Midwifery Today Community

Hello All! My name is Sarah Grace. I recently graduated with a Bachelors in International Affairs, but even before graduation I knew I was going to switch gears and enter a midwifery program as soon as possible. I am struggling between two paths to becoming a midwife: a direct-entry (CPM) or a nurse-midwife (CNM). However, I have hit a roadblock in my decision of which path to take and I was hoping to get your help.

On a personal level, I have issues with the need to become a nurse to be a midwife. The main reason I want to become a midwife is the philosophy behind the practice and I plan on only working in a birth center or home birth setting rather than in a hopsital. In fact, I really have no desire to be a nurse other than as a means of becoming a midwife. Therefore, I am having trouble accepting the fact that CNMs are always under the supervision of an obstetrician and very rarely allowed to perform home births (this is my understanding at least).

However, I am young and do not want to limit myself. I understand the benefits of an "acknowledged" degree such as CNM. So...should the benefits of a "professional" degree vs a certification outweigh the personal reasons I want to become a midwife in the first place? I do want to be able to work and hopefully raise a family someday, so financial issues cannot be ignored in my decision. Hopefully someone can help me weigh these financial decisions with my political ones....

I look forward to seeing your comments.

Thanks!

 Well I'm a bit older than you, oplus a mommy of five (age 6-22) and find the education commitment for both and the CPM NARM documentation requirement to be a bit overwhelming, though surely necessary for the integrity and credibility of the discipline.

I'm going the CNM ( plus maybe the FNP) route strictly for broader scope of care delivery, long term career planning and financial reasons  

Some of my thoughts are:

easier access to financial aid, grants and scholarships

loan forgiveness when i go to work in a public health clinic which i've always wanted to do

volume and variety of birth experiences in the early years of practicing and adequate access to a hospital where I hope to have privledges just in case a transfer is needed ( this may not be an issue in your state)

being able to actually afford to provide care to those desiring quality midwifery care without having to consider financial implications

ability to serve underserved and marginalized populations right here in the USA without having to think about how i will eat

access to populations not easily reached by CPM's either due to legal, political or reimbursement issues

knowledge to provide a continuum of care for the whole woman her child and the family if needed

clear ascension path to academia if I decide to replicate my ideas and best practice, what better way to augment, change or fix "the system" then to reeducate those who follow you on the same path

because international spots I've been too and that midwifery friends are setting up (schools and clinics) actually desire a CNM to assist with curriculmn devlopement, supervision  etc...  and I want to avail myself to this opportunity also

after looking at the documentation requirement for NARM PEP process vs the other options through NARM there seems to be no time short cut, especially if you live in a state with to few CPM's qualified to evaluate/ mentor you and two few home births and 3-5 birth centers

This is just some of the rational, and after years of working in and around health care, education, promotion research etc... I definately resonate more with the CPM model plus all the potential for holistic and alternative integration but I have present day infant morbidity/ mortality rates two zip codes over to think of and those mamas aren't always thinking about home birthing.

Hope this helps 

Sarah Grace,

Welcome to MT and MTF.  Its pleasure to meet you and hope to stay you around.  Have to say that I'm sorta in the same boat as you in and etc.  Have no clue and really have not that much info on this.  At the same time have no desire to pursue the path of becoming an doula or midwife because everything that it invovles.  Even though it would be nice and etc in the long run.  On the another hand have seen this topic for an threads in the past, but at the same time have forgotten what were my responses to them.

Highly recommend that you check out the rest of MT.  Also Our Bodies, Ourselves, The Boston Women's Health Book Collective and their companion website/blog as well.  Found its really helpful no matter what. At same time do recommend that you do additional learning and research besides the books and website I give you to give you. For more info on this.

Hope my recommendations do help you.

Good luck and etc.

 Forgot to mention that I working on networking and affiliating myself with assorted birth/ parenting affinity groups nd plan to pursue some doula coursework/training even though I've been brith assiting on and off I while/ Plus I'm gravitating towards Childbirth International for personal updating so I can begin offering CBE classes with some current credentials.

Even though I've personally birth in the 80's, 90's and new millineum the language seems to change and there is so much more info for families/comsumers.

Good Luck with your path the links provided by the other poster should provide some good insight. My first post was just the rationale I used for comig up with my decision.

Wow- LifeAGift!

What a great eye opening post- thank you!  This internal battle is why I decided to seek out forums like this!  

I am bumping this thread because I think your outlook and insight is SO HELPFUL!  

I am an RN (Associate's degree only) who has finally decided to give in to myself (lol) and become a Midwife.  I've struggle with what I really want to do with my career and I believe this is truly where my passion is. I definitely identify far more with the CPM model of care, knowledge and treatment foundation and the whole idea of homebirths in general than the CNM, in-hospital model of "medicine".  So I have been greatly struggling with this decision!  However, your rationale really helps, as I do also have to consider making an income, as well as working in States that require different levels of MD supervision, and I had completely overlooked the ability to use my Master's degree to teach- not only another revenue source, but an excellent way to educate new RN's on the "other" side of birth! 

Thank you!

NorCalRN,

No problem. My rationale continues to evolve.

