So after all that rambling…
Congratulations on ALL the letters after your name!
You have obviously worked very hard for them.

Part of the problem in getting a big umbrella for the midwifery community is the fact that midwifery is still illegal in some states in the US. Those states that are smart enough to not outlaw it still may not encourage it, and CNM is the ice-breaker of midwifery. People are more comfortable with that nurse part in there, and seeing someone who comes from within the sanctioned medical community. Those states that are smart enough to license their own midwives - a licensed midwife or LM - have huge differences in how their LMs are treated in terms of scope of practice, requiring OB supervision, regulation, etc. Midwifery still has a whole lot of fish to fry, and the ACNM can more narrowly focus on issues pertaining to CNMs, like hospital policies, perhaps?

Also, the medical professional communities do everything to keep their business, such as ACOG statements that home births are dangerous. Midwifery needs a lobby as powerful. It should be more powerful, since midwives should be treating more patients than OBs.

I’m on the West Coast and some states, like Oregon, are very progressive in what midwives are responsible for. More often it’s a catch-22. They want midwives to collaborate with physicians, but physicians are not willing to provide backup. Or malpractice insurers refuse to cover them. A broader national legislative policy change would go a long way, except I’d hate for it to undermine the few progressive states where midwifery has more of a chance to thrive.

This whole issue is affecting care for regular people. Not many, but a few of us interested in home birth, or natural birth, or not becoming a c-section statistic. I was only able to see a CPM for my second birth because I paid cash and because she was willing to work without being covered by malpractice insurance. I’m grateful that she did, but she shouldn’t have to put her livelihood on the line to do her job.

I do wish we could be as sensible as NZ in resolving this, but of course, there is a lot of money and power at stake. It’s not just the nursing schools and the ACNM, it’s the OBs and ACOG who have a stake in who gets to attend birth, and it’s going to be a long struggle to get things in better shape.

I do wonder if, as looks likely, we’re moving towards more universal healthcare coverage, how that will shake up these power structures. It may be an interesting few decades.

I’ve heard a lot about Mainstreaming Midwives, but I haven’t read it yet. I will definitely get on that ASAP, especially since I am such a fan of Robbie Davis-Floyd.

Thank you so much for responding to my questions! I am much more familiar with the nurse-midwifery track, obviously, because that’s the path I took, but I have so much respect for my CPM colleaugues. One of my really good friends in Kentucky is thinking of becoming a CPM at the moment, and I’m really looking forward to following her progress through her education. Strangely enough, for all its forward progress in direct-entry midwifery, CPMs are not actually legal in New York State, only CMs, so when I was debating my educational options, CPM didn’t even occur to me, sadly.

Sounds like you have a really good practice situation set up, though. And I’m really glad to hear that you can do well-woman gyn care too.

1. Depending on the state the CPM is legal, she may or may not require physician supervision. Example, I was previously in a state where I had autonomy but my guidelines for scope of practice were pretty narrow but at the same time open for interpretation (some say purposely designed that way). In the state I am currently in we must practice with physician supervision, however, the malpractice policies of physicians expressly prohibit their participation in our practice so it’s a Catch-22. I am in a practice with a CNM who has a collaborative doc who signs off on both of us.

2. Again depending on the state we are in we may or may not be able to do well-woman care. I am a MEAC grad, a CPM, and a LM. My MEAC education prepares me for this but it is not a competency required of entry-level CPMs, but my current state grants me the scope to provide that care. So I do normal well-woman gyn, paps, breast exams, etc. Rx for contraception are written through the CNM if desired. In my last state of practice well-woman care was not addressed and was readily considered a gray area; some provided it, most did not.

Did you know that the ACNM wanted to name their DEMs “CPM”? Davis-Floyd told a story about the inception of NARM and a landmark MANA meeting where the titles of CM and CPM were tossed around before CPM was settled on. The only thing left for ACNM was CM and that was adopted at their next meeting. The contention between ACNM and MANA runs deep. Her book Mainstreaming Midwives chronicles the events of the most important meetings between the two organizations that she was either a part of or a moderator for during heated conventions.

The CNM I work with had an ADN, a BS in Nursing Admin, and a direct-entry CNM through an old community type of program designed to get “lay midwives” off the streets and into respectable titles back in the day. Her CNM is the last of their kind. I’d love to have that pathway. I’d really appreciate the nursing education, but don’t want to be a nurse and that is a huge stumbling block to proceeding with a CNM path.

Happy midwifery week! I appreciate the ACNM not calling it nurse-midwifery week and I think we have Kitty Ernst to thank for that.