SUNY Downstate-Midwifery: Anti-Nursing?

mef06011 · Feb 14, 2011

I think I was at that open house with you....hahaha. I didn't necissarily read her statements as anti-nurse, but she was pushing the certified midwife option pretty hard, and considering only one person in the room was a nurse, I'm not surprised. I have opted to go the CNM route and believe I will be better prepared as a midwife if I have traditional nursing education first, but that's just the right path for me. Also, I have done some research and it looks like one of the only places you can practice as a CM is in New York, and a few other states in the Northeast, so that would seriously limit where you could live.

I was recently accepted to Downstate's Accelerated BSN program, but am holding out for some combined BSN/MSN programs I have applied to.

Best of luck, and hopefully someone else will have more information for you!

DiverseWoman · Mar 29, 2011

I am a midwifery student at SUNY Downstate. It is a better program than Columbia and StonyBrook. I'm not just saying that because I attend the program. I also work with many midwives and whnps who precept Columbia students. They always say the Columbia students are "clueless" and "Ill prepared". Most love the Downstate students better. Downstate is not anti nursing. I have been an RN for 5 yrs and I am graduating with the title CNM. The point that they are trying to make is that midwives are midwives. You don't have to be an RN to become a midwife. It makes alot of sense because MD's are not trained as nurses before they become MD's. Most MD's have no background health education at all. But they learn the tools of the trade as will a non nurse who wants to become a midwife. Anybody can deliver a baby. In 3rd world countries nurses and village women deliver babies with little intervention. I think that is what they were trying to bring across. Doulas are usually more prepared then RN's when it comes to non interventional practices. RN's are used to working on L&D and managing interventional care with pit drips etc. Downstate gives you a full scope of practice. Midwifery is all about non interventional and holistic care for better outcomes with normal pregnancies. There are many women who don't have BSN's and they are great midwives. CM's can work in many states. They just need a written practice agreement with a physician which is not required in NYS. You have every right to be proud to be an RN. You will maintain you RN license when you become a CNM. You will have that right to keep your title.

TLAandy · Mar 31, 2011

I hear this a lot that if someone is pro-direct entry then they must be anti-nursing. Our country is the one of a few that have the nurse-midwife model. I am an RN and currently in a midwifery program (FSMFN) and I did not have L&D experience at all, and was told it was not really a benefit. I think the important aspects of nursing that apply toward midwifery could be learned in the LPN diploma program (I have been both LPN/RN). Sorry if I offend anyone. I just don't see "nursing" as vital to midwifery. I am proud of being an RN, but nursing tries to do everything from bedmaking to complicated chemotherapy IV infusions. You cannot master everything. We need to learn to let our old roles go and assume new ones. In this case a midwife. There is nothing wrong about being just plain ole' PRO-MIDWIFERY!!!

PamCNM2Be · Apr 8, 2011

I'm pretty sure people are talking about two different types of direct entry here. There are obviously the direct-entry midwifes (CPMs, LMs, CMs, etc), but I think by direct-entry in this case, ibambamama is talking about direct-entry nursing education. A lot of programs, including downstate, frontier, columbia, etc have programs where you graduate as a CNM with an MSN without having any prior nursing experience (thus, "direct-entry"). Ibambamama is already an RN and therefore will be starting her CNM training not as a "direct-entry" student (like the doulas she was referring to). I definitely think it sounds like at that open-house the director was gearing it toward the direct entry students (again, not CMs/CPMs/LMs etc, but to CNM students with no prior nursing experience). But, as DiverseWoman mentioned, it's probably because most of the students there were in fact not nurses, and because women of all backgrounds can make excellent midwives. I wouldn't fret too much!!! Good luck with whatever decision you make :)

CEG · Apr 17, 2011

I'm pretty sure people are talking about two different types of direct entry here. :)

For clarification, I think SUNY downstate offers the CM credential and those students are in classes alongside the CNM students-- it is the same exam. That's what the OP is referring to.

