CNMs and homebirth

[pittnurse08]

hey everybody! i'm a nursing student and i plan to go on to become a CNM after a few years of experience in l&d. the only reason i plan on going the CNM route is that i don't want to risk the legal problems that many CPMs encounter. i definitely want to attend homebirths, but i have been hearing that in some states it is illegal for all midwives, including CNMs, to attend. is this true? and if so, what states? thanks so much for your help ladies!

~rachel~

[mwherbs]

This is true- but I couldn't tell you I will ask a CNM friend of mine- there are also restrictions on practice as well some states allow you to be an independent practitioner and some require a back-up, collaborating doctor. I know that ACNM does have a web site maybe they have the info listed there. In addition let me tell you the advice my CNM friend gives her daughter and any one else pursuing CNM status-" get your midwifery training elsewhere even get your CPM and train with homebirth midwives but become a nurse practitioner or a physician's assistant- because there is less stigma , you have more clout, bigger scope of practice and a bigger range of employability." I hate to say this but CNMs are pretty much as marginalized as any direct entry midwife- sometimes they run into even greater prejudice in Oregon where you can either choose to be licensed as a midwife (which would allow you to get medicade) or not licensed and still do births but a CNM in the same state has to have a masters in nursing order to be a CNM there. You will find that most states that are punitive or exclude direct entry midwifery are very strict toward CNMs too.
here is a page with a ton of info on CNM practices in different states as well as requirements...most of the way down the page it has a section on states with regulations on physician relationship

http://www.acnm.org/legis/print.cfm?id=209#5

[Glittergal]

pittnurse -
mwherbs had some very good points. i am a cnm who aspires to do homebirths, once i'm done having small children. for now, i work at a freestanding birth center and i LOVE it. the ability for cnms to attend homebirths varies from state to state...there is just as much gray when it comes to cnms as cpms...I think a huge issue is that in some states to be licensed as a cnm, you have to have a joint practice agreement with a collaborating md..this doesn't mean you have to work with an md, but like where i live, no md will collaborate with a cnm who does homebirth SO, although homebirth isn't illegal, it is almost impossible to practice legally because its hard to find a doc to back you up...

still, i think it's worth it. no matter what kind of midwife you become, there will be professional challenges. i love being able to prescribe and care for my women in the hospital if they need to be transferred, plus i feel like there is more job flexibility in terms of income as a cnm. if i want to just do gyn for a yr or so, i can work at family planning clinic, or whatever.

[virgomama]

Well, I can speak for Oregon, if that helps! I'm having a homebirth with two CNM's who work at Oregon Health Sciences University with hospital privileges there, but also have a private homebirth practice on the side. OHSU is aware of their dual practice, and while I'm sure it is difficult to have one foot in each world so to speak, they haven't encountered legal problems that I know of. If I remember correctly, one of them is even trying to establish a homebirth option through OHSU. (She's a pioneer, all right!)

[berkeleyp]

I'm so glad that there are people out there like you. I am in my second pregnancy with a CNM team who do homebirth. They have priveleges at Yale and are in the process of applying at two other hospitals. They have an independent private practice and are not officially backed up by a particular doc thought they have a pretty good working relationship with several. In CT at least, it is totally legal for them, while the CPM function under alegal status, meaning it's not legal or illegal for them to practice. Good luck to you in attaining your dreams!

[mwherbs]

Originally Posted by virgomama

Well, I can speak for Oregon, if that helps! I'm having a homebirth with two CNM's who work at Oregon Health Sciences University with hospital privileges there, but also have a private homebirth practice on the side. OHSU is aware of their dual practice, and while I'm sure it is difficult to have one foot in each world so to speak, they haven't encountered legal problems that I know of. If I remember correctly, one of them is even trying to establish a homebirth option through OHSU. (She's a pioneer, all right!)

Oregon in general is far more supportive of home birth and midwives than most states but the insistance on having a MASTERS in NURSING is a bit punitive---and not in keeping with the lax attitude toward no nurse midwives.
In Florida there are CNMs who have become CPMs because of the required signed practice guidlines-- which makes doctors liable and in charge of nurse midwifery practice-so no homebirths are offered by CNMs in Florida because of doctors.
So the point is to be really looking at where you want to live and what kind of work you want to do .

[mamabutterfly]

I see you're in PA - CNM's can do homebirths here. I know some great ones in the Philly area!

Good luck in your path.

[pittnurse08]

thanks everyone

thanks to all of you! i truly respect all of your wise words. becoming a midwife is definitely not going to be easy, but i just know it will all be worth it. glittergal, that's so exciting that you work in a birth center! that is definitely another option i would consider, especially if i end up living in a homebirth/cnm hostile state. i have another question. do you recommend i wait 'til i have had all of my children and they are at least a few years old before going on to a midwifery program? or is it possible to work as a midwife when you have small children? also, i'm considering programs at frontier, philadelphia university, or maybe emory... any suggestions for other programs or anyting you've heard about these programs? jeez, i plan too much! haha... i'm only a freshman in my bsn program! thanks again ladies! you all rock!

~rachel~

[Full Heart]

When I started Apprenticing I had 2 kids, then got pg with #3. I found it very difficult. Had I had more support prehaps I could have done it, and probably would be licensed by now. But I decided I will have my babies then finish. It was a hard decision to make. Now I am workin on #6 and I am glad I waited. I didn't know what life would hold for me. Of course my kids are very close together so that makes a huge difference.

