Tell me about CPMs

[Tdunahoo]

Hello,
I desperately want to have a homebirth but want to know what your opinion's are on CPMs.

Our first DS was born in a hospital, we discovered the morning after he was born that he had a heart deformity and he was rushed to another hospital for hear surgery.

We just found out we are expecting out second child and couldn't be more excited but of course the thought that there could be something wrong with this baby is in the back of my mind. We live in Iowa where are options are limited and it looks like the only real chance I have at having a homebirth would to be with a CPM (in our area) but honestly, I don't know much about them.

For those of you who are familiar with CPMS, can you tell me about your experiences? Would a CPM be able to do things like ultrasounds (not many, because honestly, I don't want to have more than 1 or 2 but I just want to know about the ability to do so if needed) to make sure baby is growing ok? I honestly know nothing about them so any information you could give me would be very helpful.

Thanks. I'm sorry if this post sounds scatterbrained

[*MamaJen*]

The majority of homebirth midwives are CPMs. They are trained to provide prenatal and birth care for healthy, low risk pregnancies, and to transfer care to a hospital if it's indicated.
CPMs don't do ultrasounds themselves, but they do refer you to a clinic for ultrasounds. For example, I had a 20 week ultrasound to check that the baby was developing okay -- my midwife referred me to an ultrasound clinic. There was one thing they were concerned about, so from there I went and saw a specialist for a second ultrasound, and he was able to tell me that everything was fine with the baby's development and we were okay to have a homebirth.
You would definitely want to talk to your midwife about your first child's heart issues. Is it something that would show up on an ultrasound? If so, you could start out your prenatal care with a midwife, get an ultrasound to make sure you're still a good homebirth candidate, and go from there. Or if the ultrasound did show a problem (or if it's the kind of issue that they might not be able to diagnose beforehand from the ultrasound) then you would likely want to deliver in the hospital.

[Sijae]

You have to talk with each individual midwife just as you would hire any other professional. Being certified as a CPM doesn't tell you much about the midwife. You should set up interviews with each midwife in your area and they will give you information on their education, experience, philosophy of practice, etc.

Having a baby at home means you are taking responsibility for all of your decisions in pregnancy and birth. Hiring a midwife (or not) is one of those responsibilities and you shouldn't rely on any credential to tell you if the midwife is qualified or not. Many of the best midwives have no letters after their name at all and are not certified by any agency.

Laura

[MsBlack]

Originally Posted by Sijae

You have to talk with each individual midwife just as you would hire any other professional. Being certified as a CPM doesn't tell you much about the midwife. You should set up interviews with each midwife in your area and they will give you information on their education, experience, philosophy of practice, etc.

Having a baby at home means you are taking responsibility for all of your decisions in pregnancy and birth. Hiring a midwife (or not) is one of those responsibilities and you shouldn't rely on any credential to tell you if the midwife is qualified or not. Many of the best midwives have no letters after their name at all and are not certified by any agency.

Laura

Nicely put--and I agree

I especially want to point out that becoming a CPM does not require all that much apprenticing...a relatively low number of birth assists (and prenatal/postpartum visits) are required to take the exam.

I know many CPMs who had lengthy and thorough apprenticeships, usually involving more than one preceptor/mentor. By the time they took the CPM exam, these apprentices had seen/assisted well above the minimum number of births to qualify for the exam; this means they'd had a chance to see variations on the norm and even some complications of birth.

There are also apprentices who do barely the minimum number of assists/prenatals/etc to get qualified to take the CPM exam.

And regardless of her training route and apprenticeship, I'd want to know a mw's experience level generally. Whatever her apprenticeship was like, is not as important as knowing how experienced she is now, what is her philosophy/approach, etc. You might be happy with a mw of relatively low experience--the point is that you need to know this info, to be able to consider what is important to you as you make your choice.

You can go to www.narm.org to find out more about CPMs.

[homemademom]

Definitely agree with the others here. Here's a site with questions you can ask potential mws when you interview them: http://www.gentlebirth.org/archives/intrvu.html

I've used 3 experienced CPMs over the years, but they were all slightly different in approach and very different in personality. It was most important to me that they be competent in handling emergencies, and after that, personality was my next priority.

If you can, talk to other women who've used the mws in your area. Also, Interview as many mws as you can before making up your mind. Good luck!

[Peppamint]

Depending on the legalities in your state, you may need to see a CNM or OB to get your ultrasounds. IME, they will do a level 2 ultrasound and if all appears well, they will want you to bring your baby in at a few days old to get a checkup with a pediatric cardiologist.

