Organization apps; Feel more in control of your life

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This post is a continuation of my series on organization. I’ve been an organization nerd since childhood. When asked what I wanted as a gift, I’d tell people I wanted office supplies so I could “play office.” Now, instead of excitement about new office supplies, I get excited about trying out new productivity apps and websites. I love using technology to organize.

The apps and websites I use to keep my life organized

Tasks Apps; To-do Apps

  • My favorite task app is Wunderlisttodo
    • Free
    • Available for Mac, Android and desktop
    • I like having the ability to create subtasks under a task. I also like the options for recurring tasks
  • I know many people who love the productivity app Asana
    • Free
    • Available for Mac, Android and desktop

You can check out my tips for organizing tasks and getting this done on this post.

Calendar & Contacts

I previously used Google, but I’m currently using the default iPhone apps. Regardless of what app you use, I beg you to pick something that syncs to the cloud to avoid posting the “send me your phone number because I lost my phone” message.

Email

  • I use SaneBox to keep email from overwhelming my life.sanebox
  • Why do I love (and pay for!) it? By simply transferring an email to a folder I can ensure one of these things:
    • I will NEVER see an email from that sender again
    • This email will come back to my inbox when I need to deal with it in a week (or some other timeframe)
    • This email will get grouped with all my other promotional/bulk emails that I may want to see but I don’t want to clutter my inbox

Notes

I used Notes to create a drawing indicating the measurements in my bathroom

The apps I use are:

  • iPhone Notes
    • Apple keeps adding features that make this app so useful. Now you can draw in it and add photos.
  • Evernote
    • When I started using it in 2012 it was the best option. I still use it because
      • I have over 1,000 articles saved and I don’t feel like moving them anywhere else.
      • I like their web clipper extension for Chrome
    • They’ve changed their pricing model, so the free plan only allows 2 devices and 60MB of uploads per month.

Finances

mintI highly recommend using a tool that aggregates information about all your accounts so you can quickly see how much cash you have on hand and how much debt you’ve accrued.

  • The website I use: Mint.com which is owned by Intuit (the makers of TurboTax). Mint automatically categorizes your purchases so you can see where your money is going and you can set budgets that alert you when you’ve overspent.
  • If you use another website/app for this, make sure they are owned by legitimate companies.

Traveltripit

  • I use TripIt, which is a website and app that organizes all your travel reservations into one place. It can even automatically grab your reservations from your email inbox if you want it to.

Password tips. Use technology safely

Don’t use the same password everywhere1password. To keep all these different passwords straight:

  • Come up with a password algorithm so every password is different but you can still remember them. Learn more about creating password algorithms.
  • Buy an app that stores (and/or generates) passwords.
    • Please don’t use a free app
    • Make sure the app you use is encrypted.
    • I use: 1Password

Check out the rest of this series

This blog contains affiliate links.

Getting stuff done: how to organize tasks and stay focused

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This is the second post in my series on getting organized. Today we’re focusing on how to prioritize tasks and stay focused until they’re finished.

#1 Use a system that reminds you

I’m a huge fan of Getting Things Done (GTD). To get a feel for the concept behind todoappsGTD, ask yourself, “Does my brain consistently remind me what I need to do when and where I need to do them?” If so, that’s awesome. If you’re like me, you remember that you needed to buy milk while you’re in the shower instead of at the grocery store.

So, this leads to the idea that you need a reliable system to keep track of, and remind you about, the things you need to do.

I highly recommend digital to-do lists like Wunderlist or Asana, but if a handwritten list works better for you, check out the Bullet Journal Format or Franklin Covey (a time-tested planner system).

#2 Identify all the things you need to do

Do an initial brain dump of every single thing you can think of that you need to do. The initial brain dump could take a LONG time depending on how many ideas and responsibilities you have.  Once you’ve done this you’ll probably feel overwhelmed, so…

#3 Prioritize all the things

Now that you have this monstrous list of things, use Eisenhower’s Urgent/Important Principle to figure out what to do now, soon, later or never.

