Questions for Nurse Midwives (trying to make life decisions here)

[Synchro246]

For years I've been planning on returning to school to be a licenced (certified prof.) midwife. I had a year left on my bachelors that I decided I could finish while my kids are babies and I would return to midwifery in no less than 5 years, possibly more than 10 years. These plans were for later.

In my bachelors I'm doing Anthropology. One professor of my is encouraging me to get a masters and has brought up a PhD a few times. I have to say in the back of my mind I've had a fantasy of having a PhD and writing and doing things in public health that I probably couldn't do with "just" midwifery training. (I soooooo don't mean that as a dig, but we all know that in general midwives aren't taken as seriously as we would need to change birth culture).

Anyway--that's the backround. The prof. is encouraging me to do nurse midwifery instead of DEM so that I can use it to build more degrees.
I'm a bit scared of nurse midwifery. I know there are very practical bonuses (easier to find work, easier to work/more $$ should dh die and I need to support my family by myself).
I'm scared of having to do things that aren't evidence based, I'm scared of working under someone else. I don't really understand the structure (some CNMs do homebirths--how? where? limitations?)

Any info and perspectives would be much appreciated. TIA

[mothercat]

If you check the ACNM web site, they have a state by state listing of CNM scope of practice- how independent they are, etc. It is a very common myth that CNMs can only serve women in the hospital. Depending on the state, they can be very independent. Michigan is a good example, the only restrictions CNMs have is for prescriptive privileges - you need a consulting physician for prescribing things like antibiotics (when really needed). but can order labs, ultrasounds, etc.

There are 7-8 CNMs doing OOH birth here. They get paid by most insurances and they are working on payment for home birth from Medicaid.

As for doing things that are not evidence based, there was study in the Journal of Epidemiology in 2001 that looked at outcomes for all singleton births by provider type (physician vs. CNM). Surprisingly, the CNMs had better stats as far as birth weight, infant mortality, preterm birth, etc. One of the authors' comment was that as far as EBM was concerned CNMs practiced much closer to evidence and were much more aware of current standards than the physicians, including the OBs.

The Frontier Nursing Service CNEP program requires an RN and a Bachelor's in a related field for admission. It is a distance learning program, so you have to be a self starter. However, you do most of the studying at home for the first 18 months. Most of the instructors are from OOH backgrounds and a lot of the students are DEMs who have decided to become CNMs. There are also the same sort of programs available at the Institue of Midwifery in Philly, and Stoneybrook in New York.

[BeckiCNM]

:

It's important to read the state regulations where you might want to practice, and be picky about what job you take if you want to be independent as a CNM. My state has a collaborative practice agreement required for prescriptive authority ONLY, and the statute specifically states that the collaborative practice requirement does not keep CNMs from making independent judgements or require MD supervision of CNMs. Having said that, some of the jobs here I would not take because I would be working with/for a doc who would want to "supervise" me because I was their employee or some other reason. Be very picky and ask lots of questions.

I think CNM practice is waaaaaaay more evidence-based that your typical MD practice, from my own experience. In my classes, my profs would ask every day "what does the evidence say about this?" so it got drilled into our heads to ask that about everything we did. Plus, we have a good relationship with AWHONN, which is very pro-evidence based practice. (Wish more nurses would pay attention to what AWHONN says, but that's a whole 'nuther issue...)

I've thought about the whole PhD thing, too, just because I think I would be able to make more of a difference, especially since I'd like to keep teaching. You could, though, get advanced degrees in public health and write and still do a CPM credential.

There is a yahoo group for the ACNM/MANA Bridge Club - that might be a good place to ask this too.

And I would really recommend looking into Frontier - great school with an awesome reputation. Their students are required to take the AABC's how to start a birth center workshop as part of their education.

[Synchro246]

OMG the acronyms are flying

Ok, this may be a dumb question: Does one need to become a nurse *first* then do additional stuff to become a CNM or can I become a CNM in one swoop after I have my bachelors?

[Midwife Kris]

Originally Posted by Synchro246

I'm scared of having to do things that aren't evidence based, I'm scared of working under someone else. I don't really understand the structure (some CNMs do homebirths--how? where? limitations?)

I'm not sure why you think CNMs aren't evidence based practitioners. As someone else said the level of autonomy for CNMs will vary by state. Some states they are totally autonomous and have prescriptive authorty for certain drug classes relevant to women's health and labor/birth/postpartum.

