Aspiring - Student - Apprentice Midwife Chat

Re: CPM vs CNM

Brlnbabies — Sun, 17 Feb 2013 16:54:40 GMT

That's us! Same website. :) Simply click on the "Shop" button above.

Re: CPM vs CNM

mommytomna2 — Sun, 17 Feb 2013 06:33:44 GMT

Hey! I'm having the same dilema. I'm reading this book and its helping me sort through the options, understand the state-to-state laws, and find the perfect path for me. It's called Paths To Becoming A Midwife: Getting An Education edited by Jan Tritten and Kelly Moyer. It's not very widely known yet. I couldn't find it on Amazon.com or at Barnes and Nobles or Craigslist.com, but it's wonderful! Make sure to get the newest edition, the 4th edition, printed in 2010 to get the newest info. I bought it online from Midwifery Today (different website than this one) for $32.00 plus shipping. Here's the link: http://www.midwiferytoday.com/reviews/Paths_4thEd.asp

I highly recommend getting it. Hope this helps!

Re: CPM vs CNM

jolene — Sat, 29 Dec 2012 09:37:54 GMT

sweetmama:

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!

Sweet mama: Other than the first statement, I was not directing this comment at you or at anyone else on this forum. I appreciate and respect all of women interested or working in this field. I just found this page and was surprised by some of the comments and wanted to say a few things. I'm not saying I know more or what's best. I admit that my experiences have let me biased. But, I also think I have a perspective that might be valuable for someone out there...

There are accredited CNM programs all over the place! And 2 of those states are North Carolina and Tennessee. Don't know of too many fancy Ivy Leagues in those parts.. I planned to become a CNM for many years and looked into all kinds of CNM programs available for BSNs. I know I had at least 20 choices... Although I can't recall a single Ivy League from the list... Columbia, I guess... Anyway, I definately have a huge passion for birth. I know the tragic history of midwifery and empathize heavily with women who fear a sterilized, prepackaged, unhealthy birth experience without anyone to tell them it could be different.. But I don't understand why I can't have those ideals AND have an accredited, formal educational experience.... I'm planned to become an L&D nurse for a few years, than continue on to become a midewife. I'm still deciding what I want to do. My focus on birth has not changed. I've just seen and experienced a lot in the NICU. Watching those tiny paper caskets go out and holding devastated, wailing women has changed me. But all is not lost. I'm able to provide comfort, love, encouragement and individualized care to my patients even though I have a degree and work in a hospital. I have seen so many things go wrong during births. Most of the time, no one could have seen these problems in advanced. Sometimes though, it will be a doctor that missed something. Sometimes a CNM will have missed something. Sometimes a CPM will be the one who missed that little detail that could have saved a life, or prevented a permanent debilitating condition. No one is perfect. I know some if you will hate me for saying this, but most often, the ones that miss the BIG details are CPMs. And the ugliest tragedies are the ones that could have been prevented with simple cerclage at 15 weeks or access to a piece of simple piece of equipment that was unavailable at a home birth or a c-section that would have taken less time than it took for the ambulance to get tote home birth location. Now, I know that there are lots of CPMs who are great and I haven't had the privilege of seeing those beautiful births. And they haven't seen my reality of paper coffins and ruined lives. I'm not saying that all CPMs suck or all (or even most) doctors are amazing (although there are some really incredible ones). I'm saying that birth is important and needs attention and love, even in the form of "accredidations" and government regulations. I have 3 very close friends that are CPMs. (I run with a crunchy crowd.) 1 in AMAZING, the other 2 are just not. The felt they were too artsy to take Chemistry and Stats. I am very left brained, have major ADHD, and took retard math in HS. If I can do it, anyone can. I'm always shocked by the things that come out of my less competent CPM friend's mouths. You really do learn things in nursing school that are incredibly important, in certain situations. When it comes to birth, you are taking womens/children's/families lives into your hands. There is no room for laziness. If you are not passionate enough about birth to take a Chemistry class, you shouldn't be a midwife. I am not saying that this applies to all CPMs are lazy. I'm not against home births. I'm all for women being able to choose what they want for their birth experience and I'm all for midwives finding their own personal route to becoming the best midwives they can be. I know those routes can be different for different women. But I also know that some CPMs take that route due to a lack of confidence and due to laziness. To those women, I would say that losing a child is not an experience you can comprehend until you've lost one. I know this personally, unfortunately. It's not something that a mother can ever recover from. I've done a lot in my last 3.5 years, but I'm still stuck in the day I saw my first paper casket, where my beautiful daughter was placed 12 hours after she was born. I had a CNM who overlooked something that an OB would have seen. Did see, but it was too late. It wasn't a home birth. I had access to every medication and machine... But it was too late. No one is perfect. But, if you get into this field, you should try to be perfect. You should do everything you can to be ready for every possible, improbable situation. Even if you hand 999 smiling women 999 sweet little ones, missing something you could have seen and letting one little baby die before she ever lived will feel like you lost all 1000. That baby that never played outside, fell in love, kissed her mother... Who left a family in pieces, a family that will never experience joy without heaviness and tears because someone is missing who should be there... That baby, not the other 999, will be the one who shows you how precious life is and constantly remind you that 99.9% in not acceptable. Be 100%. Let my little girl be that baby and do everything you possibly can to do you best, know the most and never accept giving care that is less than miraculous. Every little miracle desearves nothing less.

Re: CPM vs CNM

jolene — Sat, 29 Dec 2012 09:24:31 GMT

midwifea:

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 know a lot of CNMs who only do home births.... Why can't you be a CNM and do both? I'm not familiar with laws, aside from a few states that I've lived in, but I've seen a lot of people here allude to the fact that they can only do home birth/birth centers with a CPM and not with CNMs and would like to understand.

Re: CPM vs CNM

Adrienne — Sun, 02 Sep 2012 03:15:23 GMT

Also, if you look at the NARM job analysis, you can see a sampling of educational backgrounds from the larger CPM community. In 2010 this is what was found amongst respondants:

5. Highest level of non-midwifery education achieved.

High school        41        9.0%
Some college   166      36.1%
College degree 173      37.5%
Nursing degree   37        8.0%
Master’s degree 34        7.3%

Doctoral degree 7 1.5%

No response 3 0.6%

Re: CPM vs CNM

Adrienne — Sun, 02 Sep 2012 02:30:31 GMT

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.

Re: CPM vs CNM

joycnm — Fri, 13 Jul 2012 21:41:45 GMT

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.

Re: CPM vs CNM

midwifea — Mon, 18 Jun 2012 16:17:38 GMT

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!!

Re: CPM vs CNM

lifeisbliss — Sat, 16 Jun 2012 17:20:45 GMT

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

Re: CPM vs CNM

loveofmidwifery — Thu, 19 Jan 2012 07:13:47 GMT

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).

Re: CPM vs CNM

sweetmama — Sun, 01 Jan 2012 23:38:15 GMT

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!

Re: CPM vs CNM

dancindoula — Thu, 05 Aug 2010 15:06:25 GMT

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? ;)

Re: CPM vs CNM

lifeAgift — Thu, 05 Aug 2010 13:37:38 GMT

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!

Re: CPM vs CNM

NorCalRN — Thu, 05 Aug 2010 00:51:43 GMT

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! :)

Re: CPM vs CNM

lifeAgift — Wed, 04 Aug 2010 14:18:24 GMT

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.