BAtoCNM

Apropos of drug companies, check this out: http://www.nytimes.com/2007/05/10/health/10psyche.html?pagewanted=1

AK, You might want to read Born in the USA by Marsden Wagner. He offers a lot of evidence for why birth with a MW (even home birth) is often safer than the highly medicalized alternative for mom and baby.

You might want to check out this website: http://nofreelunch.org/faqs.htm A resident told me about it and I've learned a lot.

The midwives I've spoken to in Boston work a total of 35 hours a week "officially." They are on call 1-2 times per week, which is roughly a 12 hour shift, and spend the rest of their time in the office. 80 hrs/wk doesn't make sense to me-who could be effective with that kind of schedule? Are you sure that these midwives are actually working all those hours?

Likewise, I"m happy to help.

Yes, I've heard this from several woman that, when they choose the CNM route or a low-tech birth in general, people accuse them of everything from being a naive hippy to being a child abuser. Some women who want to give birth at home or with no epidural pain relief are chided for being silly or denied choice once they're in labor and can't really argue.

epi- i'm starting at penn this summer and in the dual concentration as well. i tried to private message you but your box is full. feel free to private message me!

Deann, you might want to take a look at this book: Born in the USA: How a Broken Maternity System Must Be Fixed to Put Women and Children First by Marsden Wagner The information provided is current and backed up by research, plus it's written in a very conversational style.

I'm so sorry you've dealt with judgmental jerks Deanna! I guess those come in every profession. I am a soon-to-be midwifery student, but one reason I chose that route rather than OB was the emphasis in midwifery education on patient advocacy, and giving the patient all the information she needs to make the best choice for her. For some women (I'm sure for me!) that will include an epidural. For others, it may not. The history of OB in this country, which many awesome OBs have been working hard to change, has been to perform interventions for the convenience of the practitioner and/or the hospital rather than for the benefit of the mom/baby. For example, episiotomies were standard operating procedure for decades, and now research shows that they are associated with a slew of negative outcomes for mom and do not improve outcomes for baby unless s/he is truly in distress during delivery. Also, there is peer-reviewed data that one intervention often leads to a cascade of others. I've read that an epidural often predicts a C-section, even when controlling for other factors that could require one. Likewise, constant electronic fetal monitoring is associated with epidurals and C Sections. And C sections do carry the risk of death, disability, infection, and complications in your next pregnancy. It really sucks that one helpful intervention can trigger a whole slew of others, and that's why CNMs are trained to be conservative on that count, at least according to the midwives I interviewed. I've met a few people who think CNMs will only perform "natural" births, or that working with one means you can't get a C Section if you need one. However, most of the time, CNMs are medical professionals working within a hospital system that allows them access to all kinds of pain relief, including epidurals, and the surgical skills of OBs should a section be neccessary. Several midwives I've interviewed in the area (all CNMs - perhaps CPMs are different) said that although they did not have epidurals during their own labors, nearly all of their patients choose to have one. Like any practitioner, a midwife should not judge the choices you make for your own health! I have had this experience with MDs in the past and the result has been I never return to their practice. I guess when you know a lot about health you can get to thinking you know better than the person whose body you're treating, and yours is a cautionary tale for clinicians and other health professionals (ie breast-feeding folks) to remember their place as advocate for, not overlord of, a patient.

Yay Massachusetts! I think in general things are pretty good here, though they may be better in states with less of an MD presence. Sort of related, I was looking for an NP for my mom outside Chicago and found essentially none. So, my questions to piggy-back on Diahni: a) what is the best site for finding an NP, if you are a patient? b) does the number of NPs practicing in a particular area serve as a good marker of how NPs are treated there? I found loads on NPs in the Boston area, but just a handful in Chicagoland. Thoughts?

I can't speak for the field, as I'm not in it yet, but the CNM that I shadowed at an urban safety-net hospital was a midwife, not an L and D nurse. There were 2 L and D RNs assigned to her cases, and the 3 of them worked together, but the CNM was the primary practitioner responsible for her laboring patients. This same set-up applied to the OBs as well, who were assigned 2 L and D RNs but were the primary practitioners responsible for their patients. At least here, it doesn't make sense to hire a CNM with a Master's and pay her upwards of $80K if she's going to do the same job as an RN.

I got a preliminary one in the mail several weeks ago. You might want to check with Financial Aid to see what they hold up is-I've always found them to be quite helpful.

I'm not the first person to ask this but only one person seems to be offering more detail about why Illinois is such a terrbiel place to be an NP. Several people have mentioned it's among the worst, but only one person has offered her 2 cents (thanks, mamanaynay!). Any body else want to comment? IL is also not ranked well on one of the websites that offers a measure of job conditions for NPs.

Right on, Asherah! Iriska, every time I get the "but why don't you just go to med school" speech, I take it as an excellent opportunity to be an advocate for my chosen field. That way, I educate the many people utterly ignorant of what NPs do and the focus of their training-more public health, more preventive med, etc, etc. Also, the training philosophy is different, and I for one DO NOT want to suffer as a lowly med student and then a lowly resident working 60 hours a week for pennies just to "prove" I have what it takes to put MD after my name. Some people are willing to do that, but I'm not, and that's one big reason I chose to go the NP rather than MD route, and I often explain this as well.

I'm going too, CNM route! I've been calling around to landlords in the area (I'll be moving from Boston) and they seem to think apartments open up two months or so in advance.