Originally Posted by MsBlack

I know many CPMs who had lengthy and thorough apprenticeships, usually involving more than one preceptor/mentor. By the time they took the CPM exam, these apprentices had seen/assisted well above the minimum number of births to qualify for the exam; this means they'd had a chance to see variations on the norm and even some complications of birth.

There are also apprentices who do barely the minimum number of

The minimums are just that... it is I think apprentices should make every effort to attend as many births as possible with as many midwives as possible.

[MegBoz]

Originally Posted by Sijae

Many of the best midwives have no letters after their name at all and are not certified by any agency.

I really think it's the same with any profession - certification & formal education don't necessarily guarantee competence, nor does the lack of certs or college degrees equate to a lack of competence, experience, or knowledge. I do know that some think CPM is not good enough & only CNMs should attend births as primary health care providers. Although I think this is a rare opinion in the birthing community. (That is the opinion of ACOG, but then again they oppose HB & most HB MWs are CPMs, so...)

I was fortunate enough to have both CNMs and CPMs to chose from for HB here in the Baltimore area & I've chosen a CPM, even though they are illegal in my state, although they're legal in neighboring states & my MW is licensed in Virginia. Honestly, she is so on-top of things with regards to continuing education! She's also passionate about & active in training apprentices (she has one apprentice at a time who acts as her asst.) I'd rather have someone who stays current, then someone who got a Masters Degree in Nursing 20 years ago & hasn't read a journal article since!

To get ultrasounds, I just went to the hospital-based CNMs where I had my DS. I'll stop going there after my upcoming 20-week scan. I was honest with them about my HB plans & they even know my MW, so that's worked well for me.

[luckiest]

I'm seeing two CPMs with this pregnancy. They are both also LMs, which, as I understand it, just means that in addition to the national certification it takes to be a CPM, they also met whatever local requirements there are to practice in my area.

I chose my midwives less because of their credentials, and more because their philosophies are aligned with ours moreso than other midwives I met. They are both brilliant women, have been attending births for years and years, so I never felt uncomfortable that they didn't have a nursing degree or anything like that. I picked them because they are even more "hands off" than other midwives - they only touch the baby if absolutely necessary and try to let only mom and dad touch babe for the first couple hours. They don't clamp the cord for a couple hours, they do very limited VEs, they were fine with no ultrasounds, etc. At the same time, they have a higher transfer rate than other midwives because they don't stay at home until "the blue bitter end," as they put it, and have no problem transferring for pain relief if mom says she needs it.

I think finding your midwife has everything to do with finding someone who thinks the way you do and whom you click with, rather than the letters behind her name.

[camprunner]

I have googled the midwives names to see what birth stories they appear in online. Sometimes, I've found a lot about how complications are handled by a particular midwife that way.

[rajahkat]

Originally Posted by luckiest

They are both also LMs, which, as I understand it, just means that in addition to the national certification it takes to be a CPM, they also met whatever local requirements there are to practice in my area.

Normally, it just means that in addition to CPM certification, they paid money to the state licensing board.

[Sijae]

Originally Posted by rajahkat

Normally, it just means that in addition to CPM certification, they paid money to the state licensing board.

It also means they may be less able to help some women due to state restrictions, and may have a tendency for more intervention in order to avoid things (for instance inducing to avoid transfer at a certain gestation) which can be problematic.

[iowaorganic]

Hi! As another fellow Iowan I would recommend if you do decide to go with a CPM you are also documented with an OB or someone else since the legal situation in Iowa is questionable at best. We are using a CPM who has decades of experience and feel more comfortable and safe with her than with our old OB. But should there come up any 'situation' during or after the birth you will want to be documented with a medical professional. The OB you have for backup will be more than willing to take $1000 from you or your insurance to give you an ultrasound and any other testing you desire/is recommended.

The other thing you could of course do is complete shadow care with an OB. This would not be my first choice though.

[SilverLace]

www.mothersnaturally.org

www.cfmidwifery.org

Both of these sites are written for consumers to learn about birth and midwifery options.

Good luck!

[AugustLia23]

CPM's, and most classicly trained midwives are awesome! Not all of them everywhere of course, but as a whole, it is an amazing profession. Some of the most intelligent women I've met are CPM's.

I don't know much about midwifery in Iowa, but I'm sure there is a local organization that could let you know what the laws and regulations are there.

Homebirth is the best decision I ever made, and I hope you get the chance to feel that way too!!