Basically, you organize your tasks into four buckets:

  1. The important and urgent things.Urgent/Important Priorities
    • Ask, “Is this really as urgent as it seems?” If so ask, “What is the quickest way I can get this off my plate?”
    • This may mean delegating or getting it to a “good enough” place so you can focus on #2.
  2. Important but not urgent things.
    • This is where you want to focus most of your energy.
    • These are activities that help you achieve your goals.
    • Ask, “What other things do I need to say ‘no’ to so I can make this happen?”
  3. Urgent, but not important.
    • Avoid these whenever possible. They easily absorb the time and energy you need for #2.
    • Ask yourself, “Is this really as urgent as it seems?”
  4. Not important and not urgent.
    • Ask yourself, “Do I really need to do this?”
    • If the activity is to help you destress/unwind, ask yourself, “Does this activity actually refresh me?” If not, try something new until you find activities that bring more energy to your life.

Other questions to help prioritize

  • Ask, “what will happen if I don’t do this?”
    • When I was a project manager I would often prioritize tasks that would lead to a lot of interruptions if I didn’t get them done first.
  • Ask, “What’s one thing I can do right now to make everything else easier or unnecessary?”

#4 Focus on the important things

Once you’ve prioritized what’s important it requires discipline to actually accomplish the important things.

Say “no”

One of the most important actions you can take that will help you stay focused is saying “no.” By making intentional decisions on where you invest your time and energy you can make progress toward the things that are truly important to you.

Get started; Decrease procrastination

I haven’t found the magic potion to eliminate procrastination, but here’s how I deal when I have an activity that I’m avoiding:

  • Be a “productive procrastinator.” I’ll knock off all the easy/little tasks that I pomodorocan find. These are often from buckets #1 and #3 (see above). This ends up freeing up mental space so I can focus.
  • I use the Pomodoro technique which alternates 25 minutes of focus with breaks. I can typically find motivation to focus for 20-25 minutes. And then after the first break I’ve normally found a groove that gets me to keep going. I use the Block & Flow iPhone app.

Stay on task

The things that help you stay on task will be unique to you. Ask yourself, “What distracts me? What are some creative ways I can combat that distraction?” Here are some of the things I do that work for me:

  • Keep my phone on vibrate and limit the number of apps that send me notifications
  • Work in quiet space or use earplugs
  • Do the “heavy lifting” when I first wake up before I talk to anyone. This is my peak performance time. Everyone’s circadian rhythm is different. To find your peak time ask yourself, “What time during the day do I feel the most effective/productive?”
  • Rewarding myself after I complete big things. (Frozen yogurt!)
  • Have a post-it note with a short list of my current priorities in the order I need to complete them.
  • If I keep thinking of other things I need to do, I do a brain dump of all the things so I can add it to my to-do app and get it off my mind.

#5 Stop keeping tasks in your mind

Instead, when you think of a task, add it to your list. Keeping all your tasks out of your head creates space to think about new ideas and to focus on the thing you’re doing right now.

Check out the rest of this series

This blog contains affiliate links.

Organization tips and tricks

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I was recently asked to lead a workshop about organizing. As a self-professed “organization nerd,” I’ve discovered that organization is really about doing whatever works best for you. I see organizing as small adjustments that help people feel like they have a little more power over their physical space and time.

organization-topics-from-workshopSo instead of lecturing on the best ways to organize, I decided to make the workshop a conversation. We started with asking every attendee the question, “what area of your life feels the most out of control?”

The answers included:

workshop-handoutKnowing it would be impossible to cover everything people were concerned about, I compiled a handout with the tips and tricks I thought would be the most helpful to share with others. My plan was to share the handout, but it has turned into a blog series with organization tips.

Future posts will include: getting stuff done, using technology to keep the information you need within easy reach, keeping papers from overrunning your life, and how to be effective at leading meetings and taking notes. For now, we’ll begin with some basic tips on organization.

General Tips

  • Be okay with not getting everything done
  • Have a place for everything, including a junk drawer
  • Have a “home” for all the things you use regularly
  • Be realistic about what you can keep up with (don’t over achieve when you organize)

You can check out the PDF of the handout I shared, or you can stay tuned for the additional posts in this series.