Went to the midwifery today conference since my last post and had the blessed benefit of meeting so many other midwifes in various scopes of practice and it was an even greater eye opener.

Met one CNM from NY who rarely attends births because of the "stuff" (politics and staffing issues I assume are at her hospital). As a matter of fact on a hectic and crazy day she has seen as many as 40 women (not all preg.) in the hosp affiliated clinic where she works. I was like no way sounds to much like an OB office. The trade off for her was that she was able to get funded to start the centering pregnancy model and now has I think two clinic days and eves where she can spend hours with just a few mamas to be at a time, primarily teens and first time mothers. Imagine the impact! Not the trade off everyone wants to make but to be in a position to empower so many young mamas and also the psycho social support system she is able to create for a demographic of women who often skip care.

I met another CNM so not interested in the medical model of care in her area that she has opted to do well woman care and lactation education only plus work as an adjunct professor until she can open a free standing practice with appropriate hospital privledges. Her academic preparation didn't totally prepare her for homebirth but she is now incorporating that level of training independently through international travel and stateside trainings and conferences and will eventuially add the CPM credential.

I also met numerous CPM's who are very vocal activist in their communities. Changing state laws and hospital protocols every chance they get for the benefit of women everywhere. Some CPM's come from states where their model of care is so accepted and sought after that MD's make refferals to them. They are in the trenchs, collecting the data, sacrificing time and resources for apprentices and making vbac possible for so many whom mainstream has denied. This woman's work is so multifaceted, convulted and IMPORTANT that there is room/ need for all!

As a 5x vaginal birther who has had both midwifery and ob care I believe that one goal should be to continually provide families with choices! Every woman will not have the support, sense of empowerment/ confidence or economic means etc... to birth at home. Those mamas still need a no to low intervention birth experience, facillitated by someone who cares more about them than meeting the hospitals bottem line.

Is there a place for medicine, absolutely. With my fourth I needed an appendectomy while at 7months. I didn't have knowledge of any herbs, homeopathics, or alternative modalities to alleviate the pain or dis-ease my body was dealing with. I needed a surgeon. Baby and I made a deal, I had the surgery got stitched back up and went on to term. What my OB lacked in bedside manner and what I like to call crunchygronalabohemianyogamama friendliness she made up for in surgical skill. 

I'm grateful to every CPM/CM/CNM/OB I've ever encountered.

Yes, all additionally really good points. Thank you. :)

It is nice to know that I can add the CPM/Homebirth skills and knowledge down the line as well.  My main source of confusion and ignorance right now is my own state laws regarding CNM's doing homebirths, etc.  Which is something I intend to remedy shortly. I have found a lot of resources to follow up on.

I am excited about this journey though- wherever it ends up taking me.  It's nice to know there are so many wonderful women out there working together towards this beautiful bigger picture of better-informed and well-cared for mamas! :)

I DITTO your sentiments

THE LAW...ever changing and always confusing

what I've gathered in my state and I may be total wrong is:

deleted because I got confused just trying to explain it!

In additon to the law you have malpractice insurance and or hospital policies that make things all that more convulted. If your state regs are like mine you might find that meeting the NARM requirements is easier before or during the pursuit of the CNM if you decide to go that route.

BEST WISHES ON YOUR JOURNEY! 

LifeAGift,  You articulate the inner debate between the two main paths to midwifery so well!  Those are precisely the reason I ultimately chose to pursue my training as a CNM (starting in 2 weeks!!!).  I also am seriously considering adding FNP into the mix, then completing the CPM portfolio later.  Not over-achievers at ALL, are we? ;)  

Hi Ladies,

I found this thread of posts a couple weeks ago and it brought me to tears. To read about the CNMs who take alternative paths and don't just work in hospitals and support their bottom lines was very reassuring. These threads let me rest easy for a while but now there is some indecision rearing its ugly head again. I live in Massachusetts. There is an amazing CPM school in Maine (you've probably heard of it: Birthwise) that I would love to go to. My first BA is in photojournalism & magazine writing and I've studied documentary, so my background is pretty left brained and artsy. I've been working as a birth, and occasionally postpartum doula, for a little over a year. CPM is much more "me": I've always worked for myself, and am very independent. I don't really like hospitals and I'm not so keen on having to be watched under an OB. But I'm pulled to the CNM route so:

1) I can eat and have a house.

2) I can make a change in how birth happens in this country (USA). I am playing by these CNM rules so I can affect change from the inside out but I fear I will have sacrificed a bit of who I am to make that happen. To me, it feels like being a painter and trading in your oils and canvas for a computer. Or, more aptly, working in the darkroom and then switching to photoshop (been there, done that, no likey).

My heart wants to be in the trenches with the CPMS, learning all the skills I need AND tuning my intution for birth. For the CNM route, I will do it but am not psyched about on moving to a new place for some big fancy ivy league program (which, it seems most of the CNM programs are--Yale, Columbia, Vanderbuilt, Georgetown) and papering up just so I can help moms and babies. I don't care about being an RN, I just want to be a midwife.

