Deciding to go CPM route - Mothering Forums

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#1 of 5 Old 08-24-2012, 10:29 AM - Thread Starter
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A little background on me: I have a BS in Microbiology, and have always been interested in the medical field. I recently got my CNA and had planned on getting some clinical experience to apply either to medical, physician assistant, or nursing school. But after recently having my own child, I really hate lots of how the medical community operates - I don't blame them, and I know they can do amazing things, but it is completely controlled by profits and insurance companies. Since having my own baby in a hospital, I have become very interested in midwifery and have started looking at programs.


I have pretty much narrowed it down the the Midwives College of Utah since the program seems like the best fit for me (I can do distance learning and have a local preceptor), they are MEAC accredited, and it seems like it would be a good, legit education. I plan on practicing in Montana and I really like that they offer a state license since it seems like CPMs are held more accountable and there are clear standards on when transfers are required, etc.


The main thing holding me back at this point is there seems to be a huge amount of vitriol for CPMs and many people who think they are completely incompetent, shouldn't be allowed to practice, etc. I do think there are some problems with standards and accountability within the CPM community (taking people who are high risk, not transferring when they should, general irresponsibility) so in many ways the CNM route is more respected. However, I want to do home birth and basically have no interest in nursing outside of midwifery, so it seems pointless for me to go that route. 


I think some of the negativity towards CPMs comes off as very patriarchal and I think I could be an excellent, responsible, home birth midwife. It thrills me to think about. And I think some of the most important midwifery education is just attending many births, experience is hugely important. But it still bothers me how disrespected CPMs seem to be - I'm fine with being a little rebellious, but at the same time I don't want to be thought of as incompetent because of the educational direction I chose. 


Sorry this is so long, but I would love to hear some reassurance/advice/personal anecdotes. Thanks!

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#2 of 5 Old 08-25-2012, 10:20 PM
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I have a lot of respect for CPMs and I know quite a few of them, since I live in Oregon, home of many CPMs.


I would highly recommend that you come to the Midwifery Today Conference next spring, where you can meet lots of amazing midwives and students. I went even when I lived on the East Coast. It's worth the cost.

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#3 of 5 Old 08-26-2012, 06:33 PM
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I just wanted to add that even CNMs are looked down upon.  I think it's midwifery in general that people lack the respect because midwives aren't doctors.  CNMs, at least where I live, have a lot to deal with as far as doctors lacking respect for them even.  So the CNM isn't always greener.  There are positives and negatives to both types of midwives, and I've struggled for years debating on which route I want to go.  I finally decided that I want to go the CPM route.  I have a Bachelor's degree already and I could easily go for a Master's degree in Nurse-Midwifery, but I don't know...I'm fond of tradition and I like how knowledge is passed down between a preceptor and an apprentice.   Plus, I figured if one day, I still want to go the CNM route, then I will, but at this point in my life, I have no desire to go into nursing anymore like I once did.   

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#4 of 5 Old 08-27-2012, 06:57 AM
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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.

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#5 of 5 Old 08-29-2012, 01:23 PM - Thread Starter
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Thank you for your very well thought out reply, and honestly I share a lot of the criticisms and concerns that you mentioned. In particular regarding it not being "scientific" enough, since I have a science degree that is something I am very into and it really bothers me when medical care isn't evidence based. However, a lot of what CNMs and hospitals do isn't evidence based either, just in a different way. 


Your critiques are very legitimate, and come off as well educated to me and not patriarchial at all. Basically what I mean by that, is lots of the criticism of CPMs I see is like "Those uneducated women don't know what they are doing, they were just too stupid for an actual medical profession!" and to me that seems to suggest that only doctors (ie men) could possibly be competent caregivers for pregnant women. I think CNMs can be fantastic, but they are too much under the thumb of doctors/hospitals/insurance companies and can't give the sort of care they might want to or that women desire, because of strict rules about not being able to do home birth (unless you are working under an OB who supports homebirth, but that is very uncommon) and being required to follow hospital policies that aren't necessarily the best. 


Ultimately I think I will go the CPM direction just because I really want to provide home birth services to low-risk women, and the state I am going to practice in does set some standards that I think are important. If I can keep in mind all of the (very reasonable) criticisms of the certification though, hopefully I can do something to change and improve the standards of practice and so forth. Probably have a better chance of that than I would trying to change the current medical industry from inside as a CNM. I definitely respect that education, but I see major downsides to either route into midwifery so that is kind of frustrating for me. 

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