I have spent a few days considering this post and how to respond to it.
I have experience in a private graduate program for nursing (three-year MSN program for non-RNs) as well as experience as an apprentice enrolled in a MEAC program.
To sum up: the private graduate school was too expensive for the poor quality of instruction ($100K+ for MSN in 3 years), the MEAC program with apprenticeship was not enough - in terms of professional career development.
I'm currently on the slow and economical route toward the CNM - currently working on my RN through a community college.
Some of the challenges I had when I was apprenticing to become a CPM:
- Disconnect between practice and theory. I would read about certain conditions in pregnancy or labor - and how they are to be treated - and often this did not coincide with what I experienced (ie was taught) in clinical situations.
- Developing professionalism. The CPM credential is relatively new, and the profession struggles because of this. There are problems not only between hospital-based providers and midwives - but among midwives themselves. There seems to be a great difficulty in the CPM community with enacting respect among *all* the peer CPMs.
- Lack of research conducted in OOH settings exclusively with CPMs. Lots of things that CPMs do is use research from obstetrics and try to apply it to their OOH practices. The closest thing that exists is the JMWH from the ACNM - but that still largely addresses nurse-midwifery. This was frustrating for me - because it left a lot of things unanswered. I don't believe one can or should extrapolate: "If XXX is safe and effective for an OB/GYN to do, then XXX is safe and effective for a CPM to do in an OOH setting." CPMs need data in that circumstance.
- Lack of position papers on standards of practice, best practices, current research updates. When I would assist another CPM, my preceptors would often kind of grill me about 1) how often did she check heart tones? 2) how often did she do vital signs? 3) what was her postpartum protocols for monitoring mom and baby? 4) did she use the bulb? etc etc etc. By law, CPMs are required to provide prenatal and IP care "per ACOG guidelines". That is what was put into law, but a lot of CPMs don't even really know what that means (ACOG probably doesn't either). Because what are the ACOG guidelines for intermittent auscultation of heart tones in an out-of-hospital setting? Right? This goes back to the profession being new. Guidelines for practice coming directly from a professional organization representing CPMs would be greatly helpful to the profession.
- Lack of position from profession about role of 'alternative therapies' in pregnancy/childbirth/postpartum. Here is where specific data and positions would be extremely helpful. Many CPMs use herbs and homeopathic remedies - and use of these modalities is based largely on empirical knowledge. Is there evidence of safety? Is there evidence of harm? Is there a decision-tree that could be developed for using alternative therapies for something pretty critical, like PPH?
I have a Bachelor in Science - and perhaps that makes my opinions come across as 'patriarchal' - I hope not. If one understands and values the scientific method - some of the stuff that comes up in midwifery may be very difficult to swallow. I had a very hard time accepting opinions among groups of midwives that were not supported by any scientific evidence. Because I was an apprentice - my role was to be silent and observant. It wasn't until my own pregnancy and care with CPMs that I really became uncomfortable with the non-scientific, non-evidence-based aspects of some of the care. I say some of the care because I recognize that much of the care provided by CPMs is excellent. But having certain excellent practices does not erase the poor practices and some pervasive faulty belief systems.
On the positive side:
I learned things during my apprenticeship about supporting women through natural pregnancy and birth that I would never have learned in a hospital-based practice. I witnessed some incredible family-centered, satisfying births. I assumed responsibility (by nature of OOH birth) for women and babies that I would not assume in a hospital setting. All of these experiences have positively influenced me in how I provide care and how I will practice in the future as a nurse and a nurse-midwife.
I know many excellent CPMs. And I am fortunate to have learned from many of them.
You'd mentioned the negativity surrounding CPMs - I just wanted to address that - I think it comes from multiple places. But I want you to know the negativity exists within the profession as well as outside of it. And the reason I think it's happening is due to the relative newness of the profession. I really hope CPMs can start to address this - and come to some unity and cohesiveness about midwifery practice, education and standards. I think once all CPMs respect each other and the credential and what it means, that respect will naturally radiate outward. And the profession will garner more and more credibility.
I've written this post with incredibly cautiousness trying not to offend. I really want to contribute to this discussion (the larger discussion surround midwives - not necessarily the discussion on this forum) in a constructive way. Not in a bashing way. And the bashing is out there.
For me the decision to leave CPM midwifery was about my future, and the future of the profession. There are some midwives working very hard on addressing the viability and sustainability of professional midwifery, so hopefully we'll see some positive changes soon.