Why I chose nursing

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A few years ago I was working late when a co-worker said, “Why are you still here? It’s not like we’re curing cancer.” The reason was simple: it’s in my nature to focus intensely and invest significantly regardless of what I’m doing. This conversation prompted questions like: Am I making a difference in the world? Am I doing something I’m passionate about? When I’m old, will I have regrets about how I invested my time?

The conclusion to my soul search was that I wasn’t in the right career despite my success. I decided I wanted a career that allowed me to be empathic, strengthen others, distribute information/knowledge, be an advocate, and make a long-term impact on people. This change required significant sacrifice: I resigned from a high-paying position, relocated, moved from living by myself to living with family, and am utilizing my savings to go back to school.

After eight months in nursing school, I’m thrilled to say that nursing meshes more naturally with who I am than I ever hoped or expected. Here’s how:

Nurses look at the whole person including their emotional, psychosocial, and physical needs. As a nurse, empathy allows me to quickly hear what a patient is saying, brainstorm through a bunch of potential solutions, and identify the best strategy I can use to help.

Nurses advocate for patient needs and for the needs of the community. In many healthcare settings, a patient is completely and utterly dependent on others to do simple tasks they would normally do for themselves. It’s an honor to be able to represent these needs and ensure they get what they need.

The more patients I work with, the more convinced I am about the importance of empowering others. I am constantly looking for opportunities that allow patients to exert some level of control in an otherwise out-of-control experience.

Nurses educate patients. I am passionate about the human body and fascinated by disease processes and treatments. I love educating patients about what’s happening with their bodies and what they can do about it.

Nursing offers unlimited variety. There are so many different roles, settings, and specialties. There are so many things to learn. When I tackle a challenge there will always be another challenge on the horizon (and that’s just how I like it).

Overall, I’ve determined that I want to support patients and families who are unexpectedly experiencing some of the hardest days of their lives. I want to be challenged to become the best of the best. This is the kind of work that will allow me to look back and say that I lived a life that was meaningful.

 

If I was my patient, how would I feel?

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THEY say “Remember apple, table, coin.”
Apple.
Table.
Coin.

I am angry.
You would be too.
Try not being able to speak.
Attempt to communicate and cause only confusion.

Try wearing a brief.
Sit in your urine and wait.
Then in your feces.
And to make the indignity worse
Allow a stranger to invade your privacy and
wipe. your. butt.
THEY did this to me. So I couldn’t be president.

Then skip all enjoyment of food.
Instead have a tube where sustenance goes
No. more. swallowing.
Water sipped could kill.

Maybe I’d prefer to die than to sit here like this.
D.N.R.
I told THEM not to help me.

I blame THEM for this arm that doesn’t work.
Then THEY extend my fingers just to make it HURT like *%#

THEY are trying to control me.

THEY tell me these are voice.
How would you like to be told your reality isn’t real?
*%$@ you.
I. Am. Angry.
You would be too.

Then THEY ask me, “What did we memorize?”
Why are they asking? Of course I remember.
Boat.
Bird.
Child.

 

———-

This is a piece about how I imagine it feels like to have Schizophrenia, dementia and a CVA (stroke) that caused dysphasia (inability to swallow, which means my nutrition is delivered to my stomach via a PEG tube) and a contracture of the arm and hand. It’s part of my reflection on CNA clinicals.

Asking a patient to remember three unrelated words is part of testing memory. It’s common for our minds to replace information we don’t remember with other information without us even being conscious of it.

Several times when I use the words THEY and THEM I’m referring to caregivers and several references are to delusions/hallucinations caused by Schizophrenia. I thought about differentiating them, but ultimately this piece is from the patient’s perspective and they may not be able to differentiate.

To prevent infections, a patient with a contractured hand will need to have their hand opened so it can be cleaned and dried. This can be extremely painful. So, this use of THEY refers to caregivers.

———-

Nursing school starts on Monday, so this may be my last post for a while.

Humans not diagnoses; Reflecting on CNA clinicals

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This summer I took a CNA class in preparation for nursing school. Here’s what I learned.

Our patients are not just diagnosis. They are people. They have a history. Their feelings and experience—both past and present—matter deeply. I can imagine that it becomes easier to see them as tasks to perform instead of people to care for. But we can’t do that and still take care of the WHOLE person. And as nurses we are there to care for their whole person.