If you're close to finishing your bachelor's you can apply to a fast track nursing program. For instance, many schools that offer advanced practice nursing degrees have a program where you do three years. Year one is the BSN and the next two are the MSN plus certificate nurse-midwifery education (or nurse anesthestist, family nurse practitioner, etc.).

The ACNM education link lists every school and every program that is available.

[Synchro246]

Originally Posted by metromidwife

I'm not sure why you think CNMs aren't evidence based practitioners. As someone else said the level of autonomy for CNMs will vary by state. Some states they are totally autonomous and have prescriptive authorty for certain drug classes relevant to women's health and labor/birth/postpartum.

If you're close to finishing your bachelor's you can apply to a fast track nursing program. For instance, many schools that offer advanced practice nursing degrees have a program where you do three years. Year one is the BSN and the next two are the MSN plus certificate nurse-midwifery education (or nurse anesthestist, family nurse practitioner, etc.).

The ACNM education link lists every school and every program that is available.

I'm trying to read about the education programs right now, I just wanted to clarify: I don't think CNMs aren't evidence based practitioners--I worry about the education or the work enviroment that might have "protocols" (like VBAC bans or no food for the patient, etc).
I'll be back with more questions. . .


Those who are CNM's-- what is your practice like?

[BeckiCNM]

Originally Posted by Synchro246

OMG the acronyms are flying

Ok, this may be a dumb question: Does one need to become a nurse *first* then do additional stuff to become a CNM or can I become a CNM in one swoop after I have my bachelors?

Sorry I should know better. I have a 6 page handout of OB acronyms/abbreviations I give my students when I teach. It's another language.

AWHONN - Association of Women's Heath, Obstetric and Neonatal Nurses
AABC - American Association of Birth Centers
ACNM - American College of Nurse-Midwives

Technically, no, you don't have to become a nurse. You could do a Certified Midwife (CM) program, but CM's are only legal in 3 states. I wouldn't go that path. Or you could do a master's direct entry program - look at Yale for an example.

Re: protocols - VBAC bans - hard to get around. No food in labor - much easier to get around. Sometimes protocols can be your friend if the protocol is evidence based and works in your favor. I've never been at a hospital where intermittent monitoring is not included as part of their protocol for fetal monitoring. So if the nurse you're working with tells you she doesn't know how to do that and wants you to order continuous fetal monitoring (yes, I've heard that), you help her look up intermittent auscultation in the protocol manual. I've done that. And if the protocol isn't evidence based - someone needs to change it. Sometimes you feel like you're banging your head against a wall, and sometimes you make a difference.

[Synchro246]

Thanks
So a nursing degree can be an associates or a bachelors? To get a masters in nursing one must already have their RN right? Does the CNM program count as a masters?

I'm sorry for being thick, but wading thru the school terminology (matriculating, etc.) makes me and .

[mothercat]

It depends on the program. The universities are getting more creative with helping nurse get a BSN and/or Masters. Some are 2+2 where you do the associate's and then use those classes to complete the MSN with specialization to nurse anesthetist, CNM, etc.

BTW, CNM is a certificate which although at the gradute level is not a Master's by itself.

With CNEP, they used to have an agreement with Case Western where you could take 3 classes and would have your MSN by the time you finished with CNEP. Now, CNEP has been accredited to provide those classes and you can complete them as aprt of CNEP. Plus if you have ever considered providing care for the children beyond the newborn period, most of your CNM classes apply toward a family nurse practitioner program at CNEP also. A lot of work but then you have a lot more to offer the family. Also gives you more options for employment if you need to help support the family.

Originally Posted by Synchro246

Thanks
So a nursing degree can be an associates or a bachelors? To get a masters in nursing one must already have their RN right? Does the CNM program count as a masters?

I'm sorry for being thick, but wading thru the school terminology (matriculating, etc.) makes me and .

[MsElle07]

I've been looking into this recently myself. I have degrees in other non-nursing fields. You need to have an RN to be admitted to a CNM program. There are many schools that offer RN programs for people with degrees in other areas. (Georgetown, for example.) It usually takes 16 months. When you're done, you take the exam to be an RN, and you have a BSN in nursing. You can then apply to school to get your Certificate of Nurse Midwifery, which is usually two years full time.

Other places, like Frontier, offer a CNM program that also results in a Masters, but they require a year of nursing experience before you can apply.

There are also a few programs that are three years full time for people with degrees in other areas that results in both an RN and a CNM.

