CPMs and state requirements

[BeckiCNM]

Any one out there want to help me with my research?

I am looking at the ways states regulate direct entry midwives. The MANA site links to the state laws are rather outdated (August 2003), although the chart is helping.

Are there any states that require the CPM credential to practice legally as a (non CNM, non CM) midwife? As in you must be a CPM to be legal?

If you've lived in a state that required an exam for licensure other than the NARM exam, please tell me what state that was, and what exam they had you take. If any states are writing their own exams, it would be helpful to know that.

And if anyone wants to tell me what they like about their state's regulations and what they don't, I'd like to hear it. It's hard to get the feel for what it's actually like from just reading the statutes

Thanks!

[pamamidwife]

Oregon uses the NARM CPM process for their licensure. Though licensure is voluntary in our state, not mandatory.

I like that our protocols are pretty progressive - we can do twins, breeches, vbacs, etc. I like that our board isn't under the medical licensing board. I like that we can get meds (Rhogam, Vit K, etc) without a prescription.

I hate that our license costs us $1500/year.

[MidwifeErika]

WI requires CPM to get the license, which is madatory in this state.

The protocols don't seem too bad, most of the things that arise you just need to consult with a doctor OR CNM... I really like the fact that you can consult with a CNM and that it doesn't have to be an OB.

The things I don't like: that it is mandatory. Also that as an apprentice, you need to get a temporary permit and that comes with a time limit that you need to finish the licensing requirements in. That time limit is 3 years.... which isn't very long if you are working with a low volume practice (I seriously doubt that I will get 40 births in 3 years.... more like 4-5 unless I start attending with more midwives). After that 3 years the state does have the option of granting a one time 3 year extention, which would give a total of 6 years, but they don't have to give that extention if they don't want to. It is all a new law, so I don't know if they are going to be generous or not with giving the extentions. Some midwives I know have really encouraged me to find a way to finish in under 3 years to be sure and others have felt that the state will allow me more time if needed. But I just don't like that there is a time limit like that to apprenticeship.

[Midwife Kris]

Originally Posted by hotwings640

The things I don't like: that it is madatory. Also that as an apprentice, you need to get a temporary permit and that comes with a time limit that you need to finish the licensing requirements in. That time limit is 3 years.... which isn't very long if you are working with a low volume practice (I seriously doubt that I will get 40 births in 3 years.... more like 4-5 unless I start attending with more midwives). After that 3 years the state, the state does have the option of granting a one time 3 year extention, which would give a total of 6 years, but they don't have to give that extention if they don't want to. It is all a new law, so I don't know if they are going to be generous or not with giving the extentions. Some midwives I know have really encouraged me to find a way to finish in under 3 years to be sure and others have felt that the state will allow me more time if needed. But I just don't like that there is a time limit like that to apprenticeship.

Wow, I actually think that is great. I love the idea of a student permit-- we should all know who is holding herself out there as a midwifery student just as nurses and doctors must. I also like the idea of a time limit for reasons of weeding out the dabblers and getting the preceptors on track for graduating students.

[MidwifeErika]

I guess I just don't like the time limit. I am apprenticing with 2 midwives and I still won't get enough births to finish in 3 years. I have no problem with a preceptor putting a time limit on the apprenticeship, but I am not a big fan of the state doing it.

[pamamidwife]

I think the time limit only encourages women to go to high volume birth sites. This training, IMHO, does not prepare you as well as a traditional apprenticeship. But that's just me.

Why would it be positive to hurry students along? Why would we need to get "rid of the dabblers"?

[birthgreeter]

those requirements for the student sounds god to me also.

[Midwife Kris]

Originally Posted by pamamidwife

I think the time limit only encourages women to go to high volume birth sites. This training, IMHO, does not prepare you as well as a traditional apprenticeship. But that's just me.

Why would it be positive to hurry students along?

I completed a three year program in three years and didn't find it a rush to complete. I was not in a high volume birth site either, although the advantage to working in one of those for any length of time opens the student up to experiences she may not otherwise see in her home town.

Why would we need to get "rid of the dabblers"?

IMO: Dabbling is fine in the wannabe stage which should be a time when she is working on theory and academics and learning how to assist at births in a non-apprenticeship position, but when a student enters the gonnabe stage and secures her clinical apprenticeship she should be encouraged to move right along and complete her requirements in a timely fashion. Three years to complete that with extensions possible either by the state or program is reasonable to me.

[pamamidwife]

It took me four years to complete my "numbers" and I was in a fairly busy practice (2-3 births a month). I just think that there are many women who don't have that luxury - and it will take them longer. I don't think they should be penalized for sticking with an apprenticeship as long as it takes.

THere is alot of focus from students on "getting numbers" and it sends them to places that are very different than what a normal homebirth practice would be like. I won't even get into the race issue in some of these places and how uncomfortable it makes me...

I've always likened midwifery apprenticeship to labor. With time constraints and a push to hurry things along, at birth we inevitably end up with an end result we didn't desire originally or problems. I think that midwifery is an art - and creating a time frame of SHOULDS feels like it goes against the true nature of midwifery. The focus becomes more about getting the numbers and BEING a midwife rather than going at your own speed. How many women are out there before they really felt ready because of those time restraints?

I guess I just feel differently about "dabbling". IMO, we are ALL dabbling. Sometimes the goal isn't to BE a midwife, but to have this education and training be part of their journey. We don't always know ahead of time if we will be cut out for this...I definitely feel like it's an asset for many women in whatever path they're on, no matter if it turns in the middle of their journey.

[mwherbs]

I live in a low volume birth area and it took me completely the 5 years to get the numbers in- and I was traveling 2+ hrs to get the numbers and worked with every midwife that would work with me- there are other areas - where only clandestine midwives work because there is no one to apprentice with and really not enough births-- I hate the time deadline- I think that 10 years to complete the things fine but 5 can be unreasonable- depending on where a woman lives.
Here in Az they require the NARM but the licensing process is different than CPM at this point- and the state requires it's own test on laws and clinicals to be past- If you move here from somewhere else they may have some other requirements before you can become licensed(even if you are a CPM or hold a license in another state)


here is the narm web address
http://www.mana.org/statechart.html

[BeckiCNM]

Thanks for the help. I finally found the old thread on the best states to be a CPM/DEM that I remembered reading. It looks like Oregon, Utah, New Mexico, and Texas are fairly good places to practice. Any others?

The student permit is an interesting idea, but I can sympathize with the low volume concerns.