This experience has identified some of my fears and assumptions about getting old and being alone. These feelings are raw and unresolved and every day when I walk out of clinicals they are there.

But I value my time at the clinic because when I walk in my patient’s door I’m no longer focused on MY life. I’m focused on theirs. How can I make their day better? How can I prevent this conditioning from worsening and removing even more of their independence? What can I do to encourage them to be independent? Regardless of their diagnosis, I have the opportunity to do this with each of them. I love, that as a caregiver, I have the choice to be completely present with my patient regardless of what else is going on. For those moments they can and should be the only thing I focus on. And I can only pray that if I end up in their position that my caregivers will do the same.

When I first met one of my patients and they said they didn’t want me to be their nurse I was afraid to care for them. But I enjoyed it. We laughed a lot, even when doing things that demonstrate just how dependent they are on others. And as I laugh with them, a little part of me thinks, maybe it’s possible to be completely dependent and still joyful. Maybe that wouldn’t be the worst thing in the world. Maybe I could survive, and even thrive, if I wasn’t so independent.

One day I answered this sequence of questions dozens of times: “What’s your name?” “Are you married?” “How old are you?” “30 and not married! Why?” And every time I answered I became less sensitive to the fact that I am 30 and single. It allowed me to embrace the choices I’ve made.

I feel incredibly sad to leave my first patients. When I leave their room and think back on what it must be like in their skin, sometimes it breaks my heart. But my heart isn’t broken when I’m with them. They are not just the sad diagnosis and the dependent individuals. They joke and laugh with me. They yell and express anger at me or others. They are deeply human. The last few years have been a journey to embracing my humanness, And the truth is, as a human I won’t be able to fix their physical or mental problems. But that isn’t my job. My job is to be present and to do what I can to alleviate a little bit of their suffering.

Next stop: nursing school!

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Thought I’d post an update on where I’m at with “going back to school and completely changing careers”.

I start Nursing School at Wenatchee Valley College in 17 days! It’s a 2-year ADN (Associates of Nursing) degree. As preparation, I completed a CNA course over the summer. I walked into class saying “I’m not sure if I want to be a nurse, or if I want to become a doctor.” But after spending 8 weeks with a phenomenal and passionate teacher and LOVING clinicals, I feel really comfortable with my decision to go to nursing school.

I’m currently working (very) part-time as a Nursing Assistant Registered and med aid at an adult family home which means I can give patients medication (which is scary and cool). I’m enjoying the work way more than I thought I would.

$800+ worth of nursing books

This fall I’ll take my NACES exam to become a Certified Nursing Assistant (CNA).

I was incredibly fortunate to receive an Opportunity Grant from the state of Washington that covers my books (check out the stack in my pic) and part of my tuition!  Plus the awesome Wenatchee Valley College Foundation gave each nursing student about $500-$600 worth of supplies including our lab supplies, a Littmann stethoscope (check it out in my pic) and our uniforms (navy blue scrubs with white shoes). Can I also just say I’m so glad to be in navy blue instead of white?

The more I learn about nursing, the less confident I am about what I’m going to do after I graduate. There are a ton of options within the nursing field, and I’m looking forward to exploring them. Maybe I’ll even become a traveling nurse. I am so happy with my decision to change paths and so thankful for the support of those around me.

Here’s to two years of craziness followed by who knows what.

How fats we eat become energy in the body

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The farther I get into organic and biochemistry the harder it is to find information that uses minimal jargon, helps me find the big picture amidst thousands of details, and that connects the biochemical concepts with what I’m learning in Anatomy & Physiology. So, I decided to post what I recently learned about how the fat we eat turns into energy in the body.

STEP 1: When you eat lipids (i.e. fats), an enzyme in your saliva, called Lingual Lipase, starts to break it down. (Lingual refers to your tongue).

STEP 2: When your food combines with saliva it’s called a bolus. When you swallow the bolus it moves through the esophagus and to the stomach. In the stomach an additional enzyme, called Gastric Lipase, breaks down fats from milk (it is specifically meant for breaking down breast milk in babies). When the bolus combines with gastric juice it’s called chyme.