Also remember that a lot of programs have prerequisites you may need to get out of the way before admission -- stuff like biochem and anatomy.

[BeckiCNM]

Originally Posted by MsElle07

I've been looking into this recently myself. I have degrees in other non-nursing fields. You need to have an RN to be admitted to a CNM program.

To a typical CNM program, yes. To a direct-entry or graduate-entry CNM program, no. If you look at the ACNM website here - http://www.acnm.org/careers.cfm?id=105 - the programs with a "B" behind them accept non-RN students into CNM programs and give them the RN education along the way.

There are many schools that offer RN programs for people with degrees in other areas. (Georgetown, for example.) It usually takes 16 months. When you're done, you take the exam to be an RN, and you have a BSN in nursing. You can then apply to school to get your Certificate of Nurse Midwifery, which is usually two years full time.

Yes, there are lots of accelerated nursing programs that will give you a BSN, so that is one option. After you have a BSN, you can then apply to a CNM program - which should also have some mechanism for you to either get a master's degree or a doctorate, since you will need at least a master's to practice in many states, and probably in all states at some point.

You could also do a associate's degree program in nursing, and then do a RN-MS program, sometimes called "bridge" programs, where some of the requirements make up the differences between associate degrees and bachelor degrees in nursing.

Other places, like Frontier, offer a CNM program that also results in a Masters, but they require a year of nursing experience before you can apply.

Some schools require experience, some do not. There are pros and cons.

There are also a few programs that are three years full time for people with degrees in other areas that results in both an RN and a CNM.

These are the direct-entry or graduate-entry programs.

It's very confusing, I know. In my class, we had two "traditional" master's students (RNs with BSNs doing a master's degree program), two doctoral (DNP) students who were not nurses before being admitted to the DNP/CNM program, and two post-master's certificate students who were nurse practitioners in other areas who wanted to also be CNMs. Lots of ways to get to the same goal.

[MsElle07]

Becki, I think we're essentially saying the same thing, just in different ways.

I haven't investigated all the graduate entry programs out there, but I know the ones at Maryland and G-town require you to complete their accelerated RN program before beginning your CNM work. You apply to both the CNM and accelerated RN programs simultaneously, but there isn't a separate RN program for the people in the grad-entry CNM program.

[jengacnm]

[QUOTE=Synchro246;7643532]
Anyway--that's the backround. The prof. is encouraging me to do nurse midwifery instead of DEM so that I can use it to build more degrees.

Well, building more degrees is what you'll be doing, since you'll need the BSN before the MSN. An important question to ask is, what do you want to accomplish professionally, and can it be done with a DEM and an MPH?

I'm scared of having to do things that aren't evidence based, I'm scared of working under someone else. I don't really understand the structure (some CNMs do homebirths--how? where? limitations?)

The evidence based question has been addressed, as has the state by state analysis on the ACNM web page. A collaborative relationship with a doctor does not mean a supervisory one. I'm in Illinois and do home and hospital births. Our doc is relatively hands off with us, only seeing patients if we ask her to.

I've also run the gamut. I've been a doctor practice employee and a hospital practice employee. In each place I just adapted to where I was and tried to be one degree crunchier than was typically tolerated. I rarely if ever felt like I was sacrificing a core ideal.

So if the commitment of time doesn't bother you, and your only fear is practicing in a way that is discordant to your values, rest assured that you can still be the kind of midwife you want to be regardless of the initials. As a PP said, be picky in your job selection. Avoid large hospital practices (too many protocols) and micro managing MD's.

Good luck!!

Jennifer

[Synchro246]

So I think I figured out what I'll need to do if I want to do this (which I think I do). . .and it does take a commitment of time!!!

By the end of fall semester 2008 I will have completed my Bachelors in Anthropology and all the pre reqs for the RN accelerated program.
That program at my university is 6 semesters long (with lots of web courses). I can finish that (and earn a second bachelors in nursing) end of the fall semester 2010. I will be 29, my sons will be almost 6 and 3 and a half. Then I can do the CNM program (frontier sounds really good) in two to three years.


If I did it right away my children will be school aged when I am ready to work. I don't mind going to school when they are young because I can set it up (usually) where my away time is packed into two days a week and my mom watches my son and loves it. He loves it too. I don't feel badly about that.

I don't know when I'll have more children. I do want more. I don't know when I'll do the PhD. I do want that. Would it be weird to get the PhD a few years before retirement and then write?