As a CNM who did a non-nurse entry CNM program, I can say that there are definitely very divided sentiments on the nursing experience. I did have about 2 years of experience as an L & D RN before graduating as a CNM. My experience as a nurse was pretty negative. I wanted to become a CNM because I had a passion for evidence-based care and wanted to work closely with patients. Instead I was doing things "per protocol" and having to follow MD orders for things I disagreed with. I loathe the fact now that it is accepted that my patients and the MD patients get a different standard of care. Seriously, my patients have no risk of cord prolapse with ambulation after ROM but the MD patients do?

It did make me more adept at things like IV starts, catheters, doing pericare, etc. I think when nurses look at a nurse midwife and they see that she lacks basic nursing skills like that they feel her skills are in question. They also lack the understanding of the bigger picture. Let's face it, we all know nurses who have worked in L& D for 5, 10, even 30 years that are very skillful but do not understand basic physiology or bother to read new practice recs. They would not make good midwives despite their extensive experience.

On the other hand if your first code or cord prolapse is when you are the provider it is a different level of responsibility. There is comfort in having been through the drill before. However that doesn't mean that someone without nursing experience can't do well in those circumstances. Remember that while physicians have a longer residency very few of them could run an IV pump, do pericare very well, or do very well with patient interaction. But we don't expect them to.

So, although the nurse experience is helpful on many levels, it is not essential in my opinion. I think the speaker either is on the no experience side of the fence or was trying to reassure those who have heard negativity.

Best of luck with your apps-- remember even if you ulimately encounter that sentiment in your program it doesn't matter in the grand scheme of things. Frontier and Downstate are quality programs and you will get your credential and title either way:)

HappyNurse2005, RN · Apr 18, 2011

I'm pretty sure people are talking about two different types of direct entry here. There are obviously the direct-entry midwifes (CPMs, LMs, CMs, etc), but I think by direct-entry in this case, ibambamama is talking about direct-entry nursing education. A lot of programs, including downstate, frontier, columbia, etc have programs where you graduate as a CNM with an MSN without having any prior nursing experience (thus, "direct-entry"). Ibambamama is already an RN and therefore will be starting her CNM training not as a "direct-entry" student (like the doulas she was referring to). I definitely think it sounds like at that open-house the director was gearing it toward the direct entry students (again, not CMs/CPMs/LMs etc, but to CNM students with no prior nursing experience). But, as DiverseWoman mentioned, it's probably because most of the students there were in fact not nurses, and because women of all backgrounds can make excellent midwives. I wouldn't fret too much!!! Good luck with whatever decision you make :)

At Frontier, you must be a nurse to apply , with at least one year experience, but other significant healthcare experience will be considered in lieu of the one year requirement. But-- you still have to be a RN. Frontier has no program for non-nurses to become CNMs or FNPs or WHNPs

ibambamama · Apr 24, 2011

Oh, I'm so glad this thread got picked up again - thanks to everyone for replying!

I am still completely up in the air about which program to choose (there are actually lots of other factors I have to take into consideration), but it is really helpful to hear other people's various experiences.

I am definitely familiar with the two camps in regards to whether or not actually working as a nurse is useful for becoming a midwife (for those going the CNM route); and I clearly chose my camp and made my decision a long time ago, without any regrets.

I don't doubt that you can become a great midwife without the experience (heck, my entire cohort from Columbia- which, btw, I found very anti-nursing - are all graduated and working as fantastic midwives now without having had the nursing experience), but I just knew for myself that that was something I really wanted. I have known for a long time that I want to midwife, but I also really enjoyed nursing school and nursing - and felt like it could only strengthen my skills in the future. As CEG mentioned, I really wanted to hone those fundamental nursing skills (IV starts, pericare, dealing with emergency situations, etc) and feel comfortable on an L&D floor, so that I would have those things down and not have to worry about them when I will have so much else to worry about as a midwifery student!

I also really enjoyed my time on L&D - yes there was a lot of BS and some crappy docs - but some really great ones too, as well as many independent midwives and a true on-site birthing center in our hospital (1 floor below the regular L&D floor).

I guess it just makes me sad that so many people in the midwifery world (in the US at least) seem to have such negative feelings about nursing and nurses.