Hi Chaundrah, I've just been accepted to a BSN/MSN program and have received two kinds of federal student loans, both subsidized. The school also gave me a significant amount of money in need-based grants. Some schools are willing to consider your previous loan burden when awarding need-based grants that come from the school itself, while others adhere strictly to the FAFSA calculations, which do not account for loan payments you already have and limit your aid if you have already received some for a previous bachelor's degree. Speak to someone "at the top" (ie, the director) at various schools' financial aid offices and likely they will be able to tell you the real deal (that's what I did). Best of luck to you!

Hey there! As a liberal arts grad who later considered either med or nursing school, I thought I'd offer my two cents. When I first started looking into this, I thought nursing was just "medicine lite." It's not. The reality is that nurses' work is cheapened in our culture (though that's changing thanks to the efforts of many nurses) and glossed over as "tender loving care," when it's much more complicated than that. So it can be hard to get a realistic view of what nurses do. Or at least it was for me. There are many different specialties you can pursue as a nurse, like oncology or critical care etc etc that would best match different types of people. If you want to be a different kind of provider, keep in mind that PA/MD/NP all have slightly different models of practice. Yes, these fields have a lot in common and work together, but the training and philosophy are not identical. I would highly recommend you decide which one is best for you before you spend too much time or money pursuing courses that will only be suitable for one of these paths. What I found most helpful was conducting informational interviews with all sorts of practitioners. You'd be surprised how many people are happy to share their career stories with you. I also read a lot about the different fields and shadowed an MD and a certified nurse midwife. Which path you choose depends on what you really want to do. What patient population are you interested in? What clinical setting? Are you most drawn to primary care? Surgery? Research? A combination? You will find it MUCH easier to get admitted to programs if you can clearly articulate in your personal statement and admissions interview WHY you want to pursue a particular track, and how the end result (the degree) will take you where you want to go professionally.

Congrats on your acceptance, though!

I'm going to Penn! Anyone else here heading that way?

Marzipan penguins? Your post was hilarious. I have not started any classes yet; in fact, I am anxiously awaiting word from the programs I applied to as we speak. What I can tell you is what helped me decide to apply, which was: 1) reading LOTS of books about midwifery and the role of CNMs. I highly recommend Midwifery and Childbirth in the United States by Rooks. It is more of a textbook but it's the most comprehensive history of where CNMs started, where they're going, etc that I have found. 2) I scheduled informational interviews, some in person but most by phone, with midwives at different stages of their careers, most of whom had taken the accelerated route that I'm pursuing. 3) I shadowed a CNM for a full shift on the labor and delivery floor. 4) I also learn a lot from two blogs: one written by a midwife practicing in Malawi (http://babycatching.blogspot.com/) and another by a student midwife in NYC (http://www.studentmidwife.org/) Hope that helps! Best of luck as you decide on your future path. Remember, being a nurse is not the same as being a midwife, so your sister in law's opinion may or may not apply to you.

Just for the record, I've chewed my fingernails down to nothing waiting for results from Penn and Columbia! You're not the only one. . Also, I heard from a friend of mine that her acceptance envelope was THIN, so not to worry if you get a small one! Best of luck to all, BtC

Alias, I was in your shoes last spring and decided to apply to a few accelerated BSN/MSN programs as I have a BA in something other than nursing. There are several routes to take, depending on whether you are an RN already, have a degree in something other than nursing (like liberal arts) or have not yet started college. The ACNM website, while very helpful, doesn't always have the most up to date information about programs. They are all listed here, although some of the info about which programs they offer isn't always accurate (for that I would recommend you go to the school's own website): http://www.acnm.org/careers.cfm?id=105

By the way, med students begin clinicals in their second year of medical school. The large majority never practiced nursing or medicine prior to this exposure. But don't we all have to start somewhere?

Cyndee, you should consider re-reading your last paragraph and thinking how it would sound to a new nurse - ANY new nurse. You're basically saying that sight unseen, you and your colleagues are ready to go out of your way to berate my choices and sabotage my learning? If you care about helping patients, isn't this counterproductive? On the other hand, if you're honestly concerned about my non-existent level of expertise, why don't you try harder to train people like me, rather than wasting time making my life miserable? I don't understand.

Also, I think that there are misconceptions here. You can't be an NP w/o being an RN first; I know this because I'm in the process of applying right now. Straight from Vanderbilt's website: Pre-Specialty Entry for Non-Nurses Students who have completed at least 78 semester hours of transferable college credit or have earned a bachelor’s degree "bridge" into the Masters of Science in Nursing (MSN) program via a three semester sequence of accelerated generalist nursing courses. The three semester pre-specialty year prepares students for the NCLEX exam to become a Registered Nurse (RN) and provides the foundation equivalent to the bachelor's degree in nursing for course work in the selected nursing specialty. Upon completion of three semesters of pre-specialty courses, students enter an additional three semester sequence of courses in their declared specialty in order to earn the MSN degree. So in addition to your undergrad and pre-requisite work, you have at least 3 years of nursing education (clinical and classroom) before you are "let loose" as an NP. As a non-nurse, I have to say I'm very confused. Why aren't we allowed to change our minds and go into nursing after all? I've met people with BAs in sociology or Chinese who then complete the pre-med coursework (about 1 year) and get through medical school just fine. Should they be required to be nurses first? Do CNAs out there think that that RNs must have several years of CNA experience first before being accepted into RN programs? I welcome anyone to help me understand these distinctions. I'm wondering if our medical education system, though flawed, is based around the idea that experience is the best teacher. Thus, they fill students - whether nursing or medical - with lots of knowledge and then throw them into the mix, to be mentored by more experienced clinicians and learn from their new jobs. I heard somewhere that in med school and residency, "medical education is a series of calculated mistakes." Or something along those lines. That scares me as a patient and a future practitioner, but if that's the way it's done, why penalize _only_ the direct-entry NPs for this fact?