[CEG]

I am a student in a graduate entry CNM program. I have a bachelor's degree in French. The reason I chose that program is that I knew I wanted to be a midwife and I didn't want to apply for a nursing program, wait to start, finish, get nursing experience, go through the application program all over again, get in, wait, start, etc. I found out I got into my program in June, started last January, will finish my RN after 15 months, start working this summer, and begin my Master's in the fall. Although I am planning to do my Master's part time I think it will be faster than the traditional route.

The degree you earn is a Master's in Nursing with a certificate in Midwifery. The midwifery part is just a certificate but my understanding is that you have to have a Master's in Nursing to get a certificate in Midwifery.

I am also doing a certification in Women's Health so I have a little more I flexibility in case we move to a less progressive state (although it's hard to imagine that there is a state that is less progressive in terms of midwifery ). There is a great website www.allnursingschools.com where you can search for schools/programs. Good luck!

[MsElle07]

Originally Posted by CEG

The degree you earn is a Master's in Nursing with a certificate in Midwifery. The midwifery part is just a certificate but my understanding is that you have to have a Master's in Nursing to get a certificate in Midwifery.

At some schools (like Frontier), it's a requirement. Other schools offer just the CNM with no Masters, and all you need for admission is a BSN.

[Synchro246]

Originally Posted by CEG

I am a student in a graduate entry CNM program. I have a bachelor's degree in French. The reason I chose that program is that I knew I wanted to be a midwife and I didn't want to apply for a nursing program, wait to start, finish, get nursing experience, go through the application program all over again, get in, wait, start, etc. I found out I got into my program in June, started last January, will finish my RN after 15 months, start working this summer, and begin my Master's in the fall. Although I am planning to do my Master's part time I think it will be faster than the traditional route.

The degree you earn is a Master's in Nursing with a certificate in Midwifery. The midwifery part is just a certificate but my understanding is that you have to have a Master's in Nursing to get a certificate in Midwifery.

I am also doing a certification in Women's Health so I have a little more I flexibility in case we move to a less progressive state (although it's hard to imagine that there is a state that is less progressive in terms of midwifery ). There is a great website www.allnursingschools.com where you can search for schools/programs. Good luck!

Ok, that's what I really want. I want to enter a graduate program with my bachelors and get the RN and the CNM at the same time. I don't really want two bachelors. I couldn't figure out how to find a school that bundles the RN and the CNM. I went to that website, but wasn't finding what I needed. What school are you going to?

[MsElle07]

Double post

[MsElle07]

Originally Posted by Synchro246

Ok, that's what I really want. I want to enter a graduate program with my bachelors and get the RN and the CNM at the same time. I don't really want two bachelors. I couldn't figure out how to find a school that bundles the RN and the CNM. I went to that website, but wasn't finding what I needed. What school are you going to?

The accelerated RN programs offer a second bachelor's degree. You must have a bachelor's in nursing to get admitted to a graduate nursing program. (Either just a CNM program or a Masters/CNM combo.) (I have not investigated every program in the country, but the large number I have, this has been the case.)

There are nursing programs that offer RNs as an associate's degree, but you would need to have additional coursework to get into a grad program. (The additional coursework is called a bridge program, and they have one at Frontier.)

[CEG]

Originally Posted by Synchro246

Ok, that's what I really want. I want to enter a graduate program with my bachelors and get the RN and the CNM at the same time. I don't really want two bachelors. I couldn't figure out how to find a school that bundles the RN and the CNM. I went to that website, but wasn't finding what I needed. What school are you going to?

My program is the University of Illinois at Chicago. I actually do not get a BSN from mine. Rather, I satisfy the requirements of the state of Illinois to sit for the NCLEX-RN and receive a certificate of completion from my school. Then I will earn the MSN and midwifery certificate. There are quite a few schools offering the RN-MSN bridge these days but I think my type of program is the most streamlined because most MS programs require work experience before you can begin. My program requires one year full-time L & D (or equivalent such as working with a homebirth practice) experience before you start midwifery clinicals.

I haven't been to the allnursingschools website lately, but the programs like mine that I know of are Yale, Marquette, Oregon Health Sciences U, UCSF, Columbia, and a few others that I can't think of off the top of my head.
I think if you google "Graduate Entry nursing" Masters Entry Program" Masters Entry to Practice" Entry to Practice" and "nursing" you should be able to find some good info.

Good luck! If you have any other questions I would love to help. I think this is a great program.