(image source)

STEP 3: Your stomach slowly squirts chyme into the duodenum (the first part of your small intestines) where it meets bile from your liver. Most lipids haven’t been digested yet because they are big blobs of fat and the enzymes can’t get to them. Thankfully, bile contains bile salt which emulsifies any undigested lipids. Emulsifying basically means that the big blobs of fat get broken into little droplets.

(image source)

STEP 4: The little droplets of emulsified lipids are now ready for Pancreatic Lipase to break them down. For example, triglycerides are broken into 1 glycerol and 3 fatty acids molecules.

Triglyceride to Glycerol and 3 Fatty Acids

(The idea for this image came from this image. I used ChemAxon’s Marvin demo to create the molecule structures.)

STEP 5: Because fat and water don’t mix, fat needs help moving through the body. In the small intestines they organize themselves so that portion of the lipid molecules that hates water (“hydrophobic”) is protected by the portion of the lipid molecule that loves water (“hydrophilic”). This is called a micelle.

(image source)

STEP 6: The micelle moves through the wall of the intestines (called epithelial cells or absorptive cells) via diffusion. Diffusion means they move from a place where there are a lot of them (high concentration) to a place where there are few of them (low concentration).

How lipids move into absorptive epithelial cells

(image source)

STEP 7: In the absorptive cells 1 glycerol and 3 fatty acids are are recombined into triglycerides (reverse of step 4). The triglycerides are put into protein “packages” called chylomicrons.

STEP 8: Chylomicrons exit the absorptive cell via exocytosis and end up in the interstitial fluid (the fluid between cells)

STEP 9: From the interstitial fluid, the chylomicrons enter openings in lacteals. Lacteals are specific types of lymph vessels that transport fats.

Chylomicons in Lacteals

(image source)

STEP 10: The chylomicrons travel from lacteals to lymphatic vessels, to the Thoracic Duct and then are dumped into blood where the left Subclavian and left Internal Jugular Veins merge.

STEP 11: The chylomicrons in the blood are quickly captured by cells throughout the body using Lipoprotein Lipase.

STEP 12: If the cell needs energy it breaks the triglyceride into 1 glycerol and 3 fatty acids molecules (same as step 4.)

STEP 13: The fatty acid is activated by Coenzyme A (CoA) and forms Fatty Acyl-CoA (this is a substitution reaction).

Fatty Acid to Fatty Acyl-CoA

Beta  Oxidation CycleBeta Oxidation of Fatty Acid

STEP 14: Fatty Acyl-Coa is converted to Enoyl-CoA by the enzyme Acyl-CoA dehydrogenase.

STEP 15: The double bond in Enoly-CoA is hydrated to form an alcohol group (-OH).

STEP 16: The alcohol group (-OH) is oxidized to a carbonyl group (an Oxygen that is double bonded to a Carbon; C=O).

STEP 17: The acetyl-CoA portion of the molecule is cleaved off and enters to Citric Acid Cycle. The remaining portion cycles back through the beta oxidation cycle.

(image source. emphasis mine)

 

Citric Acid Cycle / Kreb’s Cycle / TCA Cycle

STEP 18: Acetyl-CoA enters the Citric Acid Cycle. Acetyl-CoA combines with Oxaloacetic Acid to form Citric Acid (also known as citrate).

STEP 19: Citric Acid undergoes a series of reactions that reduce FAD to FADH and FADH to NADH2. Reduce means the molecule accepts/gains H+ (a positively charged Hydrogen ion). FADH and NADH2 enter the Electron Transport Chain.

Krebs Cycle

(image source)

Electron Transport Chain.
The Electron Transport Chain takes place in the mitochondria of cells. This animated video and this Khan academy video help explain this process.

Mitochondria

STEP 20: In the matrix of the mitochondria, FADH and NADH2 are oxidized. Oxidation means they lose a hydrogen ion (H+).

STEP 21:The hydrogen ions are moved across the Crista Membrane to the intermembrane space. As this happens, the intermembrane space becomes more positively charged than the matrix. As a result, the Hydrogen ion wants to move back to the matrix and this movement can be used to generate energy.