I noticed the last post is from sometime in 2010. Anyone new out there having this same dilemma still? Or, anyone who chose to pursue the CNM in a program and want to share about their experience?

Thanks!

I'm in a state where CPMs cannot get licensed and only CNMs are allowed to practice midwifery, nonetheless, that has not deterred me from signing up to take a state approved program for licensure in a neighboring state. I already work in health care in a technical capacity and I'm a certified paramedic in my state with the previous goal of becoming a nurse. However, based on what I see in our health care industry, I find it hard to make myself enroll in a nursing program. Many of the nurses I work with spend more time documenting the "care" they give instead of actually providing "care". I do not place the blame for this on them, but on the health care delivery system in this country.

I am also a more holistic person and find that it would be a true conflict of my beliefs to practice within a medical model of care, and in my state, that is what the CNMs are forced to do. I believe that the CPM credential and the training required to obtain it are a good initial starting point for the individual wanting to provide out-of-hospital maternity and birthing care. Furthermore, I unfortunately have had the misfortune of reading comments written by one of the CNMs in my area that denigrates CPMs and their desire to be licensed here. I thought we were ALL midwives (or aspiring midwives). The CNMs in my area (this one in particular) have attacked those who have chosen the CPM route the same way the medical community attacked midwives when obstetrics was being established as a medical specialty in the late 19th-early 20th century. Comments have been made to allude to that fact that CNMs are the "gold standard" and that CPMs need nothing more than "a high school education" to be credentialed. I don't know about the rest of you, but I have found in my experience that the amount of book knowledge an individual has doesn't have any bearing on their ability to actually PERFORM their job. I've known many intelligent dummies in my time :). Also, if any of you are like me and are entering this field late in life, it's dangerous for others to assume what our educational background is (I personally have a B.S. in Business and I'm currently working towards an MBA /MHA - definitely more than a "high school" education).

Needless to say - the decision is yours alone to make. You have to decide what's important to you. I personally feel that I can affect more of a change where I am as a CPM being vocal on the outside of the establishment as opposed to being a CNM on the inside of the establishment (and risking being branded opinionated, a trouble-maker, or worse, getting fired).

I have been researching the requirements of CPM & CNM and I find myself in this same debacle of which route to take. I find it completely obsurd that people reference CPM as only having a high-school education. I have my B.S. in Am.History and have recently discovered my passion for women's health. I am so torn between CPM & CNM. I desire to open a birthing center yet I also desire to do gyn care for women. My state is not restricting either way I go, but to have many more children myself and attend college for more years and then midwifery school seems absolutely crazy at this point. Perhaps years down the road once all of my children have grown I will reconsider CNM path, for now CPM it is......I think :)

thoughts would be helpful

So many homebirth midwives are leaving practice and heading back to school for the CNM route I worry for the future of homebirth.  Glad to know there are some who continue on the CPM route.  They are needed!!

 I'm a CNM who has worked all my years as a midwife attending home births. I practiced as an L&D RN for 10 years prior to becoming a midwife. I used to be one of those CNM's who spoke highly about CPM's and thought, "Let's just get along."  My opinion has changed recently as I'm precepting a CPM candidate and I am finding out more about the NARM requirements to sit for the CPM exam.  NARM recently changed some of it's requirements, one of them being proof of a high school diploma.  Prior to this change, one assumes, a high school diploma wasn't even necessary!! So the people who said that other health care providers put CPM's down by saying they don't even have to have a high school diploma--these people are just speaking the truth.  My student said that it is okay for her to be going to a midwifery "school" that is not accredited, and she can sit for the CPM exam.  She said, you actually don't even have to have proof of going to any school--you just need proof of your clinical experiences.  I checked the NARM website, and this actually looks to be true! They call this the PEP process.  Another change was that you must spend AT LEAST 2 years obtaining your experience--previously, you could spend one year doing clinicals and sit for the CPM exam.  I hope someone can correct me on these issues because even though I read it on the NARM website, it just doesn't seem like it can be true that the requirements to sit for the CPM exam are so limited.  Up until the changes last year, a person could spend a year getting the appropriate number of clinical experiences (even from an unlicensed DEM), didn't need a high school diploma, did not need to attend any kind of midwifery school, and as long as they passed the CPM exam, could be considered a midwife capable of caring for mothers and babies. 

It seems to me the PEP process was/is/will continue to be fairly rigorous.  There are core areas of education expected and each candidate has to document everything: hours of study, skills evaluations, clinical experience....  (Have you looked at the Candidate Information Booklet?)  You can do self-study or complete an organized curriculum.  It's not just about passing the exam, although you do need to know your stuff to pass that exam!  Yes the qualified preceptor can be an unlicensed DEM, if she is an experienced CPM.   Please look into the details before you completely bash NARM and a group of women who have worked very hard to be able to serve mothers and babies!  Remember that once upon a time, not too long ago, relatively uneducated women were commissioned by state governments to serve their rural (mostly southern) communities as midwives, entrusted completely to do their jobs well. And they did!  Before that time, throughout human history, each community has chosen its wise women to serve them in birth, illness, and death.  Please let's not be judgmental and divisive.