cpm vs cnm

[sattygirl99]

Anyone nervous about having a cpm instead of a cnm? I'm nervous I will risk out faster if I choose a cnm (I'm a vba2c) but I worry about a cpm nott being licensed... iwhat do I tell my insurance and all when they ask who I'm getting care from if my cpm isn't legal in my state?

[cathicog]

I would ask, how many VBACs has each mw done? I think you are right, a CNM would be more likely to risk you out, not for health reasons only, but that her back-up doc, might be more strict, and it's her licence on the line. A CPM who isn't licensed in your state, could still be a very qualified mw otherwise, and in many states is the ONLY option for avoiding more surgery. So my question would be: how badly do you want to avoid another c/s? I would do a homebirth with a CPM in a heartbeat! It's harder to get a CPM, than a bachelor's degree! (said from experience!) and I would not tell the insurance company ANYTHING. When you do the birth, at home(if that's what you want to do) then the midwife just files the paperwork with the ins. company. Some companies pay, some don't. It's in thier best interests to pay someone less expensive, but as good or better care, IMO...Most CPMs require payment by 36 weeks, but you can talk about it with the local mw, and see if you can work something out...If the insurance co pays, then you get that money if you have already paid the mw out of pocket...

[xixstar]

I don't know why you'd need to tell anyone you're seeing a CPM versus CNM. I just mention that I have a midwife and that's the end of discussion. I'd say bring your concerns up with your mw and you'll probably find there is no reason to worry. The legal difference doesn't matter much to me, but it's also not a risk for me because I'm not doing anything "wrong". My mw has some risk, though insanely minor here, but that's something she chooses to take. If you're worried about what might happen in different situations (transfer for example) then just talk to you mw to see what she would do. You're not in a very hostile birth climate and wouldn't be abandoned if transfer was needed.

[MegBoz]

Originally Posted by xixstar

The legal difference doesn't matter much to me, but it's also not a risk for me because I'm not doing anything "wrong".

Right.
Personally, I didn't really consider HB with #1 because my "Bradley" teacher (in quotes b/c she wasn't following the curriculum!) told me it was illegal in Maryland! . As posted above, it's NEVER illegal for the couple, although it's true that CPMs are illegal in Maryland - so a CPM could be charged with a felony crime of "practicing medicine with a license." But, again, as posted, Maryland isn't currently on a witch-hunt for midwives.

I was uncomfortable with the idea of using a "renegade, illegal midwife" so i didn't really consider it (Plus, I was happy with the CNMs at Upper Chesapeake.) It seemed so "out there" to me!! But when you learn more about the birth climate in the US, it really doesn't seem so weird anymore!

Actually, CPMs are legal in BOTH the neighboring states of PA and VA! AND - NOT being licensed can be an advantage since they don't have limits on their practice! (& I've heard of some crazy, stupid limits, like not being able to carry oxygen for resuscitation, not being able to do stiches, not being allowed to attend VBACs, breech, or twins, etc.) But the reality is that one of the best CPMs in our area happens to be your single best bet for achieving vaginal twin birth! She's attended more than anyone else.

I highly recommend reading, "Born in the USA" by Dr. Marsden Wagner. It really helped me realize that a "renegade, illegal CPM" is NOT a bad or crazy choice for my care provider! it's the birth climate in the US that is the bad & crazy piece!!
That & just evaluate your MW choices based on their individual credentials - ask about total births they've attended, total VBACs, how they keep up with their continuing education, how they handle supporting you in case of transfer, etc. I know it's hard, but I'd really try not to let the CPM vs. CNM factor into your decision.

As for getting insurance to pay, you can get lots of great tips on that in your tribal area. You CAN get insurance to pay a CPM in Maryland even though they're illegal! Crazy, but true!

[Sk8ermaiden]

To be quite honest, I think most insurance people (or people in general) don't even know there are different types of midwife. Mine certainly never asked.

[sattygirl99]

Thank you!

I didn't tell them I'm having a hb but I did have to give them my midwifes name for our pregnancy program (in which we get a rebate check and a carseat at the end). I never mentioned she was a cpm at all and they never asked, just said she's out of network so I get less coverage.

