Allison T

Just mentioning that it is absolutely not necessary to be a nurse to become an IBCLC. IBCLCs also come from PT, SLP, OT, MD/DO, social work, and many other backgrounds.

Hi Claralee, I racked my brain and found I knew 3 CNMs who attended Jefferson University. All 3 liked it a lot. They all said it's a program where you know your faculty and that was important to them. I worked with 2 of them clinically and to me 1 seemed exceptionally green as a new midwife. Like, I used to ask myself how she passed certain classes. But that could come from any program, believe me. She was an older student; maybe this played some role.

I could not agree more! The media perpetuate this notion of injecting the vaccine up high, too close to the shoulder. Ouch. Both times I got the COVID vaccine, the person injected it much too high. It felt like it hit bone. I was worried it had not gone into the muscle. I wish I had said something. Neither time did they palpate my arm: they just jabbed. No Z-track, either. Working in a mass vaccination event, you may not have a choice of needle, so "modifying the arm" (bunching or not bunching the tissue, or Z-track -- try it! it's so amazing -- and considering depth of injection) are ways to best administer a vaccine. I keep the injection guidelines in my head about depth to inject. I palpate the area to make sure there's not going to be scar tissue in my way and to locate the muscle. ACIP Vaccine Recommendations

I am giving COVID vaccines, too. I hadn't given deltoid injections in a while: I am usually injecting a larger volume (>1 mL), so I favor the dorsal gluteal or ventral gluteal sites. I was required to take the CDC website training on giving the vaccines: anyone else do this? And I read up about vaccination techniques, which said that the Z-track method is recommended (though ACIP doesn't mention it). I've now given 100 or so deltoid injections using Z-track, and it's been truly life-changing. It's so easy, and most people don't feel it. https://www.CDC.gov/vaccines/covid-19/downloads/COVID-19-Clinical-Training-and-Resources-for-HCPs.pdfhttps://www.immunize.org/askexperts/administering-vaccines.asp

There are actually a number of birth centers that employ lactation consultants (IBCLCs). They tend to be the larger birth centers. For example, Women's Birth and Wellness Center in Chapel Hill, NC, and the Midwife Center for Birth and Women's Health in Pittsburgh, PA.

I'm sorry I didn't see these replies months ago. I love the discussion. I do want to say that however much CNMs with L & D experience who work in busy, medicalized practices may feel that their L & D experience was helpful (and I am one of those who felt it was helpful), the research does not support that it is necessary. The parallel credential to CNMs, i.e., CMs, does not have L & D experience because they do not enter midwifery from nursing. Yet they go through the same midwifery education as CNMs, take the same board exam (AMCB), and belong to the same professional association (ACNM). There is no statistical difference in outcomes between CNMs with L & D experience and CNMs without it. I know people who've worked at and volunteered at Holy Family Birth Center and loved it. https://www.holyfamilybirthcenter.com/ There is an organization for those affiliated with or interested in birth centers (for birth center midwives, birth center owners, doulas, etc.) called AABC (American Association of Birth Centers). www.birthcenters.org.

I didn't go to Jefferson (which used to be called Philadelphia Midwifery Institute) but I have friends who did. I'm a CNM who went to a different school.

Well, hello. I am a certified nurse-midwife who loves talking about midwifery. I'm pretty active in midwifery organizations and will try to direct you to resources and answer questions. I'm sorry the midwife at your local hospital wasn't open to networking (?). Going from RN, ADN to CNM (or getting BSN along the way first, depending on which school you go to) is certainly doable. http://www.midwife.org/ http://www.midwife.org/Education-and-Careers

