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A common question for those interested in the Midwifery field is whether to go the nursing route or to become a Midwife without nursing training. To be completely honest, I didn't decide to become a Midwife until I was already in nursing school, so becoming a Nurse Midwife was the next logical step. Originally, I planned to become a Pediatric Nurse Practitioner, but when I fell in love with OB working as a doula, I shifted gears towards Midwifery. Even if I wasn't already on the path to becoming a nurse when I decided to become a Midwife, I still would have chosen to become a Certified Nurse Midwife (CNM) as opposed to a Certified Professional Midwife (CPM). Let's compare the two, and then I'll highlight the deciding factors that appealed to me.
Before we focus on the differences, let's first look at the similarities. Both CNM's and CPM's are able to provide prenatal care, manage a woman's labor, attend vaginal deliveries, repair vaginal lacerations, and provide postpartum care. So, if you are interested in being actively involved in the pregnancy and childbirth process, both of these routes will satisfy that need. Both routes require completing education and clinical requirements, as well as obtaining licenses. Regardless of the letters behind a Midwife's name, she is a professional and able to recognize abnormalities and warning signs that require referral or interventions. Deciding which route to take is honestly a personal choice depending on what type of career and lifestyle you are seeking.
There are a few differences between the two routes of Midwifery that details where and how a Midwife can practice.
1. Scope of Practice - One major difference is that while CNM's can provide women's health care from adolescence to beyond menopause, CPM's focus on pregnancy and childbirth. So if you are interested in performing wellness exams, Pap smears, the insertion of birth control, colposcopies, endometrial biopsies, and other gynecological care, you would want to become a CNM. I love GYN as much as I love OB, and have enjoyed learning more advanced procedures. OB can also become tiring after awhile, so it's comforting to know that I can one day choose to only do GYN care if I desire. As a CNM, I can also prescribe medications. Although CPM's cannot prescribe, in some states they can obtain permission to administer certain medications.
2. Practice Settings - Another major difference is that CNM's can work in more diverse locations. Our license enables us to work in hospitals, birth centers, at home, offices, and clinics. Unfortunately, CPM's are not able to work in hospitals, but they can care for women at home, in birth centers, and occasionally in offices and clinics. If you are only looking to work out of the hospital, then this may not matter to you. However, in general, Midwives who work in hospitals receive higher salaries and benefit from shift work. Be careful, though, because this is not always the case. For instance, I was the only provider at my first job, so I was on call 24/7, even though I delivered in the hospital. There are also some birth centers or group home birth practices where CPM's share call. It's more common, though, for CNM's to work in a group practice where they don't have to be on call everyday, while CPM's take on individual clients that they are always available for. This type of care appeals to many Midwives because they love the relationship that they build with their clients and want to see them for every prenatal visit, as well as the delivery. However, it can be extremely demanding to be available 24/7, which can lead to burn out and disruption of work/life balance. I love being a Midwife, but I also enjoy having a life outside of work, being a wife, and pursuing other interests. Additionally, CNM's are able to become licensed in all 50 states, while CPM's can currently become licensed in 31 states. I feel that being a CNM offers me more flexibility, as well as a greater earning potential.
3. Training - In order to become a CNM, you first have to become a nurse. This is beneficial because if I ever decide to leave the field of Midwifery altogether, I am still licensed to work as a nurse and can branch out into other specialties. After nursing school, I attended a graduate nursing program to become a Nurse Midwife; you can hear more about my journey here. CPM's complete required courses and then a 2 year apprenticeship program where they train under an established CPM. Both CNM's and CPM's are required to obtain a certain number of clinical hours, attend a certain number of deliveries, and become certified in their respective field.
Although CNM's and CPM's have a few differences in how they learn and practice, both type of Midwives are focused on delivering compassionate and evidence-based care to women. Both are highly trained professionals that go through rigorous training and are able to provide safe and competent care. Like I said, I was already in nursing school when I decided to become a Midwife, so it made sense to continue as a Nurse Midwife. However, I do love the flexibility that being a nurse provides, as well as the greater scope of practice and ability to work in more diverse settings. While deciding, consider long-term goals and which route may serve you better if you ever experience burnout. Unfortunately, that is a very real reality in this field.
Other alternatives to consider are becoming a Certified Midwife (yes there's a third type of Midwife), Women's Health Nurse Practitioner, L&D nurse, or OBGYN. There is no one path to serve women, but only you can decide what career path will best fit into your lifestyle and help you achieve your individual goals.
xoxo, Global Midwife