Michelle

[Glittergal]

no doubt every midwife copes differently with having small children and working...I think it's all about your personality, your practice options, your partner's flexibility, your support system. Personally, I work part time and have only one young child and it feels like alot. I have a husband who works very regular hours, which is nice but have no family in the state to help out. The hardest part is dealing with childcare issues at weird times, like 5 am to 7 am (my dh goes in at 5). I find it extremely stressful and I worry about it constantly, even when I'm covered. If I lived by my parents or sisters, and knew there would always been someone around if I was in a real pinch, working would be alot easier for me. I'm not sure how I'll do it with more babies....especially since I'm already part-time. But since I do have to work financially and want to be with my daughter as much as possible, I decided not to sacrifice my time with her and work long hours at a job I don't love. I knew I wouldn't be happy working in most midwife practices and I was prepared to do some sort of nursing work on the weekends until I found the perfect midwife job. I LOVE my job and the families I care for, which makes being away from home easier.

[pamamidwife]

I don't know that CNMs with a homebirth practice have less legal issues than a CPM. I suppose it depends on the state where you live, but in many states, being a homebirth mw - whether you're a CNM or CPM - has it's own issues, as does being a CNM in the hospital.

I love being a hb mw because I'm autonomous. I love not having a physician oversee my practice.

[mwherbs]

Originally Posted by Full Heart

When I started Apprenticing I had 2 kids, then got pg with #3. I found it very difficult. Had I had more support prehaps I could have done it, and probably would be licensed by now. But I decided I will have my babies then finish. It was a hard decision to make. Now I am workin on #6 and I am glad I waited. I didn't know what life would hold for me. Of course my kids are very close together so that makes a huge difference.

Mine are spread out and still becomes a deal. When #3 was getting too old to go to births and I had to leave her and the older 2 kids with babysitters, one day it just became too much- I remember thinking I am telling moms how to parent well but I am not doing it ..... I never completely quit either- we moved to get away from the clients- because I just knew too many people in town and we saw each other often enough that there would have just been too many exceptions. I did alot of morning over leaving but our last client I had to stay in the house an extra month to do the birth.So I ended up finding people who needed help still in all and i would do it --- I think in some ways I would have been better off as an new apprentice rather than an experienced one- some things drive me nuts.... differing practice styles is a real challange. Here in the town I live in several midwives do not practice because of family- they took their license and then became nurses so they could do shift work and not be on call all the time.

[FrumDoula]

I think you have to think long and hard about your path of education and the differing philosophies between CPM's and CNM's.

If you desire most of all to become a homebirth midwife, and you don't have a burning desire to be a nurse, you might consider NOT completing your BSN program and simply studying to become a CPM instead. 3 years as opposed to 6 years. That's a lot of money and a big difference.

Also, I find that although many CNM's may have started out with good intentions, they are still educated in the medical model, to a great degree, and many simply become obstetric handmaidens to MD's. They no longer question routine testing and intervention, and their appointments are just a short and hurried as their MD counterparts.

I would speak with both CNM's and CPM's in your community - perhaps even shadow one or two. Also, have you attended births yet? Consider going through a doula training and being a doula first. What sounds wonderful in theory can be overwhelming in practice.

And heck, if you're a REAL educational go-getter, and want ot support homebirth, consider becoming an MD and backing up midwives or having a physician-run homebirth practice with midwives. Physicians have such power in this arena, and in a time of increased c/s'sand interventions, we can use truly cool MD's to support midwives, natural and home births.

Just a few thoughts!

Alison

[Electra375]

Keep your eye on VA!!! The General Assembly just passed in the house and the senate bills licensing CPM for independent practice. It's before Gov. Warner to pass it into law.

From what I understand this will also be a big step for CNM to get rid of their overseeing OB. It would make sense that if a CNM becomes a CPM in VA, she could do homebirths as a licensed CPM.

I'm not sure how that is all going to play out. It has been very exciting to watch. If you want more information you need to get involved with Citizens for Midwifery and local midwifery groups. NARM is also good for rules and regs per state.

[pittnurse08]

awesome responses and suggestions everyone! mdc is such a wealth of information i think i'm so concerned about the legal issues with non-nurse midwives because there was a really wonderful midwife in western pa that had charges pressed by the state (the parents didn't want to press charges) for the death of a baby. it's such a hard decision on which path to choose. i've definitely considered the md possibility, but i think i'd have a hard time committing myself to 4 more years of school, 3 years of residency, etc. when i know that i don't want to be doing surgeries and all that other stuff that goes along with it. some of you have also mentioned becoming a doula first, i went to a dona training last summer and have yet to attend a birth, but i just e-mailed the local women's hospital today about volunteering as a doula there this summer, so we'll see how that goes. i think another reason i want to go the cnm route is that when i have kids, i'll have the option to do shift work instead of being on call all the time. i really don't want to be a "medwife"!!! does anyone know much about the reputation for the frontier school of midwifery and family nursing? i looked at their curriculum and they had stuff about birth centers and encourage having preceptors in various kinds of practices... seemed a little less "mainstream" to me. ugh... decisions, decisions! thanks again for the advice!

[TRIBE]

Originally Posted by berkeleyp

I'm so glad that there are people out there like you. I am in my second pregnancy with a CNM team who do homebirth. They have priveleges at Yale and are in the process of applying at two other hospitals. They have an independent private practice and are not officially backed up by a particular doc thought they have a pretty good working relationship with several. In CT at least, it is totally legal for them, while the CPM function under alegal status, meaning it's not legal or illegal for them to practice. Good luck to you in attaining your dreams!

Sounds like we are going to the same midwives Hi Im Jennie