I too was the pioneering CNM at a hospital. I was on call virtually 24/7. My plan was to gradually persuade management to hire another CNM. I did ultimately succeed with that. However, our service got shut down by the CEO a short time after we hired the 2nd CNM. I am an experienced midwife (and state affiliate leader) who has heard many, many sad and abusive stories from midwives who started midwifery services at hospitals. One thing to do is really thoroughly research the hospital, the CEO, and the OBs. For example, I have seen hospitals hire a CNM to start a service, then fire the CNM when the local OBs get threatened. Then a few years later, with the OBs complaining about the workload, the same hospital again hires a CNM (who is unaware of the history). You may learn some helpful things from the state ACNM affiliate members and/or other APRNs such as NPs. If I had done my research, and seen how the hospital treated NPs (like they were disposable), I wouldn't have gone there. It is essential that the office staff understands you and midwifery. If the person answering the phone says "Do you want to see the doctor or just a midwife?" it is not good. Another tricky thing is that you are not really a midwifery service if you aren't 24/7. How will your patients feel if they come to a midwife for prenatal care and get a non-midwife at their birth? When you are the sole midwife at a hospital, it is inevitable that this will happen. Many, many hospital administrations do not understand that midwives labor sit. I would get phone calls asking, "Can't the nurse or the monitor watch the patient?" In fact, I was trying to get to the place that the nurses would be at the bedside (or birth ball side, LOL) with the patients so that I could stay in office a bit longer, but I lacked the support of administration with this. There was no nurse training unless I provided it, uncompensated, and with no one stepping in to help with my other other duties. And this in a state that provided nurse training in Lamaze childbirth techniques, lactation, and other relevant topics at a huge discount for nurses. So make sure that admin understands this about you (if indeed you do plan to practice "real midwifery" and be with your patients in labor). You have to be willing to either reschedule people's prenatal or GYN visits, or have your office colleague (MD/DO or whoever else you are working with) see the pts if you are at a labor/birth. I do recommend monthly team meetings (CNMs/CMs, head L & D nurses, OBs, CEO or maternity service leader) to ensure everyone is on the same page. We had these, but because the CEO was essentially off his rocker, they didn't work well. However, in general they seem a helpful concept. Good luck, and I hope you do your research.

Oh, I just answered this in the Georgetown thread...

Re Georgetown and dual specialty, I would highly recommend not doing CNM with WHNP. The WHNP doesn't increase your scope of practice. Do an FNP. Even if you think you only want to see women now as a future CNM, I can guarantee there will come a time when you want to care for a man or for a baby past one month. I believe there are just 3 states in the country where having WHNP with CNM makes sense due to state regulations.

In most states, it would not be worth your while to be both a CNM and a WHNP. Everything that a WHNP does is within a CNM's scope of practice. The reverse is not true. If you want to be an NP in addition to being a CNM, consider being an FNP, etc., or something that would expand your scope of practice beyond what a CNM does. I highly recommend touching base with the ACNM affiliate (i.e., state chapter of American College of Nurse-Midwives) for your state if you are considering the CNM-WHNP combined option. Do not rely on what a graduate school tells you. Even if they are a wonderful program, they cannot possibly know all the political ramifications.

Hello. Your plans and questions sound good. Note that since you are already a nurse, you would become a CNM, not a CM. The certified midwife (CM) path requires a bachelor's degree in a non-nursing field, and then a program for a master's degree. Only 2 schools offer CM: SUNY Downstate and the Midwifery Institute at Philadelphia University. Here's the link from the ACNM's website which explains the pathways. The vast majority of midwives in the ACNM are CNMs, not CMs. Pathway Results As for the HRSA, I found the process and language complicated. Also there are several options within HRSA. Legislation is being debated that would expand the options. Stay tuned. You could possibly contact your legislators' offices, too, for info. I took a job where another CNM and I were told, "No one's ever been turned down for the loan [NHSC]." It turned out that the HPSA score (Health Professional Shortage Area) disqualified us. HPSA Find I definitely recommend signing up for alerts through HRSA and being on their webinars and conference calls. Also some states have their own loan repayment options, and some employers offer loan repayment. And yes, I got into one of the schools you mentioned, with a somewhat similar background (I am also a certified childbirth educator, an IBCLC, and I have my RNC but it's not RNC-OB) and had 2 years as an L & D nurse. Keep on reading and posting.

I agree about e-mail! I get a fair amount of people wanting to e-mail me to ask about being a CNM. I'm definitely willing to meet people face to face if they are serious about it after several rounds of e-mails. I did have one recently who ended up working alongside me for a while, and I was surprised that she had not really read (or understood?) my e-mails. She kept asking me about being a "nursing midwife." And yes, I have had this conversation with a number of patients, and lunch/coffee with them too. Not an issue for many of us.

Sadly, on social media, I sometimes see practitioners who are advanced practice nurses (such as nurse practitioners) being called "doctor," and not correcting the person who posted it. Like "You are the best doctor." There's also an issue with some dialects of American English where people say, "I do my doctoring with Ms. Smith the nurse practitioner." That one surprised me . . .