Tuesday, October 7, 2008

Types of Midwives

I am finally getting back to answering questions. The one I want to talk about today is the difference between a CNM (Certified Nurse-Midwife) and a CPM (Certified Professional Midwife).

There are a lot of different types of midwives out there. It can become very complicated. I am not going to go very in depth, as the laws are different depending on where you live.

Some states do not allow for homebirth, but most do. Some are very good states to work in if you are a midwife, and others make it hard to practice. If ACOG, the American College of Obstetricians and Gynecologists, gets their way, things will become worse for a midwife to practice anywhere. I would encourage all people -- men and women -- no matter where you are, to be an advocate for midwifery care. Check out www.thebigpushformidwives.org for more information on midwifery care in the U.S.

First of all, I am asked quite often what the difference is between a doula and a midwife. Simply, a doula provides labor support to both the woman and her husband. She is a knowledgeable woman, trained in physical and emotional support before, during, and after the birth. I highly recommend seeking out a doula for your birth. You are less likely to have interventions or a c-section with a doula by your side. Ask your local Birth Boot Camp instructor for recommendations. Some instructors will work as doulas, as well as educators.

A Certified Nurse-Midwife, or CNM, usually works in a hospital, but not always. They have attended nursing school and then specialized in midwifery usually for another year. I have seen a wide range of CNMs over the years when it comes to their attitudes towards birth. Some are very comfortable with interventions and medications. I don't like this. Some view birth as a normal process that works better without intervening. Unfortunately, when you work in the hospital, I believe that your view of birth becomes warped. 95% of women have medication in labor, and this requires a number of interventions as a result. One leads to another. Whether the CNM wants this or not, this is what she is usually surrounded by in the hospital.

I read a book by a Licensed Midwife, or LM, a couple of years ago. She practiced homebirth for more than 10 years. There came a time in her life, however, where she needed to have a more regular schedule. She decided to work in a hospital solely because of the hours. It is interesting to hear her experience there and how it affected her views and feelings towards birth. She found she started to fear the process of birth and use intervention more because this was the attitude she was surrounded by. She would have to step back, attend a handful of homebirths just to be around normal birth again, and then return to her shifts at the hospital.

A CNM, or group of CNMs, in a hospital will practice under a group of doctors. There are certain procedures that a midwife is not allowed to do, such as a vacuum extraction of a baby or a c-section. If there is truly a complication, the doctor will "deliver" the baby. Often, you will not know which midwife will attend your birth. It is good to rotate through so you can meet all of them during your pregnancy. Some groups encourage this and others frown upon it. Remember, attitudes vary and it's good to know which midwives support natural birth and less intervention. Another thing to remember is that this type of midwife has other patients when you are in labor. She will be in and out to see you, similar to a doctor.

There are Licensed Midwives and Certified Professional Midwives, depending on the state you live in. Requirements vary. These are often women who have worked as an apprentice under an out-of-hospital (homebirth or birth center) midwife. They have to attend, literally, hundreds of births. In order to receive their license to practice they have to pass a very intense exam. In some states there are other requirements as well, some type of "schooling," but generally, this midwife has hands-on experience and has thoroughly studied pregnancy, labor, birth, and postpartum. If you are or become high-risk, you will be referred to the midwife's back-up doctor. This type of midwife will be with you as much as you want her to be when you are in labor.

There are also lay midwives. These women have been around birth most of their life and often "work" where there are no other options, maybe where people live far from healthcare or are very poor. This midwife has no license, just varying degrees of experience. In this day and age, a lay midwife is likely someone who is practicing homebirth in a state where homebirth is illegal. These women believe that women should have the right to choose homebirth and are willing to take risks to make that possible.

I hope this answers some of your questions. No matter which type of midwife you think you'd like to try, interview them just like you would a doctor. You should feel very confident in who you choose. Remember, as long as that baby is still inside, you have choices!


Kate's mommy said...

Yay, Donna! Thank you for addressing my issues. Well spoken, indeed. Man do I wannna have another baby!

Lena said...

One of the things I like about Betty (CNM) is that she was in a birthing center but still had the authority to write presciptions. It was nice not to have to go to a different Dr for something like a sinus infection. Just something little but very convenient. You mentioned how much more time a midwife will spend with you too- LOVE that! That was one of the reasons I left my old Dr- he would ask if I had any questions as he was opening the door to leave after our 2-5 minute visit!