My midwifery journey is not that different than many others. I birthed all four of my children with midwives, two CNM’s, a CPM and a traditional midwife. After completing all of my pre-nursing requirements, graduating with a Bachelors of Science degree in psychology, working as a Certified Nursing Assistant and working for five years as a doula and childbirth educator I began my apprenticeship with a traditional midwife. She had had a whirlwind apprenticeship that ended with her spending 5 weeks working at a birth center in the Philippines and returning home to a full practice as her preceptor moved out of the state while she was gone. About a year later I began my apprenticeship with her. She was a great preceptor. Matching my skill level where I was while continuing to stretch my thoughts and learning by working out situations both intellectually and hands on as they evolved in the births I attended with her. She encouraged my didactic education spending numerous hours studying and reviewing information, protocols, and reports written in my personal study. I quickly stepped into the primary under supervision role. We worked together like a well oiled machine. After about three years I had completed all of the required numbers in order to apply to sit for the NARM through the PEP process. I was surprised to discover that all of the forms and paperwork had changed since I had originally printed them in 2008. I was also surprised to find that they were putting restrictions on who would qualify as a preceptor.
Preceptor guidelines are as shown from the NARM.org website “ A preceptor for a NARM Entry-Level PEP applicant must be credentialed as a Certified Professional Midwife (CPM), Certified Nurse Midwife (CNM), or Licensed Midwife. Preceptors must also have an additional three years of experience or 50 births, including 10 continuity of care births beyond the primary birth experience requirements for CPM certification.
Preceptors who do not meet the above requirements must be approved by NARM before signatures will be accepted on CPM Applications. Exceptions will be considered only for midwives who meet the experience requirements but do not yet hold the required credentials.
No new preceptor exceptions will be accepted after January 1, 2012.”
My main preceptor applied for an exception as did another midwife that I occasionally attended births with. My main preceptor was denied as a NARM preceptor. She had met the experience requirements concerning the number of births but was about a year short of being on her own long enough and had no goal of acquiring the CPM credentials. My second preceptor, a midwife with 25 years of experience and an intention of applying for the CPM credential in the next year was approved. There is only one CPM with in a 200 mile radius of where I live and practice and she was a personal midwife of mine that ended in a very traumatic birth. Apprenticing with her was not an option for me. So where did that leave me on my personal journey?
When I contacted NARM about the denial they replied that “ACTUALLY, NARM HAS BEEN PLANNING TO REQUIRE THAT ALL NEW CPMs BE TRAINED BY CPMs SINCE THE BEGINNING OF THE CERTIFICATION PROCESS. IT IS FOR EDUCATIONAL QUALITY ASSURANCE. THIS IS THE FIRST STEP TOWARD THAT GOAL...THAT IS WHY THEY CREATED THE PRECEPTOR EXCEPTION. WE ENCOURAGE
EVERY MIDWIFE TO BECOME A CPM.”
They have a goal of only CPM’s being able to act as preceptors for students wishing to take the NARM? I was flabbergasted. What about areas such as my own where the CPM credential is not valued? What about areas where midwifery isn’t legal? Can they really put such restrictions on who can sit for the NARM exam? I thought the whole purpose was to increase the accessibility to midwives nation wide by having a national standard?
When I voiced my concerns about the limited access that traditionally trained midwives (who do not apprentice with CPM’s) will have in attempting to sit for the NARM I was encouraged to look at out of state options such as a high volume birth center in order to get “my numbers”. I then questioned NARM about the possible complications of taking midwifery training and experience away from the obvious need in my community to train as a birth center midwife when my goal was to work in the home setting. I also questioned my families needs not being met by me leaving them to “get numbers” at an out of state or country clinical setting.
This was the response I received “IT TAKES MANY MIDWIVES 3-5 YEARS OR LONGER, DEPENDING ON MANY LIFE INTERVENTIONS, TO COMPLETE THEIR EDUCATION. I ENCOURAGE YOU TO KEEP PLUGGING AWAY AT IT. IT ALSO SOUNDS LIKE YOU HAVE A FAMILY THAT NEEDS YOU, AND SOMETIMES THAT IS THE PRIORITY AND MIDWIFERY EDUCATION TAKES A LITTLE LONGER. I GUESS THE OLD ADAGE THAT "PATIENCE IS A VIRTUE" IS APPLICABLE, BUT MORE THAN THAT IT IS A CRITICAL LIFE LESSON FOR A MIDWIFETO LEARN.”
When I addressed that almost all of the midwives in my community didn’t find value in the CPM credential so my potential NARM approved preceptors were essentially non existent I was told that
“IT IS A PROBLEM THAT WE ARE AWARE OF. HOWEVER, IT REALLY IS A COMMUNITY PROBLEM AND NOT SOMETHING THAT NARM HAS ANY CONTROL OVER.”
Really? . Here I was trying to bring midwifery and the CPM credential to an area that found little value in it and they were trying to tell me I wasn’t being patient and that I needed to put my family first and work on my priorities. I had more than completed all of the requirements laid out by NARM for the PEP process but the new stipulations of only allowing CPM’s to act as preceptors changes the entire dynamic of the PEP process for the traditionally trained midwife. Also the lack or responsibility from NARM for the affect it has on communities was disheartening. So that leads to the ultimate question, will NARM’s new preceptor guidelines actually lead to fewer CPM’s? I believe the answer is YES, and I may just end up being one of them.