I would just like to point out though, to DiverseWoman - and I say this as I sit in my mud house in a village in Rwanda (well, technically I'm in my office, where the internet is, but later will go back to my mud house :) - yes, the vast majority of deliveries in the developing world are attended to by nurses (most of whom have minimal nurse training and little or no OB training) or traditional birth attendants 'without interventions' - but the maternal mortality rates in the developing world are also absolutely atrocious and unjust - almost half a million women a year die while giving birth, the overwhelming majority of them in the developing world.

Now I am all for normal, natural birth and minimizing the unnecessary interventions that we practice in the US; but more than anything I am all for having those interventions available when necessary to prevent women from dying needlessly in places like my village. It is why I am here now (actually working for an international NGO on nurse capacity-building initiatives for maternity nurses in rural health centers) and, ultimately why I plan to go back to school to become a midwife - not just for the beautiful natural births that I might have the privilege to attend in New York, but also for those natural births that can and do go awry, especially in the developing world, where other help can sometimes be many hours away.

Just a thought. Nurses here provide 90% of all healthcare (there are only a small handful of doctors for the entire country, and most live in the capital); and, ultimately, better-trained and better-supported nurses - and nurse midwives - will save the lives of hundreds of thousands of mothers every year.

I'll get off my soapbox now :)

ktliz · Apr 24, 2011

Oh, ibambamama, your current position sounds awesome! I briefly looked into the Peace Corps before deciding to go back to school for nursing. I still dream of working internationally some day but am not sure what options are out there for RNs or APNs. Sorry for hijacking the thread, but I would love it if you shared how you landed where you are currently. :) Is it a temporary or permanent placement? (I'm assuming temporary since you were in NY several months ago and are returning for midwifery school.)

ibambamama · Apr 24, 2011

Hi Klitz,

Yeah, I guess I sort of hijacked my own thread :)

I feel like we hear so much about the nursing shortage in the US that we don't realize it is really a global phenomenon - and its' implications are even more serious in the developing world. For example, here in Rwanda, there are only a total 6,000 nurses for a population of about 10 million people - I often go out to rural health centers where there might only be 1 or 2 nurses, covering every service (everything from pharmacy to maternity) for up to 100 or so patients - It's insane.

So any nurse or NP (and definitely any midwife!) who wants to do international work, I say go for it! There are so many opportunities and you are desperately needed! I had actually worked in international public health for many years before becoming a nurse, so it has been quite easy for me to find work in the field since graduation (I am currently on a 1-year assignment, pretty long-term, but am returning home to give birth to #3 - and yes, finish school!). If you are just starting out, I would recommend volunteering or doing short-term assignments first (there's tons of organizations that offer these opportunities - MSF (Doctors without Borders) is probably the most well-known, but there are lots of others as well) and then if you really love it, there are lots of international NGO's that really need nurses on board - either for short or long-term work, which could be direct care in hospitals, health centers, clinics, refugee camps, etc. or doing more systems and programmatic work to help developing countries build up their own nursing workforce.

Here in Rwanda, I work for Partners in Health and am lucky to get to do a combination of both.

Hope that helps, and best of luck to you!

ktliz · Apr 24, 2011

Thank you for the info! What an inspiration. :)

If you don't mind me asking, you do this with a family, as well? How do you manage that?

ibambamama · Apr 24, 2011

Hi Ktliz,

No worries - I am just very very lucky I think! My husband is a biologist and this year was his sabbatical, so we were able to pack up the whole family (we have two girls already - ages 8 and 2) and move here together. He actually holds down the home fort in the village while I am working during the day (like I said, I am very very lucky! :)

I had lived in Africa many times before and so felt pretty comfortable bringing my family here - we take medication to prevent malaria and do most of our cooking (and boil/filter all of our water). It also really helps that I work out of a PIH-supported hospitals, so there are always lots of American docs around as well, just in case anything were to happen.

It is definitely harder to find volunteer work that would allow you to bring a family along - even MSF, which requires a minimum 6-month commitment, doesn't allow families. If you do have a family though, you might consider just doing very short assignments with other volunteer organizations at first - 1 or 2 week, direct care, like medical missions; and then, again, if you find you really love it, the work is definitely out there!

Hope that helps!