CNM's in OB practice- would you trust 'em?

[chrissy]

I'm checking out midwives in hopes of being pregnant sometime soon. My first pregnancy/delivery, I had an OB and nothing went as I had planned- induction, breaking of waters, epidural....

Today I met with a CNM in a practice with 2 OB's and 5 CNM's. I felt very comfortable with her personally and I was pleased with how she answered my questions, but I am wondering if I should be wary of midwives in a practice with OB's.

Thanks for your input,
Chrissy

[Angiemama]

Thats a tricky question to answer not knowing the midwife personlly. I have met OB's who were very suportive (adovcates even) of natural birth and I have also met midwives who seem uncessiarly interventionlist.. we call these "medwives".
It really depends on the person... why don't you ask her about her personal philosiphy when it comes to birth.. what kind of questons did you aks? what were her answere?

[safe womb]

I really feel for CNMs because they have to balance the best of two worlds.
a office with 5 CNMs and 2 OB sounds like it is a place where they support natural birth.
my first year of midwifery training I went back and forth " should I be a CNM or a CPM, LM?"
I decided I wanted to support the CPM movement and only do home births. CNMs usually are very rounded and as with any person you meet and interview for your birth, you need to vibe with them.
make sure to tell her what you expect in your birth and if she is ok with every thing that you need. don't hold back anything or feel like you need to please her. this is YOUR birth, she is being paid by YOU

[hahamommy]

I've had experience with two CNMs in OBs offices. The first one worked in the office of the OB I originally wanted to attend my births anyway (I swear the man was a midwife in a past life!!). *He* recommended the midwife to me, as it was a much cheaper alternative to getting his care. When I met her, I was hooked! She was a great lady, but had lots of groundbreaking to do... no one in the medical field was ready or willing to allow a midwife into their club. Loved her in the office (though she was reluctant to recommend anything natural for healing because of the political climate), but was sorely disappointed in her at the hospital, only because the support staff was absolutely UNsupportive of any and everything she said and did.
The second midwife had been a L/D nurse for years and had OBs pay for her CNM training. She had much more latitude to do as she wished, but her doctor group was *SCARY* ~ if she had been out of town for my birth, I would have stayed home or gone to the other hospital and presented myself as OB#1s patient. She was here, but really treated me as an OB would, in and out of the room, not much physical presence. Luckily we had an *awesome* L/D nurse who should have been the midwife!! The attitudes of the docs really do influence the attitude, not only of the midwife, but of the support staff you will be dealing with in the hospital. You probably don't want someone backing up your midwife who has a 75%+ episiotomy rate (as one of the 2nd midwife's OBs did ~ I heard someone describe him as "the nice doctor who doesn't even make you push! he just cuts you and sucks the baby right out!! :eek)
So yes, question her about *her* attitudes, but also question her about her back up doctors and their % for episiotomies, and C-sections, also ask about their attitudes regarding positions and support.

~diana :wild

[chrissy]

Okay, thanks you guys. I guess I should have asked her more specific questions. What I did was sort of told her about the birth of my son and how it was WAY more medical than I wanted it to be. She assured me that they she/they are very conservative regarding induction (which I see as the beginning of the downward spiral of medicalization- is that even a word?!- that was my son's delivery). She also said that the OB's are the same way and that they (the midwives) often tease them that they are more like midwives than doctors. I did ask her about Group Strep B because I was positive the first time. I asked if they would automatically treat me as + this time and she said no that they used to do that but no longer do. That was good. I do get the feeling that they are not very into herbs and other "alternative" treatments though.

I do still have plenty of time though (seeing how I'm not even pregnant yet) so I will have a chance to go back and ask more questions.

Thanks so much,
Chrissy

[moonglowmama]

I think another important thing to consider is what are the office procedures? Will you be required to see all the mw's/ob's in the practice during your pregnancy? When you go into labor will you definantly get your mw? or whoever's on call? What is a typical birth like? And I would ask stats: c-sec, episiotomy, induction (pit and ROM). Are there past clients you could talk to?

Good luck to you and a beautiful birth for you and your babe.

[Kirsten]

I would suggest looking into midwives who are NOT nurse-midwives. We had our first child in the hospital with a nurse midwife. It went well (much better than all my friends who used doctors). But for baby #2, we went with a certified midwife who did all prenatal appts and delivery (unless you wanted homebirth) in her freestanding (not part of a hospital) birth center. THAT was the best experience of my life! Better in so many ways that it would take me all night to go into it all. Look in your area for certified midwives who work out of freestanding birth centers. I'm sure there are websites but I don't know what they are.
Kirsten

[tmarina]

I don't think finding a midwife who is not a nurse midwife is going to be very easy since it is illegal in NC :( Pretty sure there are lay midwives who attend homebirths there, but they are doing so outside of the law and will be hard to find.

It sounds like you are choosing to birth in the hospital though, and if so, your best bet is to find the right certified nurse midwife for you. I think that in order to do this you have to be as up front as possible. Be clear that you are the consumer, this is your birth, and keep in mind that the midwife is going to earn the privilege of being at your sacred event by being the right midwife for you. Best of luck.

[candiland]

I personally would not use one unless there was absolutely no other possible option. I have found - at least here in Baltimore - that even the most hands-off CNMs HAVE to follow certain hospital protocol, even if they feel it is not in the best interest of their client. Otherwise they can lose hospital privileges/ob. back-up. This, in turn, really lessens the quality of care; they have to look at things in terms of what the hospital does and does not allow, instead of focusing on each and every individual woman and what is best for her and her baby. That's why I chose a homebirth with a CPM. I had to pay out of pocket, but it was the most well-spent money of my life!:D