Electron Transport Chain

(image source)

STEP 22: The hydrogen ions get back to the matrix via the enzyme ATP-synthase.  This step is best shown in this video. As they move, the enzyme causes ADP and phosphate to form ATP (Adenosine Triphosphate).

ATP is the chemical that the body uses as an “energy currency”.

What’s next on my midwifery journey

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Hi friends and family!

As I shared in September, I am on a journey to become a midwife.

I’ve wrestled through the decision on what training and credentialing to pursue and even

took a little sidetrack exploring medical school. But I’ve settled on the decision to become a nurse-midwife. This means I’ll become an RN first and then get a masters in midwifery.

There are still a lot of decisions to make. Some of which are completely out of my control.

stork delivery

The next step is completing my prereqs:

  • I’m currently taking Anatomy & Physiology I and Microbiology (and am loving it!).
  • Next quarter I’ll take Anatomy & Physiology II and Lifespan Psychology (and I may add in a chemistry class for “fun”).
  • This summer I’ll take a quick CNA (Certified Nurse Assistant) course, which I’ve heard is helpful for getting acclimated to the nursing culture.

In June I’ll apply to the ADN (Associates in Nursing) at Wenatchee Valley College for the fall quarter. The program is 2 years long. Upon graduation I will qualify to take the NCLEX-RN exam after which I will be able to apply to master’s programs for midwifery. The midwifery program will probably take 3 years.

So if all goes well I’ll be in school until 2020!

So far it’s been amazing to see God orchestrate so many details that continue to confirm that I’m moving in the right direction, including some awesome financial aid for tuition!

At first I was itching to finish my education as quickly as possible, but I’m learning to enjoy each step of the journey instead of just focusing on the end result. It’s been a refreshing change in perspective. After a month back in school I feel like I’ve found my groove. The work is challenging but I am energized by the learning. If you’re curious about what I’m learning you can check out my digital flashcards.

Well… I’m off to take a two-hour exam on all the bones in the body and read up on viruses that transfer DNA from one bacteria to another.

With love,

Krista Joy

 

Certified Professional Midwife vs. Certified Nurse-Midwife (CPM vs CNM)

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REVISED: This blog has been edited based on feedback from the Hearthside Online Midwifery Study Group on Facebook.

Once I decided to become a midwife, the next step was determining what type of midwife to become. It was challenging to find thorough information about the different options. I basically could only find a surface-level overview, which I found completely unsatisfying when making a decision that would impact the rest of my career! To help future aspiring midwifes, I’ve decided to share an overview of the CPM vs. CNM option (Certified Professional Midwife vs. Certified Nurse-Midwife) based on my research.

A variety of opinions

  • The U.S. is unique in that it offers a variety of routes for becoming a midwife. While the primary licensing organizations are nationwide, each state sets their own regulations. Which means there is a LOT of variety between midwifes with different certifications in different states. A “licensed midwife” is someone who has met the requirements set by the state for licensure. Some states allow for non-licensed midwifes (sometimes called Traditional Midwifes).
  • There are also different camps of people who are working towards establishing nationwide definitions/regulations and increasing the scope of what midwifes are allowed to do. This leads to a significant amount of debate, and sometimes defensiveness, within the midwifery community.

Certified Professional Midwives (CPM)

  • Licensed and trained in midwifery only.
  • You can become a CPM without going to a school. This is accomplished via apprenticeship and licensure requires PEP (Portfolio Evaluation Process).
  • If you go to school, you can go to an MEAC accredited school or one that isn’t accredited. Non-accredited schooling requires PEP as well.
  • Entry-level education for an MEAC accredited school seems to range from Associates to Master’s Degrees
  • Can practice in most states, but some states will not license CPMs
  • Can only deliver OOH (Out of Hospital) in the home (if legal in the state) or in a birth center
  • Does not require physician oversight
  • Cannot write prescriptions
  • Care is limited to pregnant or post-partum women in some states. Other states allow well-woman care as well.

