CNM vs LM?

[naturegirl7]

Sorry - double post - I posted this in the general birth forum before noticing there was a professionals forum, where it is probably more appropriate.....



Aside from the obvious (one being a nurse and one not) what is the difference between a Certified Nurse Midwife and a Licensed Midwife?
Is the scope of practice different?
What kind of and how much schooling does a LM get?
Do LM only do homebirths?
Can LM take on "higher risk patients" like ones with GD, pre-eclampsia, or history of "difficult" deliveries? Most CNMs I know could.
Do they use backup OBs like CNMs?

What is your personal experience with either?


Here is my experience and why I am asking;
With DS I had a CNM in a hospital - cuz that was all that was available. It was a great experience for the most part (everything except being in the hospital). It was in a birth center styled room with tub, queensized bed, dim lighting, music, etc. I had the most amazing MW in the world, I switched to her at 28wks pregnant and it was the best decision I ever made. She is indepently practicing, with a backup OB rather than within an OB's practice and I found that made a huge difference in her approach to my care. She is very proactive with prenatal care and very "hands off" in her approach - encouraged me to stay out of the hospial as long as possible, go eat, go walk, doesnt do routine IVs, offers waterbirths, etc (she used to have a birth center in teh area until the hospital refused to renew the lease). She stayed with me thru the entire labor, coaching me, giving me gingerale and cran juice, and making me feel like I could do it. My 9lb9z beautiful rolly polly DS got seriously stuck, position changes weren't doing it, she reached in to unhook his shoulder off my pubic bone (his shoulders were actually bigger than his head!!) and finally he came out in the hands and knees position (a tiny bit blue). She defended us to the cranky old nursery nurse - to make sure he came right to me and breastfeed. I had the best MW in the world, and now I am at a loss as to how to find someone just as good as her.

Now we have moved, and Florida does it differently. All the CNMs seem to practice in the hospitals - and I have heard horrible things about the hospitals and natural births down here. There is a CNM who does homebirth a little over an hour away, and birth center a little over an hour away if we manage to catch 95 without traffic, or tons of LM who do homebirths close by.
I know I don't want a hospital birth again. Birth center would be great. Home would be great, but I am a bit nervous that the next one might get stuck again. DS had minor Erbs palsy as a result of getting stuck (and the stupid delivery nurse pushing on my stomach while the MW was yelling at her to stop), and honestly I credit the MW (and our chiropractor) with the fact that he has use of his arm - an OB or a more medical CNM would have let the nurse push on my stomach to "help" the baby come out - stretching his arm and neck even further and possibly causing permanent nerve damage. I am terrified of that happening again without my MW there to make it all okay. Or that they will recommend induction (or worse) cuz the next one is "too big" - especially since I now have a "history of big babies."

I figure if I start searching and researching now, maybe I will have someone I like when I am ready to get pregnant in 6 months or so. It will hinge of finding a great MW. DH laughs, but I will not make a baby until I find someone I trust enough to catch that baby. And they have pretty big shoes to fill.

[onlyboys]

Florida is different than other states. I'm shocked you found a CNM who does out of hospital birth! There are none near me. (I'm in central FL).

An LM in Florida is required to have at minimum 3 years of school, and have caught 50 babies. They are trained in normal, healthy birth, with some focus on recognizing complication. There is an exhaustive list of rules that accompany our law, which you can read on the myflorida.com website. These rules basically dictate those situations where a LM cannot attend, and when they must consult with an OB or refer to a hospital. Also, there is a risk screen at the initial prenatal appointment which identifies women who may have had high risk pregnancies in the past. The determination is made based on a point system, and if you have 3 or more points, the MW must consult with a physican to make sure that it is safe for the mama to stay with the midwife. In this way, women are "risked out" for complications, but some OBs will just say, yes you're okay, go back to the LM.

If you have crazy out of control BP, or have uncontrolled diabetes, the OB probably will want to keep you.

It can be challenging for a midwife to find OB backup, though, so you may run into the situation where a LM doesn't have backup. Here in our area, we have the most conservative OB who takes consults and he is really fair, in my experience. He knew I was horrified of a hospital birth, and even with major weight loss and hyperemesis, he sent me packing!

With your sticky shoulder situation, the midwife will need to be aware, but I don't know that it would be an automatic risk out. But then, I don't know that sticky shoulders are something better handled in the hospital anyway.

I have had four births: one OB, two CNMs, and one LM (homebirth). I won't even mention the OB, since that's not on the table and frankly, it sucked. The CNM births were good--the first, she decided to augment my labor because her OB back up was due in the hospital for rounds and she didn't want to get into trouble for prolonged rupture of membranes. She spun it like it could ruin their relationship and get her in tons of trouble. I had 10 minutes of pitocin induced hell. Same CNM for the 2nd, and aside from a very rough ROM (my son's head had scratches on it ) it was good. But, it could have gone either way, really. She was one of five CNMs, one of whom is totally an OB. I mean every client gets pit and AROM as soon as they walk in the door in labor.

My LM birth was amazing and beautiful and lovely. Even having had two good experiences in the hospital, I can say there's zero comparison. Homebirth is wonderful.

It depends what you want with your birth. LMs are highly trained, competent professionals who are able to attend healthy normal women and to stabilize and recognize complications.

HTH!

[Veritaserum]

CNMs do not do home births in my area. I've used a CPM (Certified Professional Midwife) which is a midwife who has learned midwifery without becoming a nurse first. I prefer a CPM because there's a whole heckuva lot of nursing info that isn't relevant to birth and I feel more comfortable with someone who has focused solely on the type of birth I want to have (normal, at home, no interventions). Of course, my CPM knows how to handle complications and when to transport and she carries oxygen, pit, etc. just in case. I've been very happy with my home birth experiences overall and cannot fathom giving birth in a hospital for a normal birth (my first was a hospital birth and it was horrid).