The midwife I chose has delivered 100s of vbacs, even vba4c. She had a hbac herself! I'm not worried about that. She's very hands off and patient and that's what I want. I'm not scared that she's not qualified but my lc gave me a hassle about not using the only cnm for my hb.

How does the birth certificate work with a cpm since they aren't legal here?

I'm planning to see KC (hopefully my fellow mders will know who I mean, that's how my doula said to post it if I needed to). She's highly recommended. And she has the most hbamc experience and only transfers for true emergency. I really liked her and I haven't met anyone who says anything bad about her.

Thank you all for reminding me that I'm not doing anything illegal by hbing... the risk isn't mine, its hers and she's obviously willing to take it. I love this board!

[sattygirl99]

Thank you!

I didn't tell them I'm having a hb but I did have to give them my midwifes name for our pregnancy program (in which we get a rebate check and a carseat at the end). I never mentioned she was a cpm at all and they never asked, just said she's out of network so I get less coverage.

The midwife I chose has delivered 100s of vbacs, even vba4c. She had a hbac herself! I'm not worried about that. She's very hands off and patient and that's what I want. I'm not scared that she's not qualified but my lc gave me a hassle about not using the only cnm for my hb.

How does the birth certificate work with a cpm since they aren't legal here?

I'm planning to see KC (hopefully my fellow mders will know who I mean, that's how my doula said to post it if I needed to). She's highly recommended. And she has the most hbamc experience and only transfers for true emergency. I really liked her and I haven't met anyone who says anything bad about her.

Thank you all for reminding me that I'm not doing anything illegal by hbing... the risk isn't mine, its hers and she's obviously willing to take it. I love this board!

[russsk]

I'm seeing KC, too. She can file insurance, though she won't be in-network. The insurance companies don't care that she's a cpm (funny, considering how often the find reasons not to pay). My oon deductible is way more than her fee, though, so I'm not going to bother dealing with them.

[xixstar]

birth certificate depends on your county, some a little different than others. for ours, a home health nurse came out a couple weeks after she was born and filled out the form. We just called the health department to register a live birth... when she came to the attendant line, she even said that we didn't have to give a name if we didn't want to... we put dh's name there. Oh and even though it was a home health nurse that came out, she didn't come out to check out the baby or anything and she barely even seemed to recognize that I had a baby with me -- it wasn't at all invasive which I had assumed it might be.

[sattygirl99]

I too am worried about it being invasive.

PP can you pm me the fee KC gave you? I forgot to ask her... my deductible is only 1K though so it ends up being worth it to file. I've been told by others its about $2500.

Thanks for making me feel better guys! The fact that she wasn't licensed didn't bother me until my lc made comment about how she's illegal here and I shouldn't have an illegal mw attend my birth. If I wasn't hba2c we would probably go uc but there's a little added risk with 2c.

[russsk]

PM'd you.

[MegBoz]

Originally Posted by sattygirl99

I'm not scared that she's not qualified but my lc gave me a hassle about not using the only cnm for my hb.
my lc made comment about how she's illegal here and I shouldn't have an illegal mw attend my birth.

Ay yi yi. What does it matter? Why would your LC give you a hard time about that?
Also, that CNM happens to already be very busy! I have a friend who called her when she was only about 12 weeks along, due date late June & she was booked that whole month so she couldn't even meet with my friend. (She called a KC!)

Sorry, but any LC that would make a statement like that is grossly uninformed about birth! As already posted, even if Evelyn were available for your due month, she has restrictions on her practice (not sure if HBAMC is one of her restrictions, but in any case, she has restrictions.) So KC is advantageous in that regard.

The fact that she's illegal is really irrelevant for you & has no bearing on her safety. I'm surprised your LC would say that. Do you really trust this LC? I had my DS at Upper Chesapeake & the LCS were AWFUL! I mean, dreadful, I have no doubt I would have been better off with the internet & my library card - I'm absolutely certain they made things worse for me. (DS is 18 mos, I did persevere but I'm still angry.)

Anyway, point being - you have to select an LC as carefully as you'd select a doc or MW that should have been obvious, but I blindly trusted the LCs & it was not wise!!!