A few observations:

  • This seems to be the preferred route for women who are highly committed to home birth and/or natural birth.
  • The schooling is regulated, but it seems like training can be inconsistent and highly dependent on the preceptor who trains you (a preceptor is a midwife who trains new midwives). This article has an interesting perspective on “black holes” of knowledge for CPMs.
  • The autonomy of not having physician oversight is appealing
  • CPMs typically also become business owners. Some aspiring midwifes prefer the CNM route because they don’t want to own their own business. Others prefer this type of autonomy
  • CPMs typically practice in 24/7 on call roles and as the years add up they can suffer from burnout. This lifestyle can be challenging on families
  • The cost of training can vary greatly. Schools I’ve seen can range from $15k to $60k.
  • The prerequisites for training vary greatly: some schools have no prereqs, others have similar prereqs to nursing schools and other require attending training to become a doula and/or child birth educator.
  • I met some students who started nursing school and discovered it was not a good fit for them, so they changed to the CPM route so they could focus solely on birth in their education instead of “jumping through the nursing school hoop” (which is a very expensive thing to do)

CPM schools
I looked into a lot of CPM schools. Here’s my personal top picks based on what I found:

For CPMs it looks like a lot of the Masters and PhD programs are primarily focused on research.

Nurse-Midwife (CNM)

  • Licensed and trained as Registered Nurse and in midwifery. 
  • Entry-level education: Master’s Degrees
  • Can practice in all states, although their scope (what they’re allowed to do) varies from state to state.
  • Can deliver in all settings (home, birth center or hospital) depending on state regulations.
  • Can provide care from “menarche through menopause” (menarche being the first menstrual cycle).
  • Needs physician oversight in most states
  • Can write prescriptions

A few observations:

  • A lot of information I read seems to assume someone is already a nurse when they want to become a midwife, which makes it challenging to figure out what to do if you know you want to be a midwife and nursing is simply part of the journey.
  • Education requires an RN and a Master’s in Midwifery. There are a variety of ways to accomplish this and as a result the educational path can seem overwhelming to navigate.
  • Some RN programs require CNA training as a prereq. A few CNMs recommend the CNA training even if it’s not required because it helps reduce the culture shock of nursing school.
  • The practice on CNM seems to range from the Midwifery Model of Care to the Medical Model (where the CNM practices similar to an OB). This article has an interesting take on the necessity for midwifes to be midwifed, which seems less common for CNMs because of the adage “nurses eat their young”
  • Doula training is incorporated into the midwifery training so it isn’t a prerequisite.
  • In states where physician oversight is required it seems like a midwife’s experience is greatly dependent on the model of care of the physician (for example: a mother is 42 weeks, the midwife thinks they should wait for labor to start naturally but the doctor wants to induce)
  • This option offers career flexibility: a midwife can practice 24/7 on call for a while, then work shifts at a hospital, can move out of midwifery and do other types of nursing or after a few years of experience can become a professor.
  • The training is expensive (in some cases ranging from $60k-100k)
  • The prereqs between programs can vary (because there are so many different routes) but along the way it looks highly likely that you’ll take Anatomy & Physiology, Microbiology, Chemistry and some upper division Psychology courses.
  • I ran into several CPMs who had decided to become CNMs for one reason or another. However, there doesn’t seem to be a smooth way to become a CNM. It’s a lot like starting completely over (educationally speaking).

Certified Midwife

In my research I also came across this option. There seems to be two different definitions: one that is similar to a Licensed Midwife* and one that is similar to the CNM but without the RN. There seems to be some controversy about the existence of the latter option (here is an article I found interesting that touched on this subject and also provides some insight on the history of certification in the U.S.) and when I contacted a school that offered this program they practically encouraged me not to apply since you can only practice in 5 states and it’s hard to find positions since it’s a “pioneering” role.

The most commonly recommended resources

midwife-pathsThroughout my research I consistently saw links to these two resources:

A few additional actions that helped me make a decision:

  1. I visited a local birthing center and talked to a CPM student
  2. I found a group on Facebook that was very responsive to explaining why they chose the CPM vs. CNM route
  3. A midwife asked me to answer these questions: What are your goals? How do you see yourself practicing?

UPDATE: I chose to attend nursing school! You can learn more about what I love about nursing here.