HBAC with CNM?

[sillynika]

I had a cesarean for previa in Dec of 08 (after a natural out-of-hospital birth in June of 06) and just went last week for an initial meeting with the same midwife group that I had used with the second pregnancy (till we switched in the third trimester). The 'VBAC wavier' that I had to sign was last updated in 2005 and they said they were currently working on a new one, but part of it said that the CPMs in the group could attend HBACs but the CNM could not due to ACNM guidelines...

I'm pretty sure I've read about other CNMs attending home VBACs, so have the guidelines changed in the last five years? Other CNMs going against the ACNM guidelines? This CNM just interpreting the 'guidelines' differently? Something else possibly going on? I'm a bit confused.

[CookAMH]

I always understood CNMs to do only hospital births or birth center births, but it may depend on your state. In WA, only LMs do homebirths and CNMs do hospital births (at least publically)

[gingerbane]

In Iowa CNMs can do homebirths. I had a HBAC with a CNM in August.

[AlexisT]

Originally Posted by CookAMH

I always understood CNMs to do only hospital births or birth center births, but it may depend on your state. In WA, only LMs do homebirths and CNMs do hospital births (at least publically)

there is at least 1 (I believe 2) CNMs in Seattle who do home births. I know someone who used one (Sally Avenson) and I seem to remember her saying there's another CNM who does them.

There are legal (in a few states) and practice agreement (widespread) problems with both CNM attended home birth in general and HBAC specifically, so it can be uncommon in much of the US.

I do not know if ACNM has a guideline against HBAC. This is the first I've heard of it. I do know of cases where it's happened, though it's not common. That said, there aren't a huge number of HBACs, and there aren't a huge number of CNMs doing home birth, so I wouldn't expect to hear about a lot of them.

[HeatherB]

I do know of CNMs doing HBACs here in Texas, but am unfamiliar with any ACNM guidelines.

FWIW, my MW (CPM) told me there are new regulations (at least here in TX) about VBAC waivers and she is also working on a new one. Thankfully, I don't expect to be frightened by any of it even if that's the intent of whatever the new legislation is.

[CookAMH]

Originally Posted by AlexisT

there is at least 1 (I believe 2) CNMs in Seattle who do home births. I know someone who used one (Sally Avenson) and I seem to remember her saying there's another CNM who does them.

There are legal (in a few states) and practice agreement (widespread) problems with both CNM attended home birth in general and HBAC specifically, so it can be uncommon in much of the US.

I do not know if ACNM has a guideline against HBAC. This is the first I've heard of it. I do know of cases where it's happened, though it's not common. That said, there aren't a huge number of HBACs, and there aren't a huge number of CNMs doing home birth, so I wouldn't expect to hear about a lot of them.

Thanks for the clarification!

[sattygirl99]

I am in MD and just had a HBA2C with a CNM.. She doesn't do hospital births, just homebirths.

[sillynika]

Originally Posted by HeatherB

I do know of CNMs doing HBACs here in Texas, but am unfamiliar with any ACNM guidelines.

FWIW, my MW (CPM) told me there are new regulations (at least here in TX) about VBAC waivers and she is also working on a new one. Thankfully, I don't expect to be frightened by any of it even if that's the intent of whatever the new legislation is.

Perhaps the new waivers have to do with the ACOG VBAC stuff from earlier this year where now twins, vertical incisions, and VBA2C are 'low enough risk' for VBAC?

[sillynika]

Originally Posted by AlexisT

There are legal (in a few states) and practice agreement (widespread) problems with both CNM attended home birth in general and HBAC specifically, so it can be uncommon in much of the US.

I do not know if ACNM has a guideline against HBAC. This is the first I've heard of it. I do know of cases where it's happened, though it's not common. That said, there aren't a huge number of HBACs, and there aren't a huge number of CNMs doing home birth, so I wouldn't expect to hear about a lot of them.

I guess there could be a state level legal issue, though that would be quite random as I think there are only a few CNMs not in hospitals in Oklahoma, possibly only the one. The practice agreement would be even weirder since both the CPMs and the CNM in the group have the same backup doctor (who has to personally give the go ahead on each VBAC the CPMs accept).

[sillynika]

Originally Posted by gingerbane

In Iowa CNMs can do homebirths. I had a HBAC with a CNM in August.

Good to know!

[HeatherB]

Originally Posted by sillynika

Perhaps the new waivers have to do with the ACOG VBAC stuff from earlier this year where now twins, vertical incisions, and VBA2C are 'low enough risk' for VBAC?

Unfortunately, that's not what it sounded like. Seemed the state (I assume) is pushing for more scary-type disclosures in formal waivers. Thankfully, most well-informed parents dealing with midwives who believe in birth will be able to work through the issues without a big problem. But we'll see when my MW gets hers finished.

[smeep]

Originally Posted by CookAMH

I always understood CNMs to do only hospital births or birth center births, but it may depend on your state. In WA, only LMs do homebirths and CNMs do hospital births (at least publically)

My midwife is a CNM and does births both at home and in her center. She also has attended (and, last I knew, still attends) breech births and VBACs...both at home and in the center. I'm in Texas.

[mamamia713]

Can you offer a contact? Would she travel to PA?