as respected in our culture, but I don't know if this is an opportunity I want to pass up. Even though it is not the career plan I had in mind...

Has anyone started as a CPM and then become an CNM? I would love to hear thoughts.

[cjyff]

I would go straight into nursing school, but it is not an option for me where I am living now, so I have to wait until we move

[IrishIzCPNP, MSN, RN, APRN, NP]

I wouldn't consider doing CPM for a few reasons. The basic reasons...not legal in all states and unlikely to get privileges at a hospital.

I admit to a bias against midwives who are not a CNM.

[klone, MSN, RN]

I, on the other hand, do not have that bias, assuming the CPM is well-trained, has a lot of experience, and practices responsibly. My second child was born at home with two CPMs. They were fabulous, and extremely conscientious.

If your interest is homebirth, then I think training with the CPM would be an exciting opportunity. You can always decide to go back to school for your CNM later.

In your situation, assuming you know that this CPM is reputable and safe, I would probably jump at the opportunity. Women are always going to have homebirths, and not every state allows CNMs to practice at home legally. THe world needs safe, well-trained CPMs.

Just reread your OP, and how will you do the apprenticeship if your husband is going to be relocated soon?

[IrishIzCPNP, MSN, RN, APRN, NP]

I, on the other hand, do not have that bias, assuming the CPM is well-trained, has a lot of experience, and practices responsibly. My second child was born at home with two CPMs. They were fabulous, and extremely conscientious.

If your interest is homebirth, then I think training with the CPM would be an exciting opportunity. You can always decide to go back to school for your CNM later.

In your situation, assuming you know that this CPM is reputable and safe, I would probably jump at the opportunity. Women are always going to have homebirths, and not every state allows CNMs to practice at home legally. THe world needs safe, well-trained CPMs.

Just reread your OP, and how will you do the apprenticeship if your husband is going to be relocated soon?

And if a CNM can't practice at home legally what do you think happens to the CPMs and lay midwives who practice at home and something goes wrong.

[klone, MSN, RN]

And if a CNM can't practice at home legally what do you think happens to the CPMs and lay midwives who practice at home and something goes wrong.

In most states, CPMs and DEMs *can* legally attend homebirths. I'm assuming since she's being offered training and an apprenticeship, the OP lives in one of those states.

Since CPMs and DEMs are not nurses, they're not bound by their state's nursing regulations the way a CNM would be. That is why CNMs may not legally attend homebirths in some states, but a CPM can.

[IrishIzCPNP, MSN, RN, APRN, NP]

In most states, CPMs and DEMs *can* legally attend homebirths. I'm assuming since she's being offered training and an apprenticeship, the OP lives in one of those states.

Since CPMs and DEMs are not nurses, they're not bound by their state's nursing regulations the way a CNM would be. That is why CNMs may not legally attend homebirths in some states, but a CPM can.

But she's talking about needing to relocating.

Also, even if it isn't illegal it doesn't mean that if there is a problem that the law won't attack! It has happened here even when the parents were okay with the negative outcome.

[klone, MSN, RN]

Of course, it happens to CNMs and OBs, too. Obstetrics is one of the most litigious areas of medicine. Nobody is claiming that she would be immune to prosecution if there were a bad outcome. That's a risk you take when deciding to go into this field. However, research has found that midwives are generally sued less often than OBs. I imagine part of that is due to the fact that midwives tend to form closer relationships with their patients, and families are less likely to sue someone they like and have a relationship with.

As far as prosecution goes, she needs to act within the confines of the law. And know what her state's laws (whichever state she lives in) are with regards to CPMs. I have no reason to think she wouldn't do that, do you?

[klone, MSN, RN]

Here's a link to information about which states legally recognize CPMs. 26 of them, in case you were wondering.

http://narm.org/wp-content/uploads/2012/04/State-Licensure-of-CPMs.pdf

[IrishIzCPNP, MSN, RN, APRN, NP]

Of course, it happens to CNMs and OBs, too. Obstetrics is one of the most litigious areas of medicine. Nobody is claiming that she would be immune to prosecution if there were a bad outcome. That's a risk you take when deciding to go into this field. However, research has found that midwives are generally sued less often than OBs. I imagine part of that is due to the fact that midwives tend to form closer relationships with their patients, and families are less likely to sue someone they like and have a relationship with.

As far as prosecution goes, she needs to act within the confines of the law. And know what her state's laws (whichever state she lives in) are with regards to CPMs. I have no reason to think she wouldn't do that, do you?

I'm not talking law suits. I'm talking about then law prosecuting when there is a negative outcome. We have nonCNM midwives here and the law has gone after the, after negative outcomes....even when the family was okay with what happened. The legal protection for a CPM isn't always as strong as a CNM.

This is just something to consider...is it a risk you want to take....

[cayenne06, MSN, CNM]

i practiced as a licensed midwife (cpm) in Florida. We got ins. and Medicaid reimbursement and were fairly well integrated into the health care system. No hosp privileges, but that is because a cpm scope of practice is fairly limited and we couldnt care for pts with epidurals, use vacuums, etc. Once i moved out of state i went back to school to become an RN because it is hard to make a living as a cpm in an unregulated state unless you are a real go-getter. I am hopefully starting a post-msn CNM program in the fall. So that's my story! pls excuse my crappy typing, on my phone.

[klone, MSN, RN]

I'm not talking law suits. I'm talking about then law prosecuting when there is a negative outcome.

And like I said above, OBs and CNMs are not immune to